American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

How to Evaluate Practice Opportunities

Choosing a practice can sometimes be a very easy task or it can be quite difficult. Below are some tips to help you evaluate practice opportunities:

  1. Proactively think about the surgeons that you emulate and how they practice medicine and surgery. It is also important to understand your own experiences as a patient and what you felt was important when you were seen by a doctor.
  2. During residency, you may decide whether private practice or an academic setting is right for you. Both practice settings can be very rewarding but remember this should be an individual choice as you will be practicing medicine and surgery for 30–35 years. It is important that you are comfortable in your selection of practice setting.
  3. In an academic setting be sure to understand what is truly important to you. For example, is protected time for either basic science or clinical research important? If you are interested in basic science research, does the academic institution have other physicians and postdoctoral fellows with whom you can collaborate? Is start-up grant funding available? What are the expectations of your chair and the institution about your progress in research? Is tenure important to you and/or is it necessary to remain at the institution? Do you need extra basic science or statistical training and, if so, is that available at that institution? Is laboratory space available and/or will you share a lab? There are a multitude of other questions related to basic science investigation, but these are a few to help in your evaluation process.
  4. In an academic setting you may want to be involved in clinical research. If clinical research is of interest, be sure to find out if the institution has a good track record with clinical or outcomes research. Inquire if you will have protected time for clinical research. You also will want to know the expectations of your chair and the institution regarding your progress in research. For example, is grant funding necessary to either start (not likely) or continue after two to three years at the institution? Also, it is important to know if there others at the institution that can help you get started in your area of interest.
  5. It is important to understand the financial structure of an academic institution, especially regarding clinical practice. For example, how will you receive your salary as an assistant professor? Are you in a straight employment model with the hospital via a defined salary, or is your salary dependent on your clinical productivity? Who pays for malpractice, travel, administrative assistants, books, etc.? How do you advance along the academic hierarchy, as well as financially? Does your salary increase the more productive you are? Be sure to fully research the financial structure before making a final decision on your preferred practice opportunity.
  6. In private practice it is fundamentally important to understand the financial structure of the practice. Below are some key questions to help in your evaluation process as the financial structure will directly impact how you are paid and advance within a private practice. For example, will you be salaried for one, two, or three years, and then progress to having your salary based on your productivity (i.e., the “eat what you kill” model)? Is there adequate operating time at the hospital(s) where you will practice? How many hospitals will you cover? What is the call schedule? Is a retirement plan available within the group? Are the partners collaborative or are they competing with one another for patients? How are expenses divided among the group? Is there an opportunity to buy into the practice after a few years? Is the group owned by a single senior partner or is ownership divided evenly among the partners? Do they have a “non-compete” clause if you choose to leave the practice?

In addition to better understanding the offered compensation models and available clinical and research opportunities, it is also important for you to weigh personal reasons. For example, does your significant other and/or family want to live in the city where you want to practice? Does the location offer you what you are looking for in schools, recreation, sports, arts, etc.? Importantly, it is essential that you will feel comfortable in the practice and with the people you will work with on a daily basis. As a young surgeon it also is critical to have access to good mentorship. You will need to feel comfortable asking your partners/colleagues about difficult patients and those with straightforward problems, as well as those with complicated conditions.