In today’s wide-open job market, hospitalists can pick a plum position anywhere in the United States. With promising opportunities in sunny Hawaii, bustling New York City, and everywhere in between—likely including your own hometown—the temptation to move to a warmer climate, kid-friendly small town, or bigger paycheck may be irresistible.

Michael-Anthony Williams, MD, chief medical officer for the Rocky Mountain Region of Sound Inpatient Physicians, has hired hospitalists who come to Denver from across the country.

“Market competition [for hospitalists] is definitely fierce and will remain so,” he says. “But no matter where you’re looking or what you’re searching for, you need to get a sense of the group you’ll be joining.”

Sameer Badlani, MD, hospitalist and instructor at the University of Chicago, agrees location should come second to the job itself. “You have to do a lot of introspection and decide what you’re looking for,” he cautions. “If you’re unhappy, ask yourself why a new job would be different.”

After taking this advice into account, consider the challenges and opportunities of starting life anew somewhere else.

Career Nugget

Consult the Salary Wizard

How does your compensation stack up? The latest SHM hospital medicine survey offers an overview, but you an also consult the Salary Wizard at Salary.com. The site, updated in January 2008, shows a $171,302 median salary for a typical hospitalist. Check data on hospitalist salary, bonuses, and benefits at http://swz.salary.com/salarywizard.—JJ

Reasons to Relocate

Why think about moving in the first place?

“Money might be the biggest reason,” speculates Dr. Badlani. “The only way to make significantly more money is to become a partner in the practice. I’d say if you’re a hospitalist who’s relocating, you should definitely try to become a partner.”

Another reason to consider moving might be family reasons. “If a spouse gets a job offer in a different city, it’s easy for the hospitalist to move there and find a job,” Dr. Badlani points out. “With the economy the way it is, I think that more and more you’ll see spouses’ jobs influencing where hospitalists relocate.”

Some hospitalists move because they are drawn to a certain region or lifestyle. Dr. Williams says. “We certainly see people who target geography as playing a big role in their job search.”

If you fall into this category, be careful to do your research to discover the realities of your dream location.

“I’d advise that you make more than one trip to a place if you’ve never lived there before,” Dr. Badlani says. “See exactly what it means to live there. Visit the hospital medicine group more than once. Go out with a real estate agent and look at houses.”

The only way to make significantly more money is to become a partner in the practice. I’d say if you’re a hospitalist who’s relocating, you should definitely try to become a partner.

—Sameer Badlani, MD, hospitalist and instructor, University of Chicago

Timing Is Everything

Once you’ve decided you are interested in moving—or have to move—get started with your location scouting and your job search.

“You should start looking [for a job] even earlier when you’re relocating,” Dr. Badlani advises. “And be sure to tell your supervisor that you’re thinking of relocating. This seems like a bad idea to some people, but it will be worse if you wait and give two weeks’ notice. That is unfair to your employer and your colleagues who will have to cover your work, and you will end up burning your bridges.” He recommends telling your current employer while interviewing for next year. If you’re already deep into your search, that should be about six or seven months in advance, he says.

“Your current employer will appreciate it, and they may even try to make some changes in order to keep you,” Dr. Badlani says.

Try to negotiate to keep your transition dates flexible. Your plans to move may not go as smoothly as you’d like. “Recently, we’ve seen a couple of people have a tough time selling their house before they move,” Dr. Williams says. “If you live in a tough real estate market, you might want to see if your new employer can be flexible on your start date.”

Consider Cost of Living

As you compare compensation offered by hospital medicine practices in different parts of the country—or even different parts of the same county—consider cost of living in each area.

“If you make $150,000 in Tulsa, Oklahoma, (then you need to make) $210,000 in Chicago,” Dr. Badlani says, who has worked in both cities. Cost of living, he adds, “can be misleading. Do your research and find out housing costs for the area. Online calculators only give approximations; make sure you compare housing in desirable areas of the city, not across the board.”

In addition, Dr. Badlani says, “If you choose a smaller town, it’s likely that you can get paid more—because they need you more—and live in a cheaper place. And you’ll find more opportunities in a smaller town because there are fewer doctors.”

The biggest challenge when comparing jobs is assessing the work required to make that salary, Dr. Williams adds. “Find out how many shifts per month you’ll work to earn it, and how many patients you’ll see per shift,” he suggests.

Relocation, Negotiation

Before you start negotiating a new contract, Dr. Badlani advises you first look at your current one to see what you’re walking away from.

“Every place has a golden handcuff,” he says. “The University of Chicago gives you three years before you’re fully vested in your retirement benefits; I know an Oklahoma hospital where it takes seven years. Leave before you’re vested and you could lose thousands of dollars in employer contributions. You have to ask, will your new job help you recover that quickly? Can you get a signing bonus that’s equal to all or most of what you’re walking away from, or the promise of a partnership? Try to mitigate that loss with other opportunities.

“Places like Kaiser Permanente offer money to help with a down payment for a house—that’s their version of a golden handcuff. If you stay in the job long enough, that becomes a free loan.”

Dr. Williams adds: “Will the group cover your moving expenses? That’s a lot of money. Also check on the state’s licensing fees and how long it will take to get your license—it varies greatly from state to state.”

While you’re interviewing, keep the negotiation process in mind: “I would never tell a recruiter or prospective employer all the reasons why I’m moving,” Dr. Badlani says. “You don’t want to show how interested you are. It’s a game you have to play. Be sure to say you’re looking at other opportunities and other towns.”

Finally, weigh your options against the rest of the market—and against what your peers are getting in terms of compensation and benefits.

“Talk to your friends and try to figure out what the best deal is,” Dr. Badlani says.

Although you can choose a hospitalist position anywhere in the country, the most important thing to consider is the group you’re joining. If it is not a good fit for your values and personality, then the state you’ve decided to move to will be one of discontent. TH

Jane Jerrard also writes “Public Policy” for The Hospitalist.

Change Jobs Wisely