#new doctors

This is a reminder that you should definitely do that.

Especially if it's a new symptom.

Anyways, got diagnosed with heart failure after spending 5 days trying to ignore feeling like I couldn't breathe and being told by the original doctor that it was just anxiety over an upper respiratory infection. But the antibiotics weren't helping and I had never had dyspnea as a symptom for anything. Even covid.

It’s a holiday weekend in both countries and the emergency departments are going to be combining new doctors with:

•People who think explosives are toys

•People who can’t be responsible with alcohol

•People who forgot how to drive during the pandemic

•The usual people needing emergency care

•Covid patients

Do you have any advice for a Family Med R3 looking for their first job? Any questions you wished you asked? Any tips to figure out if a place is toxic? -arianrhodswheel

Yeah! This post is a good place to start. 

Things to ask about:

daily schedule - Is there a way to work your schedule so that you can work 4 days a week? Can you work extended hours one or two days to benefit both the clinic and yourself?

how are appointments arranged on the schedule? Is it totally random or is there a method to the madness? Note: some places will schedule 2 chronic visits followed by an acute visit to help even the schedule. Or they schedule extra time for physicals or new patient visits. Is there a limit to how many physicals you will have to do in a day?

Extenders - how will you be compensated for supervising a PA or NP if you are not in a state where they are autonomous? (or will you be compensated at all? My hospital doesn’t, so my office doesn’t have them.) 

time off - is time off accrued or is it a set number of days? Does it increase over time? What sort of time off do you have for CME?

CME - how much does the practice pay for CME? What is included in that?

Benefits package - are there penalties or incentives built into your compensation package? Is your pay a flat rate or is it productivity based? Is the insurance decent?

bonus incentives - does your employer cover things like your cell phone bill or a tablet? Is a gym membership included or discounted? Do they offer a signing bonus and adequate moving expense reimbursement? Do they have loan repayment options? There are lots of little benefits you can negotiate into your contract 

call schedule - do you get paid extra to take hospital call or to pick up extra urgent care shifts? How often do you get called on home phone-only call? Does your new practice have a policy on after-hours prescriptions?

Patient demographics - what is the payor source division in your practice? Is your practice heavier in a certain age group or type of diagnosis? 

EMR - is the system decent? Does it make your job harder or easier? 

Area resources - how are the surrounding hospitals? Is there a problem with availability of specialist care? 

privileges - will you be required to do any inpatient care? What about nursing homes or hospice? 

Moonlighting - can you pick up outside work if you want it? What is available to you? Is there a noncompete clause? 

Your pet peeves - does your office manage a lot of chronic pain? Do they have a policy on after hours prescriptions,  appointment no-shows, walk-in appointments, or calling in antibiotics without being seen?

Standard of care - are the other doctors following the same guidelines and standards you are? Will they back up your decisions? Can you feel comfortable backing theirs?

Personalities - will the other doctors be supportive of you since you’re a new kid on the block? Will they be available for hallway consults or lunch break pep talks? Are they workaholics or do they value time at home? What do they do for fun? Are they friends or just co-workers?

culture of the office - do the staff genuinely seem to like their jobs? How is employee turnover? Will there be enough staff to support adding a new physician? Is the office manager available and helpful (you’d be surprised how much this will matter to you)?

DOES IT SOUND TOO GOOD TO BE TRUE? If yes, it is. They may promise you the world, but it’s because something is seriously lacking. 

As for figuring out if a place is toxic, I think if you ask a lot of these questions and you observe people’s personalities, you’ll pick up on it pretty easily. If the other docs look tired and burned out and they don’t seem to love their jobs, beware!