Part II: Single Specialty Groups, Multispecialty Groups, and Alternate Paths

A single specialty small group practice is a great environment for a physician who wants to start in an established office and be busy with patients immediately. Before you join a single specialty small group practice, consider Dr. Shaw’s advice: most practices should keep their professional expenses below 50 percent of gross.

Many physicians are enticed by the cost advantage of a single specialty large group practice. Physicians can share business overhead expenses and may also enjoy working with and around a large group of similar physicians. As practice size increases, however, administrative staff and management size can become unwieldy and cumbersome.

Perhaps the greatest benefit of a multispecialty group practice is that physicians benefit from a built in referral base. Many physicians in multispecialty group practices also enjoy fewer working hours. In general, compensation in these practices may not be as competitive. Check back for our upcoming blog on negotiating a physician employment contract if you think you want to join a multispecialty practice group.

Finally, there are career paths such as locum tenens, academic practice, and military service. Locum tenens is an alternative to permanent full-time practice that has gained popularity in recent years. Academic practice allows physicians to interact with students and residents although tenure is not easy to achieve and salary is generally not as competitive as the private sector. The New England Journal of Medicine profiles military physician career information and provides links to other informative resources.

Practice Types Part I: Starting or Joining a Solo Practice

After you determine your ideal location, the next basic step is to decide the type of practice in which you want to work. Although the different types of practices are too numerous to analyze within the context of this blog, we can highlight the pros and cons of several of the most popular practices types for physicians. If you want even more detail, look to chapter 3 of Dr. Shaw’s book.

Part I of this blog series will contrast starting a solo practice with joining a solo practice. Part II will investigate single specialty group practices, multispecialty group practices, and other alternative career paths. Part III will advise you of considerations regardless of the type of practice that you want to join.

Starting a solo practice is demanding and places a great burden of responsibility upon a physician, but can also be very rewarding. Physicians who start their own practice enjoy flexibility and autonomy. However, you must have the patience to build your patient base. Start up costs and initially inconsistent revenue are not always the best match for a resident with high medical school debt. Our upcoming blog on business involvement in your practice will offer advice about how to start your own practice.

Join an existing solo practice if you want to work in a smaller practice but are willing to sacrifice some occupational autonomy in exchange for an existing patient base. Be sure to perform your due diligence regarding the solo practice and make sure that you have good chemistry with the other physician in the practice.

Determining Where You Will Practice

The first step in the job selection process is to create a self-evaluative profile so that you can determine your preferred location. According to Dr. Shaw, new physicians only stay at their first job for about three years. Relocation is expensive in terms of reestablishing personal and professional relationships and rebuilding your patient base. If you take the time now to choose your ideal location, you can avoid a costly mistake later on down the road. The following factors are all significant:

City/Town Statistics
· Cost of Living
· Various City Rankings (or This Site)
· Crime Rates
· Climate
· Quality of Schools

Marital and Family Status – These factors are relatively self-explanatory, but I mention them because for many physicians they are the most important consideration. Keep in mind that if your spouse is also a physician, you need to find an area that can support each of your specialties.

Your Specialty – Be aware of how the demographics of a location will affect your practice. For example, if you are a pediatrician or your specialty is geriatrics, the U.S. Census Bureau is a great resource to analyze age data by geography.

Also note that in addition to a higher cost of living, salaries in large cities generally tend to be lower than they are in rural and less populated areas where there is less competition. There are, however, many exceptions to this rule. We will cover salaries and benefits (disability insurance, of course) in more detail later in this blog series.

Guiding You Through the Job Selection Process

While you focus on your residency, a complex job selection process looms ahead. That process includes many important business and economic decisions. Most experts recommend that you begin your job search one full year before you finish your residency. If you are about to enter your final year of residency, you should start your job search now so that you are on a realistic pace to complete your search by the time you graduate. Over the next several months, our blog will offer you job selection tips in an effort to decrease any stress that you might be feeling about the process.

Dr. Koushik K. Shaw recently wrote an excellent book, The Ultimate Guide to Finding the Right Job After Residency. We will highlight some of Dr. Shaw’s recommendations and supplement his suggestions with additional advice and links to relevant websites. Many of the topics will be business-related, including salary and benefits negotiation; the job type that best fits you; performing due diligence in investigating a practice; and investing in disability insurance now to save you money later. However, we will also examine topics such as the interview process and potential pitfalls; the credentialing process; and your curriculum vitae or résumé.