Yay me, I found the perfect physician job: warm (but not hot) all year round, right on the beach, 1 hour drive to mountains with skiing, large international airport (with Southwest), 7 figure pay, low cost state with no income tax, tons of benefits (401k, 457b, match, healthcare), no buy in immediate partnership, no call, 15 weeks paid vacation and 2 fulls days off a week.
But I jest…..
The job mentioned is not the holy grail of jobs because the grail may exist, the above job does not exist. As a young physician in a changing medical landscape, I keep my hand on the job market pulse. Why? Because you never know…. I’m in my second job out of training. The first job just wasn’t as promised and an opportunity (once in a lifetime) came up. Medicine is undergoing major changes, so it doesn’t hurt to be prepared.
I’d like to examine the aspects of a physician job one looks at when choosing a new job. More specifically, how these aspects give and take with each other because you can’t have it all.
As I see it, there are 3 major aspects of a job that one can control: location, money and lifestyle. This is simplification, but the goal is to provide a framework. Think of them like a triangle. I’ve analyzed plenty of jobs, talked with colleagues and attended many lectures on physician job finding. The triangle is a fair distillation of a complex situation. Let’s go through these.
I realize that some physicians want to live in a big city, and some want the smallest town they can find. However, for the purposes of this topic think desirable, ie supply and demand: good location is where a lot of other doctors live. Think big cities and desirable midsize and small cities such as coastal, mountain or vacation destinations. Some examples would be New York City, Chicago, Charleston South Carolina, Asheville North Carolina, Bay Area California, Seattle area.
For the purposes of this discussion, more money would be more than average and less money would be less than average. FOr example, let’s say an average is 300,000, more would be 500,000 and less would be 200,000. We’re not talking extremes in the 99th or 1st percentile, just generally more and less around a mean.
This is not what you do outside of work, as in “he led a frugal but not cheap lifestyle”. Rather, it’s the myriad non-monetary, non-location aspects of the physician job such as call schedule, nursing support, administrative support, administrative burden such as meetings and committees, adequate technology, vacation schedule, coverage of satellites, mid-level providers, etc.
There are a few ways to look at how these three factors interact, the simple method is that you can choose 2. The third one you can’t have right away. Maybe with time you will get the third one, but you cannot find all three right away.
Let’s Examine the 3 combinations of this pick 2 strategy.
Location and Money
Think urban Chicago and making the 75th percentile for your specialty. This would be a rare situation right out at the start of a new job. However, lifestyle would not be possible right away. This would likely be a single doc practice, possibly with minimal support in order to pay the large doctor salary, outdated technology, solo call schedule etc. This type of practice I would question very much as to how they would support the large salary. Is something shady going on? Also, the poor lifestyle would start to wear on you and this type of practice would probably be unsustainable as it may lead to burnout.
Location and Lifestyle
Think San Francisco Bay Area, 4 day work week, 8 weeks vacation, large call sharing, adequate nursing, 9-4 workday. The money would be low, think 25 percentile or less for your specialty. These types of practices are definitely available and I see them all the time. Often they are part time. These types of jobs are great for those who are financially independent and want to continue working in a nice location or have no worries about medical school debt and want to live it up in a desirable location.
Money and Lifestyle
Think rural Nevada 75th percentile of pay. Your lifestyle would be good because it’s hard to get doctors out in this area so you would be treated well and well supported. However, your location suffers. The airport only has two flights a day and you have to make usually two connections to get anywhere nice. There may be an appalling lack of things to do, weather could be terrible, schools subpar etc. These types of jobs are good for those out of training who want to leverage geographic arbitrage. Also good for people who don’t really care so much about location. Usually, these types of jobs offer a lifestyle that affords enough time off enabling travel to break the monotony.
What about completing the triangle to have the 3rd side?
Of these combinations, only the money and lifestyle combination does not offer the ability to obtain the third side of the triangle: location. Like an arranged marriage, one can grow to love a “less desirable” location they might otherwise not have known much about. Unless you begin to fall in love with you our location, you will simply never be able to change where you work.
The combination of location and lifestyle, given enough time can allow advancement either academically or through a partnership track or otherwise to make more money. Also, some of these jobs are part-time so income can be supplemented with locums or a side hustle.
The combination of money and location, if given enough time can allow for lifestyle if are able to demonstrate ability and convince people to give you more support, less call, more vacation, etc. which usually comes with building a practice over many years.
The 2-sided triangle strategy
Aside from putting in the time to achieve the third side of the triangle, there is another strategy to completing a triangle. This is to eliminate the need for one of the sides.
I mention this above with regards to location, and that if location is not important then one can prioritize lifestyle and money.
I don’t think one can ever completely eliminate lifestyle. If it’s something you don’t choose initially, I think it something you need to eventually attain or risk being very unhappy. Therefore, that leaves money and location being eliminated.
How does one eliminate money from the equation? Either don’t care at all about it, live a really frugal life and hopefully have minimal medical school debt OR achieve financial independence. I’m in the FI group.
With further refinement of this model through the past couple of years, I think there are satisfactory combinations of all three that are attainable. This may actually be the most common scenario, the sort of give-and-take where compromise is reached between all three. However, this definitely complicates the issue and I think to start with, analysis using 2 factors is a good place to start, especially when comparing jobs.
On an important note, I think leaving lifestyle out of the equation risks physician burnout. Of the three factors, I believe lifestyle plays the most in terms of happiness both short-term and long-term. I can speak to this from experience and anecdotally from talking with friends and colleagues. If I ever change jobs, lifestyle is non-negotiable. Choose wisely!
What do you think? Are there other factors? How do you analyze a job?