Congratulations! You have almost completed your training in retina fellowship, and now it is time to approach seeking a job as a retina specialist. Finding your first job in retina is a daunting task. No longer can you default to a matching algorithm; instead, you now must consider all relevant factors and make a choice. In this guide, I will highlight different aspects to consider in the selection of your first retina position.
Overall, there are several variables to consider when determining your best-fitting first job. These include geography, academic versus private versus hybrid practice structures, schedule, ownership, and income. Most important is the relative weight you assign to each of these variables. Lastly, I do not claim to have any expertise: these opinions are solely my own.
Identifying the relative importance of being located in a specific city or geographical region is an important first step in your job search. If you know your preferred location, it may be best to reach out to practices in the area that appeal to you as early in the process as possible. Furthermore, getting the word out through friends/family/faculty (or if you know someone who is a patient at a practice you’d like to join) that you’re looking to come to town after training, might be helpful in accelerating your job search and help to identify the best possible fit. On a personal level, the group I joined in my hometown of Buffalo, NY made first contact with me when I was a third-year resident. I think this early contact was advantageous to both sides. Most would agree that it is never too early to reach out to a specific area you are interested in.
Geographic restrictions are pertinent to discussions of non-compete clauses (which are particularly important in a referral-based specialty such as retina). It is difficult to agree to a non-compete if it could prevent you from living in your or your spouse’s hometown should the job opportunity not go as planned. Usually, a middle ground can be reached, such as phasing in a non-compete over the course of your tenure with the practice (e.g., the non-compete becomes more restrictive the longer you are with the practice), or to have the non-compete become nullified in the event of you are not offered a long-term role with the practice (e.g., not offered partnership).
In addition to the specific geographic location, you might also want to assess your willingness to relocate again in the future. If it is relatively easy to relocate should the job not work out, then you may be willing to take a job with a higher risk-reward profile (e.g., being the second physician in a smaller practice). If you foresee it being harder for you and your family to relocate, then you may want to take a job that has more stability by joining a larger group.
Academic, private, and hybrid practice models
Choosing a practice model to best suit your career goals can be difficult. Whether academics, ‘privademics’, or private practice, one can likely find a position that allows participation in teaching and in research. However, if one prioritizes teaching and research (especially basic or translational research), then academics may offer the best route. If these are your priorities, then be certain to ensure protected time (and salary support) to pursue those goals. Additionally, it is important to consider the difference in organizational structures between academic institutions (more hierarchical) and private practices (less hierarchical). Picking the structure that is the best fit for you will ensure a higher likelihood of success. Clinical output (RVUs) and productivity will likely be emphasized in most starting positions, regardless of platform.
Polishing up your materials for the job search? Check out our downloadable CV template (plus advice on when to use a resume or a CV).
Whether desiring to be part-time or full-time with regular call or very infrequent call, there is likely a position available that fits your needs. The most important element is to know the relative importance of your desired schedule in comparison to the other categories of priorities. I think a good way to approach this from a job-seeking standpoint is to hope for an equal schedule to the other doctors in the practice that you hope to join. In my personal situation, I offered to take extra call when I started, but my future partners felt that this might set a culture of me not being treated as an equal to them. I think this was a valuable lesson for me at the time. In other words, I would now be a little weary of job opportunities that treat new hires as less than tenured doctors when it comes to call, because it may reveal how your position is valued broadly within the practice.
Additionally, your intended clinical schedule may be particularly important with regards to anticipated family leave. Ideally, a practice would share what their policy would be for a physician taking family leave without you having to ask for it, though this may not be the case. A practice might also not yet have a family leave policy.
Having ownership, or the potential for ownership, will be distinctly important for some during the job hunt and less so to others. There are multiple benefits of becoming a partner in a practice including the potential for a higher income ceiling as well as added job security and control (i.e., autonomy) of your work environment. However, it is also worth considering that becoming a full partner incurs additional costs, such as practice equity buy-in and direct financial responsibility for the health of the practice in uncertain times (e.g., pandemic, changes in reimbursement, new therapeutic agents). A partnership track may result in lower take-home pay for early years, when incorporating the buy-in, but it will likely result in a higher income later in your career. If you are certain that you wish to have a partnership track, then, ideally, you may wish for the track to be as clearly delineated in the associate contract as possible. If you are not certain that you wish to have a partnership track, there may be many more job opportunities (or higher starting salaries) available to you. Relevant to the changing landscape in retina and ophthalmology, more and more practices are being acquired by private equity groups and this should be inquired.
When exploring retina job opportunities, it may be best to think about and discuss income last. Negotiating your pay can often be viewed as a zero-sum game between you and your potential employer. Instead, it may be best to reframe the conversation as one about clinical volume. For instance, “What you do expect my daily schedule to look like?” Many starting contracts are based on a salary plus a production (bonus) model. As an applicant, you should view your starting salary as insurance that the practice will provide you with the clinical volume that you need to succeed. If a practice is only willing to offer a low salary, it may raise concerns as to whether or not the practice has the clinical volume to support your position. Alternatively, if a group is hiring you with hopes that you will grow the practice, you may want to inquire about the potential to become part-owner of the equity that you are expected to create. Regardless, it is important to align your incentives with your employer’s incentives in order for both sides to view your compensation as fair. Having your compensation be satisfactory and equitable to both you and your employer is critical to long-term success in the position.
There are numerous factors to consider when choosing your first job as a retina specialist. More important than any single variable is that you determine the relative importance of each aspect to you and your family. Making the decision regarding your first job may be challenging, but the light at the end of the tunnel is very bright, and we are lucky to be in a field with excellent career opportunities.