5 common student loan questions

Being strategic about your student loans and repayment will help you maximize your compensation.

By Jason DiLorenzo | Fall 2018 | Financial Fitness

 

Loan Repayment

As founder of the company Doctors Without Quarters (DWOQ), I speak to residents and fellows often about their financial goals—and how to get there. The answers to these five common questions can help you, too, manage your debt and maximize your income.

1 Most of my federal student loans are between 5.4 and 8.5 percent. Are there opportunities to refinance to lower rates, and if so, does that make sense?

This is an important question, as many students and graduates are being approached or seeing advertising for lower rates available from companies like SoFi, Laurel Road, Credible, CommonBond, Earnest and many others.

The private lending marketplace has become increasingly crowded and competitive over the last year, which is good for borrowers. The issue to consider is suitability, as lenders tend to be transaction-focused and refinancing isn’t always the best option for you.

Once you refinance federal loans to a private lender, you lose all of the federal benefits. Though a 3 percent rate might seem attractive, if it comes with a high origination fee and is a variable rate loan, you might find yourself in a more costly loan if rates go up from their current historic lows.

Even more importantly, a refinanced loan will also not be eligible for Income-Driven Repayment (IDR) plans or the substantial loan forgiveness available through these programs for those who work in nonprofits or public service.

2 Are public service and federal loan forgiveness really viable options?

I’ll assume that most of you at this point are familiar with the PSLF program (if you aren’t, please contact me), and that your residency/fellowship can count toward this 10-year clock if you’re utilizing an IDR. Some people don’t believe that this program will exist as it does currently, and in fact recently proposed legislation suggests considerable changes.

But housestaff at nonprofit programs should be reassured by a few things. For one, the Master Promissory Notes created a legal contract between you and the federal government saying that you borrowed under the assumption you’d be able to utilize the PSLF program under the terms of the program at the time you took out the loan.

Secondly, if you’re actively working toward repaying your loans through the PSLF program and have made economic decisions based on the program’s details, you’ve demonstrated a reliance on the terms as they exist today. As such, the federal government may be obligated to grandfather you in through any changes to the laws. In summary, we hope this means you’re unlikely to be affected by the proposed changes.

3 When and why would it make sense to consolidate my loans?

In July 2010, Direct Loans became the lender for all federal student loans. Stafford and Grad PLUS loans borrowed prior to this time may have been originated by a private lender (Sallie Mae, Wells Fargo, etc.) under the FFEL program. These loans need to first be consolidated to Direct Loans before making IDR payments on them will qualify for PSLF.

Furthermore, Perkins and select need-based loans are not eligible for an IDR on a stand-alone basis, but they can be consolidated to Direct Loans for eligibility. Variable rate loans originated before July of 2006 can also be fixed at extremely low rates through consolidation.

If you’ve yet to enter an IDR, the first step in your action plan is to review all of your loans and determine if a consolidation is necessary to maximize your savings opportunity.

If you have already completed qualifying payments towards PSLF, consolidating to a new loan will actually create a new loan and erase your progress toward PSLF. Don’t do this!

4 What is loan forbearance, and why might using it be a bad idea during my training? Isn’t that what residents used to do?

In forbearance, no loan payments are required, but interest continues to accrue. It’s true that in past years, many residents did not pay on their loans during training. But times have changed, and loan forbearance is typically the most costly option for today’s residents.

Though forbearance allows you more access to your modest training income, it is important to note that ALL of this interest accrues with no federal subsidy or forgiveness opportunity. Furthermore, interest can capitalize in each year that forbearance is renewed. A resident with $220,000 of federal student loan debt will accumulate almost $65,000 in additional interest over the course of a four-year residency by using forbearance.

Choosing among the available IDR plans is likely a superior alternative, as they require affordable loan payments during training, provide an interest subsidy, and can position many residents and fellows for significant loan forgiveness.

5 How should my loan repayment strategy change after training?

This is the most critical loan decision you’ll make if you’ve been using available IDRs strategically during training, particularly if you’re deciding between offers from a PSLF-qualified employer and a private sector employer after training.

In one of our case studies, a graduating resident after four years of training with $250,000 in federal student loan debt was comparing a $150,000 salary directly by a nonprofit hospital and a $205,000 salary from a for-profit program.

After contemplating the after-tax impact of PSLF and the corresponding reduction in payments required for the next six years, the $150,000 salary was actually worth over $240,000 on average for that six-year period. Only by utilizing an IDR during training can you position yourself for this opportunity.

Jason DiLorenzo is founder and executive director of Doctors Without Quarters, which helps physicians strategically manage their student loans. Since 2010, he has spoken at medical schools, hospitals and conferences nationally on the topic of student loan legislation and its impact on early-career physicians.

 

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What’s the difference in physician recruiter types?

Agency and in-house recruiters both aim to help physicians through their job search—but there are some differences in their approach.

By Chris Scites | Fall 2018 | PracticeLink Tips

 

businessman interviewing

As a job-seeking physician, you are probably receiving numerous emails from recruiters. If you’re lucky, you’re receiving far more than you know what to do with.

You may have noticed that some of these recruiters seem to represent specific hospitals or organizations, while others aren’t really clear about who in particular they represent. What you have noticed is the two main types of recruiters: in-house and agency.

Agency recruiters

An agency recruiter works for a staffing agency. Their agency will likely be working for multiple clients to fill their staffing needs—in this case, physicians.

A good agency recruiter tries to strike a balance between keeping the client happy by finding candidates to fill the client’s position in the hopes of repeat business and growing a long-term relationship with you, the candidate, in hopes that you will come back to them for your future job-search needs.

An agency recruiter may not immediately tell you who their client is, so you must go through them to pursue the opportunity. Agency recruiters almost always work on commission, giving them a lot of incentive to place you with one of their clients—but potentially lessening their concern about how good of a fit the position will be for everyone involved.

In-house recruiters

In contrast, an in-house recruiter works directly for a specific company. Sometimes an in-house recruiter may be covering the staffing needs of several facilities that are owned by their employer, and sometimes they serve only one facility. In-house recruiters have no reason to hide who they represent. This is primarily because they are trying to build their employer’s brand, not their own.

Unlike the agency recruiter who serves multiple clients and is interested in filling positions quickly, the in-house recruiter has only their employer to worry about and is just as worried about finding a candidate who will be a good fit long-term as they are about filling the position quickly.

This type of recruiter is usually very familiar with the culture of the company they represent and with the community the position is in, as it’s likely that they live there as well. In-house recruiters are generally salaried, and their pay is not as dependent on a quick turnaround.

The key difference between an agency and an in-house recruiter is that an agency recruiter is trying to fill a position for a client, whereas an in-house recruiter is looking to hire a colleague.

Which approach is best for you?

Deciding which recruiters to approach is a decision that you will have to make depending on your needs. Both types are usually very professional, just with slightly different goals.

Fortunately, once you have made your decision, PracticeLink makes separating the different types easy. Job search results on PracticeLink.com are separated into Employer Jobs (in-house recruiters), which is the default, and Agency Jobs (agency recruiters). After running a search for jobs in your specialty, simply click on the tabs at the top of the results to separate opportunities by their representatives.

Chris Scites is PracticeLink’s physician relations manager. Reach his team for free job-search advice at (800) 776-8383.

 

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What you need to know before signing

Before starting a new job, know your rights and obligations under your contract’s terms and termination clause.

By Sarah Yates Reddy, ESQ. | Fall 2018 | Legal Matters

 

Businessman signing contract making a deal.

Before exiting an employed position, you must know your obligations under the termination clause of your employment contract. So before starting a new job, be sure you know and understand your contract—including what will happen should you leave.

The termination process

Termination is arguably the most important provision in an employment contract. It will spell out if an employer or physician may terminate the contract with or without cause, or if the contract may terminate spontaneously by the terms of the contract or operation of law.

The most preferable contract will allow either party to terminate the contract without cause by prior written notice within a one- to three-month notice period.

With this option, both parties have equal bargaining power and equal access to terminate an employment relationship that is no longer desirable. In this scenario, the physician may terminate the contract by simply providing the employer with advance written notice. An attorney can help you review the notice period, what should be contained within the body of the written notice, how and where to send the written notice, and which clauses of the contract will cease and which will survive termination.

When a contract is terminated for cause, the parties may have more obligations that survive termination than if the contract is terminated without cause.

The reasons an employment relationship may be terminated for cause should be clearly listed and explained within the body of the contract. An employer will typically release a physician with cause for reasons associated with the physician’s inability to continue practicing medicine, including suspension or revocation of license, or felony criminal charges or convictions. The physician will typically have the right to terminate for cause if there is a material breach of the contract that the employer fails to cure.

When it is the physician who is terminated for cause, depending on the language of the contract, the physician may be entitled to some type of appeal.

Regardless of the mode of termination, it is imperative that you immediately consult with a qualified attorney because the rights and obligations of each party will vary widely from contract to contract. You’ll want to be well-informed of any obligations or remedies the contract provides.

Post-termination obligations

Regardless of the manner in which the employment contract is terminated, you and your former employer will have residual obligations to one another that should be clearly outlined in the employment contract.

It is possible that both the employer and the physician may be able to insist on additional duties and tasks of the other party. The common obligations to consider will include billing or record keeping, return of any and all property of the employer, reconciling of the financial obligations of each party, and clarification of all surviving contract clauses.

Pay careful attention to confidentiality, non-disclosure, non-solicitation, non-disparagement and non-compete provisions. Each clause will carry equal legal weight for you, but non-compete provisions are the most immediate concern. Non-compete clauses, also called restrictive covenants, are a restriction on the physician’s employment or practice after the expiration of an employment contract. Prior to entering a contract, carefully consider the level of restriction, including the time period, the designated range of restriction and the availability of buy-out provisions or mutual agreements to release the physician from the restriction.

After termination, consider whether or not the restriction is enforceable, whether or not the circumstances of the termination trigger the restriction, and whether or not this restrictive covenant includes a restriction on the solicitation of your former employer’s patients or employees.

By consulting with a qualified attorney with expertise in physician contracting before you sign your employment agreement, you will be certain that the terms of possible termination are fair and reasonable.

Sarah Reddy is an Oklahoma licensed attorney and partner with Reddy & Feldhake, P.C., and associated as counsel with Premier Physician Agency, a national consulting firm specializing in physician job search and contracts.

 

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What physicians make (and why)

Nothing looms quite as large for your future as negotiating the best compensation package possible.

By Chris Hinz | Fall 2018 | Feature Articles

 

Negotiating compensation requires an understanding of the value of your skills and an assertive approach. Both helped Theresa Rohr-Kirchgraber, M.D., further her career. -photo by Rebecca Shehorn

Negotiating compensation requires an understanding of the value of your skills and an assertive approach. Both helped Theresa Rohr-Kirchgraber, M.D., further her career. -photo by Rebecca Shehorn

Obviously, you want a nice financial payoff for your skills. After all, they’re worth top dollar by every professional measure. But there are big picture realities to consider, too. Specialty, practice type and geography have already shaped your final offer in ways that you might or might not have suspected. How do they move the dial up or down?

Words like value and supply versus demand come immediately to mind. They’re the underlying drivers that make these three factors so important in what you’re able to earn. They’re also key to many of the compensation surveys administrators use as one critical tool in designing how much you’re going to make.

“It’s not just a random executive pulling a number out of a hat and offering it to a physician in hopes that he or she will take it,” says Jon Appino, principal of Kansas City, Missouri-based consulting firm Contract Diagnostics. “It tends to be very purposeful and calculated from the employer’s perspective on what administrators are offering most of the time.”

As to the specific roles of specialty, practice type and geography, let’s take a closer look.

Specialty

The specialty you’ve chosen will be the biggest determinant of your compensation by far. Even though primary care physicians and their non-surgical specialty colleagues are well-paid professionals, providers in procedure-rich specialties tend to rise to the top of medicine’s financial hierarchy.

Why? They experience the highest reimbursement rates for the complex tasks they perform, which ultimately is reflected in their pay. Simply put, if you’re in orthopedics, anesthesiology, cardiac and other surgeries, what you do will likely put you in the cat bird seat in commanding a top salary. Of course, other forces, such as supply and demand, can help shape any package. At its core, however, compensation is often less about the number of patients that you see and more about the nature of your services and the value assigned to them.

RVUs lead the way

Wherever you are in your medical career, you can’t underestimate the role of two acronyms — RBRVS and RVU —in how much you’re ultimately paid for your work. Shorthand for resource-based relative value scale and relative value unit, both terms have been integral to most physician practices since 1992, when the Centers for Medicare & Medicaid Services (CMS) launched RBRVS to bring consistency to the way that it pays physicians and health facilities for their services.

By assigning specific values—the RVU part of the system—to every CPT (current procedural terminology) code, Medicare, Medicaid, and some private insurers alike have a standard methodology by which to issue reimbursements.

But how do those values eventually turn into compensation? Hiring entities have their own formulas for parlaying work product into salaries and productivity bonuses. Many still use volume-related metrics such as number of patients or the amount of fee-for-service collections to craft a plan. As more payers rely on RVUs in calculating reimbursement, however, those values become increasingly critical compensation measuring sticks. If your package depends on RVUs, you want to make sure you understand the particular schema, given the plethora of complicated methodologies using them today.

In determining production and incentive bonuses, employers are primarily interested in physician work or wRVUs because they account for the time, training, technical skills and judgment a physician employs in diagnosing and delivering care. Other components—practice expense or peRVUs and malpractice RVU or mRVUs—are baked into the reimbursement pie to account for the higher direct, indirect and liability costs of providing the service.

“This is all about the effort expended in order to provide a service,” says Fred Horton, president of AMGA (American Medical Group Association) Consulting. “We’re not going to pay you based on some other type of overhead or malpractice methodology. We’re going to pay you based on your work.” Adds Travis Singleton, senior vice president of Dallas-based physician recruiting firm Merritt Hawkins: “The net outcome is to equate difficulty and value to what the physician does.”

Winds at selective backs

Even within a specialty, your ability to command top dollar is still a mixed bag depending on other forces. Being a pediatric neurologist, for instance, may increase your compensation into the medical subspecialty realm, but not into the procedural realm. As to other specialties, supply and demand is the focus. Pathologists, for instance, have been harmed lately by a difficult market. Appino can only speculate as to the reasons—perhaps technology has improved efficiency or training has produced too many. Yet with fewer job openings now than in the past, employers have the upper hand. On the other hand, rheumatologists and other short-supply specialists such as neurologists and urologists are definitely seeing an uptick in their financial outlook. With an aging population demanding their skills, in many cases they can write their own tickets.

And what about primary care? You’re likely still bringing up the compensation rear, even with promises since RBRVS originated in the 1990s that your field would one day be rewarded equal to that of procedural-based groups. Citing AMGA survey comparisons of 20 specialties between 2009 and 2017, Horton notes that orthopedic surgery still holds the top place with family medicine, internal medicine and pediatrics anchoring the bottom. “Basically, they haven’t moved at all,” he says. “The wealth hasn’t really been redistributed as promised.”

That doesn’t mean, however, that there aren’t promising exceptions. As a residency program faculty member with Jacksonville, Florida’s St. Vincent’s Family Medicine Center, Robert Raspa, M.D., is in charge of 30 family medicine physicians, with 10 not only graduating each year, but also heavily recruited for their skills.

New physicians may need to be assertive about their worth even as they’re being wooed. Theresa Rohr-Kirchgraber, M.D., preaches the value of assertiveness to her residents and fellows as the executive director of the Indiana University National Center of Excellence in Women’s Health.

Rohr-Kirchgraber, who is also the Barbara Kampen Scholar in Women’s Health, doesn’t have to look further than her own experience as an example.

Board certified in both internal and adolescent medicine, she went to bat for herself after discovering that her primary clinical appointment in pediatrics was costing her thousands of income dollars. Although she held a secondary appointment in internal medicine and saw mostly adult patients, administrators weren’t keen on upsetting the parity applecart with her pediatric colleagues by just changing her status but keeping her in the adolescent division.

It took some negotiating, but Rohr-Kirchgraber succeeded in switching the appointments. In practical terms, she now has fewer interactions with her adolescent medicine colleagues, but she’s finally on par salary-wise with other internists. “We’re always trying to be nice and helpful because we’re just so grateful,” she says. “But we have to recognize that we bring a completely different set of skills to the group. We need to understand our worth.”

Practice type

The majority of newly recruited candidates—some estimate as high as 70 percent—will join hospitals, medical groups, urgent care centers, clinics and other structures as dedicated hires, not necessarily future owners. What does employment specifically mean for your compensation package? For starters, you may not be bearing the brunt of the business responsibilities shouldered by your self-employed colleagues, but you’re also likely to experience a lower average income as a price for the freedom.

At least one survey, Medscape Physician Compensation Report 2017, demonstrates that while increased numbers of physicians are choosing an employed position, they’re also likely to earn less than their self-employed counterparts. The 2017 results reflect overall differences of 28 percent between the $343,000 average earnings per year of providers willing to take on the business demands of private practice and $269,000 for their employed peers.

Whether you’re hired by a health system or perhaps even a group, your compensation will be built initially on a base salary, which provides a predictable income level for your clinical services. The package will also include an incentive bonus that rewards your productivity and, in some cases, the standard of your work. Beyond the type and volume of your services, you may have to demonstrate your worth via quality outcomes plus other harder-to-quantify measures such as patient satisfaction and corporate citizenship.

More than likely, however, you’ll be rewarded based on some sort of volume metric. Even though there’s wide variety in the incentive models and formulations used today, there’s a better-than-average chance that your plan will revolve around RVUs.

“We can say that we want to move to quality, but fundamentally mathematics still work on volume,” Singleton says. “To me, RVUs are the bridge from volume to value. It’s the best we have at the moment.”

The nuanced ins and outs

It’s incumbent on you to understand the parameters of your specific plan, given the potential nuances. For instance, depending on the formula, the incentive portion of your deal may involve a modest kick-in for the first and second years while you develop sea legs and a following. After that, your salary may be gradually reduced or even eliminated, leaving you dependent solely on whatever productivity and/or earnings structure your employer has in mind.

Whatever the case, you need transparency. Too often, say experts, physicians look at the numbers and just assume what’s behind them rather than understanding where they come from or how they’re set. “One of the things that continues to amaze me is how many physicians can’t recite how they’re being paid,” says Horton, noting his surprise at job incumbents who don’t know the ins and outs of their original compensation packages. “They’re able to tell me how much they make but they can’t necessarily articulate the mechanics. And that’s really important.”

Geography

In medicine, like business, location is often everything—including playing a role in what you can earn, especially given supply and demand for your skills. When considering the trifecta of factors—compensation, location and practice type—that are key to any job decision, Appino suggests prioritizing the two most important ones since you likely can’t have all three.

Why so? Popular places to live and work may not offer the best shot at the best deal. If you’re willing to accept a smaller package, by all means hang tough for that idyllic place you’ve always associated with a great life. But if money is a priority, you might need to open your eyes to areas of the country that hadn’t been on your radar.

It takes more than compensation to make a physician happy in a new job. “Our feeling is that if you want to attract good people then you have to give something better than anyone else,” says Salim Surani, M.D. -photo by Dustin Baker

It takes more than compensation to make a physician happy in a new job. “Our feeling is that if you want to attract good people then you have to give something better than anyone else,” says Salim Surani, M.D. -photo by Dustin Baker

Mega trends at work

Regional analyses from the Merritt Hawkins 2017 Review of Physician and Advanced Practitioner Recruiting Incentives confirm that physician salaries tend to be highest in the Midwest and Southeast. Both areas are top pay strongholds, say the authors and other experts, because of a healthy dose of fee-for-service medicine, good payer mixes with comparatively high reimbursement rates and a large number of productive, independent physicians. There’s also a lower physician-per-capita ratio.

Conversely, physician incomes tend to be a bit suppressed on the West Coast because it’s typically the highest capitated market with the most managed care, says Singleton. Likewise, lowered physician incomes on the East Coast, particularly the Northeast, also reflect a relatively high prevalence of managed care/capitated compensation plans as well as competition.

That’s not to say there aren’t pockets that run counter to existing trends; just that you should be aware of umbrella forces driving compensation where you might want to work and live.

Final thoughts

Whatever your specialty or skills, you’ll need facts on hand to achieve a financial payoff that befits your experience and skills. By knowing how specialty, practice type and geography move the dial on any offer, however, negotiations may no longer loom quite so large.

 

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The best patient education app

The app I most recommend helps patients understand if early breast cancer screening will benefit them—or not.

By Iltifat Husain, M.D. | Fall 2018 | Tech Notes

 

In this edition of Tech Notes, we’ll cover two applications, each made by venerable medical institutions. Though one of the apps I write about, from the American College of Cardiology, is great, my favorite is from a collaboration between Weill Cornell Medicine and Memorial Sloan Kettering Cancer Center. They’ve produced the best patient education app I have ever reviewed or used—no exaggeration.

WCM BSD

Price: Free. Apple: apple.co/2MzeAfw

Price: Free. Apple: apple.co/2MzeAfw

I’ve reviewed and downloaded thousands of medical applications since 2009, when I wrote my first article on iMedicalApps.com. I’ve never said this statement about a medical app before, but I’ll say it now: The WCM BSD application is the best patient education app that has ever been created.

It takes a ridiculously complex and sensitive issue, breast cancer screening before the age of 50, and does what no one could do for years: explain it to patients in an uncondescending and educational way that just makes sense.

When the U.S. Preventive Services Task Force (USPSTF) released their draft report of breast cancer screen recommendations in 2009, they advised women to start getting mammograms at age 50 rather than 40, and recommended that screening happen every two years instead of yearly.

This caused a huge uproar and an absolute frenzy in the media because it was a drastic change from recommendations that had been made by other groups. Further, the way it was explained at the time by the USPSTF was not ideal. The USPSTF struggled to explain the real harms vs. the nominal benefits of early screening in the majority of the population—a population that tends to believe that early screening is always a good thing.

The USPSTF recommendation also made it seem like breast cancer screening should never happen before the age of 50. It didn’t consider the risks and benefits of screening from an individual patient’s perspective and experience.

In 2016, the USPSTF updated their recommendations to include the following Grade C recommendation: “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.”

This recommendation is difficult for patients and physicians to manage because it’s hard during a 10- to 15-minute office visit to truly explain and understand the patient’s risk, context and values.

Enter the WCM BSD app, a collaboration between Weill Cornell Medicine and Memorial Sloan Kettering Cancer Center.

WCM BSD is a tool to help patients and their physicians decide how often they should have screening mammograms performed.

Some of the key questions the app is designed to answer include:

  • Should you have screening mammograms in your 40s or wait until you are 50?
  • Should you have a mammogram every year, or every other year?

The app also helps patients see their own personal risk of breast cancer and learn the benefits and harms of screening mammograms.

After a patient enters responses to a series of 11 questions, the application displays the patient’s overall risk factor as a pictograph. This type of visual representation is much easier to understand than percentages or statements, such as “your chance of developing breast cancer in the next 5 years is 0.7%.” The app also explains what a screening mammogram is and how it is performed.

An important part of the app is the “benefits and harms” section. The general public has a good understanding of the benefits of screening mammograms, but often doesn’t realize there can be serious harms, such as false results that cause unnecessary biopsies, or diagnoses of slow growing breast cancers that end up getting treatment but wouldn’t have changed overall morbidity or mortality.

One of the most interesting parts of the application is the section that shows how well mammograms perform in women with similar profiles. Here, users can see—with another pictograph—how many cases of breast cancer are caught by early screening compared to how many screenings return false positives.

The USPSTF’s recommendation to take a patient’s values into account isn’t easy; the WCM BSD app handles this well. With their answers to eight statements, patients can help physicians better understand their opinions and feelings about early breast cancer screening. This truly empowers the patient.

Clinicians with patients in their 40s who are considering mammograms should tell those patients to download the app and schedule a follow-up appointment to discuss the results. There’s also an online version of the decision tool if patients don’t want to use the app: bsd.med.cornell.edu.

My only negative comment about the app is it isn’t available for Android phones—yet.

TreatHF

The American College of Cardiology was one of the first medical societies to start launching medical apps for smartphones. Their more than 20 medical apps in the Apple App Store alone range from medical calculators to clinical decision support tools. Almost all of their apps are free to use, and they are a great resource for both cardiologists and primary care physicians managing patients with cardiovascular disease.

TreatHF is an app from the ACC that focuses on helping providers manage patients who have heart failure. (This app addresses patients with reduced ejection fraction (HFrEF), not patients with preserved ejection fraction (HFpEF).)

TreatHF is based on the ACC’s Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment and the 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.

The app starts the heart failure assessment by asking NYHA classification, LVEF range, types of medications the patient is and isn’t on, renal/hepatic function status, and age.

From there, TreatHF gives advice related to the patient, such as medication change suggestions and even titrations of key medications. Medications and classes of key medications, specific dosing and frequency are all included in the suggestions.

The last section of the app, “therapies,” contains sections such as “guiding principles for treatment,” further information on classes of medications, considerations for ICD placement and more.

The app’s user interface is clean and simple to use. TreatHF does a great job of using bullet points and dropdown menus to present a wealth of information in an easy-to-digest manner.

Iltifat Husain, M.D., is editor-in-chief and founder of iMedicalApps.com, the leading physician publication on digital medicine. He’s also assistant professor of emergency medicine and director of medical app curriculum at Wake Forest School of Medicine. Learn more about our contributors on page 20.

 

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Live & Practice

Tennis Towns

By Liz Funk | Fall 2018 | Live & Practice

 

A love for tennis comes with countless options. Indoor or outdoor? Social or competitive? Spectator, singles or doubles? Fortunately, these cities—which boast great opportunities for physicians—offer everything a tennis aficionado could ever want. From a casual game at a new, state-of-the-art facility to match point in paradise, tennis players will love these locations and all the other career and lifestyle benefits that come with them.

Stillwater, Oklahoma

Stillwater has been called America’s friendliest college town. As home to Oklahoma State University and Stillwater Medical Center, the city of just under 50,000 boasts a strong sense of community. It’s not just the city that receives accolades, though; Stillwater Medical Center has been named one of the “Top 100 Places to Work in Healthcare” for seven years in a row. With access to a highly educated patient population, as well as abundant athletic and cultural opportunities, physicians can find a great work-life balance in Stillwater.

As a surgeon at Stillwater Medical Center, Cara Pence, M.D., is able to both practice medicine and participate in medical missions in her spare time. -photo by Josh Dean

As a surgeon at Stillwater Medical Center, Cara Pence, M.D., is able to both practice medicine and participate in medical missions in her spare time. -photo by Josh Dean

Cara Pence, M.D., knew she was meant to be a surgeon. Still, she wrestled with the decision. She attended medical school at the University of Oklahoma College of Medicine in Tulsa and intended to specialize in family practice and ultimately go on medical missions. She had not enjoyed her rotation in family practice, but she tried to dismiss her doubts.

Then, when Pence was on her surgery rotation, a patient who had been stabbed in the heart arrived in the emergency room. He needed his chest opened and sutures in his heart.

“I knew I was probably the lowest person on the totem pole in the room, but I ended up being able to hold and touch his heart, retracting and holding back lungs,” she says. The patient survived, and Pence says the experience stayed with her, even as she fought against surgery’s calling.

“I kept telling myself there was no way I could be a surgeon,” she says. “I thought I wouldn’t have time to be a wife, have a family or be a good mom and Christian.” Instead of pursuing surgery, she decided to go into pediatric neurology because her sister has cerebral palsy.

“I was a couple weeks away from starting my internship in Houston for pediatric neurology when I started to get sick to my stomach. I knew it wasn’t right.” As Pence recalls, she told her husband, Jared, she wanted to be a surgeon. He replied, “Yeah, I always knew you were going to be a surgeon.”

Six months later, Pence finally acknowledged that surgery was her calling.

Now, as a general surgeon at Stillwater Medical Center with the ability to go on medical missions in her spare time, Pence knows she is where she is meant to be. “I knew I wanted to work at a place with a supportive team atmosphere while also working with physicians that challenge me.” She says she knew without a doubt her colleagues at Stillwater Medical Center would foster that type of environment.

Because Stillwater Medical Center is a community hospital, there are also other benefits. “All decisions are made by local leadership, both on the management and board level. This allows us to have a cohesive medical team that makes the patients, not the bottom-line, the priority,” says Joy Haken, a recruiter at Stillwater Medical Center. Haken also notes the facility is “one of the few community-owned hospitals that has operating margins averaging 7.5 percent over the past five years,” indicating a strong sense of financial stability.

The 117-bed acute care general hospital serves patients across north-central Oklahoma, and is staffed by more than 1,200 employees and over 100 physicians. In addition to the hospital’s recurring awards for high employee satisfaction, the organization has also earned recognition for quality in patient performance and outstanding leadership.

According to Haken, Stillwater Medical Center also offers “the latest in technology so our patients don’t have to drive out of town to receive medical care,” with advancements that include robotic surgery, Xenex Germ-Zapping Robots and 3D mammography.

The hospital is currently recruiting for gastroenterology, internal medicine, hospitalist, interventional cardiology, invasive/noninvasive cardiology, psychiatry, pulmonology and emergency medicine. When Haken talks to prospective physicians, she highlights that Stillwater is a “small city with a small-town feel, with all the qualities of life that are needed for families to prosper,” including great schools, affordable housing and entertainment.

Cristy Morrison, president and CEO of Visit Stillwater, underscores the strength of the community in the small city.

“Stillwater is an extremely educated and tight-knit community,” Morrison says. “We are lucky to have great university and community relations that encourage graduates to remain a part of the community post-graduation, or visit throughout the year to attend cultural and athletics events.” The university is part of the Big 12 Conference, and the city also has the ability to accommodate regional and national NCAA events, as well as Pro-Ams in various sports.

Those who want to play or watch tennis are in luck, as the sport has become even more popular since the completion of the Michael & Anne Greenwood Tennis Center on the OSU campus. The 50,000 square foot center includes 12 outdoor lighted courts, as well as an indoor facility that houses six courts and can seat at least 350 spectators. According to Morrison, the center was “the only collegiate facility to receive recognition by the United States Tennis Facility with an ‘Outstanding Facility Award.’” Looking forward to 2020, the university will host the NCAA Women’s and Men’s Division I Tennis Championships.

Outdoor recreation, including golf, is also popular, as are cultural events like the Annual Stillwater Arts Festival, which, now in its 41st year, is one of the city’s longest-running events. There’s also the Calf Fry, a music festival featuring popular “red dirt” and country artists, the Land Run 100 bicycle race, the Stillwater Blues Festival and the Payne County Fair.

“The wonderful thing about Stillwater is that there is always something going on in town,” says Rachel Burnett, Stillwater Chamber of Commerce business services coordinator. “All ages can enjoy the culture of the town, while appreciating the food, music and fun offered by local community business and organizations.”

Pence says she loves living in Stillwater because of the people. “There is a special bond in this community, and we always step up to take care of each other. My kids love their schools, too! It’s a great place to raise a family.”

Honolulu, Hawaii

With great weather and beautiful vistas, it is not hard to find a reason to get outdoors for a tennis match in Honolulu. Located on the island of Oahu, Honolulu is known for its diverse population, its welcoming aloha spirit and its year-round moderate climate. Hawaii is known as one of the healthiest states in the country, but it also has an aging population, and physicians on the island interact with patients from many ethnicities and backgrounds.

Rajive Zachariah, M.D., an internal medicine physician, moved to Honolulu for his residency at the University of Hawaii. Now, he works at Straub Medical Center, which employs over 400 physicians and serves patients in more than 32 different medical specialties.

“Honolulu has to be one of the most beautiful cities in the world,” he says.

The good vibes that result from great year-round weather and beautiful scenery make a strong case to physicians considering Hawaii, but that is not all that makes Honolulu special. According to Peggy Andes, a physician recruiter at Straub Medical Center, there is something different about Hawaii’s culture that makes it attractive to candidates.

“Hawaii is unique in that our population is a blend of many diverse cultures and ethnicities. The concept of the aloha spirit—and being kind, welcoming and good to one another—is something that resonates with candidates,” says Andes.

Straub Medical Center is serious about welcoming new members to their team, as Hawaii is currently experiencing a physician shortage. “We are always looking for physicians who are interested in making a difference, providing quality care and contributing to our mission,” says Andes. The organization is currently recruiting physicians for internal medicine, family medicine, neurology, otolaryngology, cardiology and urgent access.

The medical center, which is part of Hawaii Pacific Health, has 159 beds and includes a network of neighborhood clinics on Oahu, Lanai and the Big Island, as well as a visiting specialist program that reaches throughout the state. According to Andes, Straub Medical Center is also home to the Pacific region’s only multidisciplinary burn treatment center and has been on the forefront of bringing new technologies and innovative practices to Hawaii, including minimally invasive cardiac surgery and total joint replacement.

With Hawaii ranking as one of the healthiest states in the country, physicians in Honolulu focus on keeping their patients healthy, emphasizing prevention and proactive care. Because the state does have an aging population, there is also an emphasis on chronic disease management. Given the diversity among Hawaii’s population, physicians have the opportunity to interact with patients of many different backgrounds. When serious health issues arise, Straub’s specialists in bone and joint care, cardiology, oncology, gastroenterology and beyond are among the best in the state.

When it comes to lifestyle, physicians have it all in Hawaii, says Andes. “Our moderate climate offers the opportunity to enjoy outdoor activities year-round, like golf, hiking, surfing and many other water sports.” Physicians can even get their exercise on their commute to work, thanks to a recently launched city-wide bikeshare program that has a stop right next to Straub. (No fear, biking-averse: There is also a great public bus system.)

Of course, there is also tennis. The Hawaii Tennis Open, which falls around Thanksgiving, is a Women’s Tennis Association tournament sponsored by the Hawaii Tourism Authority. A relatively new event, it is only in its third year, but the world-class tennis draws a crowd.

There are also numerous tennis associations and clubs that offer opportunities for social tennis or competitive matches. The Aloha Tennis Association, the Diamond Head Tennis Center and the Beretania Tennis Club all offer a variety of different opportunities. Whether you want to play a leisurely game and meet new partners or compete in a tournament, you will find a fit among all of Honolulu’s facilities and organizations.

On the tennis court, encompassed by green space (as you are at the Diamond Head Tennis Center), it is easy to forget that a cosmopolitan city is steps away. Honolulu boasts an eclectic food scene, a shopper’s paradise, and stunning arts and culture landmarks. There is historic Pearl Harbor and iconic Waikiki Beach, as well as vibrant annual celebrations of the local arts and cultures, including Chinese New Year, Honolulu Festival, Mele Mei (a month-long celebration of Hawaiian music), the Ukulele Festival and many more.

Of course, there are lots of opportunities to soak up the beauty of nature, too.

In his time off, when he is not stand up paddle boarding or exploring a new hike, Zachariah says he sometimes likes to enjoy the view of Diamond Head—a defining feature of the landscape, whether you stand atop or below it—from one of Honolulu’s nice restaurants.

“I am reminded how lucky I am to be here every time I step outside,” he says.

Rochester, Minnesota

Rochester is home to the Mayo Clinic, which was recognized as the best hospital in the nation for 2017-2018 by U.S News & World Report. Devoted physicians, scientists and researchers all call Rochester home and can enjoy the relaxed community life that embodies the Minnesota way. With four distinct seasons, there are ample recreation opportunities whether it’s 20 or 80 degrees outside, including plenty of excellent outdoor and indoor tennis facilities.

Every two weeks, you can find pediatrician Angela Mattke, M.D., hosting a Facebook Live show called #AsktheMayoMom. As a pediatrician in the Division of Community Pediatrics and Adolescent Medicine at the Mayo Clinic Children’s Center, Mattke brings in experts to talk about topics relating to pediatric health, fielding live questions from viewers along the way.

“During my third-year pediatrics clerkship in medical school, I fell in love with pediatrics,” says Mattke. “Despite being exhausted, I was excited each morning for rounds. Practicing medicine in pediatrics energized me, and still does.”

As a born-and-raised Minnesotan, Mattke earned her medical degree at the University of Minnesota, spending her first two years at the Duluth campus, where there is a special focus on producing primary care physicians dedicated to serving Minnesota’s communities.

When it came time to choose her residency program, Mattke says she was thrilled by the caliber of the education at Mayo Clinic. “The attending physicians—called consultants at Mayo Clinic—showed genuine interest in the education of their medical students and residents.”

“At Mayo Clinic, staff are surrounded by some of the most talented, experienced physicians in the world,” adds Amy Boxrud, director of physician recruitment at Mayo Clinic. “We have a strong culture of teamwork, professionalism and mutual respect where the needs of the patient always come first.”

Now, Mattke works collaboratively with other physicians to deliver the best outcomes for her patients, and it is one of the things she finds most rewarding about Mayo Clinic.

“The collaboration between medical providers—primary care, specialists, the whole care team—is what makes this place one-of-a-kind,” she says. “The needs of the patient truly come first.”

Mayo Clinic’s patient population is far-reaching, with over 1.3 million people from all 50 states and 136 countries visiting the center for care this year. The organization employs over 4,500 staff physicians and scientists and close to 59,000 administrative and allied health staff. Mayo’s extended campus comprises about 30 buildings, and the integrated medical center provides medical diagnosis and treatment in virtually every specialty.

Rochester, with a population of about 125,000, is “considered a smaller or medium-sized city with world-class health care,” says Brad Jones, executive director of Experience Rochester Minnesota. “Mayo Clinic is the community. Everything is integrated.”

According to Jones, Rochester provides plenty of opportunities for work-life balance, allowing physicians to “slide into a more relaxed community life” once they leave work.

“You don’t feel like you need to fly away to get away,” he says.

With its abundance of great schools and organized activities, the city is also known as a great place to raise families. “There’s always something to keep kids engaged,” says Jones.

The seasons in Minnesota are pronounced, and outdoor and indoor recreation activities abound regardless of the temperature outside. If you are looking to play tennis in February when a typical day is in the 20s, you can head to the Rochester Tennis Connection or the Rochester Athletic Club, both of which also have outdoor courts for when days turn warmer.

Even though Rochester is an urban area (with all the culture and benefits that go along with it), Mattke says she does not have to travel far to go hiking or biking with her family.

In the city, there are plenty of events to entice locals and visitors. Rochesterfest is the city’s annual gathering—a 10-day celebration in June that highlights the city’s people, places and food. In the heart of winter, there’s SocialICE, an outdoor ice bar experience (complete with bonfires) that celebrates the bold north. During the summer, there is a street festival every Thursday, which encourages locals to get outside and take in the good weather.

For those who need a dose of the big-city life, Minneapolis is not far away. Many who come to Rochester find the small city strikes a perfect note and has everything they want.

“People who move here, once they become ingrained in the community, they like it a lot,” says Jones.

“Rochester is a great place to live, thrive and raise a family,” adds Mattke. “The community is wonderful, and opportunities continue to develop.”

Allentown, Pennsylvania

The thriving Lehigh Valley is home to Allentown, where a major renaissance has occurred over the past several years. Featuring state-of-the-art athletic facilities, a vibrant food scene, and great schools, this city with a small-town feel is a great place for physicians to settle with their families. The Lehigh Valley Health Network has been ranked as one of the country’s top hospitals by U.S. News and World Report for 22 consecutive years, and physicians there are able to serve patients and provide excellent care that is fueled by progress and innovation.

In the mid 1960s, when Leonard Parker Pool’s wife, Dorothy Parker, had cancer, they traveled from the Lehigh Valley to Memorial Sloan-Kettering Cancer Center for treatment. Pool wanted her to have the best care available, and at that time, that meant going to New York City.

"It was a great place to grow up, and it's been an even better place to raise my kids," says Timothy Friel, M.D., of the Lehigh Valley. -photo by Tim Gangi Photography

“It was a great place to grow up, and it’s been an even better place to raise my kids,” says Timothy Friel, M.D., of the Lehigh Valley. -photo by Tim Gangi Photography

Pool would later donate the first large sum of money that made Lehigh Valley Hospital—then under a different name—possible. He vowed that no one in the Lehigh Valley would have to travel to receive exceptional care again, and that credo lives on in the area today.

“That has always been a core component of who we are,” says Timothy Friel, M.D., chair of the department of medicine who specializes in infectious disease at Lehigh Valley Health Network. In everything the health network does, “that message and motivation lives on.”

Friel earned his medical degree at Harvard Medical School before completing his residency in internal medicine and his fellowship in infectious disease, both at Massachusetts General Hospital. Though it was not immediately clear to Friel when he entered medical school that infectious disease would be his specialty, he was inspired by the physicians around him.

“Some of the best and most engaging mentors that I encountered happened to be infectious disease doctors,” says Friel. “It was the specialty that I found most rewarding and inspiring during my training.”

For Friel, who works heavily in the realm of HIV, the ability to work with patients over long stretches of time and to incorporate newly developed medicines and innovations in care are big reasons he loves being an infectious disease specialist. “We’re now able to manage patients in such a way that they’re living healthier lives,” he says.

As for how he landed in the Lehigh Valley? “I’m a local boy,” he says. He met his wife, who is an OB-GYN, on the first day of medical school. They both wanted to position themselves to have the best possible family life in conjunction with rewarding careers. For them, the Lehigh Valley and the chance to live close to family, combined with the community-oriented, progressive values of the Lehigh Valley Health Network, presented the best of all worlds.

According to Friel, a commitment to forward thinking is at the heart of the network’s philosophy, and has helped expand care in the HIV program and beyond. “One of the things I’ve loved about working here is that the organization has always been very supportive of new ideas, of new innovations,” says Friel. “It has always prided itself on the delivery of high quality care and putting patients first.”

“We are known for our progressive health care,” adds Brittany Kulp, a physician recruiter at Lehigh Valley Health Network. “Our physicians have strong relationships with their patients and play a key role keeping both local and visiting populations healthy and safe.”

The Lehigh Valley Health Network has eight campuses, including a 929-bed flagship facility with a Level I Trauma Center. As one of the nation’s largest medical groups, the Lehigh Valley Physician Group has more than 750 physicians and over 400 advanced practice clinicians in 59 specialties across over 160 practices, according to Kulp.

The network is actively recruiting for physicians in endocrinology, family medicine, neurology, psychiatry, urology and other subspecialties. Kulp speaks to many candidates who want to return home or be closer to family in the Northeast, but she is quick to tell candidates from all backgrounds that the Lehigh Valley is a great place to live and work.

“You can have a great quality of life, from the cost of living to good schools,” says Kulp, also noting the abundance of recreational opportunities, cultural activities, concerts and more.

Residents of Lehigh Valley often find that everything they need is at their fingertips. The area has everything from top-rated colleges and universities to minor league sports teams.

“Lehigh Valley is one of the fastest growing regions of the state, with Allentown representing the state’s third largest metropolitan area,” says Kaitie Burger, social media and communications manager for Discover Lehigh Valley. Across the region, says Burger, “there’s a fantastic mixture of small-town feel partnered with large-scale events.” Musikfest (the nation’s largest free, non-gated music festival), PA Bacon Fest (featuring hundreds of bacon-centric food and drink items), and horse-drawn carriage rides along streets lined with lights and holiday markets are just a few favorites of locals and visitors alike.

For the tennis-inclined, options abound. Winning Touch Tennis offers social, instructional and competitive opportunities to all levels, and the Oakmont Tennis Club was voted one of the 12 best places to play on red clay by Tennis Destinations.

“The Lehigh Valley truly offers something for everyone,” says Kulp. And as one of the top five regions in the northeast for development, Lehigh Valley’s renaissance continues on.

“It was a great place to grow up, and it’s been an even better place to raise my kids,” says Friel. “There’s everything we could have ever imagined here, and the area continues to grow. Over the last few years, it’s been really fun to be part of a really dynamic community. I think it continues to get better and better.”

 

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Stop before you make one of these errors

A plethora of job-search tools and resources still hasn’t solved these common problems.

By Therese Karsten | Fall 2018 | Job Doctor

 

Worried job candidate waiting hiring decision

We were wrong.

Old guard recruiters and employers predicted that smartphone access to CV and cover letter samples, templates, how-to guides and FAQs would eliminate most of the common CV and cover letter problems. It didn’t occur to us that the older generation’s errors might be replaced by new challenges in the era of digital job search.

Learn what they are so you can avoid them.

Using a file sharing platform and embedding macros

Dropbox, ShareFile, Google Drive, Egnyte and other file-sharing platforms are wonderful for sharing documents and photos with friends and family. They are not optimal for sharing your CV and cover letter.

Recruiters and practices work behind formidable firewalls and may not be able to open the file. I recently asked our information protection and security guru why we are blocked from so many third-party sites. He explained that file-sharing platforms are hit-and-miss on safety standards for protected health information (PHI). These vendors do not intentionally put our information at risk, but sometimes speed and ease-of-use shortcuts provide opportunities for malware.

The fastest way to get your CV and cover letter in front of a decision maker is to stick to PDF or Microsoft Word attachments. To avoid landing in a spam filter, avoid macros and embedded objects. Our firewall is looking for anything similar to malware and will either divert your document to spam or disable the suspicious element.

Not proofreading after the red squiggly lines are gone

We see far fewer misspellings today because spelling and grammar checks catch most. The dangerous downside of these tools is the false sense of security they afford.

Candidates who skip having a spouse, friend or mentor proofread a CV and cover letter run a far greater risk of:

Date errors. Only another human will catch the typo on a year or omission of key dates, such as your anticipated completion of training.

Word choice errors. We see incorrect usage of ensure/insure, accept/except, adopt/adapt frequently because spell check doesn’t see these as wrong.

Subject/verb agreement errors. These are often editing errors. You changed the subject and did not change the verb that modifies it.

Pronoun and preposition errors. We see more dropped or incorrect use of preposition pronouns: “By the end fellowship, I will have performed 50 TAVR procedures.”

Fiancé/fiancée mistakes. A female betrothed is a fiancée; a male is a fiancé.

Not caring about format

A good CV template is designed by someone who’s an expert in the visual presentation of written information. If you just wing it with a bold here or a font change there, your CV looks amateurish and difficult to read next to your competitor’s.

Choose a template that has address, email and phone prominently positioned at the top. Include M.D. or D.O. behind your name to instantly distinguish yourself from other health care professionals.

Once you’re done, save the document with a title that includes your last name and the type of document (CV or cover letter), the month and year.

Trusting Siri, Cortana and Alexa

In the last couple of years, I’ve noticed an uptick in the number of candidates who dictate their cover letters as they respond to online ads from their phones.

This can be an efficient tool when used judiciously: “Here is my CV. My husband just accepted an engineering job in Colorado, and we plan to move to the area in August. I will send you my cover letter tonight.”

Sometimes, though, the dictating physician fails to notice silly autocorrects before hitting send. We get things like: “Please accept my CV for the minimally offensive surgery position,” or “I am interested in hospitalist opportunities with no more than 15 sh*ts per month.”

Copying and pasting poorly

Copy/paste is both the best friend and worst enemy of an online physician job seeker. As long as you customize your response with a few opening words specific to the employer or location, copy/paste allows you to get a lot of responses out very quickly.

The body of your cover letter also can be copied and pasted from one response to the next. It will tell employers when you are available and what you are seeking. All prospective employers want that kind of differentiating detail.

Copy/paste is your worst enemy in two circumstances:

It makes you too generic. If you don’t customize the cover letter to the location, we don’t know why you want to live and work in our community. A generic cover letter comes off as canned and leads the reader to assume you are taking a buckshot approach to your job search. If a glance in my shared database shows that you sent exactly the same cover letter to six of my colleagues in the last six months, then I’m not highly motivated to put you at the top of my to-do list for today. You simply don’t look like an intentional, serious candidate for my city and practice.

It’s wrong. You don’t want to copy/paste another employer’s cover message, complete with the wrong location and/or practice name. If your CV gets forwarded at all, it will probably go to the administrator or lead physician along with your botched cover letter to make sure your lack of detail is not overlooked.

Times have changed. But some old-fashioned proofreading and awareness of these issues can help you make a strong first impression to prospective employers!

Therese Karsten MBA, CMSR, FASPR is the director of physician recruitment for HCA Physician Services Group.

 

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Arif Khan, M.D.

Fall 2018 | Snapshot

 

Arif Khan, M.D., recommends choosing a job that will allow you to grow. He found his opportunity on PracticeLink.com. -photo by Kim Bunce

Arif Khan, M.D., recommends choosing a job that will allow you to grow. He found his opportunity on PracticeLink.com. -photo by Kim Bunce

Employer: Pocono Medical Center, East Stroudsburg, Pennsylvania

Residency: Anesthesiology, University of Toledo Medical Center, 2014

Fellowship: Pain Management, New York University, 2015

Khan enjoys spending time with his family and is interested in finance and cricket.

What surprised you about your first post-residency job? The job wasn’t that different from fellowship in terms of work. However, it was difficult to find the right job. I started the pain program here at Pocono Medical Center, and the challenge was the administrative side, setting up evidence-based protocols and ensuring that the system works with the resources available.

What’s your advice for residents who are beginning their job search? Start early—credentialing takes awhile. Money is not as important as the location, type of practice and personal satisfaction. Choose a place that will allow you to grow.

What was the most important factor in your search for a new job? Growth, and opportunity for leadership and administrative work.

How did you find your job? PracticeLink had it advertised, and the employer responded.

Any other advice? Try to talk to the chairman immediately, even though human resources may be your first point of contact. Negotiate salary based on market rate—so have an idea of what your compensation should be.

How did PracticeLink help you in your job search? It’s easy to navigate. The communication platform is built directly into the site. Its layout is nice, and it’s easy to use. I love using PracticeLink for both passive and active searches.

Did you find your job on PracticeLink? Let us know, and we might feature you! Tell your story at info.PracticeLink.com/Snapshot.

 

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How tight is the job market in your specialty? Fall 2018 issue

The PracticeLink Physician Recruitment Index can help you gauge the relative ease or difficulty of your job search.

Fall 2018 | Vital Stats

 

What’s your competition like? For job-seekers of all kinds, it can be hard to know. A simple PracticeLink.com search for opportunities in your specialty will give you an indication of the demand for physicians like you, but without knowing who else is vying for those jobs, it’s hard to get an accurate picture of supply.

How many other candidates in your specialty are actively looking for jobs at the same time? And how does that number correspond to the number of opportunities available?

That’s where the PracticeLink Physician Recruitment Index comes in. The Index is a relative indication of the ease or difficulty of job searches in various specialties based on supply and demand information gathered by the PracticeLink system quarterly. The larger the “Jobs per candidate” number for your specialty, the better your potential standing in the market.

The change in rank reflects the specialty’s movement since last quarter.

Job Specialties List

The Most-Challenging-to-Recruit Specialties are those specialties with the highest demand-to-supply ratio in the PracticeLink system. The specialties on this list likely won’t come as a surprise to candidates; they’re often narrow fields.

The Most-In-Demand Specialties represent the specialties that have the most jobs overall posted on PracticeLink—specialties for which the demand for physicians is highest. For the Index, we then rank those in-demand specialties according to the supply. Those at the top represent specialties with the most jobs available and the fewest candidates per job.

After reading these Indexes, ask yourself: Do these Indexes match my experience of searching for a job in my specialty? Do I need to widen or narrow my job-search parameters as a result?

This PracticeLink Physician Recruitment Index was pulled July, 2018. Candidate ratios include physicians who have registered with PracticeLink.com within the past 24 months.

 

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Contracts with benefits

What’s included in a typical physician employment contract? This helpful guide lays it out.

By Debbie Swanson | Fall 2018 | Feature Articles

 

Ensure you know just what’s expected in return for any financial incentives in your employment contract, recommends Afshin Khaiser, M.D. -photo by Seth Morris

Ensure you know just what’s expected in return for any financial incentives in your employment contract, recommends Afshin Khaiser, M.D. -photo by Seth Morris

After months of filling out paperwork, traveling and dry cleaning your interview suit, you’ve finally landed an attractive job offer. Congratulations! But don’t collapse onto your sofa just yet; there’s still one more matter to deal with. Pour a cup of coffee, grab your favorite color highlighter and settle in to read your employment contract. This document spells out everything about your new position, from the hours you’re expected to be at work, to perks such as travel compensation, to the handling of malpractice claims that may pop up decades after you’ve left the employer.

“What’s offered varies with the type of practice; hospitals and academia might offer more perks, while private practice is more like a small business,” says Afshin Khaiser, M.D., an internal medicine physician based in Illinois.

Though it’s paramount to read the document from start to finish, don’t worry if you feel at least somewhat confused. Deciphering it can be tricky, yet it’s a valuable learning experience. Here are some tips and insight into some of the sections.

Seek a resource

After years in academia, you probably don’t shy away from heavy reading. But this lengthy, legalese-rich document is seldom completely understood by a lay reader. Most physicians—at least early in their careers—consult with a lawyer experienced in physician employment for guidance and reassurance before they sign.

Early in her career, Sylvie Stacy, M.D., a preventive medicine physician in Birmingham, Alabama, sought a lawyer to review her contract before she accepted a position as a medical director, which involved both clinical and administrative work.

“At the time, I had a minimal understanding of all the important factors and the meaning of the various clauses,” she says, adding that the lawyer did suggest some changes “…to protect me if something went wrong, or if I had a disagreement with my employer down the road.”

Stacy went on to have a positive employment experience—but felt that the legal consultation was both reassuring and educational.

“Since then, I’ve done a lot of independent contracting work, with numerous contracts to review. I have felt comfortable doing the review and negotiation myself,” she says.

Some parts are simple

Not every aspect of your employment contract is cryptic or controversial; some just lay out the boundaries of your contract.

Every contract has a defined time period, beginning with a start date and ending with some type of contract termination date. Choosing a start date may seem like a no-brainer, but reflect upon the date before agreeing; once you start working, free time might be at a premium. If you’ll be relocating, remember to build in time to get yourself set up. Or, if you’ve been going full speed ahead since medical school, consider slipping in a few days for some r&r.

Your contract will also state how long it remains valid; it may expire after one year, automatically renew on its anniversary date, or remain effective indefinitely. Make note of this date, as it’s easily forgotten as the years roll by.

Other areas to look for: the type of relationship you are entering into (employee or independent contractor); whether you are full time or part time; and the name and location of your employer. Your primary employment address should be defined, along with any expectations regarding traveling between offices, if applicable.

Ease the burden of moving

It’s great when your new employer offers to assist with your relocation expenses when a move is required. This is more common with larger establishments and hospitals. Covered expenses could range from only the initial expense to transport yourself and your belongings to something more inclusive of the price to get settled: hotels, meals, and public or rental transportation.

“There’s sometimes a maximum dollar amount toward your cost of relocating. Sometimes they’ll help with other things, like a loan to help buy a house,” says Keith J. Chamberlin, M.D., medical director of PeriOperative Services at Marin General Hospital and CEO of Chamberlin Health Care Consulting Group, Inc., in California.

Equally important is making sure your contract spells out anything required of you in return.

“There is a risk involved (for the employer): If you come out and leave soon after, that’s not a good outcome,” Chamberlin says. “A common stipulation is that if you don’t stay six months, you have to pay it back.”

A health care attorney's review on an employment contract gave Sylvie Stacy, M.D., a sense of reassurance. It also helped prepare her for future reviews. -photo by Eric and Jamie Photo

A health care attorney’s review on an employment contract gave Sylvie Stacy, M.D., a sense of reassurance. It also helped prepare her for future reviews. -photo by Eric and Jamie Photo

Upfront cash

A sign-on bonus is a common tactic to entice you to come on board. This is especially appealing to new physicians eager to knock off student loans and set up housing. While money is always attractive, don’t get too carried away, warns Khaiser.

“Don’t get too caught up with a number,” Khaiser reminds. “The amount may seem great, but read the fine print—there’s always something attached. For example, if you don’t stay at the company long enough, you may have to pay it back.”

What’s important is understanding your obligation. Be sure to get all the details clarified in your contract.

Know what’s expected of you

Exactly what are you being brought on board to do? This should be clearly spelled out in the areas of responsibility section of your contract. Reject any vague wording or an open-ended definition, such as “will perform duties as assigned.” Look for targeted, specific items, such as: clinical expectations, nonclinical obligations (paperwork, records, phone calls), requirement to serve on boards or committees, expectations of teaching or training others, involvement in research, and more.

Also consider what your employer must provide you to support these efforts: equipment, time, staff, lab access, etc. Get these agreements in writing; this could prove useful in the event of termination.

Another important area is your availability for on-call hours.

“Understand these expectations,” says Khaiser. “For example, are you required to come into the hospital when needed? How many calls do they expect you’ll have in a night? Will you be expected for work the morning after a particularly busy night of call?”

Don’t be afraid to speak up, he adds. “Sleep is important, and you need to take care of yourself.”

Plan for time off

Breaks from your typical workweek are an integral way to avoid burnout, remain compassionate, and focus on what initially drew you into medicine.

Paid time off includes sick time, disability and family leave. Offerings vary greatly based on type of employer and their benefits package. Be sure you understand how these items are calculated and accrue, and how they are treated if unused at year’s end. Also consider how your personal priorities may change within the time span of your contract; what is agreeable today may change over time.

Vacation time and continuing medical education (CME) are two important areas of paid time off. Vacation is time to use as you wish—key to maintaining a healthy outlook. CME is time intended for you to further your medical education by attending conferences, taking a class, or another educational event. CME is typically required both by your employer and to maintain your medical license.

“The contract should stipulate the number of weeks of (paid) vacation time and CME time,” says Chamberlin, adding that each should be broken out specifically. “For example, two weeks CME and four weeks vacation. You usually can’t extend the total, but may be able to negotiate the combination.”

Reimbursement of CME expenses

Whether you fly to a conference, register for an online course or drive to a lecture at a local university, there are always some expenses involved with CME. If your employer has offered to contribute toward CME expense, look for a dollar amount you have available.

Planning the end of your employment

It may seem strange to be thinking ahead to when you terminate this employment, but an unexpected or poorly planned exit could have detrimental consequences on your finances, career and professional standing. Get the details spelled out now so you’ll know what to do if the situation arises.

One area is assignability. It’s common for hospitals and practices to undergo acquisition, consolidation, or mergers, but what’s important is how this would impact you. If your contract is defined as assignable, your employment would continue uninterrupted under the new ownership. If it is non-assignable, your contract is terminated upon the change of ownership—meaning you’re either in need of finding new employment or negotiating a new contract with the new owner.

If you’re signing a non-assignable contract, consider what would ease the turmoil of an unexpected loss of employment. The American College of Physicians suggests negotiating for the inclusion of a cash settlement, or adding language that would release you from any restrictive covenant.

Termination notice defines the amount of time both you and your employer must provide prior to ending the employment relationship. This should be fair and equal for both sides; you shouldn’t be required to provide 120 days of notice while your employer only has to give you 60.

When Stacy had her attorney review her contract, this was one area he adjusted. “[He extended] the time frame for contract termination, and removed wording that would allow immediate termination by the employer in certain circumstances,” she recalls.

Most contracts also specify that an employment can be terminated either “for cause” or “without cause.” A “for cause” termination points to a specific reason for the termination. “Without cause” is much more open-ended; you are free to give notice without a reason, but likewise, the employer is free to let you go for no reason.

“[Avoid agreeing to] a situation where they can fire you at any time—especially important if you relocated or have a family,” advises Chamberlin. “For a brand-new employee, it’s good to have protection in place, such as that they can’t fire without cause for 90 days. After the 90-day mark, get additional protection in place, such as 180 days of notice going forward. That gives both parties adequate time to make new arrangements.”

Post-termination considerations

Issues related to your employment could arise long after you’ve packed up your things and settled into a new situation. Planning for them in your contract is another integral step toward safeguarding yourself.

You’ll probably build up a base of familiar patients who routinely seek your services. Your contract should address the proper means of notification of your departure. In other words, who will tell your patients of your impending departure? Typically, the employer will distribute a letter before you are free to discuss it openly.

Your contract may seek to limit your interactions with patients through a non-solicitation clause. This prevents you from recruiting patients to join you at your new location. If such a clause exists, ask for a clear definition of solicitation. Getting this in writing will help you know what you can and cannot say to your patients, as well as the guidelines to follow.

A non-solicitation clause may also try to prohibit you from treating patients who choose to follow you to your new location. Most experts agree that enforcement of this is questionable; courts often support the patient’s right to seek any doctor of their choosing. Check with your local legal expert if such language is included.

Another post-termination issue might be a non-disparagement clause, which prevents you from making negative or defamatory comments about your employer both during employment and post termination. This clause should be equally in effect for both parties, also preventing the employer from making disparaging remarks about you.

Understand any restrictions

Sometimes referred to as a non-compete clause, the restrictive covenant is another area to read carefully. This defines limits on where you can work after leaving your employer. For example, it might prohibit you from working for a similar type of practice, within a range of 12 miles, for five years post-employment.

This clause protects the employer by preventing you from going to a direct competitor, sharing confidential information, or drawing patients away from the practice. Though it’s a common part of most employment contracts, make sure the language is not overly prohibitive.

“If you live in an area you like and want to remain there long term, try to negotiate, ” says Khaiser.

You are legally bound to uphold anything you sign your name to, but be aware that not all states equally enforce restrictive covenants. It’s best to run the language past a health care attorney to understand your obligation, your state’s stance, and to make sure that the language is not overly prohibitive.

Protect your other income

Even if you don’t have an additional stream of income today, opportunities could present themselves down the road, so be sure your contract addresses work performed outside of the practice both related and unrelated to medicine.

For anything related to medicine, compensation may become an issue. According to the ACP, “the contract should state explicitly whether money earned from outside sources is to be considered private compensation, paid directly to the individual physician, or more typically as part of the group’s overall income.”

The contract should also identify any restrictions on non-medical activities—for example, if you play in a band or own a coffee shop. Though it is usually clear that such compensation is your own, there may be restrictions on time or type of work allowed. According to the ACP, “groups usually preclude physicians from performing outside services that will interfere with their ability to fully satisfy their practice obligations.”

Protect your future

One of the most critical sections of your employment contract is the handling of malpractice insurance. This protects you against liabilities that may arise while you are acting on behalf of the hospital, practice group or academic institution.

Coverage varies depending on the type of situation. A hospital or large practice may pay some or all of your malpractice insurance premiums, while a smaller group or practice may expect you cover your own. Your contract should define any limits or maximums on the policy, who is responsible for premiums, and any breakdown of coverage.

The type of policy is an important distinction; it will be either “occurrence based” or “claims made.” In an occurrence-based policy, any incident that arose during the boundaries of your employment period is covered, regardless of when it is raised. In a claims-made policy, only incidents that are raised while you are an active employee are covered; anything raised after your termination date are not, even if they originate from service provided while you were an active employee.

It’s not uncommon that a patient raises a claim years—even decades—after you treated them, so with a claims-made policy, look for the inclusion of an extended reporting endorsement, more commonly known as tail insurance. This is offered by the malpractice insurance carrier as a way to extend a claims-made policy to include anything raised against you post-termination.

“Be cognizant of what is covered in your contract; having tail insurance is non-negotiable,” Khaiser says. “The number-one thing is to protect yourself and your license.”

Tail insurance is costly; employers may split the cost with you, usually by deducting your contribution directly from your paycheck. Sometimes the employer will offer an incentive plan, in which the cost to you decreases each year you remain with the practice. The ACP points out that sometimes a provision states that the employer will pay tail premiums if the employer terminates the physician without cause, but if the physician is terminated for cause, the burden of cost falls to the physician.

Carefully read the details and don’t hesitate to negotiate for the best arrangement.

Moving up the ladder

You may be thrilled with your new job exactly as it is, but it’s never too early to think of the future. Your contract should address issues important to your career advancement, such as the frequency of your employee review, criteria for promotions or advancement, or the possibility of partnership.

Each time you receive an employment contract, you’ll become more adept at what to watch for. But regardless of how familiar you become, it’s always important to read it thoroughly and then consult with a lawyer or seasoned colleague. Changes or adjustments made before you sign can have lasting benefits for you and your family, improve your finances and protect your professional future.

One of the most critical sections of your employment contract is the handling of malpractice insurance.

Changes or adjustments made before you sign can have lasting benefits for you and your family, improve your finances, and protect your professional future.

 

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