Table Of ContentChoosing Your Practice
Alan K. Kronhaus, M.D.
Choosing Your Practice
Springer-Verlag
New York Berlin Heidelberg
London Paris Tokyo Hong Kong
Alan K. Kronhaus, M.D.
Founder and CEO
KRON Medical
Clinical Faculty
Department of Medicine
University of North Carolina
Chapel Hill, North Carolina 27514, USA
Library of Congress Cataloging-in-Publication Data
Kronhaus, Alan K.
Choosing your practice / Alan K. Kronhaus.
p. cm.
ISBN-13: 978-0-387-97164-3 e-ISBN-13: 978-1-4615-6637-3
001: 10.1007/978-1-4615-6637-3
1. Medicine-Practice. I. Title.
R728. K76 1990
610.69'S2-dc20 89-39978
© 1990 Alan K. Kronhaus
All rights reserved. This work may not be translated or copied in whole or in part
without the written permission of the publisher (Springer-Verlag New York, Inc., 175
Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection
with reviews or scholarly analysis. Use in connection with any form of information
storage and retrieval, electronic adaptation, computer software, or by similar or dis
similar methodology now known or hereafter developed is forbidden.
The use of general descriptive names, trade names, trademarks, etc., in this publica
tion, even if the former are not especially identified, is not to be taken as a sign that
such names, as understood by the Trade Marks and Merchandise Act, mayaccording
ly be used freely by anyone.
While the advice and information in this book is believed to be true and accurate at
the date of going to press, neither the authors nor the editors nor the publisher can
accept any legal responsibility for any errors or omissions that may be made. The
publisher makes no warranty, express or implied, with respect to the material con
tained herein.
Cover concept by C. Maurer.
Typeset by Bytheway Typesetting Services, Norwich, New York.
9 8 7 6 5 4 3 2 1
This work is dedicated to:
My parents, who made me believe I could do
whatever I set my mind to;
My wife, who is a constant source of
inspiration and strength;
and my colleagues, for whom I wrote the book.
Preface
T
he realities of practicing medicine today make the need for this
book compelling. The organizational landscape of medicine is
changing with increasing speed as a result of the growing diversity of
practice styles and professional opportunities. At the same time,
many in the profession hesitate to acknowledge the importance of
preparing physicians to function effectively in the real world.
There are few decisions we make as physicians that are more
fundamental to our success and happiness than our choice of where,
how, and with whom to practice. Ironically, there are few decisions
we treat as cavalierly, at least as judged by the lack of time and effort
we devote to choosing a practice wisely. Our failure to attend to a
matter of such importance stems from the longstanding, deep-seated
attitude within the profession that regards subjects such as career
counseling and practice management as indecently vocational, un
worthy of time on our educational agenda.
As dissatisfaction rises among physicians, the more responsible
members of our profession are recognizing the need to help col
leagues make their way in a world that appears increasingly hostile
and hard to understand. For physicians, change within the health
care industry, as in so many other areas of life, creates opportunities
as well as anxieties. To capitalize on those opportunities, we must
prepare for the challenges ahead.
viii 0 Preface
This book might well have been titled "Everything You Always
Wanted to Know About Choosing a Practice but Had No One to Ask
About." My fondest hope is not only that it will fill an immediate
need for information not previously available, but also that it will
focus attention on the value of career counseling for physicians, an
area that has long languished in the blind spot of professional educa
tion.
ALAN K. KRONHAUS, M.D.
Chapel Hill, North Carolina
Contents
Preface vii
1 Dilemmas of the Job Search 1
State of medicine today _ Neophyte physicians and
their mistakes _ "Case" studies _ Defining the
problem _ Bad news/good news
2 The Costs of Career Mistakes 23
Hard costs _ Opportunity costs _ Emotional costs _
Final statement
3 Know Yourself 32
Levell: Personality type _ Level II: External factors _
Rules of the road _ Finding out more about what
you want
4 Know the Job Market 62
Geographic imbalance _ Specialty imbalance _
Too many physicians? _ Market area profile _
x 0 Contents
Other assessment maneuvers _ Diversification of
practices _ Trend toward group practice _ Practices
from which to choose
5 Matching What You Want With What Is
Available 83
Fact versus opinion _ Long-term versus short-term
perspective _ Trade-offs and compromises _
Summary
6 Where to Look for a Job 93
Developing your options _ Classified advertising _
Society and residency program placement services _
Private placement services _ Targeting and
networking _ Locum tenens
7 How to Evaluate Specific Opportunities 108
Practice size (number of physicians) _ Specialty mix
_ Legal structure _ Method of payment _ Shared
expenses and compensation of members _ Other
variables, issues, and considerations
8 Understanding and Negotiating
an Agreement 129
Principled negotiating _ Employment agreement _
Timing the negotiations
9 Conclusion 151
Index 155
Dilemmas of the Job Search
I
nsetting the course of our careers, we as physicians make these
major decisions: We choose medicine as an occupation, we select
a specialty, and we decide where and how we want to practice. Most
of us treat the first two decisions with due care and respect, but few
of us seem to appreciate the importance of the third decision, at least
as judged by the minimal time and attention we devote to choosing a
practice wisely. The sobering fact that 50% of physicians change
jobs during the first two years after training highlights how iII-pre
pared we are to choose a practice.
Why do so many of us fail to prepare properly for a decision of
such importance? Until specialty training is complete, we generally
find that others are making the major decisions concerning our lives:
the courses and rotations we take, the clinics we cover, our call
schedule and patient load-in essence, what we do and when we do
it. Apart from choosing a medical school and postgraduate training
program, we have little or no say in the formulation of our profes
sional lives. Moreover, because professional commitments tend to
dominate life during these years, we also have little control in the
Please note that this book is written with both women and men in mind.
Forgive the author for simplifying matters by referring to physicians and all
other personnel throughout the book as "he."
2 0 Choosing Your Practice
personal sphere. Not unfairly, one could characterize a physician's
circumstances during this period as "sustained adolescence!'
As a result, physicians experience a strange dichotomy in the struc
tured, sheltered training environment. We exercise enormous respon
sibility for the welfare of others but have little control over much of
what happens in our own lives. It is no wonder, then, that when it
comes time to choose where and how to practice, we shy away from
making such a major life decision. If indeed we make mistakes at this
point and do not learn from those mistakes, our subsequent career
moves or life decisions may produce equally poor results.
Who is to blame for these unfortunate circumstances? One school
of thought places the responsibility at the doorstep of those in the
medical profession who dictate what is learned in medical school
and postgraduate training. These individuals, who might very well
have provided career guidance and counseling to the young physi
cians for whom they are making many other life decisions, have
abdicated their responsibilities in this vital area. This book is part of
a growing effort on the part of the more responsible members of the
profession to redress a glaring oversight: failure to prepare physicians
to function effectively in the real world.
To make matters worse, there is considerable pressure to choose a
practice correctly the first time. The stakes are particularly high for
two reasons. First, most of us are considerably older than the rest of
the population when we seek our first "real" job. We have invested
more in our education and have often accumulated enormous debts.
Moreover, we have generally married and so have extensive social
and family commitments. Second, although changing jobs, like get
ting divorced, has become more socially acceptable, it still carries a
stigma. Other physicians tend to be wary of a prospective partner
who has moved several times. There is thus but a small margin of
error in regard to making a false start or similar mistake. Multiple
practice changes engender great hardship for the physician and
grave misgivings among his peers.
State of Medicine Today
Today the medical profession offers its practitioners an almost limit
less diversity of professional opportunities, many of which were not
available until the decade of the 1980s. This diversity of choice, as in
