SUPPLEMENT ARTICLE
Look Before You Leap Troy Caron, DO
Summary: The decision to leave a job can be very stressful. Multiple variables must be considered before turning in your notice. The goal of this paper is to help you decide if changing jobs is a smart decision, and, if it is, when to do it. Key Words: burn out, changing jobs, job satisfaction (J Orthop Trauma 2014;28:S23–S25)
INTRODUCTION
“Should I stay or should I go?” It is well known that 70% of orthopaedic surgeons leave their first job within the first 5 years1 and often their second jobs as well. Their second jobs may align better with their practice and personal goals, but often it will not be “the job for life.” As a new orthopaedic surgeon, you will have to figure out what type of practice you want to be involved in, where it make sense to establish yourself as an orthopaedic surgeon and, whether a move will benefit your personal and/or family life. The purpose of this paper is to help you determine if finding another job is the right decision, or at least help you determine when the time to change is right.
Reasons to Leave
Your first job is a time of revelation—and can be a time of frustration. There are the highs of honing your skills, finding your professional voice, and, of course, seeing those long years of education and training pay off in positive outcomes for your patients. And then there are the frustrations inherent in learning the ropes—Electronic health records, operating room time, dealing with the bureaucracy, the politics and business aspect you may not have been trained in, and realizing you may have undervalued your worth when you negotiated your first contract. Most orthopaedic trauma surgeons don’t realize the value that they bring to a hospital when negotiate their first job2 and by default lack the confidence to negotiate to their advantage. If your needs and expectations are not written into a contract, in reality, they are of no consequence. In large institutions, it is not uncommon for leadership changes on a 1- to 2-year cycle. The person that promised you operating room time with a handshake the day you interviewed may no longer be working in the hospital or healthcare system when you start your job. “Get it in writing” should be your mantra
Accepted for publication June 13, 2014. From the Wellspan Orthopedics, York, PA. The author reports no conflict of interest. Reprints: Troy Caron, DO, Wellspan Orthopedics, 45 Monument Rd, York, PA 17403 (e-mail: [email protected]). Copyright © 2014 by Lippincott Williams & Wilkins
when negotiating every contract from the first to the last. If the institution refuses to put into your contract all that you have asked for and been promised by the individual with the winning smile and firm handshake, you have 2 choices: (1) Do not sign on with that particular institution, and (2) If you do sign, don’t be surprised when you don’t have anything beyond what is explicitly stated in the document. Some of the topics that will be discussed are practice models, partners, health care systems, compensation, operating room time, call schedule, available resources and location of the practice. These can all be reasons to potentially move on to your next job. The reality for most orthopaedic trauma surgeons is that their practice is going to be intimately tied to a hospital or healthcare system and the skills in navigating the matrix-type organization3 will be almost as necessary as your surgical skills. If you are thinking about switching jobs, this is the time to consider the different practice models available to you. Unfortunately when switching jobs it’s hard to know if it’s the practice model you dislike or if it is the way the model is run. A hospital-employed position can be frustrating if you feel that you are treated like an employee and have no power to improve things and get lost in the matrix of the system. However, in this system, you don’t have to deal with the hiring and firing of employees, malpractice insurance, and other headaches of running a business. Private practice can be rewarding if you are a partner because you have a sense of ownership. But you get all the headaches of running a business and having a medical practice in today’s ever changing medico legal environment. You can also have a pretty good lifestyle and make decent money doing locum tenens work. This can be a way to figure out what type of practice you are looking for or have a job where you go in, do your work, and get away for a while. There are also several hybrid variations of the above job descriptions.4,5 The interpersonal dynamics of a group you’re considering joining can be difficult to figure out in an interview. It is nice to join a group where you know everybody, but this is very rare. There are many styles of groups. Generally, most groups operate under democratic principles, and the majority rules when making decisions. Ideally, you will join a group where someone in leadership has the same specialty as you because you know that your interests will be represented at leadership meetings. Some groups have multiple specialties, and some groups have multiple general orthopaedic surgeons and everything in between. No matter how comfortable your new group makes you feel, it is important that all your needs are specifically outlined in your contract because there are no guarantees that the leaders you interviewed with will be there 6 months or a year from your interview. If you’re the only
J Orthop Trauma Volume 28, Number 9 Supplement, September 2014
www.jorthotrauma.com |
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J Orthop Trauma Volume 28, Number 9 Supplement, September 2014
Caron
trauma surgeon within a group of general orthopaedic surgeons your needs are going to be very different and probably given lower priority then the majority of the group. A mentor can be a very valuable resource to have when starting a new job. A lot of battles have been fought prior to your arrival and if you are questioning what to do in a case you have somebody to bounce ideas off and ask for advice. Before you sign your contract, you should discuss the types of cases you want to do and how the service is going to work when you arrive. If your mentor wants to do all the pelvis and acetabular cases and wants to pass off all metatarsal cases to you over time this may be a source of frustration if this wasn’t established prior to joining the practice. Beyond the group dynamics of the practice you are considering, as an orthopaedic trauma surgeon, you will need to take a very close look at the hospital/system where you will be working. Where does your specialty fit on the organizational chart and what is the reality? Are the interests of your service line represented by people in leadership who have the authority to make decisions, initiate change, and allocate funds? Talk to as many orthopaedic surgeon as you can about the support and encouragement they receive from their departments and the hospital or healthcare system in general. Compensation can be a major source of frustration for orthopaedic trauma surgeons. Several different compensation models are used including fee for service, being paid by work relative value units, salary, productivity bonuses, bonuses based on patient satisfaction and/or meaningful use and SCIP measures. Typically trauma surgeons work long hours, often at night. This frustration level can be even higher if you are up late at night taking care of patients and not getting paid for it. This can happen in a fee-for-service model. It can be difficult to compare apples to apples in using some of the bonus methods. A patient that is getting an elective total joint or a knee scope is much different than a trauma patient. Depending on the bonus plans used, the somewhat controlled environment of an elective practice makes reaching bonus criteria easier and should be taken into consideration when developing your compensation package. In large institutions this can be difficult because all orthopaedic specialties are lumped together despite specialties having very different practices. Another frustration of being an employed physician can be the unknown of when your compensation plan is going to change. Typically compensation plans are reviewed every couple of years. A source of frustration can be if your compensation plan changes at the whim of the hospital without any discussion multiple times. This can make for a very unfavorable working environment. Dedicated operating room time can be hard to guarantee to new surgeons. However, if you are planning on working in a busy trauma center a room dedicated to orthopaedic trauma should be available daily.4 Without having this room you will be operating late at night. Nothing will frustrate you more than having an urgent trauma case and then having to wait for your partners to do all their elective cases in the room first before you can work. You may not be able to get elective time guaranteed in your contract without proving your volume, but you absolutely need a dedicated “orthopaedic” trauma room.
S24
| www.jorthotrauma.com
If the organization is looking to hire an orthopaedic trauma surgeon that is proof enough that there is the volume to support the room. Call differs depending on the institution. Before you leave, you need to assess the institution’s call policy and make sure it is one you can tolerate. At some institutions residents take care of everything at night from floor calls to reduction of fractures in the ER to elective patient calls. At other institutions, particularly non-academic institutions, the attending physicians do it all. Other places have physician assistants available at night. If you are leaving an academic practice, where you rarely got a phone call at night, for a nonacademic practice where you have no help, you may not be able to tolerate the same number of call days in a month. The lack of sleep and constant phone calls will become very wearing in a short time. The availability of adequate resources to take care of your patients is something to find out before switching jobs. If you are working in a non-academic institution that does not have residents, you will need physician assistants and or nurse practitioners to help you. You will need help making rounds, seeing consults, dealing with floor calls, outside patient calls, emergency room calls, and, of course, the operating room. At an academic institution with residents, make sure you know that a resident will be on your service or in clinic with you. If the residents are already spread too thin, you will need a physician assistant. The location of your practice may be a reason to leave. If your family doesn’t like where they are living this can be a major stressor and likely a reason to leave. Other hospitals around your trauma center can up their trauma status and take patients away from you. This can cause several reasons to move such as lower volumes, decreased compensation, and likelihood of having to do more general orthopaedics than you may like to keep your productivity up.
Considerations Before You Leave Your Present Job There are several things to look at before you decide to switch jobs. These are going to be different for each of you, but to some degree all should be considered. The cost of living is a critical factor to consider; if you are leaving because of money and you don’t factor in the cost of living you may be very disappointed and not any better off. How do taxes, cost of housing, gas and food prices compare to your present location? Will you need to send your kids to private school? There are several “cost of living calculators” on the internet that will give you the details of the cost of living on all these specific details. Another thing to consider before moving is selling a house. How is the housing market doing in your area? You want to avoid a situation where you are paying 2 mortgages. Also, work to get your moving expenses included in your compensation package. When moving from the house you lived in during fellowship to your first job you probably did not have that much “stuff”; however, when moving to your second job it is amazing how much “stuff” you have acquired over the years and how much it costs to move it. This second Ó 2014 Lippincott Williams & Wilkins
J Orthop Trauma Volume 28, Number 9 Supplement, September 2014
move can cost upwards of $30,000 depending on how far you are moving. You also need to time when you move into your new home. The last thing you want to do is move all your “stuff” twice. Different health care systems have different retirement plans. Most places will give a physician a percent of what they themselves put into a retirement plan. Typically this occurs right away; however, if you leave before you are vested you will not get any of that money. The typical time to become vested is approximately 3 years. You may also have to pay back a signing bonus. These are typically given as promissory notes and not only do you have to pay back the signing bonus you also have to pay interest on these notes. The typical time period for forgiveness on these is 3–5 years. Malpractice tail coverage can be quite costly if you have to pay it when you leave. For high-risk specialties this can be in excess of $100,000.6 This can be a major burden on surgeons and actually prevents many young surgeons from leaving their current practice. It makes sense from a financial stand point to stay in a practice for 3–5 years if you can tolerate it. You will get vested, build equity in your house, and hopefully, not have to pay back your signing bonus. However, in some circumstances the financial benefits of staying do not outweigh the negative experience and discontent you are suffering through. Trying to get a feel of what your lifestyle difference is going to be can be difficult without actually experiencing it. Are you going to have to work at more than 1 hospital? How much time are you going to spend in the car between hospitals or between the hospital and your home? These are questions that you may not know the answers to but something you need to get an idea of before you move. This is also a reason to rent for a year or 2 before getting locked into a house. Another issue to consider is the amount of stress a move can put on your family. If you have spent any amount of time in a location your spouse and children are likely going to have made friends and become comfortable in their routines. Moving can be a very difficult experience for all involved. Will your spouse be able to transfer or find a job similar to the one she/he is leaving? The older kids get, the more difficult it is for them to feel comfortable switching schools. Are you moving close to or further away from family? Not having family and friends of longstanding around when you were used to having them may make the decision to move for your career seem less important than ensuring your family’s happiness.
Ó 2014 Lippincott Williams & Wilkins
Look Before You Leap
What Is Going to Make You Happy?
The most important thing to do is figure out what is going to make you happy professionally and personally. You may find the “perfect job” for you; however, other life circumstances may make this job change miserable and ultimately lead to unhappiness. If you are in your first job it is always good to work for a couple of years and get experience and improve on your skills as a surgeon as well as navigating the politics and business aspects of medicine today. By staying a couple of years you can get more financially stable, get vested in you financial plan, not have to pay back any penalties for leaving early. Also, it is important to get board certified, which becomes difficult if you are moving around. If possible when starting any job it is always easier to leave if you rent as oppose to purchasing a house. This is a difficult decision that should be discussed with your spouse. If you go into any job thinking it is going to be perfect, you will to be disappointed every time. You need to decide what is absolutely necessary and get those things in a contract. If an employer will not put them in a contract don’t go there. If things come up that you didn’t expect that you disagree with take a couple of days to think about how to improve the situation before getting upset about it. We all work in a highly stressful profession and things that seem like a big deal sometimes really aren’t so big after getting a night’s sleep. Take your time in deciding to change jobs. Discuss your situation with your family and friends. You should also discuss your situation with more experienced people that have switched jobs. If after all this you decide to move, don’t look back! REFERENCES
1. Beaty JH, et al. Life after fellowship: pearls and pitfalls. [AAOS Now website] September 2012. Available at http://www.aaos.org/news/ aaosnow/sep12/clinical7.asp. Accessed May 12, 2014. 2. Vallier HA, Patterson BM, Meehan CJ, et al. Orthopaedic traumatology: the hospital side of the ledger, defining the financial relationship between physicians and hospitals. J Orthop Trauma. 2008;22:221–226. 3. Finerty SZ. Master The Matrix: 7 Essentials for Getting Things Done in Complex Organizations. Minneapolis, MN: The Harbors Press; 2012. 4. Henley B. Finding your ideal job and negotiating your contract: where to get the information and numbers you need to know. J Orthop Trauma. 2012;26:S9–S13. 5. Vallier HA, Agnew S. Career and practice management issues in Orthopaedic trauma. In: Schmidt AH, Teague DC. Orthopedic Knowledge Update 4: Trauma. Andrew, published in Rosemont, IL; American Academy of Orthopaedic Surgeons; 2010:19–30. 6. Cupp R. The Ins and Outs of Tail Coverage [AAOS Now] March 2014. Available at: http://www.aaos.org/news/aaosnow/mar14/managing4.asp. Acessed May 12, 2014.
www.jorthotrauma.com |
S25
Look Before You Leap Troy Caron, DO
Summary: The decision to leave a job can be very stressful. Multiple variables must be considered before turning in your notice. The goal of this paper is to help you decide if changing jobs is a smart decision, and, if it is, when to do it. Key Words: burn out, changing jobs, job satisfaction (J Orthop Trauma 2014;28:S23–S25)
INTRODUCTION
“Should I stay or should I go?” It is well known that 70% of orthopaedic surgeons leave their first job within the first 5 years1 and often their second jobs as well. Their second jobs may align better with their practice and personal goals, but often it will not be “the job for life.” As a new orthopaedic surgeon, you will have to figure out what type of practice you want to be involved in, where it make sense to establish yourself as an orthopaedic surgeon and, whether a move will benefit your personal and/or family life. The purpose of this paper is to help you determine if finding another job is the right decision, or at least help you determine when the time to change is right.
Reasons to Leave
Your first job is a time of revelation—and can be a time of frustration. There are the highs of honing your skills, finding your professional voice, and, of course, seeing those long years of education and training pay off in positive outcomes for your patients. And then there are the frustrations inherent in learning the ropes—Electronic health records, operating room time, dealing with the bureaucracy, the politics and business aspect you may not have been trained in, and realizing you may have undervalued your worth when you negotiated your first contract. Most orthopaedic trauma surgeons don’t realize the value that they bring to a hospital when negotiate their first job2 and by default lack the confidence to negotiate to their advantage. If your needs and expectations are not written into a contract, in reality, they are of no consequence. In large institutions, it is not uncommon for leadership changes on a 1- to 2-year cycle. The person that promised you operating room time with a handshake the day you interviewed may no longer be working in the hospital or healthcare system when you start your job. “Get it in writing” should be your mantra
Accepted for publication June 13, 2014. From the Wellspan Orthopedics, York, PA. The author reports no conflict of interest. Reprints: Troy Caron, DO, Wellspan Orthopedics, 45 Monument Rd, York, PA 17403 (e-mail: [email protected]). Copyright © 2014 by Lippincott Williams & Wilkins
when negotiating every contract from the first to the last. If the institution refuses to put into your contract all that you have asked for and been promised by the individual with the winning smile and firm handshake, you have 2 choices: (1) Do not sign on with that particular institution, and (2) If you do sign, don’t be surprised when you don’t have anything beyond what is explicitly stated in the document. Some of the topics that will be discussed are practice models, partners, health care systems, compensation, operating room time, call schedule, available resources and location of the practice. These can all be reasons to potentially move on to your next job. The reality for most orthopaedic trauma surgeons is that their practice is going to be intimately tied to a hospital or healthcare system and the skills in navigating the matrix-type organization3 will be almost as necessary as your surgical skills. If you are thinking about switching jobs, this is the time to consider the different practice models available to you. Unfortunately when switching jobs it’s hard to know if it’s the practice model you dislike or if it is the way the model is run. A hospital-employed position can be frustrating if you feel that you are treated like an employee and have no power to improve things and get lost in the matrix of the system. However, in this system, you don’t have to deal with the hiring and firing of employees, malpractice insurance, and other headaches of running a business. Private practice can be rewarding if you are a partner because you have a sense of ownership. But you get all the headaches of running a business and having a medical practice in today’s ever changing medico legal environment. You can also have a pretty good lifestyle and make decent money doing locum tenens work. This can be a way to figure out what type of practice you are looking for or have a job where you go in, do your work, and get away for a while. There are also several hybrid variations of the above job descriptions.4,5 The interpersonal dynamics of a group you’re considering joining can be difficult to figure out in an interview. It is nice to join a group where you know everybody, but this is very rare. There are many styles of groups. Generally, most groups operate under democratic principles, and the majority rules when making decisions. Ideally, you will join a group where someone in leadership has the same specialty as you because you know that your interests will be represented at leadership meetings. Some groups have multiple specialties, and some groups have multiple general orthopaedic surgeons and everything in between. No matter how comfortable your new group makes you feel, it is important that all your needs are specifically outlined in your contract because there are no guarantees that the leaders you interviewed with will be there 6 months or a year from your interview. If you’re the only
J Orthop Trauma Volume 28, Number 9 Supplement, September 2014
www.jorthotrauma.com |
S23
J Orthop Trauma Volume 28, Number 9 Supplement, September 2014
Caron
trauma surgeon within a group of general orthopaedic surgeons your needs are going to be very different and probably given lower priority then the majority of the group. A mentor can be a very valuable resource to have when starting a new job. A lot of battles have been fought prior to your arrival and if you are questioning what to do in a case you have somebody to bounce ideas off and ask for advice. Before you sign your contract, you should discuss the types of cases you want to do and how the service is going to work when you arrive. If your mentor wants to do all the pelvis and acetabular cases and wants to pass off all metatarsal cases to you over time this may be a source of frustration if this wasn’t established prior to joining the practice. Beyond the group dynamics of the practice you are considering, as an orthopaedic trauma surgeon, you will need to take a very close look at the hospital/system where you will be working. Where does your specialty fit on the organizational chart and what is the reality? Are the interests of your service line represented by people in leadership who have the authority to make decisions, initiate change, and allocate funds? Talk to as many orthopaedic surgeon as you can about the support and encouragement they receive from their departments and the hospital or healthcare system in general. Compensation can be a major source of frustration for orthopaedic trauma surgeons. Several different compensation models are used including fee for service, being paid by work relative value units, salary, productivity bonuses, bonuses based on patient satisfaction and/or meaningful use and SCIP measures. Typically trauma surgeons work long hours, often at night. This frustration level can be even higher if you are up late at night taking care of patients and not getting paid for it. This can happen in a fee-for-service model. It can be difficult to compare apples to apples in using some of the bonus methods. A patient that is getting an elective total joint or a knee scope is much different than a trauma patient. Depending on the bonus plans used, the somewhat controlled environment of an elective practice makes reaching bonus criteria easier and should be taken into consideration when developing your compensation package. In large institutions this can be difficult because all orthopaedic specialties are lumped together despite specialties having very different practices. Another frustration of being an employed physician can be the unknown of when your compensation plan is going to change. Typically compensation plans are reviewed every couple of years. A source of frustration can be if your compensation plan changes at the whim of the hospital without any discussion multiple times. This can make for a very unfavorable working environment. Dedicated operating room time can be hard to guarantee to new surgeons. However, if you are planning on working in a busy trauma center a room dedicated to orthopaedic trauma should be available daily.4 Without having this room you will be operating late at night. Nothing will frustrate you more than having an urgent trauma case and then having to wait for your partners to do all their elective cases in the room first before you can work. You may not be able to get elective time guaranteed in your contract without proving your volume, but you absolutely need a dedicated “orthopaedic” trauma room.
S24
| www.jorthotrauma.com
If the organization is looking to hire an orthopaedic trauma surgeon that is proof enough that there is the volume to support the room. Call differs depending on the institution. Before you leave, you need to assess the institution’s call policy and make sure it is one you can tolerate. At some institutions residents take care of everything at night from floor calls to reduction of fractures in the ER to elective patient calls. At other institutions, particularly non-academic institutions, the attending physicians do it all. Other places have physician assistants available at night. If you are leaving an academic practice, where you rarely got a phone call at night, for a nonacademic practice where you have no help, you may not be able to tolerate the same number of call days in a month. The lack of sleep and constant phone calls will become very wearing in a short time. The availability of adequate resources to take care of your patients is something to find out before switching jobs. If you are working in a non-academic institution that does not have residents, you will need physician assistants and or nurse practitioners to help you. You will need help making rounds, seeing consults, dealing with floor calls, outside patient calls, emergency room calls, and, of course, the operating room. At an academic institution with residents, make sure you know that a resident will be on your service or in clinic with you. If the residents are already spread too thin, you will need a physician assistant. The location of your practice may be a reason to leave. If your family doesn’t like where they are living this can be a major stressor and likely a reason to leave. Other hospitals around your trauma center can up their trauma status and take patients away from you. This can cause several reasons to move such as lower volumes, decreased compensation, and likelihood of having to do more general orthopaedics than you may like to keep your productivity up.
Considerations Before You Leave Your Present Job There are several things to look at before you decide to switch jobs. These are going to be different for each of you, but to some degree all should be considered. The cost of living is a critical factor to consider; if you are leaving because of money and you don’t factor in the cost of living you may be very disappointed and not any better off. How do taxes, cost of housing, gas and food prices compare to your present location? Will you need to send your kids to private school? There are several “cost of living calculators” on the internet that will give you the details of the cost of living on all these specific details. Another thing to consider before moving is selling a house. How is the housing market doing in your area? You want to avoid a situation where you are paying 2 mortgages. Also, work to get your moving expenses included in your compensation package. When moving from the house you lived in during fellowship to your first job you probably did not have that much “stuff”; however, when moving to your second job it is amazing how much “stuff” you have acquired over the years and how much it costs to move it. This second Ó 2014 Lippincott Williams & Wilkins
J Orthop Trauma Volume 28, Number 9 Supplement, September 2014
move can cost upwards of $30,000 depending on how far you are moving. You also need to time when you move into your new home. The last thing you want to do is move all your “stuff” twice. Different health care systems have different retirement plans. Most places will give a physician a percent of what they themselves put into a retirement plan. Typically this occurs right away; however, if you leave before you are vested you will not get any of that money. The typical time to become vested is approximately 3 years. You may also have to pay back a signing bonus. These are typically given as promissory notes and not only do you have to pay back the signing bonus you also have to pay interest on these notes. The typical time period for forgiveness on these is 3–5 years. Malpractice tail coverage can be quite costly if you have to pay it when you leave. For high-risk specialties this can be in excess of $100,000.6 This can be a major burden on surgeons and actually prevents many young surgeons from leaving their current practice. It makes sense from a financial stand point to stay in a practice for 3–5 years if you can tolerate it. You will get vested, build equity in your house, and hopefully, not have to pay back your signing bonus. However, in some circumstances the financial benefits of staying do not outweigh the negative experience and discontent you are suffering through. Trying to get a feel of what your lifestyle difference is going to be can be difficult without actually experiencing it. Are you going to have to work at more than 1 hospital? How much time are you going to spend in the car between hospitals or between the hospital and your home? These are questions that you may not know the answers to but something you need to get an idea of before you move. This is also a reason to rent for a year or 2 before getting locked into a house. Another issue to consider is the amount of stress a move can put on your family. If you have spent any amount of time in a location your spouse and children are likely going to have made friends and become comfortable in their routines. Moving can be a very difficult experience for all involved. Will your spouse be able to transfer or find a job similar to the one she/he is leaving? The older kids get, the more difficult it is for them to feel comfortable switching schools. Are you moving close to or further away from family? Not having family and friends of longstanding around when you were used to having them may make the decision to move for your career seem less important than ensuring your family’s happiness.
Ó 2014 Lippincott Williams & Wilkins
Look Before You Leap
What Is Going to Make You Happy?
The most important thing to do is figure out what is going to make you happy professionally and personally. You may find the “perfect job” for you; however, other life circumstances may make this job change miserable and ultimately lead to unhappiness. If you are in your first job it is always good to work for a couple of years and get experience and improve on your skills as a surgeon as well as navigating the politics and business aspects of medicine today. By staying a couple of years you can get more financially stable, get vested in you financial plan, not have to pay back any penalties for leaving early. Also, it is important to get board certified, which becomes difficult if you are moving around. If possible when starting any job it is always easier to leave if you rent as oppose to purchasing a house. This is a difficult decision that should be discussed with your spouse. If you go into any job thinking it is going to be perfect, you will to be disappointed every time. You need to decide what is absolutely necessary and get those things in a contract. If an employer will not put them in a contract don’t go there. If things come up that you didn’t expect that you disagree with take a couple of days to think about how to improve the situation before getting upset about it. We all work in a highly stressful profession and things that seem like a big deal sometimes really aren’t so big after getting a night’s sleep. Take your time in deciding to change jobs. Discuss your situation with your family and friends. You should also discuss your situation with more experienced people that have switched jobs. If after all this you decide to move, don’t look back! REFERENCES
1. Beaty JH, et al. Life after fellowship: pearls and pitfalls. [AAOS Now website] September 2012. Available at http://www.aaos.org/news/ aaosnow/sep12/clinical7.asp. Accessed May 12, 2014. 2. Vallier HA, Patterson BM, Meehan CJ, et al. Orthopaedic traumatology: the hospital side of the ledger, defining the financial relationship between physicians and hospitals. J Orthop Trauma. 2008;22:221–226. 3. Finerty SZ. Master The Matrix: 7 Essentials for Getting Things Done in Complex Organizations. Minneapolis, MN: The Harbors Press; 2012. 4. Henley B. Finding your ideal job and negotiating your contract: where to get the information and numbers you need to know. J Orthop Trauma. 2012;26:S9–S13. 5. Vallier HA, Agnew S. Career and practice management issues in Orthopaedic trauma. In: Schmidt AH, Teague DC. Orthopedic Knowledge Update 4: Trauma. Andrew, published in Rosemont, IL; American Academy of Orthopaedic Surgeons; 2010:19–30. 6. Cupp R. The Ins and Outs of Tail Coverage [AAOS Now] March 2014. Available at: http://www.aaos.org/news/aaosnow/mar14/managing4.asp. Acessed May 12, 2014.
www.jorthotrauma.com |
S25
