Your Spouse Is Taking This Job Too. They Just Don't Get a Contract.

A physician chooses the job. The household absorbs everything else the job brings.

The most common reason a placement fails

In 20 years of moving physicians, the most common reason a good placement fell apart had nothing to do with the practice, the pay, the partners or the call. The family was unhappy where they landed.

The physician usually liked the job. Everyone else in the household was miserable, and after a year or two those amount to the same thing.

It sounds soft next to a wRVU conversion factor, and physicians are trained to decide on data, which is why the pattern gets dismissed. It is still the most reliable one I know.

Why it matters: A family that is unhappy with the location has no mechanism for fixing it, and the physician usually does not find out until the move is finished.

A physician can renegotiate almost everything except the address

A physician who is unhappy at work has options. Call schedules get adjusted, comp models get changed, service lines get switched, and none of it requires moving a single box. Almost everything that goes wrong inside the work itself can be addressed in a conversation with your partners.

A spouse who gave up a career they loved and has been angry about it for two years is outside the reach of any of those conversations.

The search is built around one person

The mechanics are almost always the same. The postings are for your specialty, the interviews are with your future partners, and the recruiter calls your phone. Every part of the process is addressed to one person in the household.

Everyone else watches a process that will decide where they live, which school their children attend and what work your spouse can find. Because they can see how much you want it to work, they tend to be supportive in the way that conceals what they actually think.

Somebody says "I could be happy anywhere" in month two and means it sincerely. Nobody has tested the claim, because at that stage there is nothing to test.

The site visit is a sales event

Someone drives you past the good school and the nice neighborhood and the restaurant that just opened.

Nobody shows you what your spouse will do all day, how far the nearest major airport is, or whether the thing your family does every weekend exists within 90 minutes of the neighborhood you were just driven through. The visit is a sales presentation, and you would treat a house tour with more suspicion.

4 things to settle before you look at a single posting

Sit down with the people who are moving and write out what has to be true about where you live. These are requirements rather than preferences, meaning the short list of conditions whose absence would make the move a bad decision regardless of how good the job is.

• Proximity to aging parents. Distance is abstract until somebody gets sick, and then it is the only number that matters.
• A market where your spouse's work actually exists. For some careers this is a real constraint and for others it is not, and the two of you need to know which applies.
• A specific school situation. Every town claims good schools, so name the particular thing your child actually needs.
• A flight that gets you home for the holidays without two connections, or whatever the equivalent is in your household.

Write it down while it is abstract and nobody has fallen in love with anything yet, because once there is an offer on the table the list starts quietly editing itself.

The second visit is the useful one

The second visit should happen without an escort. Spend a Saturday there as an ordinary person rather than as a candidate.

Your spouse should talk to somebody who moved there for a job, ideally another physician's spouse who does not work for the organization. That conversation is worth more than the entire itinerary, and a group that hesitates to arrange it has told you something.

The other career in the household

Some systems have real programs: connections into local employers, help with a spouse's licensure, and a named person whose job this is.

Some will say "we'll help however we can," which means nothing.

Spousal support is a legitimate thing to negotiate, it is often easier for an employer to provide than money, and almost nobody asks. It belongs on the same list as every other term that is worth more than the salary line.

The bottom line

I worked with a surgeon who turned down a job I thought was the best fit I had seen in a year. The group, the money and the call were all better than anything else on his list.

His wife ran a business that could not move, and his mother lived 90 minutes from the alternative. He took the second-best job and he is still in it a decade later.

I remember thinking he had left money on the table. He had, and it was the right trade.

You are the one signing, but you are not the only one taking the job. Get the requirements out of the household and onto paper before the market starts making offers, because the offers are very good at making a short list feel negotiable.

Questions physicians ask about relocating with a family

How do I bring up my spouse's career in an interview?

Directly, and earlier than feels comfortable. Ask what the organization has actually done for other physicians' spouses, by naming a program or giving an example, rather than whether they are supportive. Employers who have a real answer will give you one quickly, because they built the thing on purpose. The ones who offer to help however they can are telling you there is nothing behind the sentence.

What if my spouse says they could be happy anywhere?

Believe that they mean it, and then get specific anyway. That sentence usually arrives early, when the whole thing is still theoretical and everyone can see how much you want it to work. The test is writing the requirements down together while nothing is at stake. A list made in month two holds up better than a feeling reported in month two.

Can I negotiate spousal job help into an offer?

Often, yes, and it is one of the easier asks on the table. It costs an employer less than money, it comes out of a different budget than your compensation, and larger systems frequently have something in place already. Ask for the specific form of help rather than a general commitment, because a general commitment is what you get instead of help.

Should I really turn down the best job for the right town?

Sometimes, and the surgeon above is why. The real comparison is between a decade in the right place and however long you last in the wrong one. A job you leave in three years was not the better job, whatever the offer letter said at the time. Run the requirements first and the question usually answers itself.

Who should my family talk to during a site visit?

Someone who moved there for a job and does not work for the organization showing you around. A physician's spouse is ideal, because they have lived the exact transition you are considering and they have no stake in how you decide. Ask for that conversation explicitly, and pay attention to how readily it gets arranged.