The truth about student loan repayment

How physicians can tackle their biggest burden.

By Jason DiLorenzo | Fall 2019 | Feature Articles

 

Student loan repayment programs have evolved even since Larry Burchett, M.D., graduated med school in 2006. – Photo by Simone Anne

Larry Burchett, M.D., remembers graduating from medical school in 2006, excited that he’d matched to his preferred emergency medicine program and begin training.

“But that first year, it’s hard, man,” says Burchett. “I didn’t expect that; $42,000 doesn’t go very far in California.”

Burchett graduated medical school with about $160,000 in federal student loans, which he still carries today because his rates were fixed at nearly 2% in 2010.

Fast forward to today, where a debt load of roughly $200,000 is the average for physicians graduating from a public medical school, and often well over $250,000 from private or osteopathic programs. With fixed rates as high as over 7%, it’s easy to surmise that Burchett’s profile would be envied by most medical graduates today.

But fortunately for those who are keeping up on an ever-evolving and complex student loan repayment marketplace, relief is available for early-career physicians today.

Evolving options

Increasing physician debt levels and available federal and state repayment and forgiveness options have dramatically changed the economics of becoming a physician, and these factors are beginning to impact the career decisions of young doctors.

Jared Wenn, D.O., is one such graduate; the surgeon is the sole breadwinner supporting his family of four on a training salary.

“I needed to borrow more money than I thought I needed through school,” Wenn says, resulting in federal student loan debt of more than $400,000. Now, with five years of residency ahead and possibly up to four more years of fellowship, Wenn could reduce his out-of-pocket student loan payments by over $350,000 by pursuing the Public Service Loan Forgiveness Program. Burchett, by comparison, didn’t have this program available when he graduated in 2006.

Medical trainees today can uniquely position for this program by using an Income-Driven Repayment plan while training with a non-profit hospital.

The repayment landscape

For graduates entering training, going into a standard or extended-term payment plan at today’s average debt level and rates isn’t affordable ($200,000 on a 10-year plan is roughly $2,250 monthly), so early-career physicians often seek payment relief throughout training.

REFINANCING

Refinancing is an option for many graduates today. Simply explained, refinancing means a private lender or bank pays your federal student loan debt, and you’re committed to paying a set amount monthly for a set term, at hopefully a lower rate than your federal loans. When federal benefits such as reduced payments, interest subsidies and loan forgiveness become no longer available, that’s the point when many physicians today can and should lower the cost of their debt by refinancing if possible.

The issue comes with how to leverage the market to find the best rate. Most lenders advertise the same broad range of rates, but the only way to get firm offers is to go through the application and underwriting process, which can be cumbersome and often involves a hard credit pull.

Refinancing products, rates and participating banks have evolved rapidly over the past few years, so it’s important that you have a good understanding of the current marketplace, or have a reliable advocate who can assist with the process and help determine when refinancing is suitable.

Mike Greenberg, M.D., sought out help to understand the nuances of Public Service Loan Forgiveness. – Photo by IHNY

INCOME-DRIVEN LOAN REPAYMENT

Now let’s spend some time on the newest and most complex of the federal repayment options today: income-driven loan repayment (IDR).

Of the five income-driven repayment plans available today, there are really three that are most suitable for today’s house-staff and early-career physicians with federal student loan debt: Income-Based Repayment (IBR), Pay As You Earn (PAYE), and the newest available program, Revised Pay As You Earn (REPAYE). Where the term IDR is used below, it is a reference to all of these programs.

INCOME-BASED REPAYMENT

IBR was launched in 2009 and is a federal repayment program that limits monthly loan payments to 15% of your discretionary income.

To be eligible, a partial financial hardship must exist, which means that this 15% of your discretionary income, calculated on a monthly basis, is less than what you’d be required to pay on a 10-year standard repayment plan. This hardship exists for most trainees with federal student loan debt, as 15% of the discretionary income for a single resident with a $50,000 salary would result in roughly a $400/month payment. The 10-year standard monthly payment on $220,000 of debt, by comparison, would cost about $2,500/month. Clearly, a hardship exists.

IBR is also a qualifying repayment plan for the Public Service Loan Forgiveness (PSLF) program. Taxable loan forgiveness is granted through IBR after 25 years of repayment. However, payments in IBR are capped at the 10-year standard payment amount established when the borrower entered IBR. Because of this cap, many attending physicians would pay off their loans through IBR before the 25-year forgiveness period expires.

IBR is least used by today’s graduates with the introduction of these next two options.

PAY AS YOU EARN

PAYE was launched in 2012. PAYE limits payments to 10% of a borrower’s discretionary income (instead of 15%), and taxable loan forgiveness would be granted after 20 years of repayment.

The payment cap is also the borrower’s 10-year standard repayment amount, and PAYE is a qualifying repayment plan for PSLF as well.

Only borrowers who have no outstanding balance on a federal student loan issued prior to October 1, 2007, and who took out a federal student loan on or after October 1, 2011, are eligible.

REVISED PAY AS YOU EARN

REPAYE become available in December of 2015, and it may make sense for continuing housestaff to consider entering it. It offers:

  • 50% of accruing interest paid by government (unsubsidized loans become partially subsidized!)
  • 10% of discretionary income required (just like PAYE), and also PSLF eligible. If you switch into REPAYE from IBR, the 10-year forgiveness clock won’t reset (unless you consolidate)
  • Household income will be used regardless of how you file taxes
  • 25-year taxable forgiveness for graduate students
  • No cap to payments (10-year standard in IBR & PAYE)

Once you enter one of these IDRs, you cannot be removed from it (although you can switch between them as appropriate), even if the hardship that qualified you does not exist after training. (Hopefully the hardship does not continue, and you have an increase in income!) Therefore, a critical part of your repayment strategy is to perform an analysis and determine the best course of action based on your salary and sector of employment after training.

Paying more

I’m often asked, “If I can afford to make larger payments than required in an IDR while I’m in residency or after, should I?”

This is an important question, and my answer is somewhat counterintuitive. I generally believe you should NOT pay more than required through an IDR during training, because those overpayments likely compromise both your subsidy savings and potential loan forgiveness. In addition, unlike in forbearance, interest is not capitalized while you’re in training and have the hardship that qualifies you for these programs.

Instead of overpaying on your loans, I would suggest placing that extra in a money market or savings account. Even if you get 1% return on these funds, it’s actually outperforming the accruing interest on your loans because the interest isn’t capitalizing during your training.

If your employment after training no longer positions you for significant loan forgiveness, you’ll be able to apply this savings toward the repayment of accrued interest before it capitalizes.

If you remain employed by a non-profit or government entity after training, this savings can be retained and allocated to other vehicles.

PUBLIC SERVICE LOAN FORGIVENESS

Often the most generous federal program young physicians can leverage today is the Public Service Loan Forgiveness Program (PSLF).

Approved by Congress in 2007, this program provides tax-free loan forgiveness for anyone employed by a federal, state or local government organization, or directly by a 501(c)(3) nonprofit.

For a majority of medical graduates, full-time qualified employment combined with 120 monthly payments (10 years) under an income-driven repayment plan (IDR) can result in a much lower out-of-pocket cost than the amount borrowed.

Many medical graduates begin pursuing this program at the onset of training, as their residency years usually count as public service, and the IDR plans make economic sense during that time. As a result, there are an increasing number of physicians who are seeking PSLF-qualified job opportunities post-training today. Due to an evolving legislative climate, recent and proposed changes may impact the appropriate action plan to maximize PSLF, and understanding this marketplace can only help you.

Understanding your salary equivalent

An overlooked yet critical consideration for medical trainees today is what I call the “PSLF salary boost.” Though it’s understood that academic positions typically offer lower salaries than private practice roles, “the gap between academic and private salaries is closing,” says anesthesiologist Mike Greenberg, M.D., who graduated from St. George’s University in 2014 and transitioned to an academic position at Johns Hopkins after four years of PSLF-qualified training.

“For me, pursuing PSLF was a no-brainer,” Greenberg says. But several years ago, misinformation and a lack of education at medical school graduation left many graduates unaware or misinformed about how to maximize this opportunity. Greenberg took it upon himself to learn about the PSLF program and eventually found Doctors Without Quarters (DWOQ) to guide him while he focused on his training.

As Greenberg can attest, student loan savings should be factored into the economic analysis of any PSLF-qualified job. This can often make nonprofit roles more economically attractive than for-profit opportunities.

In the chart above, the salary “boost” is represented for a graduate who had $250,000 in debt at graduation, did four years of training with a PSLF-qualified employer, and then was offered two jobs: one with a nonprofit at $175,000 in starting salary, and one with a for-profit at $200,000.

For the six years following training, the nonprofit salary was worth an additional $73,000 per year when PSLF savings was contemplated as a pre-tax salary boost.

The risks of repayment plans

Recent headlines about 99% of Public Service Loan Forgiveness applications being denied have created unnecessary alarm for many graduates pursuing PSLF. These headlines certainly do not inspire confidence for those purposely paying the least amount possible with hopes of having their debt forgiven tax-free, but these headlines were no surprise to this author.

The PSLF program was introduced 11 years ago with little media attention and even less guidance from the U.S. Department of Education and their loan servicers. Borrowers likely pursued PSLF without reading the details of how the benefit worked. Here’s a quick list of the reasons PSLF applications are denied:

  • Ineligible loans: Only federal direct loans are eligible for PSLF. Federal Family Education Loans (FFEL), Perkins, private and other types of loans are not eligible.
  • Insufficient payments: People applied for forgiveness prior to making the necessary number of payments, thus increasing the number of denials.
  • Wrong repayment plan: We have seen many new clients using extended and graduated repayment plans that are not PSLF eligible.
  • Paperwork errors: Of the denied applications, 28% were due to missing or incomplete information.

By using the Employment Certification Form for PSLF, available from the Department of Education, graduates with direct loans using an IDR while working full-time for a qualified employer receive confirmation of qualified payments along the way.

Regarding future changes to PSLF, borrowers at nonprofit programs should be reassured by a few things. For one, the Master Promissory Notes you signed to borrow each loan for medical school included language about PSLF and your right to utilize the program. Thus, a legal contract between you and the federal government says you borrowed under the assumption that 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 towards 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 and others in the same situation through any changes to the laws.

Even if you do everything right in the pursuit of PSLF, there’s still risk associated with waiting 10 cumulative years before applying for this tax-free forgiveness.

For example, a client of ours who was six years into practice with a 501(c)(3) hospital was recently notified that his employer was being bought by a for-profit organization. Through no action of his own, once his paycheck is being issued by the hospital’s new owner, he’s no longer PSLF-eligible and would need to change jobs to remain on track for forgiveness.

Physicians should always be saving money to grow alongside accruing interest while they are making reduced loan payments through an IDR in the case of unforeseen circumstances that disqualify them from loan forgiveness.

Navigating the complexities

If you’re not staying abreast of your options as you progress in your career, be sure to identify and work with an advocate incented to help you maximize your savings vs. those who may have a conflict of interest, such as a lender or servicer. Also, take note that traditional financial advisors, including those with CFP designations, are usually not trained on the concepts covered in this article.

The student loan repayment marketplace has become much more complex over the past decade. And though debt levels are high, unique and often substantial opportunities for savings exist for those who navigate the marketplace strategically.

Jason DiLorenzo is the founder of Doctors Without Quarters LLC, a national student debt advisory firm dedicated to the financial wellness of early-career graduate health professionals.

 

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Is moonlighting right for you

The pros and cons of working extra shifts.

By Karen Edwards | Fall 2019 | Feature Articles

 

Moonlighting gave Justin Smith, M.D., experience in clinical decision-making. – Photo by Lindley Battle

Moonlighting isn’t a new practice, but lately, it’s become increasingly common. The physicians choosing to do it span a wide variety of specialties and settings. Some begin moonlighting as early as their second year of residency, while others pick up additional shifts even after they’ve officially retired.

Physicians’ reasons for moonlighting vary, but the increasing trend can be traced, at least in part, to a shortage of physicians. In 2016, the Association of American Medical Colleges predicted that the U.S. will face a deficit of 61,700 to 94,700 physicians by the year 2025. No wonder more and more opportunities to moonlight are becoming available. Here’s what you should know as you consider whether or not those opportunities are right for you.

Internal vs. external moonlighting

“There are two types of moonlighting,” explains Richard Williams, M.D., residency program director at the University of Nevada, Reno. Internal moonlighting means picking up extra shifts with your current employer or, if you’re in residency, within your residency program under faculty supervision. External moonlighting means working for a different hospital or employer altogether.

Since many residents are working with a limited license, external moonlighting isn’t an option for them. However, some residency programs, including the University of Nevada, do offer internal moonlighting opportunities. “The faculty supervision and moonlighting within the residency program is why internal moonlighting can be done with a limited license,” says Williams.

Behind the moonlighting controversy

Before you sign up for extra shifts, it’s important to recognize that the practice is sometimes controversial, especially for residents. Some residency programs won’t allow moonlighting, period. Others only allow third-year residents to moonlight. Most require residents interested in moonlighting to receive written approval from a supervisor or program director.

At the University of Nevada, for example, moonlighting by residents is permitted but not necessarily encouraged. “Any discussion of moonlighting in our program is driven by the residents,” says Williams. “It’s not something we bring up. The university’s moonlighting policy is published on our website, so if a resident wants to see what it is, there’s that option.”

Beyond program-specific rules, residents must obey the Accreditation Committee for Graduate Medical Education’s guidelines. The ACGME has capped the number of educational and work hours for residents at 80 hours per week. “The 80 hours applies to all work the resident performs, whether the extra shifts are internal or external,” explains Catherine McCarthy, M.D., professor of family and community medicine at the University of Nevada. Picking up extra shifts runs the risk of putting residents over that limit.

As for hospitals, most consider staffing moonlighting shifts “a necessary evil,” according to Dan Bensimhon, M.D., who moonlighted as a cardiology fellow. Keeping a hospital staffed at all hours is a logistical nightmare. A flu epidemic or mass emergency could strike at any time, but a lull could leave them overstaffed with full-time doctors—at the expense of a hospital’s bottom line.

“Many hospitals will typically staff toward their average census for a given season and fill the gaps with part-time physicians or doctors looking to pick up extra shifts,” explains Bensimhon. “Others will contract with locum tenens groups to fill those slots.”

This may explain the increasing number of physician-founded, physician-owned companies picking up the moonlighting baton. Suneel Dhand, M.D., for example, cofounded DocsDox, an online resource that connects moonlighting physicians and health care facilities, and Bensimhon formed Moonlighting Solutions to help physicians find moonlighting opportunities and help hospitals understand their staffing needs.

Some of these companies cater specifically to non-hospital employers. CrowdRx, founded by Andrew Bazos, M.D., an orthopedic surgeon specializing in sports medicine, provides medical services to concerts, sporting events and other large events. Its chief operating officer, Connor Fitzpatrick, says that while these setting are different from a hospital, the same skill sets are required.

The advantages of moonlighting

Financial benefits

For residents especially, the extra money moonlighting provides is alluring. “You’re restricted by what you can make as a resident,” says Daniela Lamas, M.D., a pulmonary and critical care physician. When she began to moonlight, the extra paycheck gave her more money than she was making as a resident—and her first taste of the future.

“I saw it was possible to make good money at something I love doing,” she says. The extra shifts also helped with student debts and the high cost of living during her residency at Columbia University College of Physicians & Surgeons in New York City.

Paying down debt is a powerful motivator for many physicians, but there are other ways to generate income outside of moonlighting shifts. “I never moonlighted as a resident,” says Joel Schofer, M.D., although he now does so in addition to serving as a military emergency care physician. During residency, he earned extra cash by writing articles for professional publications.

Of course, residents aren’t the only ones who enjoy the financial benefits of moonlighting. “Traditionally, there were two main groups who moonlighted: Physicians at the beginning of their careers, including residents and fellows, who moonlighted to supplement their income and pay off debt,” says Dhand. “The second group included physicians at the end of their careers who were looking to wind down their practices but also continue their income stream.” Schofer notes that more and more physicians lately have turned to moonlighting to supplement stagnant income levels.

Increased independence

Justin Smith, M.D., is an electrophysiology fellow at Wake Forest Baptist Health and a hospitalist for Cone Health Medical Group and several locations of Novant Health. He saw moonlighting in residency as a chance to “test the waters in making clinical decisions.”

Similarly, Bensimhon says it helps residents develop decision-making skills. “In residency, you make decision by committee,” he explains. “Moonlighters learn to trust their own judgments and become more confident in their skill sets.”

The opportunity to understand the full medical experience is what drove Ameeth Vedre, M.D., to start moonlighting during his cardiology fellowship. “I learned what it’s like to act as the cardiologist of the day. It gives you a huge advantage over those who don’t moonlight,” he says. “You have the ability to pick up the ropes faster and to build your confidence level.”

“When you’re a resident, you’re under certain constraints you don’t have on a moonlighting shift,” says Lamas. “There’s a greater sense of autonomy when you moonlight.” Even seasoned physicians experience a sense of freedom from moonlighting. “Physicians at all stages of their careers—increasingly frustrated with modern-day clinical practice—are also moonlighting as a way of regaining some autonomy and control over their schedule,” says Dhand.

Exposure to new situations

Moonlighting can also expose you to patients you might not otherwise see as a resident or in your daily practice. That helps build confidence and knowledge. For example, Schofer says military physicians outside of combat zones “are working primarily with a young and healthy population.” In order to see the full scope of patients, these physicians need to practice outside the military. “It’s something I’d encourage,” he says. “It helps put military physicians on par with their colleagues.”

Military physicians aren’t the only ones who need additional exposure. “These days, especially in the area of primary care, a physician will diagnose a problem, then a specialist is brought in to treat it,” says McCarthy. At rural clinics, residents who moonlight are able to both diagnose and treat the problem, so they learn and do more than their non-moonlighting colleagues.

Matt Friedman, M.D., an emergency physician and medical director at CrowdRx, says that pay is a tertiary concern for many of the residents who work the company’s events. They’re primarily interested in the learning experience. “You can make more money working in the ER,” he says. “We even have some medical students who do research for us. They find it’s an eye-opening experience as well.”

Experience working with and managing a team

Moonlighters also learn how to work alongside other medical personnel. Fitzpatrick says, “At our events, residents learn and experience what it’s like to be on the other side of the hospital run. They experience what it’s like to work with first responders onsite. For many, it’s their first opportunity to do so.”

It’s not just learning to work with hospital teams, says McCarthy. She has worked with University of Nevada residents at a Burning Man concert and explains, “Yes, you learn what it’s like to supervise, but you also learn how to work with patients from all over the world.” That’s an opportunity that these residents only were able to experience through moonlighting.

A chance to test drive without commitment

External moonlighting offers yet another advantage: the chance to test drive a job or hospital without making a commitment. “By working a few moonlighting shifts, you can determine if the hospital’s culture, position and personnel are going to be a good fit for you,” Schofer says.

Vedre agrees: “It’s a benefit for you and an employer to judge how the relationship will work. And it gives a moonlighter an opportunity to look at a variety of different systems to find the best fit.” Some physicians even like moonlighting so much that they look into locum tenens arrangements.

Having a trial period can be a major benefit to residents who aren’t sure what setting they want to practice in. “Nearly half of physicians will leave the first job they take after training within two years,” says Bensimhon. “By moonlighting with a hospital or practice during their fellowship, moonlighters get a chance to sample different jobs and hospital settings, and they are more likely to find the right job the first time around.”

It’s also a major benefit to the hospitals. Williams says family medicine residents at the University of Nevada, Reno who take the opportunity to moonlight in rural emergency rooms often decide to locate to rural areas to practice. This is a huge plus for these communities, which are often notoriously short of physicians.

The downsides of moonlighting

An increased risk of burnout

Practicing physicians and residents have demanding schedules as it is. If you’re not careful, adding hours to your workweek is a quick way to wear yourself thin. However, moonlighters say this can be avoided by setting hours that work for you and your lifestyle. “I never experienced burnout,” says Smith. “If I was getting close, I adjusted my hours.”

Moonlighting terms differ, but the arrangement usually involves contracting for a block of time, such as an entire weekend, or spreading the time throughout the week, such as a few hours in the evenings.

No matter how you choose to moonlight, McCarthy says to remember: “Sleep is important.” That’s one of the major reasons residents are capped at 80 hours of work a week, and it’s easy to neglect rest if you’re not careful.

At one point, Lamas was moonlighting at two different hospitals in addition to her full-time research fellowship. “I realized I was becoming exhausted, and I cut down from as many as five shifts a month to two or three. Eventually, I gave up one of the moonlighting jobs,” she says. “The money is great, but you can’t afford to drop the ball on your health or on the work you do in your current position.”

Less time for family life

Many physicians are drawn to moonlighting because it offers the opportunity to provide more for their families. However, there are two sides to that coin. If you’re working more, you have less time to spend with your family, which can wreak havoc on quality time.

This is especially true because of the times of day and year when moonlighters tend to work. Vedre says opportunities to supplement income usually come from working odd hours, including weekends and holidays.

To ensure that extra shifts don’t put a damper on your family life, Vedre recommends keeping an open dialogue with your loved ones. “Discuss your moonlighting opportunities with your family, and decide together what will work best for everyone,” he says.

Increased responsibility

Increased independence is one of the reasons physicians decide to moonlight in the first place, but this autonomy is a double-edged sword. “Moonlighting can be empowering,” says Lamas, “But it comes with a huge responsibility.

“Anything can happen at night,” says Bensimhon. If you do decide to moonlight, you will still have access to more experienced physicians, but you have to be ready to handle whatever comes up. That can be trickier at some locations than others.

On a hectic night, this can quickly place you outside your comfort zone. “Moonlighting in a high-risk area can also expose you to potential legal risks,” adds Schofer.

If the increased responsibility worries you, you’re not alone. “Not all residents are ready to moonlight,” says Smith. But if you decide to start as a resident, it’s best to ease yourself in. “Start moonlighting internally first,” Smith recommends. “If you moonlight externally, be careful with where and how much you moonlight. You don’t want to be in a position where you’re over your head in terms of the kind of patient care you can deliver.”

Before you moonlight

If you decide to moonlight externally, you’ll be an independent contractor, not an employee. That means there are a few additional factors to consider.

1 Ask about liability insurance

It will be up to you to determine who pays for your liability insurance. “If you are moonlighting externally, you are no longer working as a resident and no longer under any supervision,” Williams says. “That means you need to make sure your malpractice insurance is provided for.”

Bensimhon agrees, adding that it’s best to confirm these details ahead of time: “Ask [prospective employers], ‘What kind of coverage will I have?’ If it’s occurrence-based coverage, that’s fine. Everything is covered. But if it’s a claims-made policy, make sure it comes with a tail.”

Military physicians are covered by the government’s tort claims act as long as they are treating patients as part of their duties. But the same may not be true for military physicians who moonlight at a veteran’s center or event. Schofer says, “They think they’re covered because they are treating veterans, but they’re not.” Just like civilian physicians who moonlight at outside facilities, military physicians should also ask what kind of coverage they will receive.

2 Get the right licensure and certifications

Before you begin moonlighting, it’s important to know what your hospital’s moonlighting policy is and then make sure you’re following it down to the letter. You don’t want to get caught violating a contract or a residency policy.

You also need to be sure you have all of the required licenses and certifications. This can be especially tricky if you’re near state lines.

3 Prepare for salary negotiations

As an external moonlighter, you’re functioning as an independent contractor. That means you are free to negotiate any payment structure that both you and the employer can agree to. PracticeLink.com offers a wide variety of resources on negotiating, and it’s best to read up beforehand.

4 Leave enough time for your job search

If you’re considering moonlighting while in residency or while actively looking for your next position, realize that the extra hours might interfere with your job search. “Moonlighting will cut into your personal time,” Williams warns.

Since residents generally start their job search efforts a year out, moonlighting may eat into the time you have to find an employer. On the flipside, a moonlighting position may lead to a full-time job—especially if you are moonlighting in order to test drive a position or facility.

5 Wait for the right opportunity

There are plenty of moonlighting opportunities out there. That means you can afford to be picky. Make sure the opportunity involves the type of work you want to be doing. “Moonlighters like to feel good about the work they do,” Bensimhon says. “Although the money is important to help make ends meet, making a difference for patients is what really makes the extra work worth it for most of us.”

You should also make sure you know who you’ll be working with and for. “Research the hospital or company you will moonlight for, and make certain it is a bona fide company,” says Fitzpatrick. “Verify who exactly you will work for.”

Is moonlighting right for you?

All of those interviewed here would recommend moonlighting to colleagues. But ultimately, Vedre says, “It’s an individual decision—and one that should be made thoughtfully.”

Smith adds that one lesson he learned as a moonlighter is that medicine is not as clear-cut as it’s often presented in residency. “I discovered nuance,” he says. That’s the kind of lesson that comes usually after years of experience.

Finally, Lamas says that while moonlighting isn’t a good fit for everyone, the benefits outweighed the downsides for her. “Everything is a trade-off,” she says. “But I consider every incremental experience I’ve had as a physician, whether moonlighting or on my regular job, as increasing my education. All of it has made me a better physician.” 

 

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What’s in a compensation package?

Before you can negotiate, understand how your offer was created.

By Debbie Swanson | Fall 2019 | Feature Articles

 

“Consider what you bring to the position,” recommends Rose Berkun, M.D. “Assess your own self-worth.” – Photo by IHNY

You may be focused on salary when you’re job hunting, but salary alone isn’t an accurate portrayal of compensation. Other elements of a benefits package have significant monetary implications, and even benefits without dollar signs attached can make a major difference when it comes to work/life balance. If you don’t take these into account as you negotiate and consider offers, you could be leaving something on the table.

“Upwards of 25 to 35 percent of a comp package is the benefits,” says Richard Roberts, M.D., JD, professor emeritus of family medicine at the University of Wisconsin School of Medicine and Public Health. “Newer doctors don’t often think about benefits. It’s their first time evaluating this. As a resident, you just got what you got. But now, you can negotiate.”

Here’s some inside information on holistically evaluating your compensation package.

Part 1: Understanding salary

In many other professions, employees earn a set annual salary, but that’s not always the case for physicians. “Forms of compensation vary greatly between specialties and practice types,” explains Roberts. “The most common salary model for a new doctor is often straight salary, which may include some productivity-related bonuses.”

You may be offered a traditional fixed salary or one that depends on other factors. Understanding the different models can help you decide which suits your financial and personal preferences.

COMMON SALARY MODELS

A straight or fixed salary is most familiar: comply with the terms of employment and receive a pre-determined sum, delivered incrementally over the year. This model is attractive for planning and budgeting, but it may leave ambitious physicians hungry for more motivation.

Some things to consider with a fixed salary: Is the salary adequate to meet your financial needs? Do you believe it’s a fair amount in terms of your specialty—and on par with what your peers are receiving, regardless of gender or race? When will you be eligible for a raise? How frequently will you get paid: weekly, bi-monthly or monthly?

A variation on the salary model is salary plus incentives or bonuses, which provides a fixed yearly sum plus the opportunity to earn additional financial rewards. These rewards are contingent on certain pre-defined measures, such as productivity, quality, performance, adherence to non-clinical obligations and other factors. This model’s appeal is that it offers the security of a steady paycheck along with the opportunity to earn more.

“Lots of institutions have bonus structures, [which] are highly variable,” says Jennifer Hunt, M.D., chair of the department of pathology and laboratory services in the College of Medicine at the University of Arkansas for Medical Sciences. “More and more, I think, are relying on RVU-productivity-type bonuses, where if an M.D. has a productivity at a certain benchmark level then they will get a bonus after that level.”

Some things to consider with salary plus bonuses: What is the breakdown of salary versus bonuses and incentives? Is the salary alone enough to meet your financial needs? Are the incentives clearly defined, or are they subjective? Can you satisfy the incentive criteria by yourself, or will you have to rely on other individuals or departments to reach your goals? Are the requirements fixed or subject to change?

Other salary models are productivity-based, meaning your salary is calculated using your contributions to the practice. This model may appeal to physicians highly focused on improving the practice or bringing in new business, yet it is sometimes criticized for fostering a competitive work environment. A variation on this model is a conversion plan, which allows you to earn a fixed salary for the first few years then change to a productivity-based model.

Some things to consider with a productivity-based arrangement: Are earnings based on RVUs, total amount billed or total amount collected? If earnings are based on collections, what percent of billings does the group typically collect? What is the breakdown of patient insurance types (commercially insured, Medicaid or uninsured)?

A different type of model is the equal shares arrangement, which is common in group practices. After deducting expenses from yearly earnings, the remaining funds are divided among the physicians. This incentivizes everyone to work toward a productive year, but some downfalls include a lack of tangible recognition for high performance, skill level or experience.

Some things to consider with equal shares: Does the physician group have a wide range of skills within the physicians employed? Are there any additional incentives to compensate high producers?

The capitation model has dropped in popularity since its peak in the late 1980s and early 1990s, but some regions of the United States still use it today. With this model, your salary is based on the number of patients enrolled with a health plan for a certain amount of time. This model is often praised for delivering efficient care, as there are no incentives for tests or additional procedures. However, some physicians criticize capitation for a lack of control over salary because it’s dependent upon enrollment rather than care provided.

Some things to consider with capitation: Are there any modifications in place to adjust for patients who require extensive services? Are there any bonuses in place?

WHAT SALARY MODEL IS BEST FOR YOU?

When interviewing, you should research what compensation methods are common in your region and your specialty, but choosing the best one for you is a personal decision. Consider the following questions:

  • What hours are you able to work? What hours do you prefer?
  • What are your fixed financial obligations?
  • What are your long-term financial goals?
  • Are you comfortable with a variable income?
  • Do you enjoy marketing your services and promoting your business?
  • Do you want the potential to earn more?
  • Do you work better when presented with incentives?
  • What is your work style? Are you more comfortable with a defined workload, or do you like to control your own productivity?

FIXED OR VARIABLE?

Variable physician salaries allow you to earn more by increasing productivity or meeting other goals. This model has obvious upsides, especially if you’re highly motivated by financial incentives. However, you should take time to consider all the aspects involved.

“If the M.D. relies on hospital systems, ancillary staff whom they don’t manage, or advertising and market share for the institution (not the practice), productivity could suffer as a result of executive decisions,” explains Hunt. “For example, if a surgeon cannot book cases because the hospital is always full and there are ER diversions, then they might not meet productivity targets, through no fault of their own.”

She adds that compensation models based heavily on productivity can present some challenges, explaining, “Although incentives and bonuses based on added productivity can be great, I think it is also strategic to get as much in guaranteed base compensation as possible, especially if the M.D. is going to rely on the hospital or system for the functioning of their practice.”

BE AWARE OF WHAT’S FAIR

In a perfect world, salaries would be consistent across the board, and any differences would be based upon measurable factors, such as experience or performance. But in reality, inequities exist. The best way to protect yourself is with knowledge.

“Do your research ahead of time,” says Rose Berkun, M.D., clinical assistant professor of anesthesiology at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences. “Medscape’s [annual physician compensation report] is a good place to turn.” You can also ask your alma mater or specialty associations for any studies or data they have on current physician salaries.

Once you’ve determined what’s typical for your personal situation, specialty and geographic area, reflect on your past accomplishments, education and training. “Consider what you bring to the position,” Berkun encourages. “Assess your own self-worth. Have you done research, been published or volunteered somewhere, such as at Doctors Without Borders?”

“Be aware of the gender pay gap,” recommends Berkun. “Women should be offered the same salary as their male counterparts.” However, this isn’t always the case. Medscape reports that male physicians earned 18 percent more than female ones in 2018, compared with 16 percent more in 2017.

Don’t be afraid to speak up, whether that means making a case for your own worth, questioning inequality, or simply requesting a higher starting figure. “If you start at a disadvantage, the gap only increases,” Berkun says.

Don’t forget to consider call, lifestyle and even commute time, recommends Jennifer Hunt, M.D. – Photo by Ashley Sanders

Part 2: What else do you need?

Salary is only a starting point. Dig deeper into the details of your package to tally up the impact of benefits. For example, a relocation allowance can help during a move, while an attractive family health plan can ease your finances throughout the year.

“The total compensation package is more involved than you’d imagine,” says Roberts. “Classically, the focus of a package is the two Cs: cash and call. Physicians look for a lot of cash and less of call. However, the importance of those issues fades after the first few years as other parts become more important: disability, life insurance, time off, continuing education, as well as the people you’re treating and the community you’re working with.”

Here’s a rundown on some of the benefits most important to a physicians.

CALL EXPECTATIONS

For most physicians, being available to respond to patients during off hours is just part of the job. This is especially true for newer physicians. Your comp package should outline the frequency, compensation and logistics of call.

“Usually with larger groups, you’ll have less frequent call,” says Berkun, adding that call requirements also vary by specialty. “For example, I’m in anesthesia and have to be physically present for calls. With other specialties, such as pediatrics, you may be able to take some calls from home.”

Understand your employer’s expectations upfront and be realistic about the impact call will have on your personal life. Be mindful of your family and others important to you. If you aren’t at home often—or are frequently interrupted during your free time—everyone’s happiness is affected.

Compensation for call is also important. According to Becker’s Hospital Review, the four most common methods are: a daily stipend (36% of respondents), an hourly rate (27%), a per-shift stipend (14%), and an annual stipend (12%). Each of these has its pros and cons, and you need to keep in mind that additional earnings from call may be offset by the need to hire household support or childcare.

MALPRACTICE INSURANCE

Everyone needs insurance . Typical benefit packages include medical, vision, dental, life and disability policies. But for physicians, there’s one more potentially career-saving benefit to consider: malpractice insurance. Before signing a contract, you need to understand what kind of malpractice insurance your employer offers and how much it will cost you.

The cost to you varies greatly from employer to employer. A hospital, academic institution or large practice group may contribute to your premiums, while a smaller group or practice may expect you to pay it all yourself. Some employers take regular contributions from your salary, while others require a lump sum upon termination of employment. Additionally, premiums for some policies vary over time or are based on years of service, so it’s important to understand how they are calculated.

As for the type of policy, malpractice insurance falls into two categories: occurrence-based and claims-made. Occurrence-based policies cover you for any claim made against you while you were working on behalf of the employer, regardless of when the claim is raised. If a patient files a claim 10 years after you changed employers, you are still covered. Claims-made policies only cover you while you are an active employee. If a claim is raised post-termination, the policy will not cover you—even though you were an active employee when the event in question took place.

If your contract offers a claims-made policy, you’ll want to add an extended reporting endorsement, also known as tail insurance. This critical yet costly addition extends claims-made malpractice coverage after termination. And no matter what else is in your contract, make sure that a lawyer reviews the malpractice terms and that you understand any limits or maximums.

PAID TIME OFF

You may be expecting to work long hours, but even so, everyone needs time away from the office. Your compensation package should detail an amount of paid time off. According to SullivanCotter, physicians’ annual PTO benefits typically range from 25 to 35 days. This may be presented as a bundle, or the days may be designated for specific types of leave, such as:

PAID VACATION TIME

Vacation supports a healthy family life and a good work/life balance. Having more of it may help prevent burnout, while having too little may leave you stressed. According to the 2017 Medical Group Management Association Provider Compensation Survey, physicians typically receive three to seven weeks of vacation time.

PAID SICK LEAVE

Some employers require you to accrue sick days by working a certain length of time, while others offer an allotted number per year or even unlimited sick days. It’s helpful to know what you can and can’t use these sick days for and if you’re allotted any personal days. These allow you to take paid days off without dipping into your vacation days.

FAMILY LEAVE

You should also discuss plans regarding family leave and understand what your employer offers. “Maternity and family leave is important to negotiate ahead of time,” says Berkun. “Some states have a mandate for time off, [which means] you won’t lose your job but no mandate for it to be paid. Negotiate for both the number of weeks off and if it’s paid.”

Similarly, the Family and Medical Leave Act of 1993 requires that any employers with more than 50 employees maintain a job for any employee who must take time off due to a family obligation. However, there is no requirement that this time be paid.

EDUCATION AND PROFESSIONAL ENRICHMENT

To keep your knowledge current and renew your medical license, you’ll need to continue learning by taking courses, attending conferences and maintaining professional organization memberships.

“Continuing education benefits have shrunk greatly over the years,” says Roberts, adding that an allowance for this can mean sizable savings for a physician. “Things like a membership to a specialty society can run anywhere from $750 to $1,500.

In addition to coverage for courses or events, you’ll want to make sure you’ll receive your salary while you’re away from work, as well as a stipend to cover expenses related to travel, educational supplies and food.

According to SullivanCotter, annual allowances for CME typically range between $3,500 and $5,000 with paid time off between five and 10 days.

While it’s possible to save money by meeting educational requirements online, Roberts points out that there are benefits to gathering in person with colleagues.

“Attending a conference or class is a useful form of networking and helps to avoid becoming disconnected from other physicians,” he says. “I’ve always come away feeling energized and with new ideas.”

APP COMPENSATION

Advanced practice providers (APPs) are skilled medical professionals qualified to extend or provide patient care, such as nurse practitioners, physician assistants, behavioral health specialists and more. The use of APPs is widespread; however, most states require some level of physician supervision or direction.

Your package should explain how much time you’ll spend overseeing APPs, and your compensation may depend partially on how much time you spend with APPs. This might be measured by hourly rate or patient encounter, or your employer might apply a revenue-less-expenses model.

According to the 2017 SullivanCotter Physician Compensation and Productivity Survey, approximately 71% of hospitals surveyed have physicians who supervise APPs. Of these, 48% provide compensation for APP supervision in addition to a physician’s base salary.

RECRUITMENT INCENTIVES AND BONUSES

The United States is headed toward a significant physician shortage, which is good news for physicians on the job hunt. According to a 2017 study commissioned by the Association of American Medical Colleges, the deficit is estimated to reach a shortage of 8,70043,100 for primary care physicians, 19,80029,000 for surgeons and 18,60031,800 for specialty physicians by 2030.

With employers eager to recruit talent, incentives are a common part of the compensation package. Look for relocation reimbursement, student loan payments, a signing bonus or other pre-determined bonuses. Don’t be afraid to consider these issues when negotiating.

As with any part of your package, read the terms carefully and ask questions. For example, with any bonus money delivered at the start of your employment, find out if you incur a penalty if you do not remain employed for a set period of time. Similarly, make sure a bonus is truly additional money, not a front-loaded portion of your salary.

RETIREMENT

It’s never too early to think about retirement, even if you’re fresh out of residency. Retirement contributions equate to money in your pocket, as well as peace of mind, and they’re a key piece of any compensation package. SullivanCotter reports that the average employer retirement contributions range from 3 to 7% of salary. This may be paid through an employer contribution, a matching program or a salary deferral.

Part 3: Pulling it all together

You’ve thought about salary, considered benefits and arrived at a fair approximation of the financial worth of your package. But you’re not finished yet. There are a few other factors that may not be spelled out on paper but will influence your financial situation and personal satisfaction nonetheless.

REGIONAL ISSUES

Housing, groceries, transportation, taxes and other expenses vary depending on where you live. In an area with a high cost of living, even a large paycheck may quickly disappear. Conversely, you may live quite comfortably on a mediocre salary in an affordable area. Before making decisions, research a region’s cost of living and run your salary through a cost of living calculator.

Malpractice insurance premiums also vary by region, since there are different laws and coverage requirements in different states. A lawyer in the area is usually the best source of information on what’s required and how much you should expect to pay for it.

Finally, physician supply and demand can be wildly different from city to city and state to state, and your specialty makes a difference. “It’s a market economy,” says Roberts. “Be aware of the market rates in your area. For example, central and southeastern United States is the highest salary for a family M.D.

SUPPORTING A HEALTHY LIFESTYLE

Financial security is important, but so is your happiness and that of your family. Keep potential burnout in mind as you evaluate your compensation package, especially since 44% of responding physicians reported feeling burned out in Medscape’s 2019 report.

Job factors that can add to or prevent burnout include call hours, paid time off and insurance benefits, but sources of stress or comfort are different for every individual. For example, if student debt is a major area of personal worry, a loan repayment benefit may add to your peace of mind and reduce your risk of burnout.

Scheduling also has a huge impact on personal contentment. You may be full of focus and dedication as you head into your new job, but even so, you need to be realistic about your need for rest and relaxation.

An all-work-and-no-play approach is never successful.

“Things I often see people forget to account for are commuting time, excessive call requirements, mandatory extra duty (particularly for short-staffed services), and whether a group or department is family-friendly,” says Hunt.

Measure your commute time carefully. A good schedule may not be as great as it seems if you have to spend a long time in transit.

“Your commute never comes out of your work time,” says Hunt. “It comes out of your home life time. Carefully factor how much time you will be at home, versus not at home.”

Other benefits that support a healthy lifestyle include wellness programs, onsite gyms or membership reimbursement, opportunities for sabbatical leave, flexible work schedules, physician lounges, family and/or spouse support groups and mentorship programs.

Understanding and selecting a compensation package is a major endeavor, particularly early in your career when the terminology and expectations may be fairly new to you.

For the best outcome, seek the expertise of seasoned physicians as well as a health care attorney. Remember that your happiness is closely tied to that of your loved ones, so you should listen to their needs and concerns.

Finally, be flexible and don’t stray too far from your established priorities with your final decision. 

 

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Physician, know thyself

Identifying your best work environment starts with asking yourself these questions.

By Marcia Horn Noyes | Feature Articles | Summer 2019

 

Tiffany Shiau, M.D., changed her specialty after a period of soul-searching. – Photo by Jonathon Evans

As Tiffany Shiau, M.D., neared completion of her medical degree from Sidney Kimmel Medical College, née Jefferson Medical College, many people gave her advice about which specialty to choose. Often, the refrain went something like this: “Hey, I did this rotation in ophthalmology, and I think it would be a great fit for you.”

Shiau knew ophthalmology offered controllable hours and fewer night calls, two of the lifestyle factors physicians covet most. After all, it’s the “O” in the so-called ROAD to happiness: radiology, ophthalmology, anesthesiology and dermatology. But when she finally decided on ophthalmology, she wasn’t just banking on a catchy phrase or her colleagues’ advice. She also considered her own experiences.

“At Jefferson, we were affiliated with the Wills Eye Hospital, one of the nation’s top eye institutes,” Shiau says. “Everyone there was amazing. And as a medical student trying to determine what daily routines are like for different specialties—as well as determining how happy people are in their field—I spent time considering whether I could see myself hanging out with these people outside of work.”

After weighing all the factors, Shiau gave a resounding yes to ophthalmology. She assumed it would be a good fit for her personally and began her residency in Buffalo, New York. Four months later, she left the program and switched to internal medicine.

“I came to realize that what other people say is just one input. In the end, it doesn’t matter how people see me unless they really know me. Only then might they have a better chance of understanding what values are important to me,” Shiau says. “During this soul-searching time, I asked myself a lot of questions: ‘What is my gut sense telling me? What feels like the right thing to do?’”

As Shiau considered those questions, she realized that although she liked the field of ophthalmology and the people she worked with, she didn’t like the procedural part of the work. In ophthalmology, she explains, “You can’t really avoid operating on people’s eyes.”

By the time med students reach their fourth year, they usually know what specialty and practice environment they want to pursue. Most make a straightforward choice and are happy with it, but that’s not always the case.

Shiau took an extended journey from medical school to the start of one residency to a primary care residency in an academic setting. Two and a half years later, she took a full-time clinician job on the West Coast, and she says she doesn’t regret one piece of the circuitous route.

The path from medical school to residency to practice isn’t always a straight line. According to the Association of American Medical Colleges, almost 75 percent of medical students change their specialty choice before residency. Twenty percent of residents and 16 percent of physicians make a change and head in a different direction. The uncertainty can be daunting for medical students, who are steeped in a culture of perfectionism, accustomed to excelling in academic settings and trained not to show any weakness.

Mirror, mirror on the wall

Taking a long look in the mirror is important for anyone contemplating a new job or career change, but it’s especially critical for physicians. Emergency medicine physician and associate director of an emergency department in Hartford, Connecticut, Joyce Perfetti, D.O., says you can get lost in the job otherwise. She explains: “Doctors love taking care of other people. That’s why we went into this profession. It’s easy to lose yourself in something that you love.”

Self-reflection becomes even more crucial when others are involved in a career decision. “Not only do I need to know what’s important to me, but I also need to know what’s important to my family, my partner,” Perfetti explains, adding that being honest with yourself is imperative during a period of introspection.

“When you are not honest with yourself and you don’t self-reflect on what your priorities are in life and how they balance with your work—whether those priorities are family, travel, health or working out—you are going to feel a loss, and your family might feel that loss as well,” she says. “There are other things important in your life, and you don’t want to sacrifice those. You don’t want to neglect your family, and you don’t want to neglect yourself.”

Not surprisingly, self-neglect is rampant as physicians juggle competing priorities. Often, they put professional obligations above their own needs and push their bodies to do more with less sleep. Physicians have been known to cope with work pressures in unhealthy ways, including consuming excess caffeine or sugar, skipping exercise and even using drugs. The joy of practicing medicine dissipates, and burnout hits hard.

Perfetti says burnout can be prevented by paying attention to mental health and taking time for recreation. “When you start feeling tired and on days off start losing interest in those things that you love, it’s perhaps time to work out, go for a hike with your family or take a much-needed vacation.”

In the long road to career satisfaction, the only constant is change. Your family situation changes. Your circumstances change. Your goals change. Perfetti experienced this herself during residency. Early on, she thought she wanted to work in a demanding environment, but by the time she finished, her priorities had shifted.

“When I went into residency, I thought I’d work in the busiest, craziest ER I could find. I wanted to see it all and be deeply involved in a trauma center. I thought I wanted that for life,” she says. “If I had stayed in that environment, I knew I would face quite a bit of burnout. Although I did love that for training—and I do love the aspect of it in terms of a long-term career—I didn’t think it was the right thing for me at this time in my life.”

Today Perfetti works in a busy community hospital. Although it’s not a trauma center, the emergency department does see some traumas, and that’s enough for her. “Right now, this is the best fit for me, because it allows me to see a lot of pathology,” she says. “I still see a lot of critical care, it’s just busy in a different way.”

Personal think time

Seeking advice from colleagues, family members and mentors can be helpful, but it’s most important to know your own mind. Your career path, specialty and practice environment are personal choices, and you need to consider for yourself how they align with your lifelong goals—not just someone else’s opinion. Digging deep to uncover your values, interests, personality and skills almost guarantees a richer and more satisfying personal life.

Oftentimes, asking yourself good questions is the most challenging part of reflection. You spend more time with yourself than anybody else does, but that time doesn’t always equate to self-knowledge. Unearthing your own preferences and tendencies can be difficult, but it’s the only way to find much-needed clarity. It will help you identify the ideal practice setting, patient population, specialty and work environment for you. It will also help you find a good fit when it comes to your employer and colleagues.

Questions for getting to the core

Expanding on the Greek maxim “To know thyself is the beginning of wisdom,” Socrates taught that “The unexamined life is not worth living.” And it’s true—examining yourself will have a deep personal impact and help you reach your future goals. But self-reflection doesn’t have to be intimidating. There are no right or wrong questions, just different ways to approach the process. One easy way to start is by following this framework.

1 Consider your interests (your hobbies, passions or anything that captivates your attention):

  • What activities in my life kindle a fire inside?
  • What activities would I miss if I could no longer do them?
  • As a child, what types of activities did I do that led me into medicine?
  • If I didn’t have to worry about money, what would I be doing?
  • What gets me riled up? What problem in the world would I most like to fix?
  • What topics do I find myself always arguing against or defending to others?

2 Consider your personal values (your strong beliefs, personal missions and anything else meaningful in your life):

  • What is something true in my life no matter what?
  • What would I like to avoid in my future career?
  • What does quality of life mean to me?
  • Which core value can I not compromise on?

3 Consider your personality (your temperament and preferences):

  • How do other colleagues, mentors and family perceive me?
  • What kind of work environment best suits my personality?
  • What work environments would feel restrictive and stifle my enjoyment of medicine?
  • What type of colleagues do I like working with?
  • What type of patients do I like caring for?

4 Consider your strengths and weaknesses (your talents, abilities, skills and character):

  • What are my strengths and weaknesses?
  • What is one medical task I love doing even when I’m exhausted and under pressure?
  • What do I fear when it comes to practicing medicine?
  • What have I done in my life of which I’m most proud?
  • Which failure have I turned into my greatest personal achievement?
  • Do I have a self-limiting belief, and if so, why do I have it?
  • What do I believe is my highest possible achievement in medicine?

5 Consider your family (your partner, spouse and/or children and what they want):

  • How will any decision impact my family or loved one?
  • Will this new work environment benefit my family—or take anything away from them?
  • Do I have the full support of my partner and family with my new job prospect?

By asking probing questions to uncover your deepest personal values and desires, you’ll be more likely to find the right practice environment. And if you’re still struggling to answer these questions, ask yourself one more: “Who knows me well enough to help me decide which work environment is right for me?”

For Shiau, a big part of her decision to trade an academic setting on the East Coast for a full-time internal medicine clinical setting on the West Coast was her desire to connect with people. “Ultimately, when my husband and I decided to move to California, I decided not to stay in academics because my personal values were to provide good, comprehensive, kind care to my patients,” she says. “Two and a half years into my first job, I knew I didn’t want to stay in academics any longer. I wasn’t dreaming up an educational project or anything like that.”

Self-reflection doesn’t end once you find your first practice, says Stefanie Gilbert Manuel, M.D. She sets aside time regularly to consider her goals and progress. – Photo by Whole Heart Studios

Self-reflection beyond the hire

In the two and a half years since she completed her residency, Stefanie Gilbert Manuel, M.D., has been practicing emergency medicine in Rockville, Maryland. She says that self-reflection becomes even more important as your career progresses. “The self-reflection piece drives the process of finding a job, while also giving a frame of reference or focus for the next steps a physician takes with future goals,” she explains. Without that introspection, Manuel cautions that it’s easy to get lost in all the different types of residencies and job environments.

Manuel spent time considering both her personality and preferences while searching for her first job. Right out of residency, she looked at a variety of job settings: academic, community-based, mixed, and those with a teaching focus. She then considered her strengths, weaknesses and values, and she evaluated how different settings lined up with these.

“For me, it was important that once I finished residency that I get out on my own and hone my skills, rather than taking an academic setting position where I would be supervising many residents,” says Manuel. “I needed autonomy once out of residency. It was important for me to formulate my own treatment plans and procedures for my own growth development, which would build confidence.”

As she went on to evaluate each employer, Manuel used specific criteria. First, she looked for physicians at each practice with similar backgrounds to hers, reviewed their track records and asked them for input. Next, she considered the makeup of group practice to ensure they embraced diversity instead of just talking about it. Finally, she evaluated the kind of support each employer gave to physicians working their way up to leadership roles

This self-reflection helped Manuel choose her first position. She signed with US Acute Care Solutions (USACS) because the physician-owned group’s values and mission aligned with her own. “In addition to the company being open and receptive to feedback, the group practice has a big push for women in leadership and embraces diversity,” says Manuel.

Now a practicing emergency physician, Manuel carves out time for ongoing introspection. “I have a note on my calendar, set for every couple of months, to go through and update my curriculum vitae. I spend time reflecting on what I’ve done and then line out the next steps and goals I want to consider.”

By prioritizing introspective habits, she finds she’s more able to remember and document her achievements, which will be crucial for future opportunities. Regular reflection also helps her make sure she’s continually stretching herself and gaining clinical skills.

Perfetti also works for USACS, albeit in a different city. Both emergency physicians value the leadership opportunities they’ve been offered. In fact, both recently completed the company’s year-long intensive leadership course, the USACS Scholars Program, which is designed to “mentor and develop acute care physicians with leadership potential into candidates for leadership positions throughout the company.”

The program is helping Perfetti accomplish goals she set for herself during self-reflection. Early this year, she moved into an administrative position and says it’s a good fit. “Prior to entering the Scholars Program, I felt like I was being drawn to the business aspect of things. I love seeing how the hospital works and also learning more about how the USACS works within the hospitals it serves,” she explains, adding that she’s been able to balance new administrative duties with clinical work. “I love emergency medicine, and I never want to leave it. I still wanted to work full-time clinically.”

Whether you, like Perfetti and Manuel, quickly find the perfect job or, like Shiau, you follow a labyrinthine path to career satisfaction, it’s important to set aside time for reflection. Considering your personal values, strengths and weaknesses will help you start your career on track—and continue to lead a fulfilling life. Because you can only know the right path when you truly know thyself.

Marcia Horn Noyes is a frequent contributor to Practice Link Magazine.

 

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Moving for work?

How physicians can manage through site visits and relocation when a new opportunity arises.

By Linda Childers | Feature Articles | Summer 2019

 

Ann Cheung, M.D., moved from Boston to the San Francisco Bay Area to begin her pediatric residency at UCSF Benioff Children’s Hospital, drawn to California by the hospital’s excellent reputation and her desire to live on the West Coast.

But she didn’t realize the amount of planning it would take to move from the East Coast to the West.

While some physicians move to pursue new employment opportunities, others relocate to be closer to their families or to take on new career challenges presented by in-house hospital recruiters, physician recruitment agencies, alumni associations, professional membership organizations and more.

Though accepting a job as a physician in another city or state can be exciting, the actual move is often a time-consuming process. Considerations such as selling your existing home, securing new housing and transitioning your family to a new city can make it a challenge. Here’s how to make it less difficult.

Know what’s available

Relocation assistance for physicians varies from one hospital system to the next, but doctors typically receive funding to help with their relocation, as well as guidance in locating a realtor. Throughout the interview process, you’ll find out (or have occasion to ask) what the relocation package entails, and what temporary housing and moving expenses are covered.

Many hospitals will also offer a list of preferred relocation vendors, such as moving companies. Using a preferred mover could cut down on the paperwork you’ll need to complete; if you choose a company on your own, you will be asked to submit receipts for reimbursement.

At Phelps Health, a nonprofit community hospital in Rolla, Missouri, physicians are offered a competitive compensation package that includes a three-year contract, $35,000 signing bonus, a stipend from contract to starting date, and a $3,000 monthly student loan repayment, among other benefits.

“For physicians moving to the area, we also offer a $15,000 relocation package,” says Elizabeth Hedrick, senior physician recruitment and business development specialist at Phelps Health. “Because we’re a rural area, our compensation package is very competitive and includes helping physicians get their student loans paid off and enjoying 30 paid vacation days each year.”

In addition to relocation expenses, some hospitals offer physicians housing assistance.

“All of our residents are offered a $2,400 moving stipend and a $3,000 yearly housing stipend,” says Pamela Simms-Mackey, M.D., FAAP, director of the GME and Pediatric Residency Program at UCSF Benioff Children’s Hospital in California. “Both are in their union contract, which is up for negotiation this year, and I expect that amount to increase as housing costs have increased over the past three years.”

Pediatrician David Burnham, M.D. moved his family from Minnesota to Pennsylvania. Add extra time to your job-search plan when moving out of state. – Photo by Timothy Gangi

Plan for a successful site visit

Before you plan to move however, you must successfully complete the interview process.

When applying for a job opportunity in another city or state, your initial interview will probably be conducted via phone or Skype. If that goes well, you’ll be invited to an in-person site interview to meet the team. These kinds of visits may include a tour of the facility and one to two days of interviewing with administrators as well as other physicians and colleagues.

As you schedule and complete the site visit, be prepared to be screened, background checked and asked for professional references.

The on-site job interview gives you an opportunity to determine if you are a good fit with the hospital, the team and the new community. It is important to arrive prepared. Conduct background research on the hospital or medical group you are interviewing with in order to ask specific questions about your role, expectations for the job and what your schedule might look like.

Autumn Ashcraft, provider recruitment manager for Borrego Health in Escondido, California, says it is important for physicians to remember that interviews are a two-way process. That means you should be prepared to not only answer questions, but also to inquire about issues such as performance expectations, goals of the institution, and how your skills can help them meet their goals.

“Ask about the organizational culture and expectations such as productivity requirements,” Ashcraft says. “It’s important for physicians to make sure they’re comfortable with their anticipated patient volume as well as the organization’s mission and vision.”

Ashcraft says it can be advantageous for a new physician to ask if it is possible to speak with another provider in the same specialty area and even shadow them for a specific period of time.

She stresses that physicians should be clear about what they are looking for in a new opportunity, the colleagues they want to work with and the type of schedule they want to maintain. Additional questions may cover what electronic medical records systems and other technology are being used in the workplace in order for you to determine how steep the learning curve will be.

For physicians who are not sure about what to wear to the site visit, recruiters say it is fine to ask.

Considering your family’s needs

Hedrick encourages physicians to involve their spouses in the process by bringing them, and if appropriate, their children, on either the first or second site visit. Though family members do not sit in on the formal interview, Hedrick says it gives them a chance to tour the area and meet with a realtor.

“If people are unfamiliar with Rolla, they often envision a rural area where chickens and livestock are crossing the roads,” Hedrick says. “The reality is we’re a college town that services six counties, so in-person visits can really give physicians and their families a clearer picture of what it’s like to live here and what the community has to offer.”

Hedrick and other recruiters regularly recommend realtors who can offer physicians and their families tours of homes and neighborhoods. In addition, these local experts can provide information on public and private schools, safe neighborhoods, transportation options and more.

Realizing that relocation affects the entire family, physician recruiters often work to make relocation easier for everyone by sharing what it’s like to live in the area and connect them with local resources.

Brittany Kulp, senior medical staff recruiter at Tower Health in Allentown, Pennsylvania, says she frequently introduces a candidate’s spouse to the spouses of other physicians during a site visit. Families who have lived in the area for a longer period of time can answer questions about things to do in the city, schools, clubs, churches, and serve as familiar faces to those who are moving to a new area.

“Sometimes we’ll treat the physician and their family to a day at a local zoo or museum so they can experience the area firsthand,” Kulp says. “It’s important to get the entire family’s buy-in and make sure everyone is happy in order to make the transition easier.”

Kulp recommends allowing time to tour neighborhoods and explore the community while on a site visit, especially if it’s an area you’ve never visited before.

Research the city where you will be working to determine if you can see yourself and your family living there.

Ann Cheung, M.D., moved from the East Coast to the West for her pediatric residency in California. – Photo by Christian Erickson

Budget for your move

Once she accepted a job offer to move to the West Coast, Cheung began conducting price comparisons to determine whether it would be more cost effective to move her belongings, such as furniture, across the country or to buy new furniture in California.

And though she didn’t need a car in Boston, she knew she would need one to navigate the Bay Area.

“I spent a lot of time figuring out whether I wanted to lease a new car or purchase an older car,” she says. “And since I accrued a lot of items between college, working and medical school, I used apps like LetGo to sell my belongings in order to save on costs.”

With the average California home selling for more than $593,000, Cheung turned her sights to renting and found another resident who was familiar with the area and was also looking for a place to rent.

“Buying wasn’t possible with either of our budgets,” Cheung says. “Fortunately, we were looking for similar things: a relatively short commute to work, safe neighborhood and reasonable price for the Bay Area. She was in the Bay Area so she would FaceTime me so I could look at potential apartments.”

“Many of our residents have roommates or significant others that they split their rent with,” Simms-Mackey says. “It’s rare for a resident to be able to afford to live alone or purchase a house in the Bay Area.”

Determine a realistic timeline

For physicians moving to another city or state, careful planning can serve to eliminate any potential surprises that might arise along the way.

Looking back on his move from Minnesota to Palmer Township, Pennsylvania, pediatrician David Burnham, M.D., wishes he had allowed for additional time in planning his move.

“I didn’t realize how long it would take to close on our new home in Pennsylvania or that obtaining medical licensure in a different state would take three months,” Burnham says. “I mistakenly thought both processes would be similar to Minnesota.”

Because they couldn’t move into their home right away, Burnham and his family lived in an extended stay hotel for three weeks after arriving in Pennsylvania and had to store their furniture and other belongings in a storage unit.

Although he is very happy in his new job and location, Burnham wishes he had started the job search process sooner and built in extra time for purchasing a home, obtaining licensure and becoming familiar with the new area. The timing, however, worked out.

“In retrospect, I’m glad we planned the move to coincide with our kids’ school schedule,” says Burnham, whose kids are 12, 15 and 21. “They were able to finish the school year at their school in Minnesota and then start the new school year in Pennsylvania.”

Conduct due diligence online

Thanks to the internet, researching the cost of living, potential housing, and different cities and states has never been easier.

Damon Davis, M.D., a urologist at Mercy Medical Center in Baltimore, Maryland, says he was able to conduct a lot of research online before he relocated from East Lansing, Michigan.

“I grew up in the Baltimore area, so while I was familiar with the area, I was also able to look up things online such as school rankings and test scores for my three children,” Davis says. “I also connected with a realtor and supplemented that by looking at homes online and determining their proximity to the hospital and schools.”

Sites such as NerdWallet.com offer a free cost of living calculator that compares the cost of living in a physician’s current city to the cost of living in cities where they are applying for jobs. Niche.com has rankings of the best school districts in the country and links to nearby homes.

Planning carefully for a move, embracing resources that can make the transition easier, and anticipating the issues that may arise can make the move easier for your whole family.

 

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5 steps for interview prep

How to rock the interview and win the job.

By Debbie Swanson | Feature Articles | Summer 2019

 

Ask colleagues about their professional achievements— but stay away from anything personal you find on social media, recommends Stacy Potts, M.D. – Photo by Mike Hendrickson

Wouldn’t it be great if you could just walk on board to your perfect job? There’s just that one hurdle: the job interview. Interviews can be stressful for everyone involved, but the good news is there are steps you can take to calm your nerves and make a winning impression. From self-reflection to research and planning, the effort you invest ahead of time will pay off in the long run.

Step 1: Evaluate your priorities

Preparing for an interview isn’t just about researching an employer or rehearsing your answers. You should also walk in with a clear understanding of what you want in your career. Whether you need to take an afternoon off to do some soul searching or you’ve known your dream practice setting all your life, spelling out your and your family’s priorities is one of the best ways to guide a job search.

Define the job you want

For starters, what exactly is your vision for the future? Periodically reevaluating this vision can help you determine which job opportunities line up with your goals.

“Understand what’s important to you,” recommends Paula M. Termuhlen, M.D., Regional Campus Dean at University of Minnesota Medical School, Duluth campus. “Once you have a good sense of [this], you can learn more about the organization.”

As you define your vision, consider the following:

  • Practice setting: Do you want to work in a hospital, join a group practice or go solo?
  • Future growth: Are you focused on clinical work, or do you aspire to research, teach or join academia? Do you want to become a partner or move into a leadership position eventually?
  • Salary expectations: How much do you need to earn to meet your expenses? What are your financial goals for the future?
  • Motivation and mission: What initially drove you to go into medicine? What experiences so far have brought you the greatest satisfaction? The least satisfaction? Do you have a personal mission?
  • Location: Do you thrive in a certain climate or region? Are you up for relocating, or do you have ties to a certain place? Is there a particular patient population you’re especially interested in serving?
  • Lifestyle: What type of schedule works best for you? What are your obligations outside of work? What times of day do you feel most productive?

These questions are a good starting place, but everyone’s vision includes different priorities. Take time to assess any other factors relevant to your life, your immediate needs and your long-term goals.

Consider your family

You don’t live in a vacuum. Whether you’re single and eager to explore or married with children and pets, the job you choose will influence the people in your life. It’s important to ask for their input—even if you think you already know their opinions.

“No matter where you are in the continuum of medicine, you’ll be spending a significant portion of your waking hours at work. The people important to you also need to be happy, satisfied and successful without your physical presence,” says Termuhlen. “You need the support of the people close to you.”

As you talk with family and friends, make sure to address these areas of conversation:

  • Employment: Will your spouse or partner need a new job? What setting provides adequate opportunities for his or her field of work?
  • Transportation: Do you need to be close to an airport or another transportation hub so you can easily travel to family back home? Does anyone in your immediate family need access to public transportation in your new city?
  • Region: Do any of your family members have a strong preference for or against a certain climate or geographic region? Are any of them passionate about a sport or activity that’s only available in certain settings?
  • Children: What are your children’s needs? Consider schools as well as recreation, arts and athletic programs. How might your family change in the next five to seven years?
  • Family support: Do you need to consider childcare, senior resources, religious organizations or any other special circumstances?

Once you develop a list of your family’s priorities, combine it with your own and use both lists to drive your job search.

Be prepared to speak eloquently about any part of your CV during your interview, says Christa Zehle, M.D. Review important dates and research before you go. – Photo by Jaclyn Schmitz

Step 2: Research the opportunity

Educating yourself about the workplace, the position and the community will not only make you look more prepared, it will also help you feel more confident. Your interviewers will appreciate the effort you’ve put in, and you’ll be more equipped with background information.

Explore the program and organization

These days, it’s easy to learn about an employer even before you’ve stepped foot in their building. “Use the organization’s web presence to find out as much as possible and ask people with whom you have connections,” suggests Termuhlen, adding that a spreadsheet can be a helpful way to track details.

Start with the basics: the organization’s history, size and specialties. Then dig deeper on their website to learn about their core values, partner organizations, charitable programs and plans for growth. You can also look at their media releases or search Google News to find out what big events or changes they’ve experienced lately.

If you speak directly to any of the organization’s employees, focus on their firsthand experience instead of facts you can easily find online. Ask about their job satisfaction, the corporate culture and what a typical workday involves, as well as what they think about the area and community.

As you collect information, make note of things that strike you as either positive or negative. These may become topics for conversation in your interview.

Get to know your interviewers

You’ll feel more comfortable if you familiarize yourself with your interviewers ahead of time. Scan your meeting agenda for each person’s name, then take a minute to look up his or her bio on the organization’s website or LinkedIn. Search online for anything they’ve published in professional journals or national publications.

When searching online, you’re likely to uncover personal details as well as professional information. Stacy Potts, M.D., associate professor at University of Massachusetts Medical School, says you should avoid paying attention to this.

“It’s nice to mention information to make a connection, but keep to what you find in professional bios, not social media,” she explains. Congratulating someone on a publicized professional accomplishment is fine, but asking about his or her eldest child who just went to college could be off-putting.

You should also try to learn name pronunciations ahead of time. If a name seems especially cryptic, ask your recruiter for help or call the physician’s office to hear the receptionist’s pronunciation.

Find out what the area offers

Whether you are flying to an unfamiliar destination or driving to a nearby city, designate some free time to explore the area. It’s not just the job that needs to be right for you and your family. The area should be a good fit, too. Don’t assume an employer will work this time into your schedule. If you have a full itinerary, consider staying an extra night or ask if your meetings can be spread out so you can explore.

“Asking that can be looked highly upon,” says Potts. “It shows that the applicant has a clear idea of what they need and a level of commitment. Also, being able to voice your own concerns is good for your future role.”

Before you go, identify what neighborhoods, schools, religious establishments, recreational areas and other sites you’d like to visit. Set up any appointments, such as a meeting with a realtor or a colleague, ahead of time.

Step 3: Prepare what you want to say and ask

The question-and-answer session makes up the bulk of any interview, and it’s also one of the easiest portions to prepare for. Don’t assume you can figure out what you’ll say on the spot. You’ll thank yourself later if you sort out your thoughts beforehand.

Rehearse your answers

Practicing your answers to interview questions can instill a sense of confidence and ensure that you communicate key points effectively. There are plenty of resources available with lists of typical questions—both those geared to general job seekers and those specific to physicians. Your alma mater’s career center is a good place to look for one of these lists, and you can also search online for similar resources.

As you read through questions, try to formulate your responses. Take into account the unique aspects of your own career and areas of interest, then think about weaving these details into your conversation. A candidate who shares a memorable story or personal experience will leave a stronger impression.

“Find out what parts of this job line up with your priorities. [Prepare to] mention those things in the interview. Also bring up past experiences that line up with these items,” Potts suggests.

In addition to preparing for standard questions, remember that your interviewers will likely want to discuss your background and application materials. Review all the information you’ve provided and refresh your memory of the dates, names and details.

“Avoid putting anything down on paper that you aren’t ready to speak eloquently about,” says Christa Zehle, M.D., interim senior associate dean for medical education and associate dean for students at the Larner College of Medicine at The University of Vermont. “For example, if you say you’ve done research, be able to provide more information.”

Create your list of questions

The interview isn’t just about your answers. You should also bring questions of your own. Employers look highly on candidates who pose thoughtful questions, and asking them will help you uncover important details about the job you’re applying for.

“Ask genuine questions. Don’t just ask for the sake of asking something. Show that you have some familiarity and you’ve done your homework,” recommends Zehle. “Ask about a unique component or something specific about the program. Avoid topics such as compensation, call schedules or salary.” While the latter may be valid questions, it’s best to save those for your recruiter or raise them later in the process.

Write your questions down and feel free to bring your list with you. “Pulling out your list of questions at the interview is fine,” says Potts. “It shows engagement—that you’re taking the experience seriously.”

Identify a mentor

The abundance of information you’ll take in during an interview would be overwhelming to anyone. It’s helpful to have a close friend or family member you can talk with about your impressions, and it’s equally important to have a seasoned medical professional who is willing to help guide you.

“Find a mentor with more experience than you. You need someone neutral to the process to guide you, a trusted friend or colleague,” says Termuhlen, adding that you can also reach out to someone who has the type of job you’d like to end up in. “Even if you don’t know them, you can introduce yourself and explain that this is the type of job you’re hoping to have someday,” she explains. “Most professionals would be receptive to this.”

Step 4: Prepare to make a good impression

Your credentials may have gotten you in the door for an interview, but once you arrive, your presentation and social skills will determine whether or not you get the thumbs up. Take some time to assess your strengths and weaknesses.

Do a practice interview

Whether you’re just starting off or relocating after 10 years of clinical work, it’s always smart to take a critical look at your interviewing habits. One of the best ways to do that is to watch yourself on tape.

“Mock interviews are invaluable for spotting things you may not realize, such as non-verbal communication or nervous habits,” says Zehle. Ask your alma mater’s career center if they offer mock interview sessions or, she suggests, “Just have a rudimentary session where a friend asks you some questions and you video your responses on your iPhone.”

As you watch your performance, you may discover areas for improvement. For example, you might notice you tend to ramble or don’t maintain eye contact. “Try to address any weak areas so that you portray confidence and carry yourself well at the interview,” Zehle suggests. “Practice your weaknesses.”

And don’t forget to notice your positive traits. If you greeted your interviewer with a warm smile or firm handshake during your practice interview, make sure to do the same when it’s the real deal.

Prepare your wardrobe

You are likely to have a few different meetings on your schedule— everything from a breakfast meet-and-greet to a facility tour to a meeting with prominent department members. Dressing appropriately for each is part of making a good impression. “Every interaction will count,” says Potts. “You should be able to appear relaxed at each kind of gathering.”

For the interview itself, you can’t go wrong with a suit: a dress shirt, slacks or a skirt, matching jacket, a tie if appropriate. Choose subtle or neutral colors. For other events—such as a tour or meal—avoid a last-minute scramble by asking about the dress code in advance. If you’re unsure, ask your recruiter or contact the restaurant directly.

Don’t forget to take weather into account. If you’ll be going in and out of a car or doing extensive walking, dress for the elements and have something in which to carry your paperwork and personal items.

Even with a less-formal gathering, don’t stray too far from professional boundaries. This isn’t the time to be flamboyant. You want people to remember your skills and personality, not what you were wearing. “Use common sense,” says Potts. “Look relaxed, but don’t go overboard.”

What you wear contributes to your confidence, so don’t take shortcuts. Select comfortable clothing that boosts your self-esteem. Avoid anything that might preoccupy you, such as a stained shirt or slacks that don’t fall right. You’ve worked too hard to get to this point to let your clothing steal your focus.

Collect your materials

Most of your paperwork will be taken care of by the time you sit down for the interview, but it doesn’t hurt to carry extras with you just in case. Use some type of portfolio case to carry a spare copy of your CV, contact information for your references and any other relevant paperwork.

Don’t forget to update your list of references and verify their contact information. “As a courtesy, let them know they may be getting a call,” Zehle says. That way, they’ll be prepared to say glowing things about you.

Step 5: Plan logistics ahead of time

As you get closer to your interview day, do everything you can ahead of time. Small steps will make the difference between arriving rested, focused and on time instead of frazzled, distracted or late.

Deal with last-minute details before the last minute

Before your meeting, consider all the logistics of the day. Figure out your transportation plan and investigate traffic patterns to decide when you need to leave. Leave plenty of extra time—even if you’re already familiar with the location. If you’ll be using a transportation service, call ahead of time to confirm their schedule. Have an alternate plan in mind, just in case.

If you have children, confirm there is a plan (and a backup plan) for their care. Be sure your family members know what hours you’ll be unavailable and, if need be, designate an alternate contact person.

Do your best to streamline your morning: gather your wardrobe, pack a light snack, tuck any needed medicine or toiletries into your bag and fill a water bottle. Anything you can do in advance is one less thing to remember on your way out the door.

Practice self-care

By now, you probably have a handful of strategies for getting through challenging situations. An interview is just one more opportunity to put these coping skills to work, whether that means waking up early for a run or tucking a protein bar into your jacket in case you barely eat at the colleague luncheon. Now is the time to implement any habits that help you feel your best.

With an already busy lifestyle, it’s easy to procrastinate about interview preparation or assume you’ll just deal with issues when the time comes. But by getting a head start, you’ll be able to stay focused when the interview comes—and land your dream practice.

 

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It takes two: your spouse’s role in the job search

Starting early and speaking up can help physicians and their partners choose a career—and a location—that they both can love.

By Karen Edwards | Feature Articles | Spring 2019

 

Stephanie Benjamin, M.D., is an emergency medicine resident and author of “Love, Sanity, or Medical School: A Memoir.” – Photo by Derek Lapsley

Starting the post-residency job search can be daunting. You’re working long hours, studying for boards and trying to have some semblance of a personal life. How are you supposed to add anything to your schedule, let alone a job search? The solution is to take things one step at a time. And if you’re married or in a committed relationship, the good news is that you’re not tackling this journey alone.

Just don’t forget to start early. “It depends on your specialty and where you would like to work, but most residents should start their search 12 to 18 months from their completion date,” says Jen Kambies, FASPR, director of special initiatives at the Cleveland Clinic. It’s the one job-search mistake she sees most often. “Applicants can underestimate the time it takes to get licenses and complete the credentialing process,” she explains.

Wendy Barr, M.D., MPH, residency program director of Lawrence Family Medicine Residency in Massachusetts, agrees. “I hear residents tell me they’re too busy to start their job search,” she says. “But I remind them, the whole point of residency is to get a job. If the search is delayed, they can go a month or two without a paycheck while they wait for the paperwork to be done.”

So here’s a rough roadmap to make getting a head start easy. Read on for the steps you should be taking—and how your spouse or significant other can help:

Getting ready for the search together

Physician

“Medical school and residency are so regimented. A job search marks the first time new physicians have the freedom to choose their path. It’s scary and exciting at the same time,” says Barr.

Before you begin your search, sit down and decide what you’re looking for in a job. Do you want to stay where you are or move? And if you’re moving, what kinds of job opportunities does your spouse need to find in the area? What salary range do you expect to earn?

You need to answer these questions even if you plan to stay put in your current location, so it’s best to start making decisions early. “Lack of clarity is one of the biggest reasons for procrastination,” says Kenneth Hertz, FACMPE, principal consultant with the MGMA Consulting Group. He says that once you’ve set goals and made some decisions, you’ll be better able to focus your search.

John Rodriguez, M.D., an orthopedic surgeon at Texas Orthopedics in Austin, says job applicants need to think beyond salary requirements. He recommends considering other important factors, such as job freedom and flexibility.

Stephanie Benjamin, M.D., a fourth-year emergency medicine resident at UCSF Fresno and author of Love, Sanity, or Medical School: A Memoir says not to pigeonhole yourself. “Determine your priorities and think every decision through so you are building the career that you—and not someone else—want,” she says.

That’s what Sasha Thomas, M.D., did when a job opportunity in Kansas came up unexpectedly. At the time, he was practicing in North Carolina as an executive health physician. “My wife and I sat down with legal pads and made lists of the pros and cons of staying where we were or moving to Kansas,” he says. “We took everything into consideration.” Ultimately, the pair decided to move.

Spouse

“You should be having ongoing conversations with your spouse about lifestyle, location and career goals throughout residency and throughout your lives,” says Lara McElderry, creator and host of the Married to Doctors podcast. When you do talk, she says it’s important to “be honest with your feelings, and keep an open mind.”

Stephanie Benjamin’s husband, Alex Angeli, says he asks his wife questions to ensure she’s making decisions that will truly make her happy. “I’ll ask her what move makes more sense to her in terms of what she wants to accomplish professionally,” he explains. “What location will help toward that goal?”

Doing the preliminaries (residency, years 1-3)

Physician

“The first thing you should do before a job search, if you haven’t already, is pull together your curriculum vitae or update it,” says Kambies. “It’s the first thing you’ll be asked for when you contact anyone for a job.”

Matt Wilson, M.D., a hospitalist and clinical assistant professor at the University of Kansas Medical Center, says he used free online resources to help with writing and formatting his resume. “I also asked a couple of residents a year ahead of me to send copies of their CVs for me to look at,” he says.

Don’t forget to check your social media presence. “We address this from day one,” says Barr, explaining that your public persona may prevent you from getting a license in certain states. “All social media accounts should be set to private—only visible to family and friends,” advises Wilson. And Benjamin says that even though she uses only her first and middle name on media sites, she’s still careful about what she posts.

Now is also the time to research potential locations and make other preliminary preparations. “Handle the process like it’s a job,” says Hertz. “Take notes on paper or online. Hone your interview skills. Spend time researching jobs. Sign up for PracticeLink.”

Faculty can be great resources during this time since many of them have developed a wide network of professional connections. “One of our residents had to narrow his search to Texas and North Carolina because those were the best places for his wife to find work,” recalls Barr. “He asked if any of the faculty had connections to either of those places. It turned out we did.”

Spouse

As a physician’s spouse, there’s a lot you can do to take the weight off your partner during this phase of the search. For instance, you can help with his or her CV. McElderry says, “Most physicians will take care of the writing themselves,” but if you’re skilled at communication, you might be able to pitch in.

Even if you don’t help draft your spouse’s CV, you should give it a once-over before it goes to an employer. Angeli did exactly that for his wife during her job hunt. He proofed her CV and helped organize it. “I also made sure it had her voice,” he says. “It highlighted what she wanted in a job and what she can offer.”

If you have time, you can also help research locations and job opportunities. “In your initial conversation with your spouse, choose the top three geographic areas where you want to live and work and expand from there,” advises Kambies.

“It helps to build a spreadsheet,” adds McElderry. “Organizing prospects will help you both better determine the best jobs and areas to explore.” Once you’ve narrowed the field, she says you should learn as much as you can about the area. She explains, “I researched everything: climate, schools, cost of living, neighborhoods and commute times.”

Kavitha Thomas, Sasha Thomas’ wife, took a less structured approach to her research. “My husband’s a data person; he made spreadsheets,” she remembers. “I’m a feelings person. I researched the area and tried to imagine what it would be like to live there.”

Lara McElderry created and hosts the Married to Doctors podcast. “Be honest with your feeling and keep an open mind,” she says when helping a physician spouse through their job search. – Photo Zayne Williams

Starting your active search (residency, summer of year 3)

Physician

This is the point where physicians can fall behind, according to Kambies. “They become extremely busy and the search for a job can fall off their radar. On occasion, they will wait until after their boards to start the search, but that is the time when they most need to be reaching out to recruiters and prospective employers.

“Starting early doesn’t hurt,” advises Kambies. “We don’t know what our needs will be two years out, but if this is a place you want to work, you can contact us if nothing else and form a relationship.”

That’s exactly what Wilson did. “At the end of my second year, I emailed the head of the hospitalist program at my medical school since I wanted to work there,” he says. “They told me to contact them around September when they were ready to start hiring for the next year.”

After reaching out to an employer, it’s a good idea to let the organization’s contact guide you through the process, according to Debbie Gleason, director of physician recruitment for The University of Kansas Health System. “This person is often an in-house recruiting professional who will be adept at road-mapping the process and provide guidance for the timing of the next steps,” she explains.

Spouse

This part of the process is a good time to play the role of motivator and coordinator, says Gleason. “Spouses and significant others could be helpful in gathering documents that will be needed for updating CVs, completing applications and other paperwork that will be necessary once a decision is made about what position will be accepted,” she explains.

You should also plan to go with your spouse on site visits. “Many hospitals will set up realtors for you and school tours—and may even connect working spouses to contacts in their field,” says McElderry.

“It’s not unusual for in-house recruiters to offer to visit with spouses to answer their questions about the community or professional options,” adds Gleason. If this resource is available through an employer, she recommends taking advantage of it.

Conducting interviews and site visits (residency, autumn of year 3)

Physician

At this point, you should have your interviews and site visits arranged. Before any interview, Gleason says it’s a good idea for physicians to research potential employers. “It can be a way to show they’re serious about the position and the community as well as enhance the research they started at the time they launched their job search,” she explains.

When it comes to the interview itself, Hertz says small stuff matters. “Be professional, dress appropriately, remember basic social skills,” he recommends. And Rodriguez says it’s worthwhile to imagine yourself on the other side of the table. “I changed how I thought about the job search,” he says. “I try to see it from the other side, to think about the employer’s needs. Would I be a good hire for them? I want to make sure I’m what they’re looking for.”

Thomas says he goes into every interview with a list of questions. “The employer’s responses will help you make a better decision about the position because you’ve raised points that are important to you,” he explains.

And while you’re thinking about what’s important to you, Barr says to remember that employers are not allowed to bring up your family unless you do. Depending on your situation, you may choose not to. “There can be discrimination with regard to physicians and families,” she says. That’s true whether the applicant is male or female, so if this is something that concerns you, keep your family out of the interview.

Once you’ve finished the interview, your contact at the employer will likely give you a timeline for the decision. Follow-up emails and calls are appropriate. “The timing can vary, but I would say an email every week or two is likely appropriate,” Gleason says.

Spouse

Since a job decision will affect both of you, it’s a good idea to join your spouse for on-site visits. “Alex comes to every potential job site to help check out the city and to ensure the location would provide professional opportunities for him as well,” says Benjamin.

“The site visit was helpful,” agrees Kavitha Thomas. “No matter how much research you do, you don’t know how things really are until you experience the place for yourself.”

If you have kids, consider their interests and needs as you tour the area. For example, during her site visit, McElderry wanted to learn about the orchestras and sports teams at local schools because she knew those would be important to her children.

No matter what you hope to learn while you’re visiting, make sure you remain professional throughout the stay. Hertz warns, “You don’t want to say anything negative about your spouse that could get back to the employer.”

After a site visit, Hertz recommends offering to write thank-you notes to employers. It’s an easy way to take something off your spouse’s plate. You should also sit down with your spouse and discuss expectations for the typical work/call schedule and vacations.

“Be part of the conversation,” says Kambies. You’ll want to provide your feedback before a job offer is accepted and contract negotiations begin. “We had these conversations early on,” remembers Wilson. “That made the whole process relatively smooth.”

Making your decision (residency, winter of year 3)

Physician

If you started your job search a year in advance, you should have an offer by January at the latest, says Barr. But before you can accept a job, you have some decisions to make—especially if you’ve received multiple offers.

“Most in-house recruiting professionals would expect that candidates are looking at other opportunities,” says Gleason. “It’s perfectly acceptable to let organizations know you’re looking at other opportunities and to ask for their timeline.” This will let you know how long you can safely delay your decision.

But organizations have their own timelines for considering candidates for positions, which means you may or may not have as much time as you think. Effective communication and long-term decision-making may be better tools for negotiating offers than pitting employers against each other.

According to Gleason, if physicians falter at the finish line, it’s typically because of one of two reasons: compensation expectations or contract negotiation parameters. “A physician going into a job search should research what factors play into their particular personal family needs and practice setting type and location,” she says. “Understanding a potential compensation model for a future position and what is reasonable for their geographic setting and practice type is highly important.”

She adds that many organizations have standardized contacts. “It’s not uncommon for only a few components of the agreement to actually be negotiable,” she explains. “An interviewing physician would do well to understand this aspect as he or she begins discussions.”

When you’re presented with a contract, Rodriguez says, “The first person you negotiate with is yourself. Are you happy with the terms? Then sit down with your spouse and discuss it together.” Only after these steps should you negotiate with an employer.

Spouse

As your spouse makes career decisions, it’s reasonable for you to weigh in. “You’re in a partnership with your spouse, but the job will be just as much a partner in your relationship,” explains Angeli. “This is something you need to be involved in.”

McElderry says asking your spouse questions can help him or her make a decision. For example: Are there good mentorship possibilities at the facility? Does the workplace culture seem like a good fit? Will he or she enjoy the coworkers? How is the salary structured?

“I think it’s helpful to talk with the spouses of physicians who work there,” she adds. “They may give you a better idea of what kind of relationship your spouse plans to enter into.”

Your own career may affect your spouse’s choices. “My wife’s biggest priorities were location and job opportunities,” recalls Wilson. “Thinking back to medical school, there was a particular residency program that I loved but ranked low because I knew my wife wouldn’t be able to easily find a job there.”

However, according to Barr, these roles are often reversed. In a two-career marriage, the non-physician spouse often makes the professional sacrifices during residency because of the match. “When it comes time to finding a job, that’s where I think the physician spouse might want to give the non-medical member of the marriage a bit of an edge,” she recommends.

No matter where you land, you and your spouse should base your decision on the jobs and lifestyle you feel are right for your family. And if you end up relocating, Gleason says it’s best to have all hands on deck. Help your spouse with relocation planning and transitioning your children to a new community and school.

Throughout the job-search process, a spouse is often part of the decision-making. And that’s as it should be. That’s why Gleason recommends that physicians include partners in their research, thought processes and decision-making from the very beginning. “This will reduce any additional delays in deciding on an offer,” she says.

“Talk to each other even when you’ve made the move,” adds Kavitha Thomas. “Know things will change. If that happens, begin the process again—knowing you can make it work.”

“I hear residents tell me they’re too busy to start their job search. But I remind them, the whole point of residency is to get a job. If the search is delayed, they can go a month or two without a paycheck while they wait for the paperwork to be done.”

“Lack of clarity is one of the biggest reasons for procrastination,” he says, adding that once you’ve set goals and made some decisions, you’ll be better able to focus your search.

“You’re in a partnership with your spouse, but the job will be just as much a partner in your relationship.”

 

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What to ask during your interview

The interview is a time for you to get to know the employer as much as it is for the employer to get to know you. Here’s how to do it.

By Debbie Swanson | Feature Articles | Spring 2019

 

Looking for the real scoop on a health system you’re considering? Google it—and check social media for public opinion, says Janet Gersten, M.D. – Photo by Rodrigo Velera

There’s a lot to do when you’re preparing for an interview: research the employer, think about what you might be asked, formulate your answers and even rehearse your responses. Don’t overlook the equally important task of preparing questions of your own.

Asking the right questions shows that you’re a prepared, educated candidate. It also ensures you’ll have the information you need to evaluate the opportunity and steer your career in the right direction.

So, you might wonder, what exactly are you supposed to ask? The following guidelines will help you identify what matters to you and prepare your list. Write your questions down, prioritize them, and then on the big day, tuck the list into your pocket for a quick once-over before you head inside.

Why is this job open?

An interview is usually a good sign that an employer is doing well enough financially to take on more staff, but that’s not always the case. “[Ask] why the practice is hiring. This can give you an idea of the health of the group,” recommends Eric Rey Amador, M.D., business manager at Anesthesia Medical Group of Santa Barbara in California.

Your recruiter should be able to provide some insight prior to the interview, but it’s smart to ask in person as well. According to Amador, you want to hear positive indicators, such as “economic growth, retirement of a physician, the addition of a new line of services.”

Few companies will directly voice negative issues, so you’ll have to listen for clues: employee turnover, a lengthy recruitment process (with the exception of a highly skilled or specialized field), negative comments about past employees, recent changes in management or corporate shuffling. Trust your instincts if something seems questionable.

You should also do your own research to learn why a company is hiring. See if anyone in your network has connections with this company—and what people are saying about it online. “Google the practice and see how social media likes them,” suggests Janet Gersten, M.D., an OB-GYN with TopLine MD Health Alliance in Miami. “Nurses at the local hospitals will generally give you the established opinion.”

What kind of malpractice coverage is offered?

As a doctor, malpractice insurance is an obvious necessity. Without adequate coverage, a claim of negligence or wrongful treatment could have devastating effects on your finances and your future. But it’s not enough to make sure your employer offers it and check that question off the list. Dig deeper to find out everything you need to know.

“Many new doctors will hear that the job offers malpractice coverage, and that’s it. But ask for details: What type is it, and who is paying?” urges Adeeti Gupta, M.D., an OB-GYN and founder of Walk IN GYN Care in New York City.

There are two common types of policies: claims-made and occurrence-based. With a claims-made policy, your coverage only lasts as long as you remain with your employer. Occurrence-based policies offer coverage for any claims made against you during the covered timeframe—even after you leave the company.

“If it is just claims-made, when you leave, you have to buy tail coverage,” Gupta says. “It is costly. Some doctors get stuck with a job because they can’t afford the tail coverage, especially in OB-GYN.” Formally called an extended reporting endorsement (ERE), tail insurance is an add-on provision that extends coverage to any claims raised after you’ve left the employer.

Don’t be afraid to negotiate with your prospective employer regarding tail coverage, Gupta adds. Some employers will split the cost or pay a percentage. If so, inquire carefully about the terms. Some arrangements may involve withholding your portion of payment from your final paychecks.

Malpractice insurance policies and regulations vary by state and by carrier, so do your research. Talk to seasoned colleagues before you interview to learn key factors to consider in the area.

What is required in terms of call hours?

Some type of call responsibility is part of the workload for most physician positions. But what this means varies greatly based on many factors: the type and size of practice, physician seniority, holiday schedules and more.

Understanding these factors will help ensure this job fits your vision of work/life balance. For example, if you have young children at home and live far from family, extensive call responsibilities can become a strain.

Ask questions,” recommends Darria Long Gillespie, M.D., MBA. “How often do you have to cover, including holidays? How many different locations do you have to cover? That’s particularly crucial if you may have to drive between them.”

Also ask about the logistics: Will you be required to remain on site while you’re on call or within a certain geographic radius? What is your expected response time? Are there any transportation requirements you must adhere to, particularly if you live in a big city?

How will you establish a panel?

As a new face in the crowd, it can take a little time to build up your patient base. Find out how patients are distributed. Does the organization have policies to ensure even distribution? Are you expected to attract your own patients? Are you encouraged to market your services—or prohibited from doing so?

This can also be a good question to raise with potential colleagues. Ask them how quickly their patient populations grew and whether they faced any challenges when it came to building a patient base.

How does the organization support personal growth?

Your immediate focus may be landing a job, but don’t lose sight of your future aspirations. An interview is a good opportunity to determine if the company aligns with your long-term goals.

“Get a feel for if the practice supports your individual growth,” Gupta says. “Is mentoring available? Do they support an entrepreneurial mindset? Are they welcoming of doctors bringing in new ideas or suggesting new equipment?”

Gupta suggests listening carefully to employers’ answers and evaluating their motivations: “Are they bringing you in just because they need labor, or are they genuinely interested in [your professional] growth?”

Another area to consider is continued education and training. Most organizations encourage physicians to continue learning, but not all offer financial assistance or scheduling accommodations for continuing medical education (CME), medical conferences or memberships in medical organizations and societies.

What is the company culture like?

A job is more than just a means of employment. It’s also an opportunity to form friendships and grow socially. Every company has its own culture. Your interviewers will likely give you an overview of the social atmosphere, including informal after-work gatherings, community events, annual outings or sports leagues and recreational activities. That’s good information, but you should try to learn more.

“You really should be allowed the opportunity to speak with several members of the practice privately, even if only on the phone after the interview,” says Amador. “That is the best time to ask about the culture of the group and what social aspects do or don’t exist.” He adds that if the company discourages you from speaking with current staff, it may be a red flag.

Because you’re an outsider, employers may not readily open up about the true culture of a workplace, and it can be difficult to ask directly. However, indirect questions can still shed light on the company’s true culture.

For instance, you can ask how the company celebrates employee achievements, how long most employees have been with the company, and what the company has done recently in terms of community involvements and employee events. Researching the employer online and on social media can also be helpful, as these types of events tend to attract media coverage.

How will this job impact my future employment?

In an ideal world, you’d never have to job hunt again. But even if you find a fulfilling position, it’s likely that you’ll eventually look for another job. So it’s important to understand the restrictive covenant—more commonly known as a non-compete clause.

A restrictive covenant limits where you can work after leaving your employer. For example, you may be prohibited from working at a similar type of practice within a 10-mile radius for three years after terminating your employment. Gersten recommends reviewing this carefully, saying, “[Find out] about any geographic distance or specific prohibitions with the non-compete.”

The length and geographic area will be carefully spelled out in your contract, but it’s still a good idea to discuss it ahead of time—especially if you have ties to a specific region and plan to stay there even after you leave your employer. You should also research what kind of restrictions are specific to your region, as some states enforce restrictive covenants more so than others.

Press for details when presented with an offer, encourages Adeeti Gupta, M.D. “Many new doctors will hear that the job offers malpractice coverage, and that’s it. But ask for details: What type is it, and who is paying?” – Photo by IHNY

Is partnership an option?

Traditionally, physicians in private practices aspired to become partners. But today’s changing economic trends have shifted that focus. Now many physicians avoid the cost and headaches of partnership in order to focus on clinical practice. Regardless of your future goals, you should use the interview to discuss partnership potential, as well as the duties and benefits involved.

Don’t hesitate to ask for details, says Gersten. She lists some good questions to include: “When can you become a partner? How close are some of the senior partners to retiring? What is the buy-in at that time?” Find out if anyone has ever been turned down for partnership—and if so, why.

Be sure to ask about financial arrangements and pay close attention, especially if something sound too good to be true. As with most parts of your contract, you should ask an attorney to review the details in writing.

What is the management structure?

An amicable, mutually respectful relationship with management is key to success at any job. So it’s important to understand the managerial style and hierarchy at any prospective employer. This will give you a sense of how much autonomy and influence you’ll have on decisions.

Ask some basic questions: Do managers come from a medical or business background? Are all M.D.s involved in decision-making or sitting on committees? How much interaction is there with senior management? What is the procedure for feedback—both positive and negative?

Can you assist with ______ ?

It’s best to put any important issues on the table before going too deep into the process. Whether you need special accommodations for a family member, a visa to work in the U.S., or a job for a spouse/partner, an interested employer will usually try to assist you or connect you with someone who can.

It’s no fun to waste your time or the company’s, so be honest about any obstacles you’re grappling with.

Says Paula Johnson, administrative director of physician recruitment at CoxHealth in Springfield, Missouri: “…We don’t want to find out when we’re making an offer that your wife is also an M.D. or is in another profession and needs a job.”

What does a typical day look like?

Don’t go home without getting a sense of your day-to-day responsibilities, patient demographics and typical case load. “You may or may not want to do certain types of cases or patients,” Amador explains. He suggests asking: “What are the types of cases I will be expected to do, and rough percentages of case type and patient type?”

This question will help you visualize yourself working for this employer. And it may also reveal less-than-favorable arrangements. “Sometimes, more interesting or lucrative opportunities [are] reserved for full or senior partners,” Amador adds, referring to a phenomenon called economic carve-outs. “An example would be a group that has a very lucrative obstetric anesthesia service where only senior partners can participate on that panel.”

What are my non-clinical duties?

From returning patient phone calls to filing paperwork to training staff, there are always non-clinical duties in a physician’s day. Be sure to understand the expectations of your time outside of the examination room. Ask for a rough breakdown of how much time you’ll spend doing what, how available administrative staff will be, and how you’ll be compensated for duties performed outside of working hours.

What’s it really like to work here?

At some point in the interviewing process, you should be able to meet with a colleague on an informal basis. This is your chance to get a realistic picture of what it’s like working for a particular practice or hospital. Are coworkers supportive or competitive? Are there opportunities to collaborate? Are employees comfortable with management?

Try to gauge the company’s emphasis on work/life balance. Does the company offer outlets for fitness, recreation and wellness? Do physicians feel they work excessive hours or have extensive call duties?

Avoid phrasing your questions in a way that leads to incomplete answers. For example, asking “Do you find it rewarding to work here?” might get you a one-word response or a vague description. Instead, try: “Can you tell me about a case you’re particularly proud of?” to encourage conversation.

What are the company’s mission and values?

An interview is a good opportunity to make sure your employer’s mission aligns with your own values.

Many times, you can find a mission statement, list of core values or faith-based affiliation online. Large groups or hospitals often display these prominently. Others may require you to do a bit of digging through their websites or marketing materials to get a sense of what they stand for.

Use whatever information you’ve found to initiate a conversation about mission and values. Ask what accomplishments they’re proud of, what plans they have for the upcoming year and what may challenge or support their efforts. And if you’ve found no information at all about the organization’s core values, feel free to ask anyway.

How does my role or specialty fit into your future?

Just as an interviewer may ask you where you see yourself in five years, you should ask where they see your career going. That way, you can make sure there’s an ongoing need for your services in their future.

“Ask about the vision for the organization and how your role or specialty fits in,” recommends Johnson. “Every organization has an idea of their plans. Of course, anything can happen, but they should be able to tell you their current plan.”

Some things better left unasked

Questions are typically welcome in an interview, but as with anything, there are a few limits. Don’t ask too much too early about perks, such as compensation, bonuses, time off or working from home. Your recruiter should provide you with information about all of these, but it’s best to wait until later in the interview process before probing for more details.

“When someone asks right away, ‘What are you going to pay?’ or how much time off they’ll get, it can be taken as a red flag. The later [in the process], the better,” says Johnson.

By law, an interviewer can’t ask about certain details, including marital status, age, religious preference, gender identity and other personal issues. Similarly, you shouldn’t ask your interviewers about these things. If family photos or college memorabilia is displayed, you can make polite conversation along the lines of “Lovely children!” or “I’m also a Bulldog!” But don’t cross the line by asking for details, like “Where is your spouse?” or “What year did you graduate?”

Wrapping up the interview

As you conclude each meeting, the interviewer will ask you if you have any final questions. Don’t hesitate to raise any lingering concerns that may have arisen along the way. It’s better to get the information than to head home with an unresolved issue marring your ability to make a decision.

If nothing is outstanding, simply ask: What is the next step? When will I hear further? Is there other information or material you need from me? This adds a note of finality and helps express your interest in the position.

Interviews can be challenging, and each meeting presents a new scenario to assess and respond to. One interviewer may be warm and inviting, while the next one’s aloof attitude may cause you to completely forgo your questions. So get your list of questions ready, but don’t worry too much about remembering every single one.

Simply identifying your areas of inquiry ahead of time is helpful. This way, you’ll not only make a good impression during the interview, but you’ll also be more likely to go home with the details you need to make the right decision.

An amicable, mutually respectful relationship with management is key to success at any job. So it’s important to understand the managerial style and hierarchy at any prospective employer.

 

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Building a CV that works

Even sought-after physicians need to create a CV that sells.

By Chris Hinz | Feature Articles | Spring 2019

 

Adding a bit of color in your email or cover letter can help your CV stand out. “These are the first words they read that are not in a robotic format, so they give the employer a flavor of who you are,” says Alexander Hamling, M.D. – Photo by Erin Schedler

No matter how confident you are in your job-search package or presentation, you won’t win an interview unless people have an initial sense of who you are, what you might bring to the table, and if you’re a potential fit.

Obviously, it’s up to you to eventually make the sale. Your profile and personality will carry significant weight when it comes to whether or not you get the job—but it’s your CV that opens doors.

Everybody says you only get one chance to make a first impression,” says Kip Aitken, director of physician recruitment for Sterling, Illinois-based CGH Medical Center. “Your CV is often that first impression. It’s critically important.”

So, how to make your CV work for you? Focus on organization, formatting and a few other basics.

Organizational basics

Your CV should convey your education and experience in such a well-defined way that recruiters and managing physicians can quickly determine who you are, what specialty you’ve pursued, and why your background merits a closer look. You want to give anyone in the hiring food chain a distinct picture to determine if you check off all of the boxes related to a given job.

“If it’s disorganized, not legible or just doesn’t look right, that’s a red flag,” says Jana Mastandrea, FASPR, senior provider recruiter for Seattle-based Provider Solutions + Development, Providence St. Joseph’s Health. “If you don’t look good on paper, you’re not going to get a call back. It needs to be professional.”

Despite the plethora of templates available to accomplish that goal, there still is no one format for a winning CV. The information you need to provide—training, work experience, certifications and other credentials plus unique skills—is pretty cut and dried. How you arrange it, however, is not necessarily so.

“I honestly don’t think that there’s one size fits all,” Misty Daniels, FASPR, director of physician recruitment for Charleston-based Medical University of South Carolina, says of the format. “But reverse chronological order is the easiest because I can see where you are and what you’re doing right now.”

Whatever the structure, you want to make sure that your CV doesn’t meander. “I want to see a logical layout in a time-oriented way that makes sense to me so that I can easily, without undue hassle or undue time, figure it out,” says Bruce Guyant, systems director of provider recruiting and retention for Tewksbury, Massachusetts-based Covenant Health.

You’ll need to keep these key components in your crosshairs:

Contact information. Make it front and center. Top the document with your formal name, M.D. or D.O., home address, telephone number and email address. Also placing your specialty and board certification under your name gives recruiters an instant heads-up as to two major qualifications.

Training. If you’re a physician just leaving training, your education—fellowship or residency, followed by internships and medical school—will constitute the first section. Within that structure, list correct dates, formal names of institutions, programs and your field of study along with other relevant information. Ditto on similar information for any advanced degree you’ve undertaken or any undergraduate major you’ve pursued.

Work experience. If you’re already in the workforce, your initial block should focus on that experience, leading with your latest position. Make sure to include titles, roles and any other pertinent parts of the job, such as academic, hospital or other clinical appointments and privileges. Keep your fellowship and residency in training, not in this section. “I don’t consider candidates to have work experience until they get out of their residency or fellowships,” says Marshall Poole, FASPR, physician recruiter for Northeast Georgia Health System.

Licensure/certifications. Start with every medical license you hold or have held and every specialty board and other certification you’ve achieved. Even if you’re “eligible,” let people know.

Research. If you’ve collaborated on a project during training, obviously that information is ripe for here. But if this is an ongoing part of your career, threading through current and past positions, separate the details into another block. Note the name and focus of your studies and that of any principle investigator with whom you’ve collaborated. Details count, so pay attention to proper names of places plus start and end dates.

Publications/presentations. You may have enough material for a section drawing attention to those peer-reviewed journal articles, book chapters or other periodicals that bear your name as a lead author or contributor. If you’ve given talks or participated in clinical panels or roundtables, make sure you list them too. Although the information might not strike a chord with a recruiter, hiring physicians may want to know more. Also, any scholarships, awards or other honors that you’ve lassoed along the way or organization or committee memberships that you’ve held deserve individual section notes.

Other skills and proficiencies. Identifying any special procedural skills or unique qualifications can be important. For instance, if you can converse in a second language, make it known on your CV. But only offer languages for which you can have a meaningful dialogue about someone’s medical issues. “I wouldn’t mention that you’re conversational in German or Japanese if you don’t feel comfortable conducting an interview in that language,” says Alexander Hamling, M.D., MBA, FAAP, a pediatrician for Seattle-based Pacific Medical Centers.

Formatting basics

You can’t achieve an aesthetically-pleasing, easy-to-navigate CV if the margins are uneven, the spacing is awkward and you’ve used difficult-to-read typefaces. When you don’t have unanimity, you’re sending a message that you’re not good with particulars, say recruiters. As Aitken notes: “The lack of attention to detail makes me wonder how good this physician’s documentation will be and how much attention will be given to patient care. If the only thing I have to judge is a CV, it better look like someone is attentive.”

To create a clean, consistent and visually-balanced document, consider these starting points:

Think typeface. Select a typeface that not only displays your accomplishments, but also invites recruiters to continue reading. When in doubt, Times New Roman or Arial are tried-and-true workhorses. Make sure what you select is crisp, clean and computer compatible.

Structure counts. A pleasing-to-the-eye CV depends on balance, and balance depends on how you align the words and utilize white space. If you’re using a template, you won’t have to worry about parameters since they’ll be built in. It’s still to your benefit to know, however, that standard margins usually call for one inch on all sides.

Make sure your CV covers your career highlights. “They won’t magically know, and they may not ask,” reminds Lenore DePagter, D.O. – Photo by Cheko Tapia

Other need-to-know CV basics

Length. It depends on where you are in your career and what type of opportunity you’ve targeted. If you’re looking for an academic appointment and already have significant research, teaching and clinical years in your wheelhouse, the page count could be well into the double digits. (You might even need an appendix.) But if you’re just out of residency or fellowship with an eye on a clinical slot, you’ll be able to make your case in short order. Two to four pages may be enough to cover the basics. Whatever your background, you’re actually creating your CV for two audiences: The recruiter who’s interested in a quick evaluation of your qualifications, and the hiring physicians who may relish delving into the granular parts.

References. Naming people on your CV means that they can be contacted without delay. Depending on their reputations, they may even add credence to your candidacy before a word is exchanged about you. “Just seeing the name,” says Guyant, “sometimes adds a level of assurance.” By keeping them close until asked, however, you can help your choices tailor a more effective response.

Something personal. Recruiters are mixed as to the advisability of listing hobbies or interests on a professional bio. Purists who want a document devoted solely to your medical skills say the information is superfluous. But for someone who likes seeing candidates in a broader context, getting personal can help define a candidate in differing ways. For instance, Aitken reviews half a dozen bios every day and welcomes a few lines tucked into a CV revealing why an applicant is interested in his medical center. “I’m looking at each CV to see if there’s some tie to a small town in the Midwest or some reason why I should take up the candidate’s time and my time with a phone call to learn a little bit more,” Aitken says.

Roberta Gebhard, D.O., president-elect of the American Medical Women’s Association, counts among her friends an adventure medicine enthusiast who splits time between her jobs as an emergency medicine physician and a whitewater rafting guide. Would that intrigue a prospective boss? Absolutely, she says, noting anything that fosters interest, leads to common talking points, and links you with potential colleagues can be helpful. “You want to offer something that sparks a connection with you or that gets you into the door,” Gebhard says.

Updates and versions. Given that physicians often have multiple aspects to their careers—and recruiters like seeing CVs and cover letters targeted to their openings—there are plenty of reasons to have more than one version of your CV. Kennedy Ganti, M.D., FAAFP, assistant professor of medicine for New Jersey-based Cooper Medical School of Rowan University, for instance, is boarded both in family medicine and clinical informatics. If he’s asked to speak at a clinical workshop or conference, not surprisingly he forwards a CV calibrated to those experiences. If someone wants to tap his extensive work in health IT and clinical informatics, however, he offers a bio that speaks directly to those skills. “I typically advise my residents and students as they move forward to be very, very specific about what they want and very specific with their CVs,” Ganti says. “You need to generate various iterations for the different opportunities that you’re deciding.”

The finishing touch

Creating a great CV won’t get you anywhere unless you have a polished end product. To put a bow on the package, consider these points.

Get outside help. If your CV-writing skills are wanting, it’s smart to invest in professional help. “Whatever you need to do to have a good high-quality professional-looking CV, you need to do it,” says Aitken.

Daniels recalls a friend who wasn’t getting any job bites with his current CV. She realized immediately that the bio he had created didn’t reflect what she knew about him—that he was a great physician, beloved by his patients. Daniels suggested working with an outside firm to revise the document. Once he had a new CV fully demonstrating his talents, he quickly snagged his next job. “If you recognize that this is not a skill set of yours, I would certainly encourage you to work with people who can help you—particularly if you’re in training and you haven’t done this before,” says Daniels.

Edit and edit again. Even if you don’t hire a pro to craft your CV, you want an extra set of eyes to take a serious look. “It doesn’t hurt to get a second opinion,” says Jennifer Feddersen, FASPR, director executive of physician and advanced practice providers recruitment for Detroit-based Henry Ford Health System. “It’s even better if you have a friend in HR or a recruiter who can look for common misspellings and mistakes.”

Format for clean effects. Recruiters suggest converting your CV into a PDF to make sure it holds its formatting shape between your computer and that of any recruiter.

Final thoughts

You’ll have many particulars to consider in creating a winning CV. Keep in mind, however, that both you and any potential future employer are working toward the same goal—avoiding buyer’s remorse!

Your challenge is to target the right opportunities with a CV that makes a strong case for you. Since reputation, backed up by evidence, usually wins the day, present yourself in the most complete, compelling light possible.

“Physicians often feel like ‘My CV should speak for itself and I don’t have to change it,’” Lenore DePagter, D.O., MBA, medical director of McAllen, Texas-based Cigna-HealthSpring, says. “But sometimes you really have to tell them, ‘Yes, I’m a physician, but I’ve also worked in academic environments, done research, served on committees and led groups.’ They won’t magically know, and they may not ask.”

“Our role is to help both sides make well-informed decisions so that the hiring manager, medical director or department chair feels great about who’ve they’ve hired,” Daniels says, “and the candidate feels great about the organization they’ve joined.”

Your profile and personality will carry significant weight when it comes to whether or not you get the job, but it’s your CV that opens doors.

Your challenge is to target the right opportunities with a CV that makes a strong case for you.

 

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Burned out

Recognizing and addressing burnout in you and your staff.

By Debbie L. Miller | Feature Articles | Winter 2019

 

Practicing medicine has never been an easy profession. But it’s also not getting any easier. Perhaps that’s what makes burnout not only a reality, but also on the rise—and rising fast. Tait Shanafelt, M.D., chief wellness officer of Stanford Medicine, has found that burnout rates among physicians are now twice as high as that of professionals in other fields.

In the most recent data from a national research study, Shanafelt found that nearly 49 percent of physicians reported burnout, as opposed to 28 percent for other professionals.

Although physicians of all ages and time in practice can and do suffer from burnout, it’s actually the younger physicians who seem to be particularly at risk.

“Residency is the peak time for burnout,” Shanafelt says. One factor is the long hours required of training.

Female physicians report burnout at higher rates than male physicians. In one survey from Medscape, 48 percent of female respondents reported burnout symptoms vs. 38 percent of male respondents.

Specialty can also play a role. One Medscape survey cites the following specialties have the highest reported rates of burnout: critical care, neurology, family medicine, Ob/Gyn, internal medicine, emergency medicine and radiology. Additional issues also contribute. For example, working emergency department shifts can contribute to “a distortion in circadian rhythm,” says David A. Farcy, M.D., who practices at Mount Sinai Medical Center in Miami Beach and is president of the American Academy of Emergency Medicine (AAEM).Likewise, “Emergency departments are the safety net of America, social issues are mounting and resources are getting less.”

The two factors most often cited in the Medscape survey as contributing to burnout are “too many bureaucratic tasks” (cited by 56 percent of survey respondents) and “spending too many hours at work” (cited by 39 percent of respondents).

Shanafelt notes another factor: complying with the demands of electronic health records. “About 37 percent of a physician’s time in an examination room is spent entering EHR data into a computer,” says Shanafelt—time that could be spent with the patient, and time that still often requires data entry on nights and weekends.

Bringing burnout to light

The first step to getting help with burnout? Acknowledging there's a problem, says Antonia Francis, M.D. -Photo by Lauren Listor

The first step to getting help with burnout? Acknowledging there’s a problem, says Antonia Francis, M.D. -Photo by Lauren Listor

As recently as the late 1990s and early 2000s, the idea of physician wellness was rarely addressed as part of med school curriculum. Instead, the focus was on strength and resiliency. The message was this: physicians should do whatever was necessary to deal with the challenges of a career in medicine. That mindset created even more stress.

It took an increase in physician suicides to bring the matter to the forefront.

In 2012, the suicides of two residents in New York City shone a light on the issue of physician suicide. “As a result, the emergency community as a whole came together in 2016 to form a coalition of all emergency medicine groups to address wellness,” says Farcy. Goals of the coalition included defining the problem of burnout and determining ways to identify and prevent it.

Benefitting from the focus

For Farcy, the topic was deeply personal.

“During my medical school, emergency medicine and critical care fellowship training, physician burnout and wellness was never addressed,” he says. “We were taught to just press on.”

But while in residency at Maimonides Medical Center in Brooklyn, Farcy was a first responder on 9/11—an experience with memories that he put “in a box” and didn’t speak about to others.

Then, during a moment of silence paying tribute on the one-year anniversary, Farcy’s experiences hit him hard.

Farcy’s program director took notice and invited him to her office to talk. She suggested he get help and referred him to a representative from the ACGME. From there, he visited a psychologist trained in PTSD and survivor guilt—and got the help he credits with changing his life.

“I am grateful that my institution had a program in place and a plan to address the issue without fear of repercussion,” Farcy says.

Antonia P. Francis, a maternal fetal medicine fellow at NYU Langone Health Center, reports that while she hasn’t personally known any physicians who have committed suicide, “I trained at an institution that experienced two suicides of house staff within a three-week period, yet I can honestly say that during my medical training, the topic of suicide was not heavily stressed.”

Francis, who works a fairly typical 80-hour a week, says, “I experienced depression and burnout during my residency training and first year of fellowship,” she says. The first step was recognizing she had a problem. Then, she took action.

“I visited counselors and a therapist who specifically works with physicians who had mental exhaustion,” she says. “I also learned to practice mindfulness, started journaling for stress relief, and exercised more.”

When help doesn’t come

Untreated burnout can lead to medical errors, substance abuse, depression and even death.

“About 300 to 400 physician suicides are reported each year,” Farcy says, “but suicide in doctors is under-reported and often hidden, because a physician can make a suicide look like an accident.”

The AMA and STEPS Forward module (stepsforward.org) on physician depression and suicide reports that female physicians commit suicide at a 130 percent higher rate, and males at 40 percent higher rate, than that of the general population for each gender. Those statistics alone make burnout a problem in dire need of fixing.

Fixing the problem

Alleviating physician burnout is a complex challenge. Survey respondents cited more pay, fewer hours and patients, and fewer government regulations as key.

Early detection can also help. Farcy, who has been supervising residents in emergency medicine for 12 years, has seen and addressed depression and burnout in others. The early signs, he says, are “less involvement, less caring, and negative comments in a person who used to be very positive.”

Addressing burnout, however, comes with its own land mines. Sometimes when a physician who is depressed or approaching burnout speaks to their supervisor about the issue, the physician is forced to stop working or see a psychiatrist in order to be cleared to go back to work.

“Too often, this adds to the stress by causing a new burden on the physician,” Farcy says.

And when a colleague has moved beyond burnout to something deeper, expressing concern may not be enough. “By the time a doctor is in the early stages of depression, it is harder to get them involved in resilience,” says Farcy. “Telling them you need to go work out, do yoga, drink less, spend more time with your loved ones, etc., too often falls on deaf ears. The physician may hear it but won’t change or do these things because of their underlying depressive state.”

David Farcy, M.D., has seen and addressed depression and burnout in others. The early signs, he says, are "less involvement, less caring, and negative comments in a person who used to be very positive." -Photo by Rodrigo Varela

David Farcy, M.D., has seen and addressed depression and burnout in others. The early signs, he says, are “less involvement, less caring, and negative comments in a person who used to be very positive.” -Photo by Rodrigo Varela

The best answer may be in fostering a community that’s open to discussing burnout. Farcy says physicians need to feel free to talk openly, in a safe place, without being labeled as weak. “We have a wellness program where I work, and I have an open-door policy for anyone to be able to talk and share, without risk or fear of repercussion,” Farcy says.

“Once the person begins speaking, most important is listening and creating a plan,” he says.

Clif Knight, M.D., is senior vice president for education for the American Academy of Family Physicians (AAFP). He’s worked in private practice, as a hospital administrator, and as director of a family medicine residency program. As a residency program director, he witnessed resident burnout and tried to help his physicians recognize their symptoms and consider counseling and coaching.

Knight stresses that burnout is not due to a lack of physician resiliency, as was once commonly thought.

“It’s important to recognize that the majority of burnout is related to problems in the health care system and outside the physician’s control most of the time,” he says. “We need to fix the system’s problems instead of addressing only the resiliency and coping skills of individual doctors.”

Francis agrees. “Physician wellness isn’t only about individual and personal efforts, but about change on a broader level.” She suggests that institutional support and a change in our medical culture would go a long way to support physician wellness.

The path ahead

Now, medical education institutions are addressing burnout head-on. And there appears to be more help for physicians in the throes of burnout.

“Cultural and environmental changes are necessary to combat physician burnout,” says David A. Rothenberger, M.D., who advises on physician burnout at the University of Minnesota. “At our institution, we have a multi-year, major commitment from the top of the organization to devote time, talent and treasure to take on this problem.”

Rothenberger is also helping to build a coalition of those who want to address the issue of physician burnout. Currently, close to 80 individuals belong to the coalition, including academic and clinical leaders and staff.

Though progress is being made, Rothenberger says it will take a decade or two to fully address the issue.

“Achieving the needed transformation of the workplace culture to overcome the current physician burnout epidemic will take many years, and sustaining physician wellbeing is dependent on continuous effort to meet the future needs of physicians and other health care professionals,” he says.

 

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