Comparison of two jobs, which would you take?

[har02052]

I currently have two job offers. Both of which are somewhat unexpected. I had interviewed at 8 other jobs around the country and then just before accepting one of those jobs, both of these opportunities came up. Both within hours of each other. Pretty much completely threw my world upside down. This will be my first job out of residency. I will try to succinctly describe both but still get an adequate picture of the scenario. Specialty-Anesthesia. I have a wife and 3 kids.

Job #1

Medium sized city (200K), great place to live. One hour away from where I am currently. Private hospital. Bread and butter cases and patients. Nothing super sick, no trauma, no transplants. Fast paced work, probably 50ish hour weeks with 2 in house calls plus one weekend call per month.

Pay is $350k base, with quarterly overtime of about $4-5k per quarter with potential of about 15% bonus at each anniversary if you meet benchmarks. 401k match amounts to about $18k. 6 weeks of vacay plus 2 weeks of education.

$15k signing bonus

Pros: Seems to be a good group small group of people, very friendly, good money, good cost of living, good schools.

Downside is that hospital system/group are a bit unsteady. 4 people recently left the group because of instability. They claim that they have stabilized and that is why they are hiring.

Job #2

Medium to large city (<1mil in the surrounding area). Staying on as faculty in the residency program I trained in. Large university system. Huge diversity in cases, some very sick patients, level I trauma, lots of organ transplants. Teaching of residents (I actually enjoy teaching). About 45ish hour weeks with 1-2 in house calls plus one weekend 12hr shift.

Pay is $325k base, with some overtime/extra call amounting to about $10k yearly, and a 2-5% bonus yearly. $32k put into 401k by employer. 7 weeks vacay plus 2 weeks education.

$36k signing bonus.

Pros: ability to stay in my current home with will allow me to save up for a down payment on new home and/or pay off debt faster, good schools, I get along well with current faculty, I would have a large support system, I could continue to improve my own skills, opportunities for teaching and growth, good schedule.

Downside is not nearly as much money, although the major difference is mostly in the end of year bonus.

 

I am currently undecided. I could go either way.

[Joseph]

What does your wife say?

Do you currently own your home?

Option 2 is easy and seems risk-free.

Do you enjoy sick patients?

[Hemonc]

Option 2

 

No brainer

 

Problem with Option 1 include; unknown issue you will get into after you join, Not big difference in salary,  smaller city, previous Doctors leaving is big red flag

[Zaphod]

Call the option number one doctors and see how they feel and why the other guys left, their life/work balance, average pay (how does bonus, etc...stack up). I assume you know the ins/outs at your own program. The money is basically a wash on first glance aside from the overtime/bonus, and obviously you will work much much harder at the university. Luckily you know your second option, so really feel out the first to see if its worth it and stable. Weigh all the little things and what makes you happy outside of work, good running/riding, lakes, etc...and of course what the family thinks.

[jfoxcpacfp]

Can you talk to the guys who left? The doc's who are trying to hire you have told you they have fixed the problem and it's unlikely you are going to get an unbiased opinion. I think it would be helpful to get the other side of the story before deciding, especially since they no longer have a dog in the fight. I would lean toward staying put given that you are happy there and are dealing with the known rather than the unknown. Your wife's opinion should weigh heavily, though. The pay really isn't that different.

[PTM]

once you get to certain level of income--and I think you're there at 325-350k per year--the small differences in comp from one of these jobs to the other will be indistinguishable in your budget.  Go where you and your wife are happier.  Now maybe if it was 350k vs 600k...that's another story b/c even if it was a tougher job, you'd be fast tracking your FIRE date

[Seroma]

I vote for option number 2.
If you like the place where u r right now, then stay. Retirement seems better and salary pretty much the same.
It also may be unlikely to have a restrictive covenant in a university setting, so may be easier to leave and stay in the area in case u decide to settle where u currently are

[Dicast]

I think this one is decidedly leaning to option 2. I agree that the pay looks like a wash to me. Other questions to think about..

How scalable are the hours or are they completely inflexible?  Are the quoted hours for a fully staffed group/are you going to be working more until it is filled?

At some point the bigger issue will be how much time you are saving for yourself and your family.

 

How much actual in the hospital time vs hospital time plus home call?

Time that is dedicated to the hospital, even if it is low volume or even home call, interferes with life.

[Zaphod]

I would guess that while the base pay is similar, the likelihood at a private group vs a university is that when you do more, you get paid more. For call, covering shifts, etc...everything. At universities you just kinda do whats necessary and that can vary significantly. What effort you're putting in for the pay matters a lot, if that is a deciding factor. They cannot be compared as similar just because their nominal values are close.

I would never work at a university for my current level of pay, as the standard workload required would be a giant step up. There are lots of nuances, and no "right" answer, just a best fit. You and your family have to be very honest with yourselves about everything of course. Obviously there are more risks with the new, and calling old partners is an excellent idea.

[Osiris]

Ask you spouse would be my first suggestion.

If your spouse is has not preference, I would take job number 2: you know the people. no move. If you like to teach, this would be a no brainer and would keep you broadening your skills.

Good luck and let us know, how it worked out for you.

[anojones]

I would also echo exploring why 4 docs left, this is a big red flag. If 4 left, others were probably thinking the same thing, and may even still plan on leaving.   It's hard to get an unbiased opinion from those currently in the group, they need your help.

 

[har02052]

Thanks for all the good input. The reason the four left is that the hospital took over the group. They were independent but the group wasn't doing well financially. So the hospital took things over. Those that left, were looking for more stability. In fact, more are apparently leaving because one of them also interviewed for my option #2 from above. The university has 6+ available positions, so I am not worried about competition for the position. It is a large university that has gone through massive growth over the last couple years.

 

 

[VagabondMD]

The pay difference is very minor. The lifestyle difference may not be, and this might be the biggest consideration. It would also be useful to know if your wife works outside the home as that will but a crimp on home life if you choose Option #2.

Option #3 is to take Option #2 job and keep your eyes open for Option #4, #5, etc. You will be more desirable as a candidate for future jobs with the academic/university experience, more challenging caseload, and connections than you will be coming from the community hospital (Option #1).

[squirrel]

You are missing one huge difference and that is the practice.  You are basically looking at a community (independent) job and an academic with teaching. These can be vastly different.  Usually at some point in training, most answer this question (do I want to teach and do academics, or do I want to be in regular practice?).  What have you answered when you have thought about this in the past.

 

Regular practice: as you alluded to, you are on your own running your own case.  No as many "sick" patients and more run of the mill.  Some find this monotonous, some find it more fulfilling and relaxing.  You are responsible for all your own work (seeing patients, charting, etc).  Usually there is more pay in this environment.

 

Academic: Kinda opposite.  More group oriented, often working alongside residents.  Group mentality more and not as "lonely."  Downside is can also be monotonous (Teaaching similar basics over and over each year, to new residents), but also some find this fulfilling.   Also be sure to ask about what admin or research type roles are expected of you (many acadmic positions involved further non patient  care involvement i.e. research, mentoring, journal club, etc).

 

While some argue there is more "risk" with independent practice as you are on your own and often less "back-up", some also argue more "risk" as you are responsible for resident mistakes and have to fix possible errors.  Both of these can be stressful.

 

If you are not sure, ask yourself, how do you feel as a senior, with a more junior or medical student on your service.  Do you get annoyed and feel they slow you down and cause aggravation, or do you enjoy the group experience and supervising.  Also as note, in academics, most procedures you will give up to the residents, and some argue that you may get rusty.

 

Just my 2 cents.  It seems the money is fairly similar, (though if you add in the other academic duties if there are any, may be overall less per time put in).  I have done both and currently work mostly in community (emergency medicine) but also still occasionally work at teaching hospital.  I currently enjoy my independent practice but may in the future return to full academic.

[Jackmomma]

Option 2 no brainer.

Option 1 really only works if you are getting a lot more money AND a lot more stability. The whole point of going to a smaller town/city is to just kill it financially. And have a better pace of life. You sound like option 1 for you is more hours, questionable stability and not much better pay.

Option 2 gives you better prestige. As a young doc do not underestmiate the perks of a few years in academia. You make yourself more attractive to a lot of employers in a few years.

Also remember option 1 = moving. Movign is a pain. it requires time. And its not fun having to get a new house. Its not fun having to get your wife and kids settled. And you have 3 kids.

Unless option 2 is in a city that is problematic for you i.e. very expensive, unsafe etc.

Oh yeah I will also mention having been an attending for 10 years option 1 type jobs are always available. Different cities similar scenarios.

Finally I will also mention with having kids its important to me at least, to have access to excellent healthcare. Sometimes being in a larger city is important to have all specialists.