A general surgeon and a neurosurgeon’s path to employment: The job search

I thought this was going to be the fun part. As my friends have graduated from residency and moved on into their grown-up jobs, I’ve wistfully wondered how amazing it must feel to be wooed and recruited to a glamorous physician practice. I’ve also observed with a degree of incredulousness as my friends have each complained about the anxiety of this process. I didn’t believe them. C’mon, man, you’re at the good part–the reward for all your hard work! You’re just being humble, right? It must feel great to be at the end.

But now I get it. Josh and I have spent something like 13 years (THIRTEEN! YEARS!) hammering away at this goal. Our pre-med requirements (2 years) deserve their own chapter in the tome that is our professional training, and then med school (4 years) was tough but of course a blast, and residency (7 years) has been a mixture of great and terrible, but generally complicated and incredibly tough. So here we are, ready for launch. All we have to do is pick a destination. But it’s been very, very, very difficult. Want to know why?

For starters, there are two of us. So we must each find a suitable job for ourselves and then check to see if there is a corresponding job for the other one. Once that is established, we delve deeper and even go interview, only to realize that the job might be great for one of us but not ideal for the other one. On and on the cycle goes.

Next, there is the fact that we have children. When we ranked Mayo #1 in our residency match lists, we were confident this was 100% where we wanted to be. With no kids, th move felt like an adventure. I knew we would miss our wonderful families, but I had no complicated feelings; it felt right. Now, we DO have complicated feelings about being away from Family. Our extended families are pretty great and would undoubtedly be a wonderful part of our girls’ childhoods. But, because of the situation in the previous paragraph, we have considered several jobs far away from family and we have found good opportunities here in the midwest. Nevertheless, being close to family is a weighty factor in this equation.

Next, there is the decision to make between private practice and academics. Many residents will clearly see themselves as one or the other, but Josh and I are both firmly on the fence on this one, Josh more-so than I. He has always pictured himself in an academic job, teaching residents, publishing papers, and doing more complex cases. As I’ve seen myself more as a trauma surgeon these past few years, I’ve also assumed I would be a part of an academic trauma/critical care practice. Additionally, at Mayo we are not exposed to the private practice world and know nothing about RVUs or running a business. The interview trail has been a crash-course in different practice models, and I’ve had to do quite a bit of reading about reimbursements, opportunities for buying into practices and surgery or imaging centers, etc. Josh and I don’t really love big cities (Rochester is about right for our level of excitement and tolerance for traffic), which really makes working in academics more difficult. So to find that perfect “big hospital in a small town” again, we’ve found mostly non-academic positions available, which has required a big shift in mindset for us.

We also want to select the right pair of jobs keeping our North Star in mind, which is that one day we want to be working on major global surgery projects. Whether that means moving overseas long-term or not is unclear right now. My thinking has been majorly influenced by the book Love Does by Bob Goff, specifically for the many examples within it of the merits of having a steady, good-paying income here in the U.S. and being able to invest in amazing, high-impact projects elsewhere. Josh keeps reiterating, “I just want to help a lot of poor people. That’s what I feel like the meaning of my life is.” So while we know that it’s necessary for us to work here in the U.S. a while, the bigger goal of wanting to be financially independent so that we have the freedom to pursue this humanitarian medicine path is constantly on our minds. We are trying to select positions that get us closer to this goal, but to be honest it feels like all of our options are only taking us farther from what we ultimately want to do.

Lastly, we have dealt with some serious disappointment from a practice that really sold us on a vision for both of us, and then my half of the deal completely fell through. This practice kinda had it all–location near family, a great group for Josh, opportunities in both trauma and critical care for me–but in the end the administration just couldn’t work it out. This situation was difficult to get over, and every job we have interviewed for since then has been compared to what was this original dream scenario.

As of now, we have essentially 3 choices. One of these choices is close to family. The other two are far away but have their own merits. When we’ve signed a contract, I’ll post more specifics about the positions, locations, and our decision making process.

One day, I hope to have some wisdom from the job-hunt to share with other young physicians. In the meantime, I would welcome any advice my readers my have for selecting a job. What do you wish you had known? What helped you make a great decision? What might you have overlooked in the process? Please leave a comment below.

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