Navigating job interviews in medicine

WHEN IT COMES TO FINDING YOUR FIRST OR NEXT PRACTICE, there are many factors to consider. Location and compensation are often high on physicians’ wish lists. But practice environment, organizational values and the flow of your day-to-day may have a bigger impact on your career happiness. The truth is that, despite commonalities among physicians’ job-search priorities, the exact mix that will make a practice your best fit is likely unique to you. 

”It’s kind of like Goldilocks and the Three Bears,” says Chicago-based family medicine physician Rene Roberts, M.D. “There’s no perfect practice. There’s no perfect job. You want to find the job or the practice that is just right for you.” 

Finding your just-right practice entails identifying your personal priorities (even the oft-overlooked ones), asking the right questions and, ultimately, going with your gut. The steps ahead will help you do just that:

Step 1: Prioritize your priorities 

Speaking of fairy tales, “priority” was, once upon a time, a singular noun with no plural form. The plural “priorities” was a linguistic construction of the 20th century, prior to which people spoke only of having one single priority. Certainly, many factors matter in your job search, but it’s helpful to remember that not everything can matter most. Start by identifying what matters to you, then pare down your list to the factors you think will have the biggest impact on your happiness. 

The obvious: Compensation and location 

So, what does matter to you? For good reason, many job-seeking physicians put compensation at the top of the list. After all, you likely have loans to pay back and savings to catch up on. 

“What a lot of new attendings do is they look for compensation,” says Roberts. “People are usually looking forward to finally becoming an attending and making an attending salary. … There’s definitely pros and cons to that.” 

Prioritizing compensation helps ensure you’re paid fairly, which can set you on a better financial trajectory for the rest of your career. However, it may also lead you to take a job that isn’t the right fit in other ways. 

Understanding your market value will help you prioritize compensation enough without making it the end-all be-all, ensuring you don’t accept a figure that’s unfairly low—or fall prey to one unreasonably high. Your market value is typically based on your specialty, location and experience level. You can find yours by talking to your peers, using free online tools like the Resolve compensation data available on PracticeLink.com, Medscape’s Physician Salary Explorer or even checking the Medical Group Management Association’s annual physician compensation data, which your residency program or contract lawyer may have access to. 

In addition to compensation, location tends to be a top priority among physicians. Perhaps you want to live near extended family, want access to various outdoor activities or just want to avoid uprooting a spouse and kids. 

For St. Joseph, Missouri-based hospitalist Tammy Crouse, D.O., owner of Financial Residency, location was paramount in the job search. “When I was looking for a job, I knew I needed to stay locally because of family obligations, so that was the most important priority,” she says. 

Like compensation, there are pros and cons to prioritizing location. It narrows your search, can help you preserve community or family ties, and may improve your quality of life outside work. Weighing location too heavily, however, may lead you to miss out on opportunities that could be a perfect fit in other ways. 

The not-so-obvious: Environment and values 

Though location and compensation are important, an organization’s environment, culture and values may play a bigger role in your career satisfaction. 

“One thing that a lot of people may not necessarily spend enough time on is the actual practice environment, the nuts and bolts, the day-to-day activities that go on in an office,” says Roberts. “I want to know what goes on behind closed doors.” 

To suss this out, she advises asking how patients are scheduled, how double-bookings and late arrivals are handled, whether there are staffing shortages, and whom you’ll be working with on a daily basis. 

Crouse, too, emphasizes the importance of environment, stating that her first piece of advice for a job-seeking physician would be to find a group that appears to be supportive and happy. 

“You will spend as much time with your work family as you will your real family. It is much easier to get through a bad day when you work in a supportive environment,” says Crouse. “I currently work in a place where I absolutely love my coworkers. They make me laugh, offer advice when I ask and will cover me in an emergency. For me, relationships are the most important thing to building a sustainable career.” 

Similarly, Shana Johnson, M.D., Phoenix-based physical medicine and rehabilitation physician and founder of AskDrShana.com, points out the primacy of shared values. Whereas environment entails the feel of an organization—the pace, the pressure, the people—values entail the underlying goals that drive an organization and how those goals affect both patients and providers. 

“I need to work where the integrity of medicine is still intact versus a health system that solely values profit,” says Johnson. “Quality of care is very important to me and not something I can compromise on; I need to work where the leadership feels the same.” 

Prioritizing alignment between your values and those of an organization can help ensure you choose a job that’s a long-term fit. It’s easier to burn out in an environment that doesn’t share your convictions. 

Step 2: Find your additional fit factors 

Beyond your top priorities, many additional factors will likely work together to make a job a good or bad fit for you. Here’s a look at more criteria that physicians recommend you consider. 

Schedule and work/ life balance 

A terrific job can become a terrible one if you never get to clock out, whether figuratively or literally. 

As Johnson puts it, “A position needs to fit with my medical interests and my life outside of medicine. I need to be able to prioritize my son’s needs without feeling I am letting anyone down.” 

To evaluate schedule accurately, you must have a clear handle on when and where you’ll be working and what the call expectations will be. (And by the time you reach the contract stage, these details must be spelled out in writing in the contract itself.) 

Don’t hesitate to advocate for the schedule you need. If you lack sufficient margin, you will struggle to care both for yourself and for your patients. 

Administrative, clinical and C-suite support 

In addition to a reasonable schedule, you’ll need support. If you’re taking on a clinical position, you may need a medical assistant or nurse. If you’re taking on an administrative role, you may need a secretary. Depending on your role, you may also need coworkers with whom you can share call or trade shifts. 

“Do I have my own dedicated team?” Roberts recommends asking. “Do I have my own nurse? Are there enough allied health professionals, ancillary staff on site?” 

The support of administration and C-suite is also key. Is this an environment in which the C-suite is supportive of its physicians, where physicians have a voice and feel comfortable using it, and where providers have autonomy over the way they practice? 

“Having an administration that supports you is invaluable,” says Crouse. “I have learned that medicine is a business, and there are metrics that need to be obtained to get paid and keep the doors open, but having an admin that limits the burdens to those that are necessary is key.” 

Productivity and work expectations, including non-reimbursable work 

Productivity expectations are another factor to consider. How many visits are you expected to squeeze into a single day? And how will that number affect your compensation? 

Before finding her current role, Roberts considered an urgent care opportunity and asked candidly how many patients she would be expected to see. Compensation and bonuses often depend on that number. 

“Depending on the company, [urgent care] is very volume-based. And so I had to point-blank ask. … ‘How many patients do you expect me to see in a day or per hour, for that matter?’ …And the response that I got was jaw-dropping. … ‘Our physicians see an average of anywhere from 30 to 50 patients a day,’” says Roberts. “That’s just not me as a physician. …So I [decided], let’s not waste any more of my time or this employer’s time, because if I know that I am not going to want to wake up three times a week for a 12-hour shift to go in and crank out 30, 40, 50 patients in a day, then I don’t need to pursue this opportunity any further.” 

Crouse also advises learning about additional obligations that come with a role, such as researching and publishing, educating medical students and supervising support staff. “Some physicians enjoy those responsibilities and others do not,” she says. 

Johnson recommends asking how much time you’ll spend on non-reimbursable work—and how you’ll be compensated for it. Excess time for which you aren’t compensated could be a recipe for resentment. “In medicine, there is a large amount of work that is not reimbursable,” she says. “How is that managed?” 

Growth opportunities and the future of a practice 

Depending on your career goals, you may also want to consider whether an organization provides growth opportunities. If you have your sights set on partnership or envision your future self in a leadership or administrative role, then you need to suss out whether such a trajectory is possible at an organization and what the typical timeline for promotion would be. 

Additionally, as more practices get purchased by larger health groups, it’s worth considering the future of an organization. Is the practice you’re considering likely to get bought by a larger conglomerate? How would your role change if so? You may even want language included in your contract that would change your exit terms in the event that your practice gets bought. 

Community and commute 

Even if you’re not married to one specific location during your job search, the community you land in will likely play a large role in your day-to-day happiness. When evaluating a job in a new community, you’ll want to assess cost of living, lifestyle and family fit. 

“If you are interviewing in a community unfamiliar to you, you should ask about housing and neighborhoods, activities available locally outside of work and potentially school systems,” says Crouse. “If you have a significant other, I would recommend bringing that person with you to explore the community to know if it will be a good fit for your entire family.” 

Perhaps you’re considering working in one area and living in another. Roberts suggests doing a test-run of the drive to see if it’s realistic. A frustrating commute could certainly take a toll on your career happiness. 

“I live in Chicago, so what’s going to happen when we hit that snowstorm? Is this a commute I’m going to be able to do?” asks Roberts, who did rush-hour test drives to multiple clinic locations during her job search. 

She also advises physicians to consider their sense of safety. “Oftentimes people just don’t … think to ask about [office safety],” says Roberts. “What type of safety measures are in play here? Is there on-site security? What does that look like? Do I get escorts to and from my vehicle if need be?” 

Moonlighting and side gigs 

Consider also your work outside work. Many physicians take on moonlighting roles and other side gigs, especially those trying to pay off loans quickly. If such work is important to you, find out whether it’s permissible with an organization you’re considering. 

“Maybe you moonlight at the hospital down the street two weekends a month,” says Roberts. “I do a lot of stuff with medical media and hosted a television show here in Chicago. I had to let my employer know about those things [to find out if that was] going to be a problem. … 

Some employers do have clauses or stipulations [that] your outside gigs cannot take away from your patient care responsibilities here.” 

She recommends having an attorney assess your contract in light of your own side interests. Can you write a book, speak at conferences or own your intellectual property? If it’s important to you, it needs to be protected in your contract. 

Step 3: Identify red flags 

Just as you want to identify and consider the factors that would improve an organization’s fit, you also want to be on the lookout for red flags. These likely indicate that a practice is not the best place for you. 

Turnover and frustrated physicians 

If an organization’s other physicians have consistently left in short order, find out why. The last thing you want is to walk into a situation that many others have left. 

“Many years ago, I interviewed at a location where all four providers had quit in the last two months,” says Johnson. That flag is so red it’s crimson. 

She also advises you to scout the morale of the physicians who are still working for an organization. “If, when interviewing, the providers you see working seem unhappy and frustrated, run!” she says. 

Outlandish income promises 

Another red flag is a compensation figure that seems too good to be true—or, as Johnson calls it, “physician clickbait.” Crazy high compensation may indicate desperation on the employer’s part or unattainable volume expectations. 

“They’ll dangle money in front of you all day long,” says Roberts of the urgent care role that she turned down due to unrealistic volume expectations. “It was very tempting, but then you really have to ask yourself, at what expense? [What] is this going to do to [your] own well-being or that of your family?” 

Vague or predatory contracts 

One-sided contracts should also raise scrutiny. Perhaps the restrictive covenants are too restrictive, the exit terms are unfair or the insurance and benefits are lacking. Alternatively, the contract may simply be too vague, which can suggest an unwillingness on the employer’s part to put in writing any promises made during the interview process, be they about schedule, support staff or sign-on bonuses. 

As Johnson puts it, “If [an employer is] difficult during the negotiations, that is a sign of things to come.”

Step 4: Ask the right questions 

Your interviews will be key in ensuring you’ve gotten an accurate picture of all your fit factors and identified any red flags. To get the clearest information, make sure to get on site—and off. 

“A site visit is crucial,” says Roberts. “Anyone can sell you anything over the phone. …At the end of the day, you need to know what you’re walking into.” 

She recommends confirming that you’re interviewing at the actual clinic where you’d be working and even suggests spending a morning there shadowing another physician. 

Johnson also recommends talking to current physicians—and doing so outside the office. “Schedule a phone call or grab a coffee; get the inside story,” she says. 

Roberts notes that new attendings in particular may hesitate to ask their questions. “[If] you’re just coming out of residency, there might be a little bit of hesitation…because we don’t want to come off as being too aggressive or too pushy,” she says. “That’s not the case at all…. This is literally your well-being every day. You want to know these things…ahead of time.” 

Beyond the answers themselves, the manner in which your questions are received and answered can also give you an excellent feel for the culture of the organization. 

And even after the interviews and site visits, you can still raise questions, especially regarding the contract. “Don’t be afraid to ask for [a] sign-on bonus, moving expenses and clarification of contract items such as scheduling or number of patient encounters,” says Crouse. “You won’t know specifics about the job if you don’t ask.” 

At this stage, it is wise to work with a contract attorney rather than trying to decipher the contract alone. You simply don’t know what you don’t know. 

“Particularly for residents that are coming out and taking their first job, it is worth the investment to have an attorney look over your contract,” says Roberts. “That is money well spent. …Have an attorney peel through that contract, word by word, page by page, and if there’s any ambiguities, any uncertainties, or anything that you’re not comfortable with, it’s OK to bring it up, discuss it with your potential employer, so that you guys can find a solution.” 

By making sure a contract works for you, attorneys can actually help turn a good opportunity into a great one. They may even help you lock down better compensation. 

Step 5: Evaluate after the fact 

After you’ve prioritized your needs, identified potential red flags and asked all your questions, it’s important to remember that finding the best practice for you typically involves both your head and your gut. To sign that contract confidently, you need an opportunity that doesn’t just look good on paper but also feels right. 

Roberts advises taking time and sleeping on the decision. There’s no reason why you need to give an organization an answer right after a site visit or right after a contract is sent your way. “It’s always really important to step back,” she says. “Whether you give yourself a day or two … to really come down off the high and say, ‘OK, how do you still feel about that place?’” 

With a little time and space, you’ll typically have more clarity and perspective about a role so that you can proceed enthusiastically or bow out with confidence. 

At the end of the day, Johnson points out that it’s the people and purpose of an organization that are most likely to make it a good long-term fit. If you align with an organization on both of these counts, it’s likely that it would be a strong fit for you. 

“Every health system and clinic has its own personality or culture,” she says. “It’s important to find your people.” •