We are charting new waters in the world of emergency medicine. New residency graduates have to deal with issues that our predecessors didn’t. Issues such as new legislation, the ACA, shifting pay structures, contract turnovers and the iPhone culture (with its inherent good and bad baggage) are just a few examples of the sea change we are currently experiencing.

As a resident, it can be confusing to try to process it all and make a sound decision about your future work environment while dealing with so many unknowns. The short period that we are able to evaluate our job offers during the interview process does not often allow for learning all the details of what is going to keep that workplace healthy. Most residents will graduate and enter into community medicine where contracts are turning over at a faster rate than ever. Hospitals are consolidating into bigger and bigger conglomerates. It is getting harder and harder for the smaller independent ED group to survive against the competition and be successful. Unfortunately, they just don't have the bargaining leverage. Like it or not, that change is here to stay. Our patients still need us. With all that in mind, how does a new graduate ensure stability in their job?

At US Acute Care Solutions (USACS), all ED physicians attend a unique conference called Management Academy. They receive an in-depth financial breakdown of the company’s inner workings. During the most recent academy, Dominic Bagnoli, CEO, showed attendees a slide containing a graph of the most powerful ED groups in the country (based on multiple factors). Then he showed us the same field one year ago. Next, he showed a slide with a graph from just a few months later. This was an astonishing presentation because a third of the previously top 15 groups were gone. These groups were sold or acquired by even larger groups. All of their respective physicians received phone calls or letters indicating there was new ownership. You can imagine the confusion. Would there be new contract negotiations? Did they have partnership tracks anymore? Were they now forced to be independent contractors? Were they going to have to move?

USACS is not one of those disappearing groups. It was founded by emergency medicine physician groups in Colorado, Florida, Maryland and Ohio and capital partner Welsh Carson Anderson & Stowe. This partnership means stable contracts and less threat from any outside groups that want to move in on us. And as a physician-led company, USACS leaders know what you are looking for when it comes to your career.

When you leave your residency programs, look for a group that is adaptive and forward thinking. I can’t stress that enough. It is a big benefit to work with a group that has leverage to negotiate the best contracts with insurance companies and hospitals. It is also a benefit to work within a group that is experiencing healthy growth. Working in a group where each physician has an owner’s mindset and where the health of the organization is put before the health of any individual in power is of critical importance.

I’m glad I was well-informed when I was deciding where to work. That allowed me to choose a group that I knew had a good growth plan. I knew they would make decisions for the health of the group, not just individuals at the top. I would encourage you to make sure you take the time to study the landscape and politics of emergency medicine in its current and future state. As they say, skate to where the puck will be. You need to consider and discuss with your potential employer their five and 10 year plan. I’m glad I did.