Your First Job: Deciding What Practice Type Is Right for You

At this time of year, graduating cardiology fellows are either frantically searching for full-time jobs or sitting pretty with a contract already negotiated and signed. Either way, it will not be easy for us to leave the safe, protected environment of fellowship, where mentors are looking out for our best interests and ensuring we abide to duty hours. That’s why it is especially important to be extra scrupulous in your job search before diving into a world of uncertainty.

By now you are familiar with the many characteristics you need to weigh when selecting your optimal first position. Do you want to work in academic medicine or private or even solo practice? General cardiology or something more specific like interventional? How much does location matter to you? How much do you want to be paid? What kinds of career advancement help would you prefer? And on and on.

Everyone prioritizes the answers to the above questions differently, so searching for a job is not a straightforward process. I’ve found that most of my colleagues use word of mouth to find out about open opportunities, but recruiters may also be helpful. Keep in mind, however, that recruiters charge a fee. 

The first question you need to answer before officially embarking on a search, in my opinion, is what type of practice you would like to go into. Be honest. Break it down into these three categories, and compare the pros and cons for you:

1. Academic medicine

Going this route will often give you protected time for research, so consider this if being an investigator is important to you. You will also be able to teach residents and fellows, shaping the future of medicine. These positions often limited you to a single institution, so there is no need to drive to many different hospitals when you are on call. Salaries in academic practice are usually less than in private practice positions, but there are opportunities to advance with administrative duties and titles. You will also benefit from job security, as plenty of patients will always be referred to large academic centers. In terms of interventional cardiology, academic institutions generally have a higher annual PCI volume compared with private practice, but these jobs are very competitive to land and not too many positions are even available.

2. Private practice

Private practice positions can vary widely depending on the region, patient population, and how many physicians are in the practice. Things to consider would be whether you will be an employee or on a partnership track and if there is a “buy in” (upfront financial obligation) or “buy out” (late financial obligation if leaving practice). The benefits of joining a physician group include call distribution, multi-specialty availability, and stability. The salary is usually significantly higher in private practice than in academic medicine but with fewer research opportunities. On the other hand, joining a single-physician practice will eventually promote you to becoming the sole physician in charge in the future. When going this route, always ask where the practice will be heading in 5 years.

3. Solo practice

Going the solo practice route is an uncommon choice these days, but the few graduating fellows who pursue this career path do so because they strongly value being their own boss and having professional freedom. This may be a good fit for you if you not only have knowledge of how to build a practice and create a referral system, but also have the business acumen to financially support the overhead and understand the billing process. Keep in mind that this choice has become rarer and more difficult to pursue for fellows fresh out of training today, but it can be done with the right resources.

When tackling the question of what type of practice you’d like to join, use your peers and mentors for guidance and advice. Also know that nothing is permanent. Just because you start down one track does not mean that you can’t change to a different path years later. For example, newly graduating fellows tend to deviate towards private practice initially for the financial perks and experience, but this does not preclude many of them from switching gears toward academic medicine in the future. This is your first job and most likely not your last. So align your priorities, and choose what will make you happy.