While historically it was very uncommon for a physician to change jobs over the course of one’s career, there has been a paradigm shift over the past decade. Recent data have suggested that approximately 50% of young physicians change jobs early in their careers. Possible factors contributing to this phenomenon include the decrease in self-employment among young docs, and concerns about job satisfaction.
I, myself, am one of the many physicians who changed jobs early in practice. The reasons for my own personal change are complex, and beyond the scope of this post. However, it quickly became clear why job changes were historically uncommon in medicine. Our employment is not nearly as portable as in other industries. I hope to shed some light on this process from my own experience to help other young physicians contemplating a similar change.
Confirm Your Decision
There are plenty of reasons to be dissatisfied in practice as a new physician, particularly in an employed setting: lack of professional autonomy, increasing burden of EMRs, lack of professional fulfillment, problematic work-life balance, to name several. However, the decision to consider a job change should be taken seriously. There are significant costs that accompany a job change in medicine. Are these issues unique to your present position? Might they improve if given time and effort? Are they truly likely to improve in another environment?
I would suggest that most of the reasons for physician job satisfaction may not be unique to your current position. They may be systemic issues that confront all young physicians anywhere in practice. Most challenges are likely to improve with continued hard work, time, and increasing seniority.
There may be others who are given an opportunity to move to a practice with such a dramatic upside compared to their current position. For these individuals, the change is justified, and certain steps should be take to assure that the transition is seamless.
Understand the Rules
Before initiating a job change, you have to do your due diligence. Carefully review your contract. Reach out to an attorney to help if necessary to confirm your ability to terminate employment without cause, to determine your responsibilities as you leave your position, and how your departure might impact your future practice, including a restrictive covenant, or non-compete clause, for example.
The contract also may describe your obligations and rights as you leave practice regarding your patients and their health information. Whatever cannot be found in the contract might be found in the by-laws of larger organizations, including large health systems. In most cases, the practice takes ownership of protected health information, including the EMR, and physicians are not able to take this information when they depart. Moreover, the practice or system will likely have rules that determine how you are able to advertise your departure, and your destination, during the transition period.
It is critical that you have a detailed understanding of the ground rules, so that you can abide by your contract, respect your employer’s interests, while at the same time ensuring continuity of care for your patients, and a smooth transition for yourself.
How much notice required is also typically stipulated in the contract, and often ranges from 30 to 90 days. Within the range of what is required, you should find a balance between notifying your employer so they have enough time to plan accordingly, and informing them too early. Timely notification allows you to inform patients of your departure, and proactively manage their care after you leave. Believe it or not, some institutions may prohibit you and the staff of notifying patients of your new destination in practice. This should be confirmed with an attorney. From the employer’s point of view, this may be construed as advertising to existing patients and attempting to lure them to your new practice, which is often disallowed in the contract.
At the very least, provide patients with notification of your departure. With the assistance of my current employer, I drafted a letter sent to all active patients informing them of my departure, and encouraging them to contact the office for follow-up evaluation with one of my colleagues in the group, or to obtain their medical record to seek care elsewhere. Patients who had surgery in the last 12 months received a different letter, and I managed their care more proactively. I provided a referral with a similar specialist in the community with whom I had already communicated.
Patients who had surgery in the last 3 to 6 months, or those with active issues, were encouraged to present for an actual evaluation so I could assess them in person and directly manage their plan after my departure. This approach helped to avoid sense of abandonment on behalf of patients, and guaranteed they received the care they needed despite my absence.
In medicine, as in most industries, relationships are paramount, and worlds are small. We should all recognize that no matter how our first job turns out, our practice invests a significant amount of financial and operational resources in us during our early years in practice. We can at the same time value the opportunity to make a change for the better, and appreciate what our first position has provided for us in the form of professional development.
Anticipate Your Arrival
I would recommend working with your current employer to develop a strategy for the last 30 to 90 days in your current position. Determine when you plan to stop operating, so as not to leave patients without follow-up with their surgeon. There will be patients who insist on proceeding with surgery as discussed previous to your resignation, and this can be considered after thorough conversation and planning for postoperative care by a colleague.
Begin the credentialing process for hospital privileges and insurance contracting as early as possible. This may have to wait until you formally provide notice of your resignation, since this process may require involvement of your current employer for references, for example. Begin to plan outreach efforts with your new practice’s communications team to meet with referring providers and patient communities in your new area. If you manage your own social media and internet presence, develop a digital strategy to formally announce your move. I created a splash screen of my professional website to inform established and prospective patients of my move. If you don’t already have a professional website, this would be a good time to design one on your own through a free service such as Wix (www.wix.com) or with the help of a company such as Your Practice Online (www.yourpracticeonline.com)
As we start practice, we all envision working in the same location for the entirety of our careers. However, in reality many of us will move practices at least once. Taking this decision seriously, and implementing this stage carefully and thoughtfully, will assure that we maintain important relationships as we leave our practice, and hit the ground running in our new group.
- Make sure that the potential benefit of a practice change outweighs the sigjnficant costs.
- Understand the portions of your contract that pertain to leaving for a new job, and rely on an attorney if necessary.
- Provide enough notice to your employer to abide by the contract and respect the needs of the practice without being premature.
- Understand the value of maintaining relationships with current employers and colleagues regardless of the circumstances of your departure.
- Reach out to your new practice to put in motion any administrative procedures and marketing initiatives that will help you get a strong start.