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As a new graduate, you don’t know what you don’t know. Consequently, you are bound to make mistakes when finding your dream job. Let’s say you’re set on joining a corporate practice—how can you assess if it will be a good fit? In fact, what makes a good fit? I’m no expert myself, but I think there are at least two things every young doctor should look for in a practice: whether or not the practice will help you reach your clinical/surgical goals and whether or not you will be happy there.
At the very minimum, when evaluating a practice you should be asking yourself – “How is the patient volume? What is growth potential? And are the doctors happy?”
I recommend digging even deeper and seeing if this practice is a solid place or simply a pig wearing lipstick. There are many practices who masquerade as a dream job, and there are many subtle red flags that are often missed.
Hopefully after reading this post, you can start identifying these practices and save yourself the trouble from ever joining them. I’ll share three lies that new grads are often fed and three ways to uncover the truth.
Mistake #1 – “We Can Start You Off with a High Base Salary”
The Truth: We will pay you well year 1, but you will earn a lot less in your career with us.
After spending 4 years in college, 4 years in medical school, 4 years in residency, and up to 2 years in fellowship, a high base salary can be enticing. It feels like it’s finally time to get paid!
But hold on. Don’t just take the highest paying job offer without considering the bigger picture. Does it really matter if you get paid really well year 1 if at year 5 you are earning 50% or less of what you should be making?
If you get paid 300K year 1, but only 350K or so year 5, are you really winning? How much are you doing to get paid that $300,000? What if you were collecting over 1.5 million to get paid only $300,000? How much of that is overhead? How much of the $1.5 million is instead going to the private equity investors?
One of my friends was collecting approximately $1.2-1.5 million and only got paid $300,000. This means that he was only making about 20% of what he collected (300,000/1,500,000) = 20%.
One of my other friends received another job contract that offered 25%. If you collected 1.5 million, you would get paid 375,000.
I would encourage everyone to read this post in the solo building blog if you haven’t. Please don’t make the same mistake other doctors have time and time again.
Although to be fair, in this case, my friend was lucky enough to be collecting $1,500,000 as a newer grad. In many cases, you could be offered a pretty terrible contract (< 33% collections) AND still not have a high clinical or surgical volume.
This brings us up to the next mistake: the pipeline.
Mistake #2 – “The Average Surgeon has Good Clinical and Surgical Volume.”
The Truth: Actually, the average is good. But there is a bimodal distribution of volume.
A good ophthalmology practice should have good surgical volume. But if you are told that the average surgeon is doing 20 cases a week, this may sound good. However, if 1 doctors is doing 35 a day, and the other one is doing 5 a day, that is an average of 20.
Some practice will try to talk about how high the surgical volume is at their practice. But, the pipeline feeding the surgeons may be unequal. In fact, let’s go over a few examples at this fictitious location where the practice bragged about an equal pipeline. This was far from reality.
First, to clarify what they meant; Anytime a new patient called the office and asked for a cataract consult AND never had been seen by any previous doctor at the practice, the patient would truly be randomly assigned. But this makes only a very small portion of possible surgical consults.
This same practice had well over 10 optometrists. Shockingly, at this practice, some of the optometrists were obligated to refer to only a single surgeon, and thus some optometrists would NEVER be able to refer to some of the newer doctors. In this case, this was really bad as this practice did NOT have a large external referral network and the new doctors relied heavily on internal referrals.
Next, some practices have multiple offices and locations. There are some cases where if a patient was seen at one of the satellite location by a glaucoma specialist (who can perform cataract surgery), and the patient needed cataract surgery, the patient would be referred to the “assigned” cataract surgeon at this office.
There are many other hidden rules that as a new surgeon you will never find out about until later, but this can have a negative impact on your clinic growth.
If we go back to the numbers we crunched earlier, if now you are only collecting $750,000 with 30% collections, you are now paid about $225,000.
Conversely, if your contract is favorable (40% collections for example), and you collect $600,000 that year, you will actually earn more in a smaller but more lean practice. Sometimes you don’t have to have a huge clinical/surgical volume to do well.
In fact, that’s why I urge many of my friends to consider going solo. Again, those numbers on the solo building blog are very much real and reflect my experience. That’s for another post.
But aside from being well compensated, I think the most important question every doctor needs to ask is if you will be happy at your new job. That brings us up to the next possible mistake: blind trust.
Mistake #3 – “Trust Me, Our Doctors Rarely Leave. They Are Happy Here.”
The Truth: The Practice has a Very High Turnaround and Poor Retention of Doctors
Another warning sign of an unhealthy practice is a practice with a high turnaround.
To be fair, most ophthalmologist will leave their job in the first few years. The University of Iowa Website puts the number at near 80%. However, if you see an even higher number of doctors leaving a particular practice, be prepared to walk away.
Some practices may claim to have good retention.
In one practice that made this claim, out of of the last 6 hires, only 2 stayed. I am changing the years up for a little anonymity, but the doctor hired in 2020 and the doctor hired in 2022 stayed. The two doctors hired in 2021 both left. The doctor hired in 2022 left. The doctor hired in 2023 left.
Without actually talking to the 2021, 2022, and 2023 doctors, no one will actually no why they left. In some cases, yes perhaps the doctors who left were genuinely happy but had to leave for special circumstances. But I would argue that there is a reason for everything.
In another case, there was a practice with one senior partner that brought on a new associate every 2-3 years. Every 2-3 years, the new associate would leave. Why?
In this specific case, the senior partner would actually offer partnership to each associate that joins, but the buy-in was so absurdly overpriced, that every associate would leave.
In the latter example, it’s hard to say if the doctors were “unhappy” with the practice or just left because of purely the unfavorable buy-in.
How do you actually find out why the doctors left? Or even more importantly, how do you even find out if any doctors have left? Not every hiring practice will offer that information up, so here are 3 tips on how to find out.
Pro Tip #1: Talk to the Surgical Reps Covering The Area
Without a doubt, your best source of information about all the practices in an area are the surgical and pharmaceutical reps .
From walking into a variety of clinics all year long, these reps have the inside scoop. In addition, they will see doctors who have come and gone, and they will also see which practices have the happiest doctors.
In general, these reps have nothing to gain by misleading you about a practice. In fact, if they mislead you and lead you to join a practice and you are miserable, they will have forever lost your trust.
I highly recommend finding the surgical or pharmaceutical rep covering the part of town you are interested in. To find out who the rep might be, start with your current rep. For example, if you are a resident at UCLA and you are interested in a job in Houston, Texas, ask your Alcon rep at UCLA who the Alcon rep is in Houston, Texas.
Then just simple ask the right questions. “What do you think about XYZ practice?” “Has the turnaround been high? What is their track record?” “Are the doctors happy there.”
Pro Tip #2: Talk to Other Doctors in the Area
Ophthalmology and optometry are both very small fields. Odds are, you will have connections at every single city if you look hard enough.
Your program director may know a doctor who is practicing in that city and can connect you. Again, you can ask the same questions you would ask the rep.
Sometimes, I find that the reps tend to know more, but it never hurts to have more information about the practice you are interested in. Remember, “knowledge is power.”
Pro Tip #3: Check The Job Bulletin: They are hiring every single sub specialty constantly
And of course, sometimes the practice will reveal their hand to you.
If you check on a job bulletin and the practice is literally hiring every single specialty all year long, that is a red flag.
No thriving practice will be hiring a glaucoma specialist, a cornea specialist, a retina specialist, a oculoplastics specialist, a pediatric ophthalmologist all year long.
The best way to see if a practice is desperate is to start your homework early.
If you are a resident in training and you are determined to go to a city, start checking the American Academy of Ophthalmology job listing. If you see the same practice advertising for every position all year long, that is your warning sign. Just walk away.
TL;DR.
- So if you are looking for your dream job and want to join a practice, find out if the doctors are happy and find out about the surgical volume and clinic volume.
- Your best source of information is NOT the practice. They may not be upfront about it.
- Instead, rely on your connections with reps and colleagues in the area.
- And also, do your homework yourself. Look at job bulletins.
If you can’t find your dream job in a given city, consider solo. It’s what I did. For a timeline and a checklist on what to do to make that happen, check this post out.
