Are you newly minted as an attending or seeking a change? I feel your excitement. You might have thought I would render the overused “I feel your pain,” but contemplating a new position must be viewed with excitement.

Much to my corporate father’s chagrin, I’ve changed jobs frequently and have staffed around twenty different Emergency Departments over the past two decades from large urban trauma centers down to one-man shows in the boonies.

I share that to impress upon you that the options are limitless and change can be viewed in a positive light.

Trying On Hats

Despite experience at twenty plus hospitals, I didn’t nor do I suggest changing jobs every year. A reasonable person wouldn’t commit indefinitely to another after a few short phones calls, emails, and a meet and greet lunch.

Consider job shadowing, obtaining temporary privileges, and working a few days or shifts at a potential new position. Try it on for size. Window shopping is vastly different than working in the trenches.

Administrators have magic wands when it comes to issuing credentials in a pinch. While I can’t speak for all, I’ve seen the badge of admittance issued in just a few days on occasion. Even though a job search candidate may not warrant “emergency privilege” status, where there’s a will, there often is a way.

Try to speak to as many Physicians in the group as you can. Each will have a different flavor. Use your instinct and rely on gut feelings when the Kool-Aid seems too good to be true.

Open Spaces or Crowded Stages

Another critical factor is physician density. The data is a few keystrokes away. Tools such as Primary Care Physician Mapper exist and facilitate your preliminary research (enable flash and may take a moment to load).

The task is more straightforward in smaller cities where the physician staff is full visible online and the service area available from city or county data.

For the ultra subspecialist, this is never an issue. My roommate from college and med school is one of approximately 700 pediatric surgeons in the US. I suspect carte blanche was in full effect.

For others like myself, specific locales are so desirable that the pay is far below average. Looking for a job in Denver in 2000 was a dismal prospect given the rising cost of living and low wages as physicians clamored for a career in the Mile-High City.

Go For The Unsexy

While a San Diego or New York City job may roll smoothly off the tongue when talking to friends and family, it may not translate to career or financial satisfaction.

Small towns and non-urban areas can offer personal and professional rewards unthinkable to a third-year resident. Loan forgiveness, higher than average Compensation, impact, and legacy.

Know Your Math

Compensation and bonus calculations often adopt a form of math you have never seen. Ask for clear and concise explanations, and be sure you understand how the check is written at the end of the day. Plan for contingencies, adjustments, market or regional shifts, and ask pointed questions. You deserve to see the entire playing field before you lace up your cleats.

Sheepishly, I admit I’ve been on the wrong end of this scenario more than once after grabbing hold of the “dream” job.

A few questions to ask:

• The average salary of all physicians in my specialty in the group
• How the bonus is calculated
• Any incentives for medical staff participation, community outreach,   teaching, supervising mid-levels, etc.
• Overhead
• Collection rate
• Payer mix
• What is the overall strategic direction of the group
• Payment bundling
• Proposed changes to the compensation package
• Past data on salaries
• What is my growth potential in this position
• Why are you hiring for this position
• How many new hires do you anticipate, and what impact will that have on my income, responsibilities, etc
• How does the existing staff feel about the recruitment of another physician
• What is the malpractice policy, and who pays the tail
• Retirement plans
• Equity or profit sharing
• Alphabet soup (see – how I lost $67,500 in 60 seconds)

Make sure you have a solid grasp of compensation and productivity calculations. Pitfalls exist in how RVUs are tallied and tracked. While the nuances of being an ICD10 expert coder may cause one’s eyes to bleed, there are salient points all doctors must know.

Regional Compensation Data Matters

Physicians are routinely surveyed, and groups are contracted to dredge the data on physician salaries. Depending on the specialty, income for similar work can vary significantly, and the cost of living is not the driving factor. Having a solid grasp of the salary range for a region is essential information at the beginning stages of any discussion.

Speak The Language

Do you like patients armed with WebMD printouts or those with a cousin who took biology in college and is now their medical advocate?

The same applies to many of us – myself included. Contracts are confusing and the language is foreign. Consult an expert and save yourself headaches. Lawyers can indeed be your best friend and worthy of counsel.

The skill set and talent of negotiating contracts rely heavily on experience and art. Before quickly jumping any ship, make sure to understand the ground on which you are about to land.