Choosing your employer is the most important next decision you will make for yourself. Signing that employment contract is the single most important use of your signature you will ink and affect your happiness for years, even the rest of your career. PAs and NPs: This applies to you, too.

1. Decide where you want to live. Location matters, and in today’s polarized political environment, choosing a state or region to live in that aligns with your personal beliefs and desires is critical. Whatever your beliefs or desires, make sure where you choose aligns with them. Including your partner and family in your decision matters. Rural, suburban, urban, proximity to shopping, school quality, restaurants, hunting, and fishing all matter differently to different people. Ideally, pick two or three areas that would work.

2. Find the possible employers in that region. Few regions do not need more physicians of any specialty, and even if there seem to be no openings, keep looking, call around, and talk to local physicians, hospitals, employers, and groups. Be wary of recruiters, who are fundamentally salespeople who profit from putting you in a job. They can be very helpful, but they may not have your best interests in mind.

3. Investigate the employers you find. That does not mean listening to the recruiter alone or relying on the answers of those who interview you. Find reviews by colleagues. Some key questions: What is your physician turnover? Why do physicians leave? High turnover or hesitancy in answering those questions should be a clue.

4. Review any contract carefully before signing. Have your contract reviewed by an experienced health care attorney. Don’t use the family lawyer. There are too many subtleties in physician employment that a general practice attorney may not understand well. Restrictive covenants, hours worked, call schedules, and reimbursement clauses are all critical issues that will affect your future. Don’t assume anything, and the cost of a contract review will often save that amount in saved aggravation. There is no such thing as a “standard” contract.

So you decide to take a job, and you’ve done all the above. You have a fat salary coming soon. Here’s a single warning. Don’t commit to a big house. After all that careful work, selling a home will add to your problems if you’re not happy. Rent for a year, or buy a house below your capabilities but in a range that is easy to sell. Get to know the neighborhoods, schools, shopping, and where your colleagues live. After a year-long stay, if you’re happy, then buy your dream house.

I’ve spoken to hundreds of physicians who regret not following these simple steps and are unhappy and stuck.

Gaspere C. Geraci is a family physician.

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