Melanie Edwards, MD
4 min read
Key Points
  • Cardiothoracic surgeons often are faced with desirable opportunities to change institutions.
  • It's important to take your time weighing the pros and cons.
  • The worst thing you can do is get swept up in the moment and make a decision too quickly. 

At some point in their career, nearly every cardiothoracic surgeon will grapple with the decision of whether to remain in their current position or seek opportunities elsewhere. This decision can stem from unexpected offers, personal and professional aspirations, or dissatisfaction with one’s situation. If every move guaranteed clear benefits, decisions would be straightforward. However, there are always associated costs, and weighing them against the benefits is often complex. 

Financial Considerations

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Melanie A. Edwards, MD
Melanie Edwards, MD

Costs come in various forms, spanning both professional and personal domains. Financially, the costs of a move are relatively evident, including salary differences between one's current and prospective positions. Ideally, a move should yield at least a 20% increase in salary and benefits. However, significant differences in compensation models may lessen long-term benefits. 

For instance, transitioning from a salaried to a productivity-based compensation model could increase salary risk depending on the practice environment. Future salary increases should also be considered, as institutions differ in their frequency and implementation of physician salary adjustments. 

When relocating, especially across state lines, discrepancies in the cost of living should be meticulously examined and factored in when comparing salary differences. These considerations include housing, taxes, education, childcare, food, transportation, and the overall cost of maintaining one's lifestyle. Moving costs are typically covered in new contracts, and the after-tax amount should adequately cover the total expense of the move. However, this renumeration will not account for potential losses in the sale of a home during a move. If a partner or spouse is also employed, their job prospects in the new location necessitate careful evaluation and will impact the balance of financial risk versus opportunity.

Time and Effort

While changing jobs, the investment of time and effort is significant and it will take several years to integrate. Professionally, transitioning to a new institution can feel like starting from scratch. Even if one is heavily recruited, there is substantial work required to rebuild their reputation in a new environment and establish new relationships. 

A referral base must be developed, even if one is replacing another physician. There is the added challenge of navigating the culture of the new organization and discerning when and how to implement changes. Integrating clinical or basic science research and adapting to new expectations or metrics for promotion is also an important aspect to consider.

Personal Considerations 

On a personal level, establishing oneself in a new community requires considerable time and effort. The impact on family when changing jobs and locations cannot be overstated. During the evaluation process, it is crucial to ensure full engagement from one's partner and to consider the needs of all involved. Social support may vary, which could be either an attractive element, especially if relocating closer to family and friends, or a stressor due childcare needs or loneliness. The disruption in routines and relationships for family members may or may not be balanced by the potential growth and development opportunities associated with the move.

Sunk Costs vs Opportunity Costs

It is tempting to dwell on the time and effort already invested in a current job. However, these are sunk costs—resources that have already been expended and cannot be recovered. Dwelling on these costs can cloud decision-making. Instead, one should focus on forward-looking considerations. 

If time and efforted committed to a current job align with personal and career goals, and have the potential to continue doing so, the allure of opportunities elsewhere may be less compelling. It is essential to assess whether desired outcomes are hindered by fixed elements at the current institution or necessitate a change in strategy before assuming that a job change is the answer. Additionally, being aware of the human bias to resist change is crucial. While short-term discomfort during a move and acclimation may be challenging, weigh these factors against potential future benefits, such as improved career satisfaction and quality of life.

The decision to leave one's current job for another is often intricate, involving multiple areas of potential benefit or loss with an uncertain future at the time of decision-making. It is crucial to objectively measure not only the present differences, but also the future potential of staying or leaving, considering both professional and personal aspects.