I recently received this email from a director in the Midwest:
“Can you explain something to me? Let's say a grad takes a job right out of residency with a small, democratic group. Seven months into the job, the director comes up to him, and says, “We're sorry, but we've found someone who will work all nights, and we are going to replace you.” That would be illegal or at least unethical, right?
“But this is what new grads do to us! Where are their ethics? Why is it OK for a new grad to dump a job after six months if one that pays more crops up? It just happened to us last month, which means we will have to spring huge bucks for a locum to fill in for the summer. As far as I am concerned, new grads are now at the bottom of the list for new hires. Let them get their experience and grow up somewhere else!”
This is obviously one ticked-off director, and you can be assured that he has ranted on this topic to anyone who will listen. Directors talk to each other, and they name names. This recent grad just set his feet on the road to a rocky reputation. If you understand nothing else about your job search decisions this year, understand this: Your actions will always have consequences.
Whether the employer is a small democratic group or a big health care conglomerate, they invest a good deal of time and expense into recruiting a new physician. The interview expenses alone for one candidate can be thousands of dollars. A recruitment fee can range around $25,000. The cost of recruiting can easily amount to some significant numbers. Needless to say, the employer expects to recoup that cost from the services provided by the physician over a period of years. A graduating resident also has an adjustment period that helps him get his feet on the ground and even study for the boards. Most directors believe the transitional period for the average grad is six to nine months.
More and more small, democratic, private groups have curtailed their consideration of graduating resident candidates for open positions. Either they do not have the time or staff to provide the double coverage necessary to assimilate a new grad into the practice, or they believed that most new grads were using their first jobs as stepping stones. Now, the candidate-driven market gives these groups no choice but to consider grads for their openings. Though the stats still show that about 50 percent of graduating residents leave their first job in two years or less, the average grad is staying longer. No doubt emergency physicians become more marketable once they are board certified, but what about the employers that helped get them to that point? Aren't they entitled to reap a little benefit from their efforts?
A graduating resident should be looking to spend at least three to four years at his first job, especially in this market with employers offering loan payback, big signing bonuses, and even stipends for multiyear contracts. If a new employer offers $100,000 in loan forgiveness for a four- or five-year contract, guess what happens if the physician hired leaves before the end of that period? He will have to reimburse the employer for the portion of loans covered that wasn't “paid for” in labor. A physician who gets a sizeable signing bonus could be on the hook for that as well if he leaves before the end of the contract. Imagine what an employer would do to a grad who took $18,000 to $20,000 in stipend money before he started and then left in six months! Have your attorneys on standby, kids; this stuff is actionable!
Another consideration that most do not consider until it is too late is the issue of references. Your new employer is going to want references from your current employer. They will ask a recent graduate for residency references, but the decision to hire will be based on the reference from the current supervisor. If that reference questions the physician's motivation for a move, it sends a message to the new employer that this physician may be just as likely to move once another carrot is dangled. You must understand that most employers are looking for stability in new hires. Serious doubt is cast on physicians who do not demonstrate stability in their background; will they be stable in the future?
There is absolutely nothing wrong with a graduating resident planning to use the current market to set himself up for early loan payback and a strong start with an employer who is happy to pay all that money upfront for a multiyear contract. But you must be ready and able to live out the terms of that contract to reap those rewards and move to the next step in your career. Make sure to read the fine print, and have the backing of your family before signing on the dotted line and cashing that signing-bonus check. Once you've done that, the commitment is cast in iron.
Think long and hard about the long-term issues before you decide where to plant your feet for that first job. There can be good reasons for leaving a job earlier than intended: if promises are not kept, if the environment is not conducive to practicing quality medicine, if a group loses a contract, or if any situation puts the physician in an uncomfortable or risky position. But if your motivation for an early move falls into the categories of income, fewer night shifts, or something that could be considered self-serving, be prepared to deal with bad feelings and a reputation that can follow you for a long time. Use your head when making choices and refrain from making your first job a short-term place to hang your hat until a “better one” comes along.
Every action has a reaction, a consequence. None of us has a crystal ball to predict the future, but you can set defined goals and map out a road for achieving them. I encourage you to make these decisions and set those goals before you send out a CV. Be prepared to accept the consequences of your actions and live out the terms of your agreements; that way everyone wins.
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© 2012 Lippincott Williams & Wilkins, Inc.
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