Have you ever thought about what your life as an emergency physician will eventually turn out to be like, or what you will be doing in 2020? If you haven't, you are not alone. Most other emergency medicine residents haven't either.
"The most important question any emergency physician can ask is 'What am I going to be doing in 20 years?'" says Greg Henry, MD, an ACEP Past President.
"You have to ask yourself 'What am I going to be doing when I am 50 or 60 -- how do I intend to mature in my career?' You can be a dermatologist until you are 70. You can't be wrestling drunks when you are 70," said Dr. Henry.
You have to think long term, Dr. Henry said, and you have to start thinking about your future before you finish your residency. But resident physicians are usually ill prepared when it comes to finding the right job and asking the right questions.
"Residencies are not good at preparing people for life. They do a much better job talking about disease," he said.
By the time most non-physicians reach their 30s, they know how to look for a job and what questions to ask prospective employers. After all, most people that age have been employed for ten years or so and have had at least one or two jobs. But physicians are different. They don't start looking for work until they finish residency training, and by that time they are usually in their 30s.
Before residents start looking for a job, Dr. Henry suggests that they first look within themselves and determine what they want out of their career and their life.
"Residents need to establish a mission statement for their life," says Dr. Henry. "What do I want the elements of my career, my family life, my social life, and my practice to be?"
One of the most important decisions is deciding where you want to live. And before that decision is made, make sure you are aware of all the implications that decision will have - especially on your family.
Your location will also have huge social, political, and economic ramifications, said Dr. Henry.
"Doctors do not move by themselves. Eighty-five to 90 percent of doctors in emergency medicine are married so you have family decisions to make. If you take a job and your spouse isn't happy, how happy are you going to be?"
Dr. Henry suggests that you look at a job as one-third of the equation.
"When you decide to take a job someplace, the job becomes one-third, the lifestyle it creates becomes one-third, and the milieu it creates for the rest of the family is one-third," he said.
It may be a great opportunity for you, but if you have to work every holiday and weekend it may not be the best situation for someone with a family or a spouse that works. Before you accept a job, you have to make sure that the situation is right for the entire family.
Your location is also going to have an impact on your compensation and you need to take that into account as well.
Say for example, the most important thing to you is to live and work in San Francisco. You should know then, that physicians in that area are not paid as much as physicians in some other parts of the country and you should also know that the cost of living in that area is very high, said Dr. Henry.
"A lot of residents have a general idea of where they want to go and what they want to do. But to be truly successful they must focus on the specifics," said Dr. Henry. "It's the details that make all the difference as to whether you are content or dissatisfied with your job, and ultimately your life."
And to get to the specifics, you have to ask the right questions.
"For example, [residents] don't know what questions to ask about malpractice insurance," said Dr. Henry. "So when they take their first job they don't realize that they have financial obligations that extend beyond that work situation."
Understanding the elements of a contract is another important area.
"Residents need to know what a contract is and where you can go wrong and make a big mistake. This is a legal document and physicians say that as long as it is close to what they want, then it is okay. But that is not the case," said Dr. Henry.
Emergency physicians should look at a contract the same way they look at marriage, Dr. Henry suggested.
"Getting into it is no problem. But getting out of it is horrendously expensive," he said. Most residents have never been given a one-hour talk on contracts and the elements of contract law and business law, said Dr. Henry. And because of that, they don't understand what to look for in a contract and what questions to ask.
For example, Dr. Henry suggests that you ask 'Who owns the hospital?' before signing on the dotted line.
"Do you realize that every year one out of nine hospitals changes ownership," he said. A simple question like 'Is this contract subordinate to the master contract - if you guys lose the contract, what happens to me?' Or if the hospital changes ownership, 'Is your contract still valid and is my contract still valid?' Isn't that a simple set of questions? And yet they never ask those questions. I've seen people screwed over on this a zillion times."