Transition from Resident to Attending

Young doctors should know pros, cons of these 4 practice settings

Brendan Murphy , Senior News Writer

Finding the right practice setting can be the key to creating a joyful career in medicine.

Physicians recently out of training, or those approaching the conclusion of residency or fellowship, may find the process of evaluating their practice options to be intimidating or overwhelming.

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An AMA STEPS Forward™ toolkit offers young physicians a breakdown of available practice settings and how each setting may affect their experience.

Alexandra Ristow, MD, is the lead primary care physician at Patina, an in-home and virtual care primary care practice for seniors in Pennsylvania. She wrote the STEPS Forward toolkit, “What to Look for in Your First or Next Practice: Evaluate the Practice Environment to Match Your Priorities.”

The toolkit is a great starting point for practice research, Dr. Ristow said, but in the end, finding a cultural fit is a process of individual exploration. It was updated last year with more information on:

“The most important thing you can do is talk to people who are doing the job you think you want to do,” she said. “Ask them questions about what their day to day is and what the culture is. If you put two exact same size practices next to each other, their day to day could simply be wildly different.”

Pros: You are, by definition, your own boss, so you have unlimited autonomy.

Cons: In solo practice, there are not going to be any mentors in your employment setting. You’ll also have no colleagues to split call or cover your vacations.

Dr. Ristow’s take: “A true solo practice, that is somebody who is a self-starter with an appetite for solving the coordination problems. If you run a solo practice, you are going to value the autonomy. Running a solo practice takes a lot of business acumen that doesn’t typically come up during the course of medical training.”

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.

Pros: It’s easier to divide and conquer when it comes to splitting call and vacation time, and you can find seasoned mentors.

Cons: There could be less autonomy and it may be difficult to coordinate care across specialties.

Dr. Ristow’s take: “This is a good fit for somebody who values having many colleagues in the same specialty around them. Somebody who values feeling like the organization is tailored to the needs of their specialty.”

Learn the things you should consider before you choose a practice setting.

Pros: This setting makes care coordination more seamless for your patients.

Cons: It depends on the practice, but in certain group practices not all specialties are valued equally.

Dr. Ristow’s take: “There’s the huge benefit in having the ability to create relationships across specialties. But it is worth thinking about how your specialty fits and is valued within that group.” Learn about the eight steps physicians can take when deciding where to practice.

Pros: Academic medical centers give physicians opportunities to shape the next generation of doctors through teaching, and gives them the chance to conduct research.

Cons: Since academic medical centers tend to have multiple specialties operating under one system, the cons are largely the same as a multispecialty group practice setting.

Dr. Ristow’s take: This “tends to be a draw for people who have an interest in something beyond clinical. Whether it’s teaching or research. There are a lot of competing specialties and there can be a political element to working in this setting.”

Explore how the AMA Young Physicians Section gives voice to, and advocates for, issues that affect doctors under 40 or within the first eight years of professional practice after their training as residents and fellows.