• What to Do When the Job Doesn’t Work Out

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    The morning before you start a new job, your employer shows up on the front page, embroiled in scandal. What do you do? Or maybe it’s not the job that changes, but your circumstances. How do you decide when and if your situation merits the search for a new position?

    High expectations or bad fit?

    “I’ve never met a person who was not disappointed in some aspect of their new job,” says retina specialist Brian Chan-Kai, MD, who relocated his family to Portland after beginning practice in Houston. “Whatever job you start with is not going to be what you expect, and is not going to be entirely comfortable.”

    Particularly for young ophthalmologists taking their first job, expectations can suffer a jolting collision with reality. “Coming out of training, you think you’re on top of the world,” says Edward Hu, MD, a refractive and cataract surgeon who wound up in the Quad Cities part of Iowa after starting practice on the East Coast. “You think you know what you want. And then when you get there, you realize, ‘This isn’t quite what I signed up for.’”

    The change from the academic setting of training to private practice can also present an adjustment. “What is out there is so shockingly different in so many components,” said Elizabeth Yeu, MD, a cornea and refractive specialist preparing to move her family from Houston to Virginia.

    And the new hire may not be the only one adjusting. When a young ophthalmologist accepts a job with a solo practitioner, it may also represent a significant change for the employer. “I think the hardest transition and growth in our profession is going from one to two” practitioners, Dr. Hu said. “When you’re solo, it’s like being a bachelor. … Once you introduce another individual into a partnership dynamic, you can’t always necessarily do everything you want.”

    Often the situation improves with time, though, Dr. Chan-Kai said. “It can take a year or so to settle in, but it becomes more comfortable and satisfying.”

    Other challenges prove more intractable. In a 2008 Academy survey of YOs, roughly one in four left their first job within a few years. Commonly cited reasons included uneven caseloads (26 percent), family circumstances or work-life balance (17 percent). Among other things, the survey showed that “job switchers” were typically asked to spend more weekends on call.

    Weekend duties were one reason Dr. Yeu sought a change. With the birth of her second child six months ago, the schedule at an academic job she otherwise loved got too hectic. In particular, the frequent after-hours commitments became too much.

    “When I realized I was trying to manage three nanny schedules in order to cover the hours that my husband and I weren’t home… I realized, ‘This is a little ridiculous’,” Dr. Yeu said. Ultimately she and her husband, a surgeon, decided to move to a state where they could be closer to family.

    Commit carefully

    Dr. Chan-Kai also left his job due to family circumstances, but their move carried a steep cost: $125,000 to get out of the contract his wife, a fellow physician, was subject to. “It’s important for people to know what their financial obligations are when they quit,” he said.

    Dr. Hu agreed. “In medicine, it’s harder to move around,” he said. “It’s very painful. If you move to another state, you have to get relicensed. The process is not easy, and financially, it’s very expensive.” In addition to restrictions on how near the old practice a physician can work, he or she will also face the expenses of tail insurance, malpractice and so on.

    Because of all that’s unknown about a new job, YOs might want to temporarily delay major financial commitments. Buying a house right away “makes it very hard financially to relocate” if the job doesn’t work out, Dr. Hu said.

    Allow time and time your search

    Once it’s clear you need to leave, Dr. Yeu recommended that YOs prepare for a long transition process. “If you are thinking about something, usually it’s not going to happen very quickly,” she said. “Even if a solid opportunity presents itself, you have to give yourself a good six- to 12-month plan for the process, which may include phone interviews, live interviews that can even include follow-up trips for further interviews and potentially searching for opportunities for your spouse.”

    Dr. Hu agreed. “When you transition, you start up shop again, it’s a full year of disruption,” he said.

    At the same time, however, leaving a practice may happen faster than expected, even if the practice requires a physician to give several months’ notice. Dr. Hu said his lawyer told him to be prepared for expedited separation. “‘They can cut you at any time. They can find any excuse to let you go,’” his lawyer advised.

    He ultimately found his current position in a large group practice with the help of a practice management consultant and recruiters. The Academy’s practice management decision, the American Academy of Ophthalmic Executives, offers a consultant directory with pre-screened consultants experienced in helping ophthalmologists.

    Dr. Yeu said the connections national meetings afford can also be very helpful resources. Many people start their job search before the Academy’s Annual Meeting, she said, because of the opportunity to network and meet people there.

    How to decide

    Aside from the logistics of the search, a job change also requires careful thinking – particularly given the debt young physicians usually have after training. “You have to break it down into all the different aspects,” Dr. Chan-Kai said — the financial implications, relationships with coworkers, family impact and so on.

    Because Drs. Hu, Chan-Kai and Yeu are all married, their job changes also involved the other person’s career. “It’s tougher when you have two professionals that have a comparable income level, because then there’s not so much of a pure economic drive,” Dr. Hu said.

    For Dr. Yeu, it helped that they were far from family in Houston. However, if her husband had been in an “amazing” job there, she said he probably would have “strongly recommended” that she stay in the city.

    When Dr. Hu first decided to change jobs, his wife – a concert pianist – wasn’t yet ready to quit her current position. So, despite a “very powerful, restrictive covenant” in his first job’s contract, he found work that didn’t require a major move.

    Eventually, however, the second job proved a poor fit, too. This time his wife was at a more flexible place in her career, however, and with the help of the practice management consultant and recruiter, he found his present job in Iowa. The practice he wound up joining even reached out to local contacts to help his wife find work in the area, tipping her off to a just-opened faculty position at a local university.

    Efforts like those helped convince Dr. Hu he’d finally found a practice home where he could settle “[Taking a job] is probably the next most important commitment you make, next to marriage,” he said. And like in marriage, bad communication “doesn’t bode well for the future.”

    Choosing better the next (or first) time

    How can a young ophthalmologist ensure his or her first – or next job – proves a keeper? Dr. Chan-Kai stressed setting reasonable expectations. “Try to talk to as many experienced people as you can,” he said.

    For women, Dr. Yeu cautioned against expecting a career trajectory identical to that of male colleagues. “‘Sometimes where we peak is a little bit different,’” she said, quoting the speaker at a women-in-ophthalmology dinner she once attended.

    Even if women choose to cut back hours or commitments while their children are young, that season will pass. “The time will come where they can pick those things back up, when the children are older,” she said.

    In her own career, she’s focused on her passions. “I had to recognize that I can’t have it all, per se,” Dr. Yeu said. “I need to really recognize what it is that I enjoy and focus on that. And what I’m best at.”

    Dr. Hu also stressed self-reflection, along with thorough research. “The more information you know up front [and] the better you know yourself, the more it enables you to ask about the environment you’re going into to ensure that it’s a true fit,” he said.

    In the end, he falls back on something his chairman once told him: “‘Don’t feel like your first job has to be the absolute, final resting spot. Treat it as another opportunity.’ That advice, in retrospect, was really valuable.”

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    About the author: Christi A. Foist is the managing editor for YO Info and the Web and member communications editor for the Academy’s website.