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Eight Pearls for Joining Your First Practice
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You are almost there. The light at the end of the tunnel is fast approaching, and frankly, can't come soon enough. You have been through this process before: first to college, then to medical school and then to residency. But this time is different. This time, you might like to stay where you are for more than four years and put down some serious roots. What to do? Relax. The tables truly are turned, and the match is far behind you. Now it's your turn to decide where you go.

As you begin this process, the most difficult question initially might be where to start. Though not all of these may apply to your situation, the following pearls are a culmination of advice from a number of sources and people who have been in your situation — mostly from those who have been happy with their practice, and some from those who may have learned a few lessons the hard way.

  1. Decide on a region. Start narrowing down the areas in which you wish to practice; it's never too early to start thinking about this. You might consider first if you want to work in an urban, suburban or rural area. You might also want to consider whether or not you enjoy working at a number of remote offices that require more frequent driving.
  2. Talk to people. Engage your colleagues, professors and, if you are lucky enough to have one, a mentor. If possible, consider talking to your drug and/or device reps. Their colleagues in the selected region you are looking into may be able to provide you with various leads. You are not the first person to go through this, so why not leverage everyone else's experiences? The more the better.
  3. Engage a consultant. This may be more important during the assessment and negotiation of your potential employment contract. This person ideally has experience in multiple markets and specifically the market in which you are looking. They can also give you an idea of typical pay/time-off/bonus structures for the area in which you are planning to work. Editor’s note: The YO Program is a great place to get expert advice on contract negotiation.
  4. Get a lawyer. At the end of the day, a lawyer is the only person who can ensure you have a solid contract that is fair and defensible in court. If you trust your future employer implicitly, you may feel like foregoing this step. Remember, if things end up going to the contract, you want to feel secure on your side.
  5. Observe the practice you are considering. If you can, try to arrange a day to follow the physician(s) around both the clinic and the OR. Ask to see a chart and observe the style of documentation. You don't want to find out the day you start that you are inheriting charts with 10 visits per page that are hard to follow and just begging for an audit. You want to see how the physician interacts with staff and what the facilities are like. You might find that you clash with the management style or that the office is a utopian dream that every tech in town wishes they could work for. 
  6. Get a feel for turnover. It's OK to ask if they have had other physicians work there who have left. Sometimes you might be taking over their patients. Sometimes you might uncover that the practice has had four new physicians in four years who have all left. Maybe they have bad selection skills. Maybe their management style is too overbearing and they have a very malignant work environment. These are the hardest things to get a feel for prior to working somewhere, but sometimes you can get a taste.
  7. Talk to a hospital they are associated with. In a larger, more diverse region, this suggestion might help you get a better feel for the practice you are joining. This may not work in a smaller setting or smaller town, particularly if the practice you are inquiring about has a financial stake in the operation.
  8. Talk to the chairman of the nearest academic center. They likely know the lay of the land fairly well and may be able to give you their observations of a given practice in a confidential manner. The idea isn't to press them for sordid details, but simply to inquire as to how their experiences have been in dealing with them in the past.

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O'Malley_October_YO_InfoAbout the author: Martin O'Malley, MD, is a comprehensive ophthalmologist practicing in the Brainerd Lakes Area of Minnesota. Originally from West Des Moines, Iowa, Dr. O’Malley trained and practiced in upstate New York before finding his own best practice match in central Minnesota.

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