As you head into your final year of training, you’ll soon find yourself face to face with the daunting project of landing your dream job. You’ve made an astounding investment of money, time and effort designing and building your professional career - and now you’re almost ready to launch. It may not be rocket science, but it certainly can feel about as complicated as a shuttle mission!
Sadly, a disturbing number of physician career launches seem to misfire. Common wisdom says that about half of young doctors are dissatisfied with their first jobs and end up looking for another position within two years. Actual studies by professional recruiting services indicate a lower percentage of two-year turnovers. About a third of survey respondents left their first position within two years. But about half left their first positions within five years.
Philip Yen, M.D., completed a fellowship in musculoskeletal radiology in 2012 and went to work in July at University Hospitals affiliated with Case Western Reserve University in Cleveland. Based on his recent experience, he recommends targeting six months before your start date as a reasonable goal for signing an employment agreement. That, he says, allows plenty of time for credentialing.
T MINUS 18 months: Physician, know thyself
Deborah Gleason, physician development administrator at The Nebraska Medical Center (NMC), is president of the Association of Staff Physician Recruiters (ASPR), the professional organization for in-house physician recruitment professionals.
Her job involves recruiting and retaining physicians for NMC, the teaching hospital for the University of Nebraska Medical Center. Her connection with the medical school finds her serving as a coach and advisor for doctors in training as they prepare to start their job searches.
She advises physicians to begin their searches at least 18 months prior to their anticipated first day. Her mantra for those wondering where to begin is: "Physician, know thyself." A successful job search starts with figuring out where you want to practice and what kind of practice you want to join (or create).
In fact, Gleason says, "If you don’t have a clue about what you want by the beginning of your last training year, you’ll be playing catch-up throughout your search."
The more you know about what you want (or don’t want) up front, the more efficiently you will be able to use the scant time available for conducting a thorough job search while finishing up your training. Gleason observes that residents and fellows are starting their searches earlier and earlier these days. You simply can’t afford to wait too long.
Yen urges job-seekers to spend a lot of time writing the perfect cover letter to accompany their CVs. The letter must grab an employer’s attention and describe how you will benefit the organization. (See the article starting on page 46 for more CV tips.)
Career coach Jack Valancy agrees with Gleason and challenges job-seekers to begin articulating their key career issues at least 18 months out. He asks residents, "How would you describe a job that you’d like to go to every day?" To answer that question, you’ll have to get in touch with your personal and professional preferences and priorities. In other words, what would you like to do, with whom would you like to do it, and where would you like to do it?
The three "C’s"…plus one
What’s important to you? What kinds of day-to-day job duties interest you? What would you consider a "reasonable" workload? Valancy guides physicians to consider what he calls the "three Cs":
• Culture: In what kind of organization would you feel most comfortable? • Colleagues: Are you interested in finding a group of older, more experienced physicians who can mentor you? Would you rather find other young physicians who share similar interests and values? • Career: How do you envision your personal career path? Do you want to settle into a community where you can remain until your golden years? Do you aspire to administrative or executive work? Do you want to teach? Does research interest you?
Most physicians can find jobs that more or less meet their criteria and satisfy their major preferences - but they may have to make some compromises regarding geographic location or personal and family lifestyle. You’ll have to decide what’s most important to you and your spouse or significant other. What if you find your dream job in a major city, but you have no taste for urban life? What if you have always dreamed of living near the ocean in a warm, southern clime, but your best opportunity opens up in northern Minnesota?
Do your recreational activities and interests rely on location? An avid rock-climber probably wants to live near some climbable rocks. A boating enthusiast needs convenient water. A couple with children may desire an idyllic suburban setting; a two-career couple might like the pace of Manhattan or Chicago’s Gold Coast. Maybe you’d like to live and work in your own version of Mayberry.
What about family proximity? Do you wish to live near relatives - or do you want to avoid being too close to certain family members?
When it comes to location preferences, the critical issues revolve around your priorities. What’s most important to you: what you do, or where you do it?
Married physicians with "his-and-hers" career paths face extra challenges. When both spouses are doctors, those challenges only grow. Omar Naji, M.D., a family practitioner with a fellowship in sports medicine, jumped enthusiastically into the search for jobs for both him and his wife, Bita Khatibi, M.D. Khatibi is also trained in family medicine, but her additional training is in obstetrics, with a focus on caesarean sections.
"In our case," says Naji, "my wife was feeling a little burned out at the end of her fellowship, so I more or less took charge of the job search. Since I wasn’t completely focused on sports medicine, I quickly found many family practice opportunities for myself. But when I came a cross something really interesting, I would ask, ’Is there a position in your community for my wife, a family medicine specialist with additional OB training?’ I quickly learned that there were far fewer openings for what she had to offer."
"I had to completely switch gears," he says. "I started searching primarily for a job for my wife. Physician couples need to figure out what the rate-limiting factor is for them, and adjust accordingly. Don’t waste your time finding a great job, getting your hopes up, and then discovering there’s no job for your spouse."
Though wedded to each other, Drs. Naji and Khatibi didn’t feel wedded to any particular geographic region. They searched all over the United States, and even considered international opportunities. They successfully landed jobs in Vancouver, Wash., which they found through PracticeLink.
Finally - and Valancy emphasizes finally - develop realistic expectations about a fourth "C": compensation. He has met too many job-seekers over-emphasizing money to the neglect of other factors that can have a bigger impact on their well-being and job satisfaction.
Look and learn Take advantage of the wide range of opportunities opening before you. This is your chance to take a look at different practice types. (For a deeper look into your practice options, see page 53.) Valancy urges candidates to keep an open mind - especially early on. "You may find something you love about a job that you hadn’t previously considered." On the other hand, he says you also just might discover some unattractive things about a job you thought would be ideal.
With so many of your colleagues (and competitors) diving into the candidate pool earlier and earlier, you might be tempted to commit to an apparently good opportunity prematurely. Hospitals and practices desperate to secure certain hard-to-recruit specialists might offer generous signing bonuses or monthly stipends for residents who sign a contract or binding commitment letter.
But there’s a good reason why we refer to these sweet offers as golden handcuffs. If you change your mind, you’ll likely have to repay the bonus - an expensive prospect at best.
T MINUS 12 months: Cast a broad net
At about the 12-month mark, you’ll likely be looking at specific job opportunities that have attracted your attention. If you’ve already been making inquiries for six months or so, your name has probably found its way into a number of recruiter databases. Depending on your specialty and other factors, you could already feel overwhelmed by the sheer number of interested employers.
Gleason advises physicians to create a new email account and use it exclusively for your job search. This strategy segregates the potentially voluminous job-search emails, and it makes it easier to organize the offers.
She also recommends using your computer to track the interesting jobs. You can set up a spreadsheet to record each job’s crucial data points. A tool like that can help minimize your confusion as you sort through many opportunities.
"Follow up on any employers who don’t acknowledge receiving your CV," Yen advises. Your package may get lost - especially when we’re talking about an enticing job with many applicants.
First contact Your first serious contacts will probably begin with phone conversations. Remember that you don’t have to agree to a phone call with every employer who shows interest in you.
Naji was surprised at the number of emails and phone calls from practices, health systems and professional recruiters that he received. On the other hand, there’s still time to keep an open mind, and a phone call won’t cost you anything but some of your time.
That’s not to say your time isn’t valuable. Make the most of your phone conversations by asking good questions that elicit useful information. Valancy likes to open with a broad, open question: "Tell me about your practice." Listen carefully to what the caller says - and what he or she doesn’t say.
Note especially what the person talks about first. What topic or theme comes up the most? You can get a sense of what’s important in each organization. Similarly, you might pick up on potential problem areas by paying attention to topics they seem to avoid. An employer who brushes off a question or fails to answer directly signals to you an area that you’ll need to explore more in depth.
Focus a lot of your questions on the job itself. Get them to describe what day-to-day life on the job will be like. Ask about duties, practice setting and call schedules. How much of the work will be inpatient or facility-based? What will your weekly office schedule look like? Does the practice maintain extended hours in the evenings or on weekends?
As you look at interesting opportunities, you will probably develop a routine and a list of "standard" questions. The more consistently you ask your questions, the better you’ll be able to compare and contrast your findings. Along with questions about the job itself, be sure you include inquiries regarding:
• The organization itself: Is it physician owned or part of a health system or larger corporation? Who manages practice operations and oversees executive administration? How is the organization governed? Is there a medical director? A board of directors? • The practice culture: Ask questions to find out if this group is "all business" or more "laid back." How does it integrate, train and mentor new physicians? How much control do individual physicians have? How does the group seek individual input? • The community: Find out what’s remarkable about the patient base - regional demographics and community health. Ask about local amenities, lifestyle, education and real estate. Cover whatever is important to you. • The compensation structure: Ask general questions about the way the group pays physicians. Ask about base salary and productivity. See what you can find out about time off for vacation. Does the group pay malpractice premiums? How does the group generally distribute expenses?
Structure your inquiries around what’s important to you. When it comes to investigating job openings, Gleason says, "Any question is a good question - this is your career we’re talking about!"
Valancy agrees: "Find out about a practice before accepting an invitation to visit. Why waste everyone’s time and expense" on a costly interview trip to a job you’re not likely to accept?
Yen found that it took him about four months from first hearing about an opening to having a face-to-face interview.
T MINUS 9 months: Take your show on the road
You’ll probably find your first few practice visits exciting and fun as some practices expend tremendous effort (and expense) to "wine and dine" prospective recruits. This can prove eye-opening as you begin to get a sense of the value you bring to the table. But beware: It can just as easily blur your vision. Don’t be dazzled by the star treatment. Get past the hotel suites, fancy dinners and real estate tours and dig for a realistic understanding of what it will be like to work with the group from day to day.
Yen reports that he narrowed his search down to two competing opportunities in divergent practice settings - one in California, and the job he accepted in Ohio. He had developed an organized priority list (work schedule and earning potential topped his list), and University Hospitals best met his criteria.
According to Valancy, you can best catch a glimpse of daily life by asking for - insisting - on shadowing one or two physicians as they go about their usual routines. Even when everyone’s on their best behavior for the visiting physician, you can learn a lot about the practice. As you follow the veteran doctor, watch for indicators like these:
• How smoothly does the operation run? • How cooperative and congenial are the support staffers? • How well-maintained are the facilities and equipment? • How happy do the physicians seem to be? Their sense of satisfaction and well-being can be pretty reliable predictors of your own job satisfaction if you decide to settle there. • How happy do the patients seem to be? Not a one-way glass
Of course, while you’re looking over the practice opportunity and community, the prospective employer is sizing you up as well. Arrive at the practice well-prepared and ready to present the value you bring to the practice. Ask yourself, "Why would this group want to hire me?" If you can’t answer that clearly and succinctly, you won’t make the kind of impression that takes you to the top of their list.
Work out what Valancy calls your "elevator pitch" before you make your first practice visit. Interview itineraries tend to be packed tightly, giving you limited time to have in-depth conversations with each of the existing partners and associates. Carefully plan what you can say in just a couple minutes that will leave them thinking, This doctor will add value to our practice.
T MINUS 6 months: Contract negotiations
If you’ve truly done your due diligence over the preceding 12 months, you should have at least one or two attractive, concrete offers by the six-month mark. If you’ve never seen a modern-day physician employment contract, brace yourself: Its size and complexity might surprise you. This is no time for a do-it-yourself approach. Find appropriate professional advice, including qualified legal counsel, to help you understand the provisions and details of the contract.
Receiving a contract, reviewing it with your attorney and finalizing all the details can easily eat up three months or more. If you ask for significant changes in the terms, the discussions and correspondence can drag on even longer. The type of organization trying to recruit you can have quite an impact on how much time is required for contract negotiations. A physician-owned practice hiring its first new doctor in a long time will move much more slowly than a large organization that regularly hires staff members.
Yen was surprised by how long it took to hammer out the contract, and by what felt like a lopsided exchange. It seemed to take forever for the employer to send a contract or a revision, but it pushed hard for the candidate to review and return it quickly. He strongly advises using a lawyer: "Most of the contract details never came up in the interview process; you need help sorting through it intelligently."
T MINUS 3 months: Seal the deal in time for credentialing
Hopefully, you will have applied ink to a signature line at least three months before Day 1 on the job. "The time required for credentialing often surprises young job-seekers," says Gleason. "In Nebraska, it will take at least a month - so I recommend allowing two months." And that’s after spending at least two months getting licensed with the state. She urges residents to allow four months for licensing and general credentialing. "And these," she adds, "are best-case-scenario estimates."
"Measure twice, cut once…"
"…Measure once, cut twice." The old carpenter’s adage reminds young craftsman that it never hurts to double-check your measurements before turning on the power saw. You can’t "un-saw" an expensive piece of lumber. Committing to a job with a medical practice without thoroughly examining your options could lead you to a regrettable choice.
If you find yourself near the end of your training program without having settled on a job offer, Gleason notes that locum tenens work might be a reasonable, though temporary, alternative. She sees more physicians these days opting for temp work as a way to pay the bills and test drive different practice settings. She recognizes the differences between candidates when she notes that there’s no one-size-fits-all job-search strategy or timeline.
Nevertheless, when you consider what it takes for the average physician job candidate to find, negotiate and settle into a new position, who would want to go through all that again in just a few short years? Nearly everyone in the industry agrees that your best job-hunt strategies include an early start - thus allowing yourself plenty of time to make the sound decisions that will launch your career on a successful trajectory.
Tim Boden, CMPE, is an author, editor and a group medical practice management expert.