I never thought much about my first neurosurgery job. With a military commitment post-training, that decision was out of my hands. But as my time as a military neurosurgeon was coming to an end 14 years later, I needed to understand the next step in my career. While I wasn’t new to neurosurgery, I was new to the process of finding a neurosurgery position. Questions started to swirl in my head. Where would I work? What setting would it be in? Who were my partners going to be? I felt like Indiana Jones in the movie from 1989 when he was trying to choose which cup was the Holy Grail and the only advice that was given to him was “Choose, but choose wisely…”
Good advice, but how do you choose wisely? So, I sought advice. I spoke with neurosurgeons and other physicians that felt that they had made good choices and some that felt like they made mistakes along the way. But it wasn’t until I spoke with an anesthesia colleague that I felt like I had a framework. He told me that it all came down to three elements: People, Place, Pay. “You need 2 of the 3,” he said. While this may seem overly simplistic, it allowed me to start to break down my process into these categories and evaluate not only what the job was offering, but what I was looking for in a job.
People
Except for your family, the people you work with are the ones that you likely spend the most time with. Who is it that you want to surround yourself with? Your partners don’t have to be your best friend, but there should be a common value system when it comes to patient care and how it is performed. Are there egos or internal turf battles within the department that you may find yourself in the middle of? Is there a collaborative nature amongst your partners? Depending on what stage of your career you are in, is there someone you can identify as a mentor? Or even someone who will be an ally in the onboarding and practice building process.
Beyond your partners, there are multiple other people that will directly influence your job satisfaction. Who are the members of your team? Are you working with residents, physician assistants, nurse practitioners or a combination? How are assignments made? Do you have someone dedicated to you and your schedule or does it rotate? What is the quality of the nursing cadre at your hospital? What is the experience of the operating room team with the types of surgery that you will be doing? Don’t forget the clinic staffing either. A good medical secretary can set you up for success. While it is possible that you will be plugged into a highly functioning system that already has a way of doing things, you may need to consider how you will be building the team around you. Will you be given that degree of autonomy?
Place
Going into the process, you need to have a good understanding of what part of the country you want to work in. In your mind, you need to be able to rationalize why this is important to you. Regional climates may sway you to one part of the country or the other. This also impacts what sort of activities you will be doing outside of work. Do you want to work in an urban, suburban or rural setting? Don’t forget your spouse or family in this process. Remember that while you are at work in your dream job, they will be going through the same transition as you. Maybe you want to be close to your parents or your spouse’s family. Or maybe you want to be far away! All things to think about and discuss before signing that contract.
Along with the place that you live comes the place that you work. What is the hospital and clinic setting like? Are you working in a newly constructed building or will aging infrastructure be a challenge? Will you have the right equipment when you start or will this be an issue? Is your practice’s market share expanding, neutral or contacting? What is the financial health of the hospital or in some circumstances your practice group? While health care financials can change, no one wants to start a new job and shortly thereafter there are budget cuts being discussed.
Pay
We all get caught up on a number, but what does it mean to you? One of my mentors once told me that the key to being happy with your salary is feeling that you are being appropriately compensated for the work you are doing. Remember, the larger the number the greater the expectation. But what are those expectations? Understanding the metrics you will be judged by is a key first step. Do these metrics change after your first year of employment? In addition to a paycheck, there are other forms of compensation to be considered such as retirement plans, deferred compensation plans and even paid time off. Taking a step back and looking at the bigger compensation pictured compared to the expected work is a must.
Conclusions
People, Place and Pay — easy, right? To throw in a final twist, you may place a different relative value on one of these factors. You may want to be close to family and this is the driving element in your decision and outweighs the people and pay. That’s fine, but at least consciously acknowledge this fact. While this framework is not perfect, and maybe overly simplified, it is what I used to start thinking about what I was looking for in my next practice.
