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    Career decisions: Should you start, buy or join a practice?

    The bottom line: Choose what will make you personally and professionally happy.


    Location, location

    As faculty on the topic for a number of medical associations, I’m commonly asked by attendees, “where in the country should I practice?”—as if there is some magic location that will ensure success.

    My answer often is not what they expect. The best place to practice is where you want to spend the rest of your life outside of practice. In other words, when you leave the office at the end of your day you should be where you want to live.

    Even those locations that might be considered grossly over-doctored will probably have a niche community opportunity within less than an hour’s drive. All the research says that money only buys happiness up to around $50,000 per year –enough to cover basic necessities–then it has no further impact. So look beyond the potential practice income in selecting a career situation.

    Related: When should primary care physicians consult a career development coach?

    When to take a risk

    That’s not to say that I suggest radical untested change in seeking happiness. If you grew up in Florida and have always had an interest in Alaska, take employment for a year before investing in a startup, just in case you didn’t realize what minus 22 degrees and 20 hours of darkness day-after-day for months really feels like. On the other hand, if you want to specialize in Seasonal Affective Disorder, Alaska in winter might be the perfect location for you.

    There are many creative ways to have a professional career. I had a client who, for over a decade, alternated practice every two weeks between rural New York State and a Caribbean island, and was quite happy with it until a hurricane eliminated the southern office. He sold the northern practice to a buyer wanting to be nearby aging parents.

    I’ve known several physicians who fly to work, either on commercial airlines or in their own airplanes.

    If you want more tangible evidence to support your choice of locale, it is easy–and more accurate– to do your own research of community needs rather than buying a demographic survey.

    Pose as needing a simple evaluation in your specialty for a teenager or parent, and call around to the majority of medical offices in your specialty to find out the wait for a new appointment. Patients like to be seen within a week of calling for an appointment. For every two weeks of wait, there is room for approximately one additional physician.

    If the only physician in town has a two-week wait, then adding one would theoretically result in two physicians having a one week wait, both still being full. If all three physicians in a community each have a four-week wait, then there is room for six to nine additional physicians. Your wait times will probably equal the others’ within weeks or months.

    With a little bit of thought and planning you can hardly avoid being successful. Private consultants, most of whom are members of the National Society of Certified Healthcare Business Consultants, can also offer personalized guidance and support to your endeavor.

    Keith Borglum, CHBC, is a practice management consultant, appraiser, and broker in Santa Rosa, California. Send your practice management questions to [email protected].com

    NEXT: What to consider when evaluating an employment offer:


    Keith Borglum, CHBC
    The author is a practice management consultant, appraiser, and broker in Santa Rosa, CA.


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