competencies to evaluate are surgical residents’ interpersonal and communication skills. The importance
of communication in medicine has been emphasized
since the pre-scientific era and is described strikingly
well in Hippocrates’ aphorism: “Life is short, and Art
long; the crisis fleeting; experience perilous; and decision difficult. The physician must not only be prepared
to do what is right himself, but also to make the patient,
the attendants, and externals cooperate.” 2
In this article, the authors discuss how to develop
a successful career track by learning how to negotiate
contracts with superiors, how to effectively communicate with multidisciplinary teams or co-residents, and,
perhaps most importantly, how to talk with patients.
These basic guidelines should prove useful to surgical
residents seeking a successful career.
Contract negotiation and
a successful career track
In a recent study of 43 surgical residents entering practice, less than a quarter of those surveyed said they
feel confident in their understanding of practice management and leadership. 3 It is admittedly difficult,
especially during the rigors of training, for a resident
to figure out which questions to ask to determine
whether a practice meets his or her needs. How is a
newly minted surgeon able to undertake the Herculean
task of selecting a practice, negotiating a contract, and
making his or her own way in a large group or hospital
employment setting? The appropriate timing, transparency, and tone when communicating with mentors,
family, and potential partners and employers are essential to starting a successful career.
Before looking for a practice, a surgeon should make
several decisions with regard to the practice environ-
ment in which he or she would like to work beyond
choosing between private practice and academia.
Residents should ask themselves what type of practice
they are interested in (solo, small group, large group,
employment by a health maintenance organization
[HMO] or a hospital), determine the potential for
advancement, and ascertain whether the location is
satisfactory, to name a few important considerations.
A recent article indicates that approximately
75 percent of physicians (n= 2,813) are employed by
large groups, hospitals, or health management organizations. 4 In fact, a smaller group or solo practice
may ultimately be absorbed by one of these larger
entities—a possibility that the new surgeon should
consider before joining one of these practice settings.
It also is important to discuss these options with those
who may be affected by your decision, such as one’s
spouse or family, to determine what setting would be
workable for all concerned. Practical concerns include
location, mobility, call schedule, vacation, and so on.
Contacting a mentor at the beginning of your search
may streamline this process and help prioritize nonnegotiable expectations versus factors that have greater
After the physician determines the type of practice
desired, there will often be telephone discussions with
a specific practice to gather additional information.
This will usually be followed by a letter of intent from
the practice, which describes in writing what was discussed. 5 This document is not legally binding. At this
point, the surgeons should contact a contract lawyer for
advice. 6 Next, an offer letter is usually sent; this document is a binding contract that may limit the surgeon’s
options at a later date. 7 This letter provides surgeons
with the opportunity to seek more information before
negotiating the final contract.
It is important to be transparent with the practice when
developing a contract. The contract should contain
details regarding the term length of the contract, automatic renewal of the contract, call schedule, benefits,
retirement planning, vacation, bonus and productivity incentives, tail coverage, disability coverage,
non-compete clauses, contract termination, and so on. 6
The surgeon should decide what he or she can and
cannot live with, and then communicate these items
to the contract lawyer, who can offer advice on what
The appropriate timing, transparency, and tone when
communicating with mentors, family, and potential partners
and employers are essential to starting a successful career.