Erin Roe, M.D., knew that staying in Dallas after finishing her three-year endocrinology fellowship would be a challenge. The metropolitan area has an abundance of good physicians, including those in her specialty.
But because her husband was already a gainfully employed attorney, Roe was up for the task. She knew, however, that she’d have to do more than rely on recruiter leads, job postings or classified ads, since there wouldn’t be many in a saturated market. So her strategy was to find jobs that weren’t yet posted or didn’t even exist by networking with every faculty member, former fellow and other physicians who might know someone who needed a new associate.
After exploring 12 possible work situations over the next nine months, Roe landed several offers, including a position at the Baylor Endocrine Center in Dallas. By merging clinical work and diabetes research, it fits her to a "T." "I definitely did my due diligence," she says. "Many of the positions didn’t exist until I asked. But I kept my fingers crossed that it would work out. It just took some time for the right opportunity to come along."
Whether you’re staying in the same community or moving across the country, searching for the right position can be a time-consuming task in an already jam-packed schedule. The rule of thumb is that you should secure your job six months prior to June graduation. (Statistics suggest that 90 percent of residents and fellows have a position nailed down by December with 75 percent of them settling as early as October.)
That means initiating your search at the beginning of your final training year (or earlier). Although most physicians find 12 to 18 months ample time, you may need longer, depending on your specialty.
Developing a timeline can help you accomplish every task of your hunt: soul-searching, identifying potential employers, interviewing, negotiating a deal, signing a contract and securing your license plus credentials - not to mention house hunting. By starting early and planning well, you’ll not only avoid the inevitable time crunch at the end of training, but you won’t miss that great match!
"The reality is that the best positions are usually taken quickly," says Brett Walker, M.S., FASPR, director of physician/provider recruitment for Indiana University Health. "So if you’re waiting to start your job search until that final six months of training, you could miss out on some excellent career options."
The first task on your training-to-job timeline is to identify what’s most important to you! By knowing yourself, being honest about your priorities and listing your "must haves," you can create an effective road map for your search. Whether you spend 30 minutes a day or two hours a weekend, you need to allow enough time for clarifying your goals and creating a hunt strategy. That includes updating your CV, adding a cover letter, and organizing the questions you want to pose to potential employers.
When Leon C. Adelman, M.D., launched his emergency medicine job search in August, 2010 - 11 months prior to his residency graduation - he focused on narrowing his choice between a community-based practice and academic medicine. Even though Adelman was drawn to the latter during training at Boston’s Beth Israel Deaconess Medical Center, he determined, by talking to former residents and seasoned ER doctors, that community physicians demonstrated near-universal enthusiasm about their choice while their academic colleagues offered mixed reviews.
"My sense from talking to physicians in community emergency medicine was that by and large they had a positive sense of their lives," says Adelman. "They were excited about their work and home life. They had found a nice balance and wouldn’t change anything."
Before joining Philadelphia’s Fairmount Behavioral Health System, Kurt P. Miceli, M.D., had spent nine months as a civilian psychiatrist at West Point. Although working with deploying soldiers was gratifying, Miceli knew that his opportunities as a civilian were limited at the military academy. So when the engagement that brought him to upstate New York ended, he focused on finding a job that would parlay the business degree he earned after graduating from residency in 2008 into an administrative position leading to bigger things. Miceli found that springboard as Fairmount’s medical director for admissions and needs assessments.
Once you’ve established your priorities, you’re ready to identify potential opportunities and make contact. Whether you’re focused on a single region of the country or looking far and wide:
• Search the ads. You’ll find a plethora of job opportunities here in PracticeLink Magazine, online at PracticeLink.com and in the career pages of your specialty’s website and journal. Don’t just assume that interested recruiters will contact you - reach out to the facilities and jobs that interest you, too.
• Contact physician recruiters. Because they may work closely with all the facilities and specialties at their organization, recruiters are great resources who can help you learn where the openings are.
• Attend career fairs. Search for fairs attached to your professional society’s national or regional meeting or that occur as stand-alone events.
• Network. Contacting former residents and fellows plus present colleagues and others (nurses, family members, etc.) is a smart tactic for a variety of reasons, not the least of which is that they may be aware of hidden opportunities.
"Doctors in training are often leery of networking because they have the misperception that it’s glad-handing," Roe says. "But calling up friends who have a feel for what you’re going through can be very helpful. You’re selling yourself short if you don’t take advantage of that."
When Veronica M. Jow, M.D., first contemplated a move from Connecticut to San Francisco after completing a sports medicine fellowship in 2009, she focused her initial energy on an internet search for contacts in the Bay area. Although she met potential colleagues by her follow-up networking, Jow actually found her orthopedic position at Kaiser Permanente Oakland through a sports medicine society website ad. It was definitely personal contact, however, that led to a recent job switch. She was volunteering at the University of California Berkeley when a team and student health physician position opened that better fit her priorities. She interviewed and accepted the offer.
As a born-and-bred North Carolinian, Adelman was eager to return to his southern roots after training for years in Boston. So he put into place an elaborate game plan that included networking for emergency medicine options in the Washington, D.C., area. During his professional society’s job fair, he talked with recruiters and department chairs from several hospitals and followed up with on-site interviews. Yet despite the effort, Adelman switched gears when he and his new fiancée decided the move would not be best. Fortunately, by staying in Boston, Adelman could refocus quickly on his contacts, including his residency program director, and identified the perfect job. Within weeks, Adelman interviewed and accepted an offer at another Beth Israel Deaconess System hospital in nearby Milton.
"The most important thing is to start early," he says. "It helped me tremendously to be one of the first people out of the gate. They hadn’t started talking to too many people, so I was fresh on their minds. They could tell I was motivated and would probably be a good worker because I called early. That was huge."
It’s always beneficial to get your references committed in advance of your first interviews. Since your clinical skills are paramount, you’ll want to tap the teachers, mentors or other colleagues who know you best. Most employers want three to five names, starting with your residency program director or fellowship coordinator. (Your references are good sources for finding out about jobs, too.)
Your references will be asked questions that will help the employer verify that you’re qualified for the position, match the job description and will do well in your new role. They want to know if you’re everything you say you are in terms of your clinical skills, work ethic and ability to be part of a team.
"Administrators are looking for candidates who will add value," says Jane E. Born, CEO of the Coconut Creek, Fla.-based physician recruiting firm Born & Bicknell, Inc. "They want to make sure that this person doesn’t undermine the organization’s sense of purpose, but will complement the staff, fit into the culture and help them move forward."
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There are many reasons to allow enough time for interviewing, not the least of which is that each on-site visit may require 48 hours away from home base. Since time is of the essence, take advantage of the fact that most recruiters and practice administrators request a phone (or even Skype) interview first. It’s a great way for you to find out if the job meets your needs.
Whenever you talk, make sure you’re as inquisitive about the situation as the interviewer will be about you. Probing can help you cut through the clutter to determine which places are worth a visit - or an acceptance.
"A face-to-face interview should be a verification, not a discovery," says Rochelle Woods, president of Mountain Medical Group, a Boulder, Colo., recruiting firm. "If you’re able to have one or two lengthy conversations over the phone with a recruiter or a physician, you can get a strong sense early on as to whether this is a fit for you."
Recruiters suggest aiming for three to four potential places to compare and contrast opportunities. Once you’ve narrowed your search, group your on-site interviews as closely together as possible. By keeping the timeline tight, you can weigh your options simultaneously without missing out on a really good job. Although variations abound, August and September are standard months for interviewing while October is when many deals are done.
"Many young physicians operate under the misconception that the timeline is up to them," says Born. "But once you start interviewing you may have to make a decision more quickly than you anticipated. You can’t expect an opportunity to be there later while you’re interviewing somewhere else."
Although Hamad Husainy, D.O., knew he’d be happy practicing emergency medicine anywhere, he and his wife focused on the Pacific Northwest for its lifestyle possibilities and the fact that their three children would be close to grandparents.
Six weeks after interviewing with Tacoma, Wash.-based St. Joseph’s Medical Center’s emergency medicine group, he accepted an offer that included his top criteria. "Sometimes I felt like I was a little overbearing in doing my search," he says. "But I gave myself enough time to step back and objectively look at each place with a magnifying glass to determine if it was right or wrong for my family and me. This was the best call for us."
Close the deal
Once you’ve navigated the interviews and have an offer, you’re ready to negotiate a deal. In theory, it should take no longer than several weeks for lawyers on both sides to fashion a final document. But it’s probably safer to allow a month, given the slow pace of attorneys and legal departments.
Your offer should include terms that you discussed first during the interview. Part of your due diligence - and that of the employer - is to clarify expectations as to what the job will entail and how you’ll be compensated for it. By the time you receive a preliminary letter of agreement and contract, you should be familiar with the terms, confident there are no surprises, and ready to negotiate minor details.
"If something has been lost in the conversation, you need to see if it can be corrected," says Carrie Galbraith, director of recruitment at Illinois Critical Access Hospital Network in Princeton, Ill. "You don’t want to blow a great opportunity if you can work out any differences. So it’s worth checking back before you move on."
Recruiters and candidates alike suggest getting a boilerplate or sample contract to ensure there’s not a deal breaker in the fine print. Roe made sure that the contract she’d eventually sign for Baylor fit any verbal promises. "You can have terrific warm and fuzzy feelings for a practice," she says, "but if the contract is heavily skewed or contains a deal breaker, you want to know sooner rather than later. Since there’s not a whole lot of customization, especially with new graduates, it’s helpful to have that information upfront."
How do you bow out of an interview or offer if it’s not a good match?
Whether it’s the contract or the chemistry - or even a misunderstanding that might be cleared up later - you want to leave as a desirable candidate, even if your paths never cross again. That means being gracious, honest, specific and fairly quick in severing your ties with a potential employer. Hopefully it will be as early as a pre-screening interview, when both of you have a minimal investment.
Should you leave an on-site interview early?
Although the hiring doctors may welcome your forthrightness, they also might see such a move as unprofessional. When in doubt, finish the visit and politely inform them from home that you want to look further.
Whatever you do, don’t avoid the difficult conversation. Even if you’ve been emailing, call your contact personally. Galbraith recalls a group who had started planning for a physician after being assured that he was on board. Admittedly, administrators had taken a bit too long to complete the contract, but they also had invested time and lawyer fees in someone they believed was committed. So imagine their surprise after forwarding the paperwork that he had signed with another group. "If he had just said a month earlier, ’Hey, I’m really considering this other position,’" she says, "it would have been better for everyone."
Adds Sharee K. Selah, MBA, director of physician recruitment services for the University of Maryland Medical System, "Honesty really is the best policy. Certainly if you find a red flag that’s uncomfortable, you don’t want to waste people’s time. But you also don’t want to burn any bridges. You never know when you may need to come back this way again."
Before joining Philadelphia’s Fairmount Behavioral Health System in May of 2011, Miceli had cast his job hunting net wide, interviewing with six hospitals including one that offered but rescinded a position as chief medical officer. Although Miceli was ready to sign the contract, much to his surprise, someone higher-up in the system than the CEO who negotiated the deal nixed the offer, believing he wasn’t ready for it. The good news was that the same week Miceli lost the offer, Fairmount emailed him. The two sides agreed on contract terms quickly since they had talked general numbers in the past.
Before Husainy landed in Tacoma, he rejected two other places that couldn’t promise a leadership role for at least five or six years, even though it was a priority for him. Moreover, one of the offers existed in a town that was both too small and remote for the Husainys, who love to travel and wanted immediate access to a major airport.
Although the job he ultimately took fulfilled both criteria, Husainy was careful in letting down the other contenders, especially since one involved his wife’s hometown. He thanked the first doctor for the offer but added that they were opting for a bigger hospital with more opportunities. The second hiring physician not only spoke highly of the position Husainy was taking, but has since become a close colleague. "I very much wanted to be open and not burn any bridges," Husainy says. "I may be in this position today but you never know what tomorrow holds."
If you’ve signed your contract by December, you should have the required 90 to 120 days to be licensed and credentialed. By giving yourself a six-month window before graduation, you’ll be ready immediately to treat and admit patients, prescribe medications and bill Medicare, Medicaid and private insurers.
Be prepared for variations, however. It can take up to a year in some states to obtain a new medical license. (You may even have to apply prior to interviewing or navigate a two-step process.) Then again it may be shorter if you’re staying in the same state where you trained. When you start your job search, register with the FCVS so that if you a choose to practice in a state where registration is required, you’ll be ahead of the game.
Also, if you’re a foreign national who wants to stay in this country, you definitely want to secure your job quickly. The faster you have proof of employment, the better your chances of snatching a coveted J-1 or H-1B visa waiver that allows you to stay here beyond training. You need to have your search completed well in advance of the application deadlines.
As soon as you’ve targeted your location, make sure your file is spick-and-span and your references on top of things. Because items get lost and people don’t reply, be ready to intervene if necessary. Jow knew she had to apply for her California medical license months in advance of her August start date. Although she was on the case as early as February, when the license didn’t arrive, Jow took three trips to Sacramento to fill in the missing pieces with the state licensing board. But the delay pushed her start date into September, temporarily costing Jow and her husband, who was still looking for work, an immediate salary plus health coverage. "I was just hoping that nothing happened to us in the meantime," she says.
By allowing adequate time for your search, you’ll be ready to field every possible contingency. Remember, a successful hunt takes strategizing, effort and a realistic timeline. As Selah notes: "The message I try to get across to physicians is that what you put into this is what you’re going to get out of it. If you spend the necessary time and energy, the likelihood of landing the right practice opportunity will be far greater than if you don’t invest the effort."
Even though Roe admits she was probably exceptionally thorough in her hunt, she still advises other candidates to double and even triple the time they assign to it. "Spending enough time, especially on the front end of your search, is definitely worth it."
Chris Hinz is a frequent contributor to PracticeLink Magazine.