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First attending job gone bad - What to do next?

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  • First attending job gone bad - What to do next?

    We see this probably too often and I would've considered myself lucky if I had found my forever job on the first try.

    I am 18 months out of fellowship and into my new job and feeling like I am getting the shaft.

    Certain things I was promised are turning out not to be true (length until true partnership "we recently changed things", salary after the second year mark, ability to drop aspects of my job that were only supposed to be a trial, expectations to start acting like a partner by showing leadership and getting involved in committees and working more hours in the 2 years leading to the actual partnership). I am feeling extremely burnout and taken advantage of. The partners are banking and living extravagant lives at the cost of the workers. I feel they keep dangling the carrot and I am getting more and more frustrated. In addition, I work approx 5 shifts more than any of my colleagues in the same specialty and make 30-50% less. I have no time for my family or myself.

    Some members of the group and extremely kind and they are all very nice so part of me feels like I am being greedy and ungrateful. At the same time, I can't fathom staying in this job for years on end, working the hours I am working and getting the pay I am getting. Although the salary is by all means enough, it is not in line with one of my goals which is to have the ability to retire from clinical medicine in 15 years. No way I can achieve that in this job.

    As many people do, I moved to a new state to take this job. We absolutely love the city, we love our neighborhood and all the activities we have available to us.

    I was looking for advice on what to do next - I am petrified of making the wrong decision. One thing that is very appealing to me right now is to do some Locums. I think it would give me some time to re-charge and hopefully get over some of the burnout I am feeling and not having to move out of the state. If any of you have been in a similar position, what did you choose to do? What did you like about your decision and what do you regret?


  • #2
    1. What does your contract say or were these verbal agreements?

    2. Do you trust that the new targets are accurate or will they continue to be moving targets?

    3. Do you like where you work?

    4. What are the job prospects/salary/working conditions if you were to leave?


    Answering those questions may help you in deciding what to do next.


    • #3

      • Since you have no time for your family or yourself with the current schedule, how would locums improve your QOL?

      • What does your non-compete say? Or do you have one?

      • Is it possible that, once you make partner, you will not keep the same schedule but will have the “lighter” schedule of the other partners? Would you even want to be one of the partners who takes advantage of the new attendings? Or, is that just the way it is in the world of medicine and small partnerships? Prepay your dues now and get more oxygen once you’ve made it to “the club”?

      • Have you had a heart-to-heart talk with one or more of the more reasonable partners in an attempt to find out if your expectations for the future are misguided and to voice your concerns? It may just be a matter of communication, an oft sorely-lacking skill. (Note: forum posts, tweets, and Facebook rants are not a substitute for good communication. Neither are emails, at least in this situation.)

      Of course, what this gets down to is your contract. What did you negotiate before you agreed to work there? Unfortunately, your problem is of the same variety of many young adults starting out in the world - you are compelled to make weighty decisions before you have enough experience to make weighty decisions (same as with marriage) and then realize you weren’t taking a 360-degree perspective when making said decision. We all (hopefully) learn from our mistakes. You are young and, if you decide this is a mistake and not a good fit for your long-term plans, it may be time to move on.
      Our passion is protecting clients and others from predatory and ignorant advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087


      • #4
        I would look to alternative employment and take a close look at your non-compete.  If you really want to stay in the area it might be worth commuting somewhere out of range for however long the non-compete is and then looking for a job back in your main area.  I'd also look at jobs elsewhere that you might find satisfying; however, I would rely heavily on word of mouth and intimate knowledge of any future practice.  As for the current situation, I would approach them after you have all evidence lined up indicating what they told you, and then ask for a meeting with whoever is in charge of making these decisions.  Should your needs not be met then you have an alternative lined up already and can leave.  Sorry this is happening.


        • #5
          The expectation is that the non-partner/employee on the partnership tract pays his/her dues. That is non-negotiable. It is also the expectation that the partnership tract employee gradually assumes the roles and responsibilities of the partners. The length of the partnership tract, if promised either contractually or as a handshake deal, may NOT change, and that is also non-negotiable. If that is being changed against your wishes, you may be getting let go, but they are doing so in a manner that is not transparent.

          What your friends earn in other jobs, in other locations, may or may not be relevant. (Plus, people talk and the reality might be different than what they say.) No two jobs are alike. If you want to work like your friends and earn what your friends are earning, join their practice.

          The advice from here depends a lot on what specialty, what are the job prospects in the area, etc. If you can easily slide into another job in the area, especially if you already have friends working there, I would strongly consider it. If you are 6 months away from partnership at the current position and believe things may turn when you become a partner, it might be worth staying and seeing what that is like.



          • #6
            is this employed or private practice setting?

            i know you feel screwed, but things change all the time for practices and maybe some changes are going on for partners as well and communication is the main problem.

            regarding committees, we frequently expect young attendings to start joining them prior to partnership.  these are generally volunteer activities.  many private practices historically were pyramidal--they rewarded longevity and seniority.  the only way to really do this is to have younger employees work longer, and yes make money off their labor.  the practice owners did bear some risk in guaranteeing salary and benefits and the practice name when they hired an unknown.  this is not a comment on whether the tradeoff screwed you or not, simply a description of the realities of one approach to managing growth in a private practice.  having said that, they should not be able to unilaterally change time to partnership.  did you have an attorney review the original contract?

            i'm sorry you are feeling burned out after one year.  this is a tough time to be making such a big decision.  in almost any interview, the practice puts its best foot forward.  the jobs are all a leap of faith.  best if you know someone well in the job but even then still a crapshoot.   consider what factors may have contributed to burnout and how you can mitigate them in the current practice as well as a new practice.  gather some data and present it to your current partners.  sometimes large practices make changes and aren't deliberately crapping on you, they just couldn't anticipate all of the consequences of a decision.  don't expect change to come quickly at your current practice, but hopefully some of the bigger challenges can be addressed.  as they say, never ascribe to malice that which can be explained by stupidity.

            good luck.




            • #7
              Sorry that things aren’t working out for you with your first job. It’s not uncommon for new attending to leave for their second job after a year or two. If you feel like that you are being taking advantage of, you probably are. Look at your noncompete first and start looking at other practices. Don’t worry about the stigma of leaving your job so soon after starting, it’s just business. If you love your city, look into other practices but far enough from your old practice as not to run afoul of the noncompete. Other than that, just do it and have no fear, it’s only a business decision at the end of the day.


              • #8
                Time to try to be objective and assess your situation, which is hard on burnout.

                As others have mentioned, the driver to the conversation is your contract.  You have a year's experience now and time to renegotiate this with that knowledge.  With that, be prepared for what renegotiations bring on both sides of the table.   Have a plan when you open that can of worms.

                It would be a good thing to get a lawyer to review and give a set of fresh eyes on your situation and options available.

                Taking on MORE work isn't the answer to burnout.


                • #9
                  Lousy situation, sorry you're in it. Burn out is terrible, I went through it but was able to work out things and stayed at my job for the time being.

                  Agree with above advice to study your contract and know the criteria for making partner, salary, non compete.

                  Reach out to mentors from residency and fellowship to get advice on reasonable expectations for your specialty.

                  Get your financial ducks in a row in case things go south.

                  Then seek out a partner you can talk with to get a sense of where things stand with the practice and you. Decide if you need formal renegotiation or to move on. There might be something you don't know that will explain how you are being treated.

                  See if you can eliminate the worst parts of your job.

                  I am 2+ years out from training and junior partners take a little more call and step up to administrative responsibilities. Both are beneficial for your professional development and are opportunities to make yourself valuable for the practice.

                  I had a hard time from the outset with my first job and considered leaving several times.  Things have improved and I renegotiated a better contract that is win-win for me, my partners and the hospital. I also did a bang up job with admin roles and am now paid well for those.  None of this was easy, I really struggled.  My partners were jerks because they themselves were burned out, and we had to work through this.  We also avoided lifestyle expansion, saved and paid off debt, and while not FI we have walk away money that lets me sleep at night since we would be totally fine if my job vanished tomorrow.

                  Good luck!


                  • #10
                    I hate arrangements like this for my residents (EM).

                    I know of a few that have long track records and don't mess people around, but you have to put in your time and during that time you are making way less than your colleagues for the same/more amount of work.

                    It's just a rough thing to step into most of the time and your ability to make an informed decision is really limited. Two years into a 3 year buy in and man you are trying to navigate sunk cost analysis with lots of frustration baked in.


                    • #11
                      Adding to the suggestions above, is there anyone in the group you can talk to?  With our group, we have multiple folks along the evolution.  The folks that are sharing your same misery.  The folks that are about to finish their buy-in and can comment that it is as miserable as when they started (or what I call the "how do we screw the new guys" perspective).  The folks that just finished the buy-in and can comment on how bad it sucked.  The folks that have been there seemingly forever and although they don't remember what it feels like, they can comment on how no matter how much stuff changes, it is still always the same.

                      What has been the turnover rate for the group?  And of the docs who left, why did they leave?  As an example, in our group less than 5% of docs who started did not stay long enough to qualify for partner and there is a clear reason for each.

                      For sure there are malignant groups out there, it's tough to identify them prospectively....

                      Good luck.  Positive thoughts are with you.


                      • #12
                        What does your contract say? The partnership track should be spelled out in black and white. On the flip side, if the partners feel that someone on the partnership track isn't performing or they don't feel like they'll be voted in as a partner, those concerns need to be addressed immediately for the benefit of both sides. I'm not a fan of moving targets and I would want a sit down meeting to hash those details out.


                        • #13
                          This is a good example of why one should not buy a house right away.


                          • #14
                            Just be glad you are not a lawyer. Many law firms hire associates as slave labor and only the cream of the crop make partner. If you don't make partner in a certain time frame you are gone to make room for the fresh meat. Those that think they still have a shot and kill themselves trying.

                            Professional partnerships are designed to benefit the partners, not employees. Some take it to greater extremes than others. Compared to law firms, some medical practice partnerships almost seem altruistic.


                            • #15
                              Thank you all for your comments and suggestions.

                              To answer a few of your questions: My contract is extremely vague regarding partnership track. It was a verbal agreement regarding the length to becoming partner. I do not truly believe on the new target for partnership.

                              Two colleagues of mine have left within the last year and we started relatively together. They left for similar reasons (they were promised certain things and these things were not delivered and horrible pay for the hours we put in).

                              Locums could probably increase my QOL and family time as I could work 7-9 days a month and make more than I currently make now (working 20 days a month)

                              non compete is for a year only. It shouldn't be hard to find another job in the area in my specialty.

                              I know this will be a tough decision and as I said before, I am terrified of making the wrong one. Thank you all again for your thoughts; I'll sleep on this one for a few weeks!