Whether you are finishing your residency soon or feeling the urge to move beyond your current position, career opportunities abound for primary care doctors. But with more choices now than ever, how do you find the job that is the best fit for you and will allow you to grow personally and professionally? This article presents a five-point framework to help you identify what's important in your career — from your mission, identity, and direction to family, fun, and finances. To visualize the framework, hold your hand in front of you with your thumb up, index finger pointed, and the remaining three fingers folded back toward you. Each finger represents an aspect of your work and life worth considering.

MISSION AND IDENTITY (THUMB)

You chose family medicine for a reason. What drives you? What makes you distinct? Clarifying your personal sense of mission and identity can help you identify the populations you want to serve, the kind of work you want to do, and the types of opportunities (and organizations) you'll pursue.

For example, perhaps you are a true generalist who enjoys the variety of a broad scope of practice and working with patients over time in the contexts of both family and community. You may be drawn to prevention. You may enjoy the challenge of balancing patients' comorbidities while helping them achieve their personal and functional health goals. You may be passionate about being an advocate for patients in a health care system full of paradoxes. But above all these things, you realize that you are part of something greater than yourself.

Action items:

• Get clear on your mission. You may find it helpful to develop a personal mission statement that you can refer back to as you're evaluating job opportunities.

• Consider adding a goal statement to your curriculum vitae (CV) as a useful way to convey your sense of purpose to others. While you're at it, make sure your CV is up to date. This will make the application process less stressful.

• Draft a basic cover letter that highlights not only your skills but also what's important to you. Later, when you apply for a specific position, you can tailor the cover letter to the job.

DIRECTION (INDEX FINGER)

The pursuit of medicine is a marathon, not a sprint. It plays out in phases over time. Knowing where you are currently and where you want to go is key.

The early phase of a medical career is usually focused on strengthening the core skills you acquired in residency while adapting to the volume and complexity of a modern-day primary care practice. In addition to doing this core clinical work, it's a good idea to start developing a secondary interest or niche, which can make you more sought-after in subsequent phases of your medical career. Many practices need internal experts in clinical areas such as geriatrics, palliative care, women's health, sports medicine, or sleep medicine. Or they may need someone with additional skills in quality improvement, population or community health, information technology, or medical education.

Figure out what interests you, and then look for a job that will help you move in that direction. A good job will allocate about 20% of your time to pursuing your aspirations, 60% of your time to core clinical work, and the remaining 20% to the less desirable “chores” that everyone must share for the good of the practice. These might include nights, weekends, vacation coverage, extra administrative work, etc.

Action items:

• Clarify how you might round out your clinical skills and develop additional competencies that will be valuable for future phases of your career. You must be able to articulate this in a way that makes your employer see it as a good investment.

• Keep the 20-60-20 rule in mind when comparing one position with another, and find out whether there may be some room for negotiation.

• Find a mentor who can listen to your aspirations and concerns, provide useful feedback, and encourage you to stay focused on what's important. Try to choose someone who is more experienced in one of the areas in which you want to grow.

FAMILY (MIDDLE FINGER)

The word “family” is used broadly here. All of us have important personal connections that nurture us and influence important decisions, such as where to live and practice, whether to work part-time or full-time, etc.

But the practice you choose to join is also a family — a “work family” — with its own traditions, personalities, expectations, and communication styles. Although well-trained teams and effective workflows are integral to a modern practice's success, the culture of the work environment also matters. Poor practice culture can lead to high employee turnover and professional dissatisfaction, both of which are disruptive.

The components of a healthy practice culture include the following:

• Quality working relationships and communication,¹

• Alignment of teams with the practice's mission and goals,

• Mutual commitment to trust, fairness, and helping out.

Action items:

• Seek the input of your closest family members and friends. Their feedback can be invaluable as you weigh your options.

• Identify what strengths you can bring to the practice family in terms of flexibility, teamwork, etc.

• When visiting practices on the interview trail, make a point to engage multiple members of the team — not just the physicians.

• Pose the following questions: Who is involved in decisions that affect the team? How easy is it to ask questions or raise concerns for discussion? How are changes communicated in the practice? How does the practice celebrate its successes? Do members of the team sometimes share a meal together or socialize informally away from work?

FUN (RING FINGER)

Let's face it, we spend a lot of our days giving of ourselves in service to others — listening, supporting, coordinating, and putting out fires. We need to be intentional about adding some fun, levity, and joy to our days so we don't burn out, but different aspects of our lives will require different strategies for enjoyment.

On a personal level, one of the most helpful strategies we've found is to choose an attitude of gratitude first thing in the morning by thinking about what brings you joy and what feeds your sense of purpose, instead of focusing on what frustrates you. In addition, as hard as it is to plan your calendar weeks or months in advance, scheduling regular time away from work to recharge and have fun is essential for well-being. Whether it's a day off during the week, a long weekend, or a real vacation, use the personal time that your employer provides. The work will always be there, but you'll feel better having gotten the break. Synchronize calendars with those you love, so you can maximize opportunities to relax together.

At the practice level, strategies that can affect how much fun you have at work include managing expectations, building emotional intelligence, and cultivating relationships.^2,3 For example, seek out a peer who can listen for a few minutes as you process your day's experiences, and do the same for the other person. It's a great way to celebrate wins while letting go of frustrations. Arrive at work a few minutes early to connect with staff and take an interest in how they're doing. Or consider a weekly lunch with your colleagues to talk about enjoyable things going on in your lives outside of medicine. In addition, be willing to ask for help, and rely on the strength of the team to brainstorm options when something goes wrong or unexpected things happen. Take the time to debrief with your teammates, reflecting on the patients you helped, what went well, and what didn't. And remember to thank your team members for their efforts and insights.

At the organizational level, be a curious and informed citizen. Hospital and health care systems in the United States are in a dynamic state of change, and accommodating change is difficult for everyone. In larger systems, your voice may need to be heard through representational leadership. It's fair to ask questions of your leaders, but try to be patient and assume good intent. When change is slow to emerge, or if you observe an unexpected behavior, don't jump to conclusions. Remain curious and ask clarifying questions without becoming irritated.

Action items:

• Take steps to add some fun to your life and promote your personal well-being. Although this might sound trivial, you will be doing yourself, your future colleagues, and your patients a favor.

• Use “fun” as one of the criteria for evaluating practice opportunities. Is there time for team connection and collaboration? Are the time off and other benefits adequate to protect your well-being? If not, don't accept the offer without negotiating.

• Consider the organizational hierarchy and challenges, and be honest with yourself about whether you can be happy working in such an environment.

FINANCES (PINKY FINGER)

Family physicians in the United States make a comfortable living, and starting salaries for new hires are more competitive than ever. At the same time, the debt burden for younger physicians is at an all-time high. Doctors who need to make money at the expense of work boundaries and professional satisfaction are rarely happy, but prudent management of personal finances can help protect you and your family from significant stress.

Action items:

• Investigate loan forgiveness programs. If you haven't already done so, make an inventory of your loans and their respective interest rates so that you have a better sense of your monthly costs and total indebtedness. You'll be in a better position to negotiate loan forgiveness with a prospective employer, or to consider loan forgiveness or consolidation programs. If you are working in a not-for-profit health system, submit the Public Service Loan Forgiveness (PSLF) application on a yearly basis. Many states and organizations also offer loan forgiveness, so ask your human resources representative.

• Create a budget. A budget helps you quantify your obligations and plan for major purchases, such as a home, car, or vacation. Sit down with your spouse/partner to look at the big picture and develop a budget together. Seeking assistance from a financial professional early in your career can also help you set realistic goals and build on your financial health.

• Live within your means. Make the commitment to stick to your budget. When considering a purchase, ask yourself, “Is this something I need, or something I want?” Be careful about discretionary spending, while still allocating money for recreation. For example, you might consider brown-bagging your lunch most days so that going out for lunch with your partners once a week is a treat. Also, be very careful with credit card debt.

BE INTENTIONAL ABOUT YOUR CAREER

Thriving as a family physician at the front end of your career involves knowing yourself and making a few key choices that allow you to be intentional about building your practice and your web of healthy relationships. Being thoughtful about your goals inside and outside of medicine can help you focus on what brings you joy and what will sustain you over the long haul in your professional calling to serve others.