Finding the right job: Balance three competing factors

Dr. Rosevear is in private practice at Pikes Peak Urology, Colorado Springs, CO.

Residency is tough. Despite my chairman’s admonition that everything a resident needs to know is in “Campbell-Walsh Urology,” the text is missing at least one lesson, namely, how to find a job. It is particularly vexing because most residents, myself included, train at academic institutions where the faculty can’t offer much guidance, having been through a very different process. With that in mind, after spending nearly 2 years talking to recruiters, interviewing, and reading contracts, I think that finding the right private practice job comes down to balancing three competing factors: the job, the location, and the salary.

Let’s start with the job itself. Not all jobs are the same, and it’s important to know both what you want in a job and understand what the group expects you to do. For example, do you want to spend your days doing major cases? If so, you had better make sure the location has all the necessary ancillary services. One position I looked at had no interventional radiology, and the ICU was simply the two beds closest to the nurse’s station. Further, while most hospitals have a robot, how comfortable are the nurses with it? The modern chief resident is proficient at robotic surgery, but starting a robotics program is very different than joining one.

What about your clinical responsibilities? Do you have a built-in referral base or will you be expected to build a practice? Is a full day of clinic 20 patients or 40? Expectations vary greatly. What about call? Some groups expect you to cover your own patients every night and then split ER/consult calls; others cross cover among the group. This can have a huge impact on your quality of life. Lastly, how many hospitals and surgery centers will you cover? You can’t bill for travel time, which means that jobs in which your office, surgery center, and hospital are all in one location have certain advantages.

The second important factor is location. Rural America has a greater need for urologists than most metropolitan areas, and that influences the jobs that are available. For example, my family lives near Chicago, but I quickly learned that town currently has more urologists than it had mobsters in the 1920s. Location, though, can be the driving factor due to family or lifestyle. I once thought that a good friend chose his job by finding a city equidistant between his family and his wife’s. Another resident simply wanted to be his hometown’s urologist. I, on the other hand, wanted to live where it didn’t take a plane ride to go skiing or hiking. If location matters, it may greatly limit your choices. If it doesn’t, numerous incredible opportunities exist in some out-of-the-way locations.

The last aspect to consider, the paycheck, is one of the most challenging to understand but likely the topic that receives the most attention. Not only does the range of salaries vary greatly but so does the way salary is determined. Remember, there is a reason one job offers $200K and another $500K; people do not hand out money. How is the paycheck structured? Is the position salaried? RVU based? Collection based? What is the growth potential? Is there call pay? What about loan repayment? Are there opportunities for ancillary income and, if so, what is the buy-in? What about the partnership tract?

Given the complexities of the contracts (the shortest I read was over 15 pages), the best advice is simply to have someone you trust read the contract. Understanding what you are getting yourself into is the first step toward being happy with your job.

Urologists are very lucky. The fact that we can be picky when choosing a job is a blessing. I believe that every one of us should be able to optimize at least two of the three job aspects I discussed here-more if you are lucky and less if you are picky. I wish everyone the best on the job trail, and if anyone has a great story, please write and share it.

I welcome questions, ideas, or suggestions regarding this blog; please contact me at UT@advanstar.com.By sharing my experiences as I start off in practice, my hope is that other young urologists won’t have to make the same mistakes I have.

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