What to look for in your next practice


AMA STEPS Forward® podcast

What to Look for in Your First or Next Practice

Jul 19, 2021

In this episode of the AMA STEPS Forward® podcast, Alexandra Ristow, MD, discusses what to look for in your first or next practice to maximize professional satisfaction, joy in medicine, and reduced risk of burnout. A little homework goes a long way. To learn more on this topic, review the related toolkit.


  • Dr. Alexandra Ristow, MD, internist


  • Dr. Marie Brown, MD, internist; director of practice redesign, American Medical Association

Listen to the episode on the go on Apple Podcasts, Spotify or anywhere podcasts are available.

Speaker: Hello and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today. Solutions that help put the joy back into medicine. AMA STEPS Forward® program is open access and free to all at stepsforward.org.

Dr. Brown: Hello, I'm Dr. Marie Brown, an internist practicing in Chicago and director of practice redesign at the American Medical Association. I'm here with Dr. Alex Ristow, an internist practicing in Florida, who has just recently authored a fantastic module on STEPS Forward® discussing what to expect in your first or next practice. Thank you for joining me, Dr. Ristow.

Dr. Ristow: Thanks so much for having me.

Dr. Brown: So, tell me, what was your experience and how did you come to write this module on evaluating a practice?

Dr. Ristow: I think my personal experience after residency entering the job market really illustrated to me that I was stuck in the mindset of medical school and residency and thinking about all interviews as their sole purpose was to try to get me accepted, try to get me a job. And it really took some time in order for me to realize that just as important was me evaluating each job and really figuring out if it was a good fit in a place that I was going to be, supported and happy as a physician. I realized that figuring out, you know, if this was going to be a supportive position was actually a quite complicated task. And that I really needed a structured approach to think it through. After going through that experience myself, I wanted to write down some of the things that I learned and, and really help others be able to approach the job search in a structured way that really empowered them.

Dr. Brown: And so, are a few of the things that you found during your experience that you'd like to share and that you shared in the module?

Dr. Ristow: I think one of the big takeaways is that it's easy to get stuck focusing on things like salary or compensation, the numbers that are easy to compare between jobs. But that it's really important to step back, to think about your own priorities. And then also to put that, that compensation, you know, into perspective. Your compensation, your annual compensation might be higher at one practice than another, but if you kind of break it down and think about what support you're getting, how much work outside of work you're going to be doing at the end of each day, you might be surprised to see that a place that offers more physician support, inbox support, documentation support, actually you'll end up with a higher hourly wage than somewhere where you have no support. You're not able to take vacation because you feel overwhelmed and you feel you are worried about the work that you're going to come back to. And so I think kind of thinking through the intangible factors of satisfaction, of culture at a workplace, will really kind of help put some of the other elements into perspective.

Dr. Brown: Can you share any experience when you were on-site interviewing where you had an "aha" moment that surprised you?

Dr. Ristow: Certainly. So, one of my very first interviews out of residency, I was sort of being shepherded around by an internal recruiter for most of the day. And I remember asking about physician support in the clinic and getting a very positive but very sort of generic answer about, oh, you know, we have wonderful MAs, physicians are very well supported, many of our staff have been here for a long time. And I didn't drill down on it. I took it at face value until not long afterwards when a physician working at that practice pulled me into her office and closed the door and turned to me and said, before you take this job, make sure it's in your contract that you have an MA that's dedicated to you that doesn't get pulled for phlebotomy, doesn't get pulled for other physicians, but is there to support you.

And I remember kind of being a little bit taken aback and realizing, you know, the huge discrepancy between what I had been told, and what the experience on the ground was. It really made me realize that I needed to be asking specifics. I needed to be asking about the ratio of MA or RN or LPN, to physician that I needed to be asking about the workflow and how it was divided and what would be my responsibility what I would have assistance with. And it really reshaped how I went about the interview process and how I thought about asking questions.

Dr. Brown: And I think that that is just so important so that you can finish your work, feel that the work was good quality. that you delivered great care. And at the end of the day, you finished your work, you weren't taking work home and you had time to build a relationship with the patient, which is why many of us were called to this. And I thank you for all your many, many other, points of wisdom that you've included in this module that hopefully will help the viewer find a great fit and a rewarding practice for them. So, thank you for your time, Dr. Ristow and I hope you enjoy your current practice. I know you found a wonderful fit and are on the other end of this. So keep up the good work and thank you again for sharing your wisdom and your experience.

Dr. Ristow: Thank you so much.

Speaker: Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA’s STEPS Forward® program is open access and free to all at stepsforward.org. STEPS Forward can help put the joy back into medicine by offering real world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series, stepsforward.org.

Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.