Even the most conscientious physician can make a job-search mistake. A misstep in the process can lead to choosing the wrong opportunity, which can prove costly both financially and professionally. Don’t let these trip-ups lead to job-search mistakes you can’t afford to make.
"The first mistake is that people wait too long to start interviewing and considering opportunities," says Tony Stajduhar, president of the physician recruitment firm Jackson & Coker. "Most hospitals are instructed to start interviewing at least a year in advance of when they believe the need is going to be," he says. The goal is to fill those positions as quickly as possible. Delaying your search can result in fewer available jobs.
"The mistake I made was I kind of pushed everything off to the side and just focused on the things we had to do for work and for the program, and so finding a job took a back seat," says Julie Taylor, D.O., an OB/GYN at Highland Community Hospital in Picayune, Miss.
She served as chief resident her final year of training, but figured there would be plenty of time for job hunting. However, the year only got busier. In addition to time constraints, Taylor says some programs are not as open to residents taking time off here and there to go on interviews. Ultimately, she figured out a way to make up for lost time. "I used my vacation to interview," she says. Taylor packed in as many interviews as possible throughout two weeks. Though it might not be an ideal way to spend a vacation, it got the job search done.
Stajduhar says that starting a job search too late can sometimes spark a feeling of panic and lead residents and fellows to stay put by default and find a position in the same place they trained.
But in addition to limiting options and forgoing great opportunities elsewhere, physicians who put location first often end up unhappy with their jobs, says Stajduhar.
In a study of 500 physicians released in July 2012, Jackson & Coker found those who spent fewer than five years in their first job were more likely to cite location as the top priority. Physicians who remained more than 10 years in a first job cited quality of the practice as the most important factor driving the decision. To help physicians avoid making job decisions for the wrong reasons, Stajduhar says his group talks to candidates about four important areas: geographic location, practice type and needs, family needs and money.
Allowing money to drive the job decision can prompt physicians to eliminate rewarding career opportunities for which they might be well suited.
"I think the money itself can be a pitfall," says Cecilia Gambala, M.D., assistant professor of obstetrics and gynecology at Tulane Medical Center. "It’s so hard not to always talk about the bottom line, which ends up being the dollar sign." She has seen physicians accept positions because of money and end up unhappy with the job. Ultimately, the money didn’t matter as much as they thought.
According to Gambala, determining whether you want to pursue private practice, hospital employment or academia is one of the biggest job-search decisions.
She offers one simple suggestion - ask the question: "Where do you see yourself 10 years from now?"
But some physicians who are good at teaching and enjoy it eliminate academia as an option because of lower compensation rates compared to the private sector. According to MGMA’s Academic Practice Compensation and Production Survey for Faculty and Management: 2012 Report Based on 2011 Data, salaries for those in academic settings continue to trail those of physicians in private practice.
For instance, median compensation for family practitioners in academia was $173,801 compared to $189,402 in private practice. Specialists, such as anesthesiologists, received median compensation of $326,000 in academia compared to $407,292 in private practice.
"We all go to medical school because we want to help people," says Gambala, "and in the end, we also want to feel like we’re being compensated and not being taken advantage of." However, she says, you have to look at the big picture when making career decisions and ask yourself if your life will be fulfilled in ways other than money. "It depends on what you value," she says. Though she interviewed for positions in both academia and private practice following her fellowship, "In the end, I was able to say, ’I want to stay in academics.’"
Not doing your homework regarding the customary salary range for the region and specialty in which you are interviewing could be a big mistake. Inadequate research on the organization and its needs is another oversight that can cost time and money.
Ben Wycherly, M.D., an otolaryngologist with the Connecticut Sinus Institute in Farmington, Conn., launched his job search by sending letters to carefully targeted practices. During a professional meeting, he had an opportunity to meet members of one of the practices that had expressed interest in him. He told the group he’d like to visit the practice. They responded warmly and invited him for a visit - but didn’t offer to pay his way. Wycherly made the trip, but throughout his visit, it became increasingly clear that they were more interested in a general otolaryngologist rather than someone with Wycherly’s expertise in ears.
"I didn’t really fully appreciate that until I started talking to the other physicians," he says. "My mistake was really not to figure out what they were looking for and how interested they were in me." He says that if a practice is not offering to pay for your trip to visit them, they probably are not that interested in you. In the end, Wycherly was not troubled by paying his own way as it allowed him and his wife to learn about a new geographic area, one they discovered did not appeal to them as much as anticipated.
According to Stajduhar, going on too many interviews is a mistake that not only costs time and money but also causes confusion. He recalls a physician who was looking at 12 practices over three months. That’s far outside of most physicians’ comfort level or need, says Stajduhar. "Don’t get caught up in numbers or have a pre-conceived number in your mind." He tries to get physicians to take a more studious approach to the job search. It can be as simple as making a spreadsheet of the things you’re looking for in a practice. Then list those things that are critically important to you. "Before you commit to an interview be sure that you’re checking to make sure those things are in place," Stajduhar says.
When recruiters contacted Taylor about a position, she asked them as many questions as she could over the phone. Then she followed up with research online to decide whether or not to move forward with a specific opportunity.
Some of the more common mistakes physicians make on interviews are not knowing enough about the institution or practice, not asking enough questions, and not asking the right questions, says Jon Appino, founder of NewCloud Medical, a full-service recruitment firm. Part of the problem is that physicians don’t always know what questions to ask, says Appino; the other part of it is that people are selling you on the job.
Questions not posed during the interview process can lead to unhappy surprises on the job. One basic question to ask when looking at a position is what the turnover is like, says Kennedy Cosgrove, M.D., MPH, a psychiatrist with Kaiser Permanente in Oakland, Calif. If turnover is high or there is a big demand for locum tenens physicians, Cosgrove says that could be a red flag.
Cosgrove, who has held positions in a variety of practice settings, including academia and locum tenens, also advises asking questions about administrative structure, such as whether your prospective boss is a physician or non-physician.
"There’s one common theme that really determined whether the job ended up being good or not; it was how the leadership of the job was structured," says Cosgrove.
Not getting to know the supervisor well enough before signing on for the job can also be a mistake. Cosgrove has experienced settings in which toxic leadership caused major physician retention problems. In one of those positions, Cosgrove recalls, "they probably went through 10 doctors in the year after I left."
To avoid such a scenario, Cosgrove suggests keeping an old adage in mind: "You’re interviewing them as much as they’re interviewing you." He suggests paying close attention to the prospective supervisor and asking enough questions to learn something about that individual’s personality and how you might get along in a work environment. "If you don’t have a good feeling about it," says Cosgrove, "it’s hard to imagine that it would work out very well down the road."
Neglecting to ask questions about workload and on-call responsibilities can also result in unfortunate surprises on the job. In one of Cosgrove’s positions, there were three physicians covering an inpatient unit of 25 beds. Though eight patients per physician was a manageable load, Cosgrove soon discovered that each physician was gone about one-third of the time for vacation, educational leave and sick time.
During those times, the workload increased by 50 percent - 12 patients per day. Suddenly, it felt like a very different job, says Cosgrove. "That’s not one [question] you always think to ask in a job interview," says Cosgrove. "I would definitely ask how it works for sick leave and vacation time."
Taylor points out that interviewing for a job is different from a residency. In a residency interview, you want to convey a willingness to work hard, so you avoid posing questions about call schedules. "You know as a resident you’re going to be on call all the time. That’s just how it is," she says. But when interviewing for a job, says Taylor, "You want to know exactly what the call schedule is."
Such details may seem like trivial matters to question during an interview, but Cosgrove explains that those are the things that define what your working life is like. "We all, hopefully, know how to do the doctoring part. It’s more the structure of the place that often ends up being a big deal," he says.
Other aspects of the interview process where faux pas can occur include making the trip without your spouse.
"My wife went with me everywhere, which was huge," says Wycherly. It was important to him to get her perspective.
Perhaps everyone’s worst fear during an interview is saying the wrong thing. For instance, "The time to negotiate money is not during the interview," says Stajduhar. And if you have a bad feeling about something you’ve said, make sure you take some time to get together with that person again and say, "Look, I want to clear something up with you," he says. Just be very honest and straightforward.
Unfortunately, contract mistakes can be expensive. "You really want to have a lawyer review your contract before you sign it," says Taylor. She recalls a colleague who did not do so prior to signing on for a first job only to discover later that the salary was not guaranteed; instead, it was based on production.
Though a lot of physicians look at contracts from a compensation perspective, there are many other issues addressed in a contract that are often more important than the dollar figure, Appino points out. He advises physicians to have a lawyer with appropriate expertise review their contracts.
It’s important to make sure you have an out in your contract. Appino has seen instances where departures were extraordinarily expensive. One physician lost $80,000 in bonus money by quitting a position on a Monday instead of on a Friday, Appino recalls, and another had to write a check for $93,000 for a tail policy. If you are not happy with your job or not happy with your boss, there is nothing in a contract that can fix that, says Appino. But if you want to quit, it is important to know what your contract looks like and how much it will cost you to get out. It is far better to evaluate those issues before signing the contract.
However, Stajduhar cautions against taking too long to have a contract reviewed, "Because time will kill deals…" He also advises against major rewriting of contracts. "No hospital or group is going to want their contract torn to pieces," he says.
Mistakes made during the job search process can cause you to miss out on golden opportunities. They can also lead to making the wrong job choice. Getting out of a position and finding another one can be costly. According to Stajduhar, it can take a good 18 months to get a practice up and running. So, if you’ve made the wrong job choice and have to move somewhere else, you have to start the process all over again. There are also plenty of expenses associated with uprooting your family.
But choosing the wrong job takes a toll beyond money. If someone has been changing jobs frequently, says Appino, "Employers are very hesitant to hire or even interview somebody who has been job hopping."
However, Stajduhar says that if you work hard at the beginning of the job search, find the right position, and make the decision for the right reason, you could be there for decades. It still happens.
Susan Sarver is a registered nurse and freelance writer.