As a resident physician, are you thinking about where you want to build your future in medicine? Meet Andrew Larsen, MD, a family medicine physician with Confluence Health and a featured voice in the AMA’s “Finding My Place in Medicine” series.
In this series, physicians reflect on what influenced their personal decisions when choosing where to work—and what they wish they had known earlier. Explore his journey to help guide your own path toward a fulfilling medical career.
If you are looking for your first physician job after residency, get your cheat sheet now from the AMA. In addition, the AMA Transitioning to Practice series has guidance and resources on deciding where to practice, negotiating an employment contract, managing work-life balance, and other essential tips about starting in practice—including in private practice.
"Following” Dr. Andrew Larsen
Specialty: Family medicine.
Practice setting: Group.
Employment type: Employed by a group within Confluence Health, in Wenatchee, Washington. Confluence Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Years in practice: 13.
Key factors that led to me choosing to work at Confluence Health: I chose Confluence Health because it seemed to be the complete package.
First and foremost, the organization prioritizes work-life balance and is very innovative in its pursuit of this. It offered a consistent, predictable payroll structure with a competitive benefits package. I like the work and call schedule as I did not have to work evenings or weekends.
The position is also very well supported with staff, including nurses, pharmacists, behavioral scientists, social workers and medical assistants. I also looked forward to collegial relationships with my peers. The organization is well suited to provide care for all types of patients regardless of the ability to pay. I also did not want a long commute.
Wenatchee itself is also a wonderful area. My wife and I were amazed at all the possibilities it provided, both for ourselves and our family. Four seasons of varying entertainment pursuits was, and is, very appealing.
What stood out to me during the interview and hiring process: The interview process was very warm and welcoming. It was very inclusive, involving both my wife and myself in the process, showing me not only the people and facilities I would be working with, but also the environment that we would be living in. We had a dinner where many of the physicians showed up and seemed very happy with life and their work. They did not appear burned out and, even when able to speak candidly, had nothing to hide.
I had lived a life of working very long hours, whether I was actually on duty that day or not, and had slept little for most of my career. After meeting this fine group of people, I realized that there was hope for an easier way. The corporation housed us in a nice hotel on the Columbia Waterfront near the Pybus Public Market and even sponsored a few additional days during the weekend so we could truly explore the area.
How feedback from peers and mentors influenced my evaluation process: As part of a partnership in a small community, I had to try to keep my search quiet initially. I had told a few of my colleagues in confidence, and they were overall positive. One was creative enough to see if there were any changes that could be made so I would not have to move on.
After I had announced my intentions, there was the general consensus that it was too good to be true—that, over time, it would just turn into me in a different place with the same discontents that I had started with, and that this was just a systemic “medicine” problem or even more just a specific “me” problem.
Why I chose to work in this practice setting: I worked in private practice for 12 years and am pleased to have had that experience. I had the privilege of working in the great community where I had grown up, with a very resourceful group of physicians and the support of the medical community in which I had completed my training. I learned many lessons, and it has definitely shaped me into what I am today.
At the same time, I am also very happy to be working for a health system at this stage of my career, especially now that I am able to fully contrast the two practice settings with each other. The lure of private practice is feeling complete autonomy or control, as it can be much quicker to make changes in that setting. But as I continue in this profession, I question how much autonomy we really have, with governmental and third-party payers continuing to exert very large influences on everything we do.
This sense of autonomy came at a price, as income could be quite volatile depending on insurance payments and other costs demanded of the practice. Overhead was a constant burden. Income usually would turn out to be satisfactory in the end, but the lack of predictability was also anxiety provoking.
In addition to the above, and probably most important, taking this position has allowed me to actually be present and enjoy more time with my family.
The top three qualities for a great place to work for physicians: Work-life balance, support and sustainability.
How my current practice supports physician well-being and work-life balance: It has a very strong emphasis on well-being for physicians. Work-life balance is more than just a buzzword. I actually have protected time off when I am not expected to work during weekends or vacations. I can go on a vacation and have very little to catch up on when I return. Contrast this with the at least eight hours of work I came back to in private practice—even when I had managed my inbox daily on vacation.
It also has offered many tools to help me be more efficient in the office. Many in our practice use DAX, and while I do not have access to this yet, I am on the waiting list. The practice also monitors my efficiency and gives me constructive ways of making improvements to better my efficiency in practice. And it organizes events for physicians to socialize and learn how to try something new.
The workplace attributes that contribute most to my job satisfaction at Confluence Health: Efficiency, support staff, real time off, no longer worrying about what insurance someone has, and predictable/competitive wages.
The biggest challenges I faced when transitioning from residency to practice: The biggest was adjusting to a competitive practice model. I was very used to working hard through training and knew that medical practice probably wouldn’t be easy either.
I found that it wasn’t just working hard that was the issue, but you had to have the proper balance of payers or you would take a drastic cut in income. I had to adapt to a business model. I felt well prepared to practice medicine after residency, but the business of medicine was entirely new to me.
What I wish I had known about evaluating a job offer before choosing my first position: I was eager to go back to the community I was raised in and thought very little of the practice model I was joining. In hindsight, I wish I had explored other job options, looking especially at required work hours and payment models. Coming from residency, any job that offered better hours looked good. Working even occasional weekends and one or two evenings per week can get quite onerous over time when you are missing your child’s sporting events or family birthday parties.
As the years progressed, I developed a lot of paycheck anxiety, especially during and after the COVID-19 public health emergency. Although the annual income usually was more than adequate and competitive, from month to month I wasn’t really sure how well we could live.
Why I changed practice settings midcareer: I was at a time in my life when my family needed me to make a change. I was putting in long hours, and the separation of personal life from work life was beyond blurred. I cannot think of many days in the past five-plus years when I did not access the EHR at work, at home or on vacation, just to keep up on the influx so care was not delayed. I was sleeping little and probably averaging three or four hours per night, often waking up with my laptop on my lap. I wouldn’t say I had reached burnout at the time, but if I had continued at that pace, I probably would have.
I assumed that that was the life I had chosen as a physician, and I knew that there were many physicians who certainly had it worse. This is not a profession where you are encouraged to complain about workload.
The COVID-19 public health emergency and EHR transitions brought everything to a head. When payments were more consistent, I probably would have persevered, but I recall a particular turning point when we were on a vacation we had planned for many months—and yes, I was in my inbox every day during that vacation—and I received a paycheck that was less than what my 18-year-old son had made working part time boxing chocolates at a local pharmacy, which pretty much ruined the vacation for me. The explanation I got was that one of our main insurance payers was several months behind on payments. I did eventually recoup this, but the damage was done.
How I knew I was ready for a change: My family deserves most of the credit for this. It takes a lot of courage to start over both professionally and personally in a new community.
I had a non-compete clause that would force me to move or commute. I am glad that my family—in particular, my wife—pointed out that I could not continue the pace or conditions I was working under, so it was worth looking at what possibilities were out there. I was happy to find that there were options that offered a work experience that was much more suited to our needs.
