Your Job Search, Career, and Considering the Pyramid

A pyramid, of course, is the type of structure that incorporates a broad and stable base, essentially the foundation, that leads to the stacking of other “bricks” or levels culminating at an endpoint, the top.

Those building blocks are metaphors for the segments in your job search that merge to build a structured avenue toward landing a position that you will enjoy. Picture yourself as the pyramid climber, climbing your way to career nirvana.

As you probably already know, where you want to be is integral to career fulfillment and ultimate satisfaction with life. You spend, minimally, eight hours a day, 40 hours a week, at your job. Usually, you spend more waking hours at work than at home.

Therefore, you had better love what you do and where you do it, or you’ve already set yourself up for discontent and emotional pain.

Your off-the-job happiness is just as important as your on-the-job satisfaction. And if you’re married or have a significant other who may be accompanying you on your next stage in life, finding a mutual place of enjoyment in whatever location you identify is essential.

Perhaps you are a fellow with 6–9 months left in training, or you’re a physician in a setting that’s not quite what you’d expected, and you’re looking to make a change. You’re in a transitional period of your life, and I hope to help you move on to the next level armed with some knowledge that will impact your decision.

The linchpin as you begin your search is a considerable level of internal honesty and introspection divining where you want to spend the next 5 to 10 to 20 years practicing medicine. Do you want to practice near family or as far away from family as is humanly possible without leaving the comfort of the Continental 48 states? Do you love the coast?

If you’re married, your spouse will have some input into that equation if you want to maintain marital harmony. Where does your spouse want to be? These questions should serve as the foundation, the building blocks, to crafting a decision pyramid that will point you to the perfect practice.

Laying the foundation of the pyramid, begin by analyzing where in the country you want to be. Then consider the type of practice you wish to join. Once you’ve conquered these components, you’ve handled a fair piece of the overall puzzle. At that point, you can narrow your search to more specific regions, local areas, and groups.

The salient components in your job search, and thus the building blocks of the pyramid, boil down to a handful of important points:

1. In the geographic area of interest to you, what is the physician penetration? How many physicians are there in your specialty per 100,000 people?

2. In what type of group or practice setting do you want to work? Academic, hospital-based, private practice, multi-specialty group? Will your choice limit where you can practice? Academic opportunities in your specialty may not be available in your chosen area of the country.

3. What is the patient demographic? Does your chosen geographic area have an older or younger population? Is the crux of the patient mix “healthier” or “sicker”?

For instance, in the greater Washington, D.C., area, there might be less demand for cardiologists per capita than there is in, say, a town in Mississippi, a state that has a higher obesity rate among adults.

4. What is the payer “mix” in the area? Does Medicare (a notoriously poor payer) dominate? Does Medicaid play a prominent role (generally a worse payer than Medicare)?

5. Would Medicare be a dominant payer in your specialty in your location of choice? For instance, in an ophthalmic surgery practice (cataracts) in Florida, is Medicare the biggest payer or is it the “Blues”?

6. The medical malpractice overview for the area is also important. Are physicians there haunted by med/mal scenarios that are out of control? Are juries “left” or “right” leaning in how they approach med/mal cases? And, is your specialty a target? Med/mal insurers take into consideration specialty trends as a component in pricing their med/mal rates. They also evaluate the area to determine if it’s a lawsuit-happy environment.

These considerations are building blocks that are metaphors for the segments in your job search that merge to build a structured avenue toward landing a position that you will enjoy. Picture yourself as the pyramid climber, climbing your way to career nirvana.

Adapted from The Employed Physician: Your Essential Guide to the Business of Medicine, by Jeffrey T. Gorke.