April 1999 Bulletin

How to select first practice

Residents get tips on tough professional decision

Going into the first orthopaedic practice is an anxiety-ridden process for residents, who generally are unprepared to make what Carl L. Stanitski, MD, says is the most significant professional decision in their career, up to that point.

"There are no courses in medical school or in residency to prepare them for making the decision," says Dr. Stanitski, chairman of the Academy's committee for candidate members. "Mostly, there are rumors and horror stories."

And there is major anxiety. "It's like getting married on the second date and the first one was a blind date," he told the 32nd annual Residents Conference of the American Orthopaedic Association.

Dr. Stanitski uses a favorite aphorism to remind residents that "you are not going into practice; you are going into real."

In his speech, "Going into Practice: How and the Five W's (who, what, when, why and what if I want to change practices)" he highly recommends that residents consult the Placement Service in the "Members Service" section of the Academy home page www.aaos.org. The Academy Annual Meeting Job Placement Service also is valuable. Other sources include recruiters. "Listen to what they say, they have a lot of free information and advice," says Dr. Stanitski. Journal advertising and word-of-mouth networking also is useful.

That's the "how." On the "who," he suggests beginning with "who is you." He tells residents to decide what are their likes and dislikes. Residents should consider if they are team players or would prefer to be solo; if they prefer to be salaried vs. a "free trade" practitioner; etc.

On the "what" he suggests close examination of the type of practice and issues such as the managed care competitiveness and whether it has the ability to adjust to future changes in the marketplace.

The "where" requires some introspection. Is an urban or rural setting more appealing? Residents should consider their avocations, life style, and family needs and preferences. "The ideal location and the ideal practice are usually not coincident," Dr. Stanitski warns.

Other considerations range from whether there is competition and a need for their specialty, to the size of the practice's support staff, how many hospitals are in the vicinity and their future plans.

The "why" is the major question, Dr. Stanitski stresses. The locale, salary/benefits, practice type and whether they really like their future partners are important. So is whether there is enough volume of patients for the resident. Is the resident just being hired as a "warm body" to treat all the low paying patients and take call or a partner with an opportunity to generate business?

What if you want to change practices? "You're not alone-30 to 50 percent do it in the first two years," Dr. Stanitski says. "You'll know if you need to consider this within the first six months."

Look at the objective reasons such as income, practice volume or quality and the subjective reasons such as locale or spouse/partner unhappiness, he advises. Determine if those factors can be changed in the short- or long-term.

The decision about the first practice must be made on valid information. He urges residents not to be tempted by the "flash and cash" in the process of being recruited. He suggests making a list of pros and cons for each offer, "seek outside opinions, revisit, communicate and get all the information possible" to make a decision.

"Learn from the mistakes of others, because you can't live long enough to make them all yourself," Dr. Stanitski says. "After all is said and done, there is nothing more to say or do, just get on with it."

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