Residency is ending. What do I do now?
It’s a question many trainees have trouble focusing on as they deal with the day-to-day challenges of residency. Some push it away, hoping for the right opportunity to come along.
Every physician has different priorities for their first job after residency. In my case, I wanted to earn a solid income but find a position that would give me the work-life balance I craved. In the end, I chose a 28-hour per week urgent care position. Here’s how I found the job that was right for me.
I’ll be finishing my internal medicine and pediatrics residency this year. My wife and I are expecting our first child in August and want to move closer to our family. She’ll be taking unpaid maternity leave for at least five months and is on my health insurance.
With the end of my residency, our coverage will be eliminated, but we need insurance now more than ever. Not to mention that we support both of our parents’ mortgages.
With stress mounting, we realized that the first step would be to understand our finances. To do that, we hired an independent financial advisor who analyzed our spending habits and created a financial plan with advice specifically tailored to our goals. The financial plan gave me a good guideline for what I’d need to earn.
The job opportunities
The next step was to find available jobs.
I used physician staffing agencies, which were fruitless. None could find the right fit for me in the state of New Jersey, which is already filled with physicians.
I wanted to do primary care and the offers were terrible, with low salaries and mind-boggling requirements. One contract required physicians to take call once a week. Another specified a patient load of 25-30 per day, with compensation tied to patient satisfaction scores.
I didn’t want to work 40-hour-plus weeks. I wanted to work a few days a week so I’d have free time to study for boards, pursue my hobbies, bond with my family and work on creating a direct primary care practice.
I pitched my idea to my colleagues, who thought this sounded like an impossible dream.
But I persisted and figured out a way to get exactly what I wanted.
Finding a niche
I learned that urgent care was the most ideal job for my plan. I had moonlighted with an urgent care since my third year of residency and choose to stay with the company.
As a resident, I received a $70/hour contract with a bonus potential to make up to $100/hour. Post-residency, they offered several choices: 28-hour full time, 35-hour full time, and 40-hour full time, each paying $105-$110 an hour.
These jobs came with full benefits, including two weeks of paid vacation and CME.
My employer also will pay for all re-certifications, which in my case includes BLS, ACLS, PALS and NRP. The offer included a signing bonus of up to $15,000, retention bonuses and up to $15,000 in loan assistance.
To top it off, the company offered free care to my family in any of its 79 urgent care facilities. No primary care job could match this. I negotiated a higher base salary, a higher sign-on bonus and a $5,000 moving bonus.
Running the numbers
The 40-hour week salary would net a minimum of $228,600/year. I’d earn $200,200 working a 35-hour week or $152,880 for a 28-hour week. I chose a 28-hour full-time position with a potential productivity bonus that could push my wage up to $135/hour.
I can meet the minimum requirement by working two 14-hour shifts. The beauty of this contract is that there is always need for coverage and I’ll be able to choose my own schedule.
The lesson from my experience: Don’t just rely on what your recruiters tell you. Use them to find open positions, look at more than one employer, compare offers and negotiate directly.
Most important of all, ask. Asking for what I wanted is what made my “impossible dream” a reality.
I tried capitated primary care, and it reversed my burnout