Guaranteed Job After Residency
Is a resident guaranteed a job after training? The short answer is no. You’re not. However, it’s doubtful that you will be able to find any position when you get out of training. When you are a resident, the length of the residency depends upon what specialty you’re in. But most residents will start looking for a job either in their second to last or at the very beginning of their final year of training. And there are various avenues to find employment, which I’ll go through a bit. But there is no guaranteed feeder system for any resident or fellow. It will be the physician’s responsibility to go out and find a job themselves.
Finding a Job after Residency
There are times when the training program you’re in is looking for a physician, and then it’s a smooth transition if they offer you the job and it’s somewhere you want to stay. But honestly, that is rare. As somebody who’s reviewed thousands of physician contracts over my career, I know the number of them staying with the hospital or health network where they trained is deficient. Most of the time, people look outside their employment training program. Now, the way to look for a job is where you want to be. And that is probably the most significant factor when finding a new job. And I’ll use an example.
Look for Jobs in Your Desired Location
Let’s say you want to move to a desirable location. For instance. I live in Scottsdale, a desirable location because of the weather, lifestyle, and all that good stuff. And so, because many people are moving here, the competition for jobs is much higher than in other areas. But if you want to live in rural Idaho or something like that, where there’s very little competition. And so, if you want to move to a remote location, you will make more money and have less competition. So, it would be much easier to find a job. However, many people don’t want to live in a remote area, and they want to live in a big city.
Finding a Job in a Medical Specialty
And if you first think, okay, where do I want to move to? That can dictate the ease of finding a new position. So, that’s the first thing. The second is the specialty. Some specialties could get a job wherever they want, whenever they want. Many of the surgical specialties, and some of the subspecialties of internal medicine, are always in need.
And you’ll be able to find a job relatively quickly. Whereas for someone in primary care, peds, or something like that, the competition for those jobs might be much higher. And it might be much more difficult to find a position in the exact location where you want to be. Once you’ve identified where you want to live, there are several ways of finding jobs.
Look for a Practice in your Specialty
One is to look for practices in your specialty in the area, reach out to them and see if they’re looking to bring in another physician. Many organizations may not have an immediate need for a physician, so they have yet to post a job online, for instance. But they’re like, okay, we’re going to need another physician in two years. So, if you contact them in your second to last year of residency, although they haven’t posted a job, it may be a great match. And they say, yes, you’re exactly what we need.
We need a new physician in two years. And at that point, they could start the negotiation and have you sign an employment agreement, and you could negotiate a residency stipend where they’ll pay you an amount of money each month to help with training.
So, that’s one way. I was doing the work and reaching out to the practices. I also find that many practices that aren’t hiring may know others in their specialty. And so you can get a referral. And anytime you can get a referral from another physician who has a relationship with a practice. That certainly is beneficial. Internet job searches are another way you could do it.
I don’t think this is that helpful for residents, to be honest, because, as I said before, most residents are doing job searches well in advance of where they will come out of training. And most organizations don’t post for jobs way off in the future. Usually, if an organization needs a new physician, it goes up, and they need someone now. So, I don’t think an internet job search is a way to go, or at least the easiest way to go if you’re a resident.
Using a Physician Recruiter to Find Work
The next could be through a physician recruiter. These can be helpful. You can skip paying the physician recruiter. The employer will ultimately have to pay if they decide to bring you on. There’s no downside to using a recruiter. It would be best if you found a recruiter familiar with the area you’re looking to move to.
If you want to move to California, you should find a recruiter who recruits in that area. Although it’s much easier to work remotely now than three years ago, finding someone with relationships in the community is still helpful. So, if you want to use a physician recruiter, find someone in the area or who focuses on the area you want to move to.
Building a Network through Colleague
Networking through colleagues is another way of doing it. People, attendings, and other physicians who work for the network may have potential job opportunities for you. And then obviously classmates as well. If all the people in your specialty are looking for jobs, they may have leads. Those are the best ways to find a new job. As I said before, nothing is guaranteed. But if you can identify where you want to live and do the work, you should be able to find a job.
Finding Work at Rural Communities
And as I said before, if you want to make more money and have an easier time finding a job, you need to think about rural communities. There are rural communities in every state. There are parts of every state with small populations in dire need of physician care. And many of the subspecialties are very underserved in some smaller populations. To find a GI in some smaller communities, they must drive two or three hours to find someone. So, identify that as well. And as I said before, you will almost always be able to make more money in those smaller communities.
And you think, all right, I can move out to these communities, work for three or four years. Maybe you will get some student loan repayment, and perhaps you’ll have a higher comp, pay down your debt, and then after that period, move on somewhere. Or you may want to put some roots down, and you never know. Maybe you will move out to the communities and think, all right, this is great. I want to raise a family here. So, you’re not guaranteed a job ever as a resident, but if you put in the work, you can easily find a job that most likely suits you.
Medical Residents are Employees, Not Students
Is a medical resident considered a student or an employee? When you come out of med school, you have your first internship year, then you transition into residency, and you will get paid a salary, albeit a small one. And many residents are still determining the tax classification once they enter residency and fellowship. So, let’s discuss that today.
There was a Supreme Court case in 2011 called Mayo Foundation versus the United States. And essentially, in that case, the Supreme Court found that medical residents are employees, not students. Therefore, their salary will have taxes taken out of it, so the FICA includes Social Security and Medicare.
Residents Tax Classification
Now, as most of you are reading this blog are probably either a resident or a fellow; you understand that you usually work 50 to 80 hours a week. Your base compensation is not commiserated with the time you spend working. And so, any amount of money that can be saved is important. I doubt it will change anytime; FICA taxes will be taken from your salary.
So, let’s talk about the different classifications in employment and why it matters to the physician. You are either an employee or an independent contractor when you are working. And when you get out of training, you’ll have the decision to make as far as if you’re going to pursue a job with one or the other. Let’s talk about the benefits of both.
Tax Benefits for Resident Employees and Independent Contractor
As an employee, taxes are taken out of it, but you will receive the benefit of having a lot of ancillary things provided to you. As an employee, you will receive health, vision, dental, disability, and life. They’re going to pay for your underlying premium for your malpractice insurance. They will provide you with potential productivity incentives, moving expenses, and signing bonuses.
When you’re an independent contractor, generally, you won’t get any of those things. There are a few independent contractor jobs where they will pay the underlying premium for your malpractice insurance, but everything else will be on you. So, as an independent contractor, you’ll get paid in amount, and no FICA taxes will be taken out of it.
You will not get any health benefits. They will not pay for your dues and fees, board, DEA, credentialing, and privileging. It’s all going to be on the physician. Now, why would you do one over the other? Ideally, the independent contractor relationship allows some more flexibility than being an employee, meaning you can work for multiple organizations as an independent contractor.
Whereas, as an employee, almost every employment contract will have exclusivity or prohibited outside activities. The employer will essentially have veto power if you want to work for another organization while employed with them. Most of the time, organizations are okay with moonlighting and locums work if it doesn’t interfere with your day-to-day activities for that employer.