Which job would you take?
 

Round 1 of my interviews for a new job starting in summer 2007 is complete. I had 4 interviews this week, all 4 essentially offered me a job. I narrowed it down to two strong candidates but am having some trouble deciding between the two. Both job are for hospitalist positions, essentially I only take care of people in the hospital, no clinic or other responsibilities. Which one would you take and why? The candidates are:

1). Join a group of 3 doctors who are looking to grow to 5 or possibly 6. The group essentially is trying to rebuild itself after losing all of its experienced members about 4 years ago. They have lost market share in the hospital due to frequent turnover of docs in recent years. Currently they have about 15-20% of the hospital business. There is one other major competing group in the hospital, although with any sort of marketing by the group I am interested in, the other group could likely be pushed out fairly easily. The competing group is a sort of fly by night, high volume corporate group which has questionable quality of care. The three current docs are all very young, one is 2 years out of training, the other two are in their first year of practice. They are looking at me to be a "leader" in the group and help grow the practice. The practice is owned by the hospital, I do not think that they would be agreeable to a private takeover by the doctors so there really isn't much opportunity for ownership. Salary is $170 per year for the first 18 months and then about 80% of what I bill I keep. Currently the docs are only seeing about 10 patients a day but hope to grow that to 15-20. Hospital is about 300 beds, suburban community hospital. I could live in a nearby area, would be 10-15 minutes away from work. Overnight call would be from home.

2). Join a group of 6 doctors looking to grow to 9 and possibly more if the demand is there. Basically this one is a semi-teaching position, I would be staffing a ward service for residents about 50% of the time and being a private hospitalist the other 50%. The group has an exclusive contract with the hospital and will be the only hospitalist group able to admit, so it's a captive audience. Time on the teaching service is salaried plus you get a percentage of what you bill. Time on the private service is all production, no salary. The hospital is assuming all the overhead for the group so I would keep about 90% of what I bill (the 10% being the fee for the billing company). The guys already there are a little older than me (early 40s) and have been established at the hospital for about 5-6 years. Group would be owned by the doctors, but they would be unlikely to sell or be taken over because they are integrated with the teaching residency. Hospital is large, 750 beds, and is located in a not-so-nice part of town. Surprisingly, the hospital itself is actually nicer than choice 1 although it is located in a questionable part of town. I would live elsewhere, commute would be about 25-30 minutes. Call would be from home while on the teaching service and inside the hospital while on the private service. Salary is projected around $225-275 depending on how hard you want to work. Docs are projecting to see about 18-20 patients per day.

Both jobs have appeal to me. The smaller hospital is in a nice part of town, however I would never own that practice and would be looked to as the "go to" guy and the experienced one (despite the fact I have never been a true hospitalist). Salary is less, but might grow as the practice grows. The larger hospital has the appeal of keeping my hand in the teaching side of things, which I do like. Also salary is more, although the workload would be higher initially. The part of town doesn't really bother me that much, it is right off of a main highway so easy to get in and out. The commute is probably less than what I have now. RIght now I am kinda leaning towards option 2 but am still very torn. Thoughts?

I didn't think there was a 'not so good part of town' in SAT. I was out in Hondo and D'Hanis for better part of a year. Loved it there, bought a small piece adjacent to Garner State Park for retirement.

Go with the second one. Is more in it for you.

#2. In medicine, better to be an owner, than always subject to the whims of a hospital.

Depends on what you want. Sounds like option 1 you get to be the big kahuna, and you can shape things how you want. For me, the teaching aspect would be a big plus, so option 2 is the one I'd go for even though I'd be "junior." As for location, that doesn't matter so much to me. USC is located in a not-great part of town...no big deal. If anything it is safer because the university throws more resources at security. Plus you'd likely see more "interesting" cases. I know that our teaching hospital is where the military sends their docs for pre-battle training because they see more GSWs in a day than most hospitals see in a month.

#2 has far more potential for income and personal growth. That's my pick. Good luck and let us know which one you choose.

Oh sorry, these jobs are in Dallas, not San Antonio...

My wife and I just sat down and talked about pros and cons of each job and option 1 came out slightly ahead on paper, mainly due to location, payor mix (less non-payor patients) and smaller commute (I hate big city commutes).
The offer sheets should start coming in next week so I will have some hard numbers by then. The nice thing is I really have a couple months to mull this over and see what else is available.

geez. Dallas? I'd take my own life before I left SAT for Dallas.

I know that doesn't help in any way, but it would make a diff to me. There are LOTS of 'not so good parts of town' there.

All the family is in Dallas. I like San Antonio, but with family there and a much better market for docs than SA, it's a no brainer...

Rick,
Don't start out trying to change the world, it's a PITA. Plus if you like the people at #2 better, it makes a world of difference when you're having a ***** day, everybody's crashing, and you can't find the specialists (;) ), or get the labs back.

my nickel.

Sing Dude, put the bottle down slowly. Ok, now go get a cup of coffee. Relax...breath...relax...breath...good.

San Antone is nice but the Big D is got way more over on it in so many ways it would be the beginnings of a thread that could easily make it to 4 turns!

Go with #2 - more bucks and sounds more interesting. When you more here you best look me up or I will take it as a personal insult and tease and make sport of you every chance I get!

Nostatic, good points.

After sleeping on it, I think it really boils down to whether I want to continue to have a teaching role or not. Both ideas have pros and cons. I do mostly enjoy teaching, however there are times when you get an inexperienced or poorly trained resident and those months are stressful. Also, I have been a teaching staff with inner city poor patients before and that can be stressful as well. On the other hand, the idea of just having to do my own work and try to build a practice has merit as well. I would be more efficient at work, wouldn't have to worry about preparing lectures, etc. I would be closer to home and might even be able to pop home for lunch every once in a while. The patients would be almost all medicare or private insurance, which is a plus on the billing side. Also, the smaller hospital is in a bit of a power vacuum right now, I would have a chance to really cement some business relationships and become one of the dominant players in that hospital. Of course, that assumes that I can do the job well and network well.

It's really great to have two very attractive options, just makes the decision harder :).

Make a decision, then sleep on it. If you feel great about it, you made the right choice. If you still feel hesitant, then it's not the right one for you. It's hard when it's not obvious, good luck.

Whenever a hospital contracts with two independent hospital groups, they will ultimately use the competition to their advantage. In the end, the two doctors groups will start backbiting and it will get ugly. Peer review becomes a joke, "us against them". It's not my style of medicine.

Take the second job and have the enthusiastic support of the hospital and your peers. You'll have a better job. Hospital politics erode happiness. I served on our hospitals governing board for 6 years and I am currently completing my third term as department chair. If your personal goals are aligned with your medical group and the hospital administration, it could be a great job. If not, nothing but pain and stress.

poll the staff. Go to the hospital with fewer liberals.

Oh wait, this is Dallas, not Austin. Nevermind :p

I don't know hospital politics very well, but I do know academic politics. Definitely scope that out and consider it. While it can change, the enthrenched power base often is in place for quite some time, and if you don't see eye to eye, it is misery incarnate.

Hah, there ain't no stinkin liberals in Dallas...I think I'm home free!! :p

Moses: Good point. The only thing working in my favor with Job 1 is that the group is owned by a 501A of the hospital, so it is really in their best interests to have their own guys doing the work rather than an independent group.

Nostatic: Another good point. There is a minimal teaching staff at this hospital, it isn't one of the big teaching hospitals, they only have two residency programs that I know of. The full time academic faculty are only two, everyone else will be doing this part time academic/part time private thing. You are dead on about the power base though, the program I am at now is that way, two weeks ago I got cross ways with the head of the department who has been there since time began. Needless to say, I just sat there and let him berate me, there really isn't anything I could do or say in return.

The good news is that there are probably more opportunities on the horizon, I made some contacts while in Dallas and will try and talk with a couple more groups this week. Hopefully by September or October I will have things pretty well scoped out.