Money isn’t everything: When to say 'no' to a job offer

Graduating from residency was one of the best days of my life, primarily because I no longer had to work 80–95 hours a week or be broke—or so I thought.

I had multiple interviews and got some enticing offers. They varied across the board—from large hospital groups to small private practice groups that offered different types of compensation, benefits packages, potential buy-ins, and call shifts.

Because I wanted to pay off my medical student loans as fast as possible, I took the offer with the biggest paycheck: a gig working in an ER for 12–14-hour shifts, 5 days a week.

Was it worth it?

The pay was great, but I soon became burned out and miserable. The 12-hour ER shifts were grueling, and the inability to do charting and paperwork during my busy work hours made for 14-hour shifts. They left me reeling for my first 8 months on the job.

Several physician colleagues had abruptly left the group, which meant I was assigned even more ER shifts. I assumed that some wanted to retire or relocate, but I later found out that they were pushed out or quit because they were unhappy.

When interviewing for jobs and assessing potential contracts after residency, I hope that young doctors do not follow in my footsteps and go after the highest-paying contract.

Support structure

Whether you are looking to work in a primary care clinic, a large hospital, a rural ER, or a Level 1 trauma center, it is crucial to inquire about what type of support structure exists:

• Do you have to set up your own procedures?

• Is there sufficient nursing staff?

• Is there on-site security?

• Are you responsible for precipitous deliveries or responding to codes?

• Are there on-call specialists in-house?

• Does the team include mid-level practitioners and residents?

• Are you responsible for overseeing the mid-level practitioners, or for teaching medical school students or residents?

Risk of burnout

When you are in the weeds without a sufficient support structure around you, you risk becoming burned out.

For example, working in an urban teaching hospital, from my experience you will most likely have an unending supply of support—such as people who set up procedures and clean up after, staff to help with difficult patients, and security staff—as well as a plethora of seasoned nurses to keep you afloat when you are drowning.

But working in a rural or suburban clinical setting, you may be on your own more than you realize. Therefore, it is essential to consider what support staff is available to you.

Look for a personality fit

The camaraderie among physician colleagues is priceless. But when working in a small practice, you may not interact often with your co-workers, as someone will either be on vacation, sick, unavailable, or post-call.

During my first job after residency, I found myself burned out and lonely, not only because I was working too many hours but because I missed the friendships and mentors I had in residency.

When interviewing for your job after residency, ensure you get a feel for the "office vibe.” Do you get a sense that these people are happy? Do they enjoy working with each other and socializing outside of work?

As when you were checking out residency programs, it’s just as important to interview for the “personality fit” as it is for the money.

Don’t rush to say ‘yes’

You may interview with some employers that want you to sign a contract within 48 hours. In competitive markets, you may feel pressured to decide quickly.

But it’s essential to explore all your options and take time to think about this decision.

How much will you work?

Do you want to work full- or part-time? Will this employer allow you to switch to part-time or decrease the number of your shifts if you have a baby or decide you want to work less?

Additional factors to consider regarding a job’s time requirements include:

• How many call shifts are you required to work?

• How many clinical hours are you required to work per week?

• How many patients are you expected to see in a day?

• How much vacation do they offer?

• Do physicians in this group use their vacation time?

• What are their policies for maternity and paternity leave?

• Could you take a sabbatical?

Determine how much your future employer will require you to work and what kind of daily workload they expect. Also, find out the minimum amount of time you can work in case you decide to take a step back or want more time off.

Perks and benefits

A few of my fellow residents signed contracts in which the group would pay off their medical student loans if they worked there for a certain time period. It sounded like a dream, but this could be too good to be true—especially if you are required to stay somewhere for 5 years where you are potentially unhappy.

Ask about loan repayment options but be careful with the terms they offer. Other perks could include sign-on bonuses, malpractice insurance coverage, exceptional medical benefits, HSA, matching 401K, options for buy-ins, raises, and bonuses.

Non-competes

I feel like so many individuals ignore this section in the contract because they assume they will be happy at their first job. After all, they are earning a big paycheck and are done with residency.

If there is a non-compete clause in your contract, be aware of the terms and understand that you may not be able to work in the same geographical area if you decide to break your contract.

Look for clauses that state you may not be able to pick up shifts at other hospitals or hold other side gigs in the medical world.

Contracts are tricky. After all, we went to school to learn about medicine, not about contract negotiations and lofty legal language. Therefore, I always advise graduating residents to look over their contracts with an attorney who works with doctors.

Some attorneys are well-versed in medical contracts. It may be wise to spend some money to make sure you’re making the best possible decision.

A well-balanced life

Money is only part of the equation when it comes to landing that big job after residency.

Take it from me; I am living a very well-balanced life while still paying off my student loans after learning the hard way that making a huge salary is not tied to overall happiness.