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This article appears in the Fall 2018 issue of the

PE GI Journal


I am frequently asked by residents and fellows how to look for a job and review and negotiate an employment contract as their long years of formal medical training come to a close. This is not a unique concern for physician house staff-it also applies to physician assistants and nurse practitioners, among others. The job and employment contract are the last and easier problems to address and analyze. First, there are important questions that need to be recognized and answered outside of a vacuum prior to entering into contract negotiations and accepting job offers.

Do You Have a Significant Other to Consider?

Do you have a significant other, spouse or partner? Although it is your life, your significant other’s desires and preferences are also important. The two of you need to discuss these issues together and come to a consensus. If you have children, consider the impact of a move on them. Are you planning a family if you do not currently have children? Lifestyle and education are major areas for discussion. Are you married? Are you planning to get married? Is marriage an issue? Are you a U.S. citizen? Is your significant other a U.S. citizen? If you have elderly parents or other family members, be mindful of their needs and expectations as well.

The discussion becomes more complicated if your significant other is also a physician or other professional with a career. It is common today for both partners to practice in different disciplines of medicine, or for one to work as an attorney, accountant, engineer or other professional. Does your significant other have commitments to fulfill before launching his or her professional career or otherwise? These issues may limit your job mobility unless the other person is able to find a satisfactory job in the same general geographic area as the one you want.

Ultimately, although it is your choice alone, you ideally want decisions to be consensual.

Where Do You Want to Live?

The next set of queries involves where you want to live. Do you want to move back home, or is the presence of family and old friends not a significant issue for you? Do you want to live in a small town, a larger city or a giant metropolis? Are you better suited to urban or rural life? Do you want to live on a large plot of land, or will a housing development suffice?


Climate is extremely important to many people. Do you have a preference as to climate? Do you or your significant other have allergies to pollen or other allergens? Pollen counts at different times of the year should be checked in that regard. What weather pattern do you prefer? Is it important to live in an area with four seasons or two seasons?

Do you have any hobbies such as hiking, camping, skiing, fishing, water sports or other activities? This is important if you desire these activities be close to your home or within a reasonable traveling distance.


If you are from another country, do you want to stay in the United States or return home? Is your family willing to relocate? How many times a year would you plan to return to your native land for a visit, thereby requiring a multiple-day travel stint? Depending on your religion or ethnicity, do you want to be in an area with professionals and others with like demographics? Do you want to live in an area with like politics?

If you plan to raise a family, what educational options, religious facilities and activities are available for children? Is there a good public transportation system? Is commute time to work important?

Many physicians get dual degrees after they complete or even while they are finishing their clinical training. Do you plan to continue your education and get an additional degree? Will you want to be in an academic center? Do you prefer to be in an area that offers medically related employment or business opportunities?

What Do Your Finances Look Like?

Before you decide to take a given job, open a solo practice or find a nonmedical employer, evaluate your finances. Be sure your anticipated salary or the amount you expect to make from your practice will be sufficient to live. This analysis includes your short-term financial needs and long-term goals. Answer questions such as:

  • What do you owe in school and other loans?
  • What are your current living expenses?
  • Do you plan to start a family any time soon?
  • Will the amount you make in a salaried position cover your expenses?

Other Options

Other important factors include the cost to open or buy into a practice, as well as your life goals and aspirations. If you cannot afford to go into practice, you may need to change your plans. You may consider the following:

  • Change the geographic area where you want to start your practice because salary and solo income expectations vary widely depending on the need and insurance company control in the marketplace. Certain rural communities may permit your practice to be subsidized.
  • Stay in a training program to extend your loan repayment and gain additional training, which may entitle you to additional salary or solo practice employment opportunities in the future.
  • Join the military or other governmental healthcare position or go into teaching, since both often afford the opportunity to have your loans paid for you while you work.
  • Make some other path-altering decision before you accept a job or start out on your own.

Once you have considered these important issues, deciding on your professional career path— clinical versus academic practice, private practice versus employment, etc.— becomes easier.


RICHARD E. MOSES, DO, JD, has practiced gastroenterology and hepatology in the Philadelphia area since 1984. He is also a risk management and educational consultant in patient safety, medical professional liability, healthcare compliance, the state of the healthcare system, medical provider well-being and medical ethics. He is a national speaker and author of articles and books, the most recent of which, Medical Malpractice & Other Lawsuits: A Healthcare Provider’s Guide, became a No. 1 best seller on Amazon. Follow him on Facebook @mosesmedlawcompliance, on Twitter @mosesmedlaw and on LinkedIn @richardmosesdojd.