After years of schooling, performing on standardized tests and surviving a year of internal medicine, ophthalmology finally begins.

I felt like I had finally “arrived” when I first got to perform ocular surgery and treat ocular disease. About this time, the bombardment of physician recruitment letters started. I was excited, thinking a real paycheck was finally in sight. Looking through the letters, I debated my first move after residency. Was it worth taking a few years in Grangeville, Idaho, on a guaranteed salary to enjoy the scenery? Should I try and go back to my hometown to practice, since I was familiar with the area? As I should have anticipated from so many years of schooling, I still had so much to learn.

Residents beginning the job hunt have myriad variables to consider. Time spent in academic medicine as a resident is such a different experience than private practice, let alone the differences from other academic institutions. With so much uncertainty, how do you find the best offer? As my former department chair Dr. Calvin Eshbaugh would tell me, “It depends.”

SEEK COUNSEL

First of all, seek good counsel. Throughout the job-hunting process, you will discover many environments that are completely different from what residents encounter in training. Because of this, I advise speaking to a variety of doctors: specialists and comprehensive ophthalmologists, private practice and academic, solo and group practice physicians. Get a feel for what a career would look like in each setting. Attend meetings and do not be shy about introducing yourself to experienced physicians, especially if an individual seems to share a similar personality as you or has taken a career path that seems in line with your goals. Ask questions and find out what their practice really looks like on a daily and weekly basis and what they recommend. Some good questions to ask are:

• What are the referral patterns in your office?
• What does your typical clinic and OR schedule look like?
• Is there anything specifically you would look out for when starting at a new practice?
• What are some possible pitfalls to look for?

Learn as much as possible before even looking at jobs. Also, the more people you meet, the more you get your name out there and the more exposure you will have.

FINDING YOUR BEST FIT

Before considering any offers, you must decide what type of practice setting fits your personality and career goals. For instance, if you have a strong desire to perform refractive surgery, it may not be the best idea to join a practice that does not have access to an excimer laser.

You will want to keep in mind your own personal goals and not how others perceive you. Would you enjoy teaching residents or have rotating medical students? Do you only want to do cataract surgery, or does performing glaucoma and oculoplastics procedures excite you? Some of these questions you may not even know the answer to, especially as a young resident when you have not even performed a tube shunt yet, but you do know your personality. For instance, if you are very risk averse financially, then a busy private practice on a partner track may not be the best fit. At the same time, if teaching is your calling, that may be difficult to incorporate into private practice. Many residents may think they want to perform 20 cases a week but do not completely understand the tradeoffs. That means a busier clinic, requiring more time and more liability.

Also, consider geography. Different regions of the country have very different hiring trends, practice environment and contract offers. Do not expect the same offer from a large practice in Dallas as a small group in rural West Virginia.

KEEPING PERSPECTIVE

Do not be short-sighted. Maybe you had very little experience with MIGS in residency or do not feel comfortable handling oculoplastics. I would not let this preclude you from seeking a practice that would afford those opportunities. Yes, there will be a learning curve, but remember that a whole generation of surgeons had to learn phacoemulsification in the middle of their careers. They did not have the luxury of returning to do a fellowship or going to residency. While you may have to learn a new skill, keep in mind that you’re not the only one. If you are interested in expanding your surgical reach, make sure you go to a practice that will provide you adequate support and even mentor you to grow in your surgical abilities.

Consider the long-term outlook with each job, such as how soon partnership would be considered or if you would want a job that is not partnership track. Each job has tradeoffs. The academic setting may have a predictable salary but with less bonus opportunity and less input on ancillary staff. In private practice, the financial ceiling may be higher, but there is more responsibility. The employed staff and each one of their families are dependent on your production and ability to manage a practice. Not everyone thrives in that setting, just like not everyone can thrive at an academic institution seeing patients, conducting research and teaching.

KNOW YOUR VALUE

Numbers are not personal. Each side is trying to make the best deal. If you can hire someone to do a job for $100, why pay them $200? Do not be afraid to negotiate, but also do not be offended by a lower offer than expected. Just like you are trying to do the best you can, the potential employer is also trying to do the best for their business.

As a new employee, especially one who is fresh out of residency, it is very easy to overestimate your worth to a practice. Yes, you can perform cataract surgery and see patients, but where will the patients come from? What kind of value do you add? Early on, you will not add any financial value and actually be a huge cost to the practice. There will be many patients you cannot see simply because the practice will not be reimbursed if you see patients with particular insurances.

With time you will add value, so there should be some understanding regarding finances. If a practice is not willing to negotiate at all and you feel it is a lower offer or really need a signing bonus or moving stipend, maybe that is not the job for you. Some jobs have a boilerplate contract that is not able to be changed, but that is not the norm. If a practice checks all the boxes but is not quite what you expected financially, strongly consider taking less money for a job that would make you happier. Also keep in mind the starting salary is just a very small percentage of your career earnings.

CONCLUSION

One of the best decisions I made was going to a practice where I have a mentor who helps me push myself to not only be a better surgeon, but also a better doctor and possible partner. However, I knew beforehand that I would thrive the most in a practice where I would see more than just cataract consults.

It is normal to feel apprehensive about finding a practice that fits your needs. Just be honest with yourself about the job and what job setting would best enable you to prosper. OM

About the Author

Andrew Johnson, MD, MBA, is a comprehensive ophthalmologist with Eye Centers of Tennessee in Cookeville, Tenn. He is a native of Athens, Ga., and attended the University of Georgia, majoring in biomedical engineering. He earned his Doctorate of Medicine at the Medical College of Georgia and an MBA at the Terry College of Business at the University of Georgia. Dr. Johnson is active in his church and has made multiple medical mission trips to locations such as Haiti, Ecuador and Honduras.