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.

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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The way back home

These physicians chose to practice where their roots were. Their stories can help you, too, decide if moving back is the right call.

By Anayat Durrani | Feature Articles | Winter 2019

 

The saying goes: “Home is where the heart is.” And for many physicians, this holds true when it comes to deciding where to practice. That was certainly the case for Amanda Mooneyham, M.D., MPH. No matter where school or work took her, she always planned to return to the Northern California town of Redding, where she grew up, to serve the medically underserved in her community.

“When I started medical school, a community health needs assessment showed that Shasta County, California, needed an additional 17 primary care physicians just to meet the existing needs of the community—and [that] didn’t account for those leaving the workforce through migration or retirement,” says Mooneyham.

This was in 2009, and Mooneyham says the needs of her community have not improved since—even though many more people in the area have been able to access care through the Affordable Care Act. In fact, this is the pattern nationwide. As residencies and high-paying specialties lure physicians to big cities, rural areas like Shasta County, which encompasses the city of Redding, are experiencing a shortage of health care providers.

Many states are trying to attract doctors to rural areas with financial incentives, such as federal- or state-funded student loan reimbursement or repayment programs. But among physicians who grew up in these areas, many need no convincing. Plenty of doctors return to their hometowns to join family practices, rural practices or the practices where they did their residencies.

Returning to your residency

Amanda Mooneyham's hometown was in need of physicians. She answered the call and moved back to practice. -Photo by Jack Vu

Amanda Mooneyham’s hometown was in need of physicians. She answered the call and moved back to practice. -Photo by Jack Vu

After graduating from UC Davis Medical School in 2014, Mooneyham returned to Redding with her husband, a civil engineer. She had done her residency in Redding and ended up taking a job there as a teaching faculty member at Shasta Community Health Center Family Medicine Program. She’s also one of four core providers in their Medically Assisted Therapy clinic. There, she practices full-spectrum family medicine, including obstetrics and addiction medicine.

Mooneyham enjoys filling the need for providers in a rural area, and she also enjoys the rural pace of life. “My commute to work is all of seven to eight minutes each way,” she says. “The hospital is less than 10 minutes from the clinic. Most of the providers at our FQHC work four days per week, which helps me maintain a healthy work/life balance.”

Brandon Allen, M.D., also chose to stick to his roots. Born in Fort Lauderdale, he attended medical school at Florida State University College of Medicine and residency at the University of Florida. He completed his residency and final year as chief resident in 2013 and joined the University of Florida as an assistant professor in the department of emergency medicine and the assistant medical director of the adult emergency department.

Allen says his transition from chief resident to assistant professor was mostly seamless because he was already familiar with the university. “I knew the environment, and I wouldn’t be starting over in a new place,” he says. “I had created strong relationships with nurses, staff and providers outside of the ED over my residency that would be hard to replace or recreate.”

However, he says he did face an initial challenge in figuring out new working relationships with residents who had previously been his peers. “One day I was a resident, and the next I was an attending physician and faculty member,” Allen says. “How would I be perceived by residents who I had shared a seat with in conference or the same shift schedule? Would they listen to me as an attending? Could I be effective?”

He also had to figure out new relationships with his staff, since he became an assistant medical director following his last day of residency.

Allen says he worked through these challenges by modeling the traits of an attending faculty member whom he had always appreciated and respected. He always tried to be the first to see patients, so he could take advantage of teachable moments. He also took the time to review charts and send regular feedback emails on performance.

“I made a conscious decision to be effective over being popular,” explains Allen. He adds that transitioning to his new role as medical director has taken time. Some faculty members embraced him with open arms while others waited for him to prove himself.

“One of the ways I did that was to focus on standardization of practice with evidence-based protocols and pathways,” says Allen. By working to improve provider satisfaction and patient care, he earned other faculty members’ respect.

Joining a family practice

The opportunity to join a family practice is what attracted Drew Schmucker, M.D., back to his hometown of Olney, Illinois. “I was attracted to the idea of practicing in a small town so that I could have the scope of practice I wanted,” says Schmucker. “I do both inpatient and outpatient medicine as well as OB.”

Schmucker graduated from Southern Illinois University School of Medicine and completed his residency at Memorial Hospital of South Bend in Indiana before joining Carle Richland Memorial Hospital in Olney as a family practitioner. Carle Richland is a not-for-profit facility, part of the Carle Health System, which serves eight southeastern Illinois counties with a population of over 109,000 individuals.

Schmucker says there were quite a few advantages to heading home. Being close to family and friends was a big one. “I spent a lot of time away from home, family and friends because of school and residency,” he recalls. “I missed some birthdays, weddings, family get-togethers, etc.” Now that he’s closer, he says it’s been great to be present at these special events. And it’s nice to have family around since he and his wife now have a 10-month-old.

As a family practitioner, Schmucker has patients ranging from newborns to adults, and he offers obstetrics services to expecting patients. Practicing medicine in a town as small as Olney has given him the chance to diversify his skills and connect with his patients. When he started his career there, one of his biggest concerns was getting too busy, since there was such a great need for primary care in the area. He says he was afraid of getting overrun with too many patients and too much call, especially because he wanted to have a broad scope of practice.

But those fears have been put to rest. “I’ve been really fortunate to have a great first year of practice so far,” Schmucker says. “The hospital system I work for keeps my office running smoothly, and there is a great group of doctors here to share call with.”

He says it helped that he knew some of his office staff before he began working with them. They have developed close-knit relationships and have a lot of fun while seeing patients. Schmucker has also noticed he has a lot of flexibility working for a small hospital in a small town. If there are ever any problems with workflow or patient care, he says it’s easy to find the right person to talk to and get the issue resolved.

“I love taking care of patients here,” he raves. “Oftentimes, people have been waiting to get in for appointments or driving out of town. It’s so rewarding to deliver good care in a place where it is really needed.”

Patients are very appreciative of his work, and Schmucker says in some cases, these patients are people he has known for years. He even went to school with some of them. Knowing a bit about patients before they visit helps him provide better care. “It also keeps me grounded as I practice,” he adds. “Patients aren’t just cases of pneumonia or diabetes here. They may be old classmates, family members of old classmates, former teachers, coaches, family friends, etc.”

Practicing solo rural medicine

Fifteen years ago, J. Scott Litton, Jr. M.D., returned to his hometown of Pennington Gap, Virginia-which has a population of just over 1,700-to open a family practice. -Photo by Andy Stacy

Fifteen years ago, J. Scott Litton, Jr. M.D., returned to his hometown of Pennington Gap, Virginia-which has a population of just over 1,700-to open a family practice. -Photo by Andy Stacy

While moving to a small rural town may not be a top choice for many physicians, others wouldn’t have it any other way. One month after finishing his residency, J. Scott Litton, Jr., M.D., returned to his hometown of Pennington Gap, Virginia—which has a population of just over 1,700—to open a solo family practice. This year marks the 15th anniversary of Litton Family Medicine, P.C.

“It was always my plan to practice in my hometown,” says Litton, who attended medical school at the University of Virginia, then completed his residency at the Spartanburg Family Medicine Residency Program in South Carolina. “I was very blessed to have exposure to wonderful mentors, both as a volunteer before medical school and with my attendings in medical school and in residency.”

These mentors gave Litton perspective on rural family care. He says, “I was able to see how a small-town family physician can connect with patients and truly have an impact on modifying their lifestyle behavior and medical outcomes.”

Litton believes one of the biggest benefits of practicing in your hometown is getting the chance to care for people you have known and loved for many years. Several of his childhood teachers, athletic coaches, church members and family now use his practice.

“My initial concern was that everyone in town has either known me since I was a kid or grew up with my parents,” he adds. “Everyone has always referred to me as ‘Scotty’ as a child, and ironically enough, many of my patients still call me Scotty, rather than Dr. Litton.”

He says that in a small town where everyone knows everyone, physicians have to politely and firmly draw certain lines about providing care. Whether he’s working as the varsity sideline doctor at a high school football game or simply attending church, people often expect him to answer their medical questions about anything at any time. Over the years, he’s learned how to handle people who get too pushy.

“I simply tell them that I practice medicine in the office, and I am happy to go over all their concerns or questions, but they must make an appointment and continue the discussion in a confidential setting,” says Litton. “Everyone has pretty much grown accustomed to it.”

He always finds it rewarding to help people but says it’s especially meaningful when you’re helping people with whom you have an emotional connection. The flipside of this is that people he cares about inevitably become sick or ill. “When I have to deliver bad news or comfort a grieving family, I just sit there and cry and pray with them,” says Litton.

A passion for his community also led David O. Barbe, M.D., MHA, to open a solo practice in his hometown. As he finished his residency in family medicine at the University of Kansas, Barbe says he and his wife had an easy decision in front of them. They had both grown up in the same small town of Mountain Grove, Missouri—with a population under 5,000—and as a nurse, she shared his conviction that the area needed more providers.

“We both knew that we wanted to return to our area of rural southern Missouri, and we saw it as a mission. That area has been underserved for as long as I can remember,” says Barbe, who attended the University of Missouri–Columbia School of Medicine.

Barbe had seen firsthand that the area never had enough physicians. He says the health care facilities there were few and far between, and there was no hospital. He knew he wanted to serve that population. “We went in eyes wide open,” he adds. “And although there were physicians in that community, joining with one of them wasn’t quite the right fit. So we opened a solo practice from scratch.”

Barbe established a solo practice in traditional family medicine, including obstetrics, endoscopy and minor surgery. “That was daunting, but we managed to pull together a simple one-physician office,” he says. “We opened our doors on August 1, 1983 and had essentially a full panel of patients the very first day. I have never regretted it or looked back.”

Over time, Barbe expanded his independent practice to two sites with several physicians. “I practiced solo for four years before I recruited my first partner,” he recalls. “She and I built that practice as an independent practice. In fact, we established a second office in a community about 25 miles away.”

After 15 years in independent practice, Barbe joined Mercy Clinic in Springfield, Missouri, a 650-physician multi-specialty integrated group. He saw merging as a way to bring more resources into his community and serve them better than he could as an individual physician.

Barbe is now vice president of regional operations for Mercy and oversees five hospitals, 90 clinics and more than 200 physicians and advanced practitioners. “But despite that growth and success, my practice eventually came full circle,” he says. “The physician who’d been with me for 22 years retired and another who’d been with me for 18 moved, leaving me as a solo practitioner, back to how I started.”

At first, he didn’t succeed in recruiting another physician to join him, but then his own son chose family medicine as a specialty and began seriously considering coming back home to practice. “He’s now decided to do just that,” says Barbe happily. “It wasn’t because of my pushing or encouragement. It was because he saw some of the merits of a rural practice that I experienced throughout my career.”

Advice for going home

Whether you’re excited about moving back home or just contemplating the idea, physicians who have done it have advice to share. They say it’s important to think carefully about the decision. Allen, who returned to work where he completed his residency, says a physician returning home should expect some people to struggle to embrace your new position.

“Having the self-awareness to understand your role and how your strengths and weaknesses may affect that will hopefully assist with prevention of burnout and/or dissatisfaction with your decision,” he says.

And Schmucker says physicians returning home to join an existing practice or hospital should talk with administrators about their expectations.

Let your employer know what you hope for in your role and address any concerns ahead of time. He also recommends talking with area doctors to see what the environment is really like. When he did this, Schmucker says, “I could tell they were happy and felt like the hospital was receptive to their concerns.”

Having this discussion ahead of time has allowed Schmucker to do all the things he wanted to do in practice while maintaining work/life balance.

He says one big help has been that the hospital arranged for some hospitalists to come in and share call on the weekends. “That gives me most weekends to spend more time with family, catch up on work at home and travel,” says Schmucker.

Litton, who opened a solo practice in his hometown, says no matter what specialty a physician chooses, he or she shouldn’t ignore the benefits of family medicine. “Sure, you won’t make as much money as a neurosurgeon, but if you start out and keep your practice small, then you can have a very good lifestyle with a very comfortable living,” he says.

The one mistake he says he made many years ago was not saying no enough. “Our practice is pretty much covered up on a daily basis,” he says. The heavy workload results in long hours and less free time than he would like, so now he’s trying to find balance by not accepting new patients for a time.

When Barbe opened his solo practice 35 years ago, he says he had to learn a lot on his own. Then, as now, medical students and residents weren’t taught about running a business as part of their training.

He says that’s something the American Medical Association—of which he’s president until June 2019—is trying to address. The AMA Accelerating Change in Medical Education Consortium is finding better ways to coach and prepare students for the future.

But whether physicians choose to pursue a solo practice or join a practice, Barbe says more physicians need to consider practicing in a smaller area.

“I want to debunk the myth of professional or social isolation in a rural community,” he adds. “Many physicians fear that in a rural community they’ll be too far from a good restaurant or sports or activities for their children.”

While it may take a little more effort to access some of those social amenities, most small communities are within driving distance of a larger community or metro area.

“I don’t think enough physicians give careful consideration to their opportunities in that regard,” Barbe says. “Rural America is a wonderful place to practice and raise a family.”

Mooneyham has found that to be true.

Her relocation to Redding—where her parents and brother still live—turned out to be a smooth move for her and her husband. The firm where her husband was working in Sacramento had a large corporate office in Redding. Now, her husband’s new office is only a quarter mile from her hospital.

Her advice for physicians considering moving home is simple: Do it. She believes it is especially important for those from underserved communities to return because they have insider knowledge of those areas and will be welcomed with open arms.

“There is a certain intimacy when working with other health care providers who have a connection to who I was before becoming a physician,” says Mooneyham. “It is likewise also rewarding providing care to those who know me as ‘Amanda,’ before I became ‘Dr. Mooneyham.’”

 

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Leveling up

How to prepare for a leadership role — even as you’re just starting out.

By Laurie Morgan | Feature Articles | Winter 2019

 

If you’re like most new physicians embarking on your career, you might not be thinking ahead to a management role. Your priorities are likely finding the right place to practice and, above all, helping patients.

But even if you don’t envision running a health system, hospital department or independent practice in the future, you should still be seeking out opportunities to develop leadership skills. These abilities will bolster your career as a physician—whether you see yourself in a corner office one day or feel certain you’ll always focus on patient care.

After all, some level of leadership is inherent in every physician role. Staff will look up to you and expect you to lead the way, and your employers will rely on you to guide new initiatives and solve problems. Learning to lead better can help you not only advance your career but also care for patients more effectively.

Filling a gap in your medical training

Mark Deshur, M.D., says it doesn't take a title to be a leader. "Even without a formal role, you can make a difference in how things are being done." -Photo by Colin Lyons

Mark Deshur, M.D., says it doesn’t take a title to be a leader. “Even without a formal role, you can make a difference in how things are being done.” -Photo by Colin Lyons

Despite their benefits, leadership skills rarely get attention in medical school and residency. With so many clinical priorities to cover, it’s hard to make room for non-clinical topics in the curriculum.

“Lots of physicians don’t want to accept that management skills are important,” says Maria Chandler, M.D., MBA, founder of the MD/MBA dual-degree program at University of California, Irvine and president of the Paul Merage School of Business Association of MD/MBA Programs. “But this is a disservice to medical students. We’re telling them [clinical education] is all you need, yet it’s not true.”

This focus on direct patient care is admirable, but it may be shortsighted. Chandler believes management training helps physicians care more effectively for patients. For example, physicians with business knowledge can be better advocates for clinical priorities. She explains, “If you’re interested in preventing chronic disease, you can learn to make the economic case for that.”

That’s one reason Chandler advises all physicians to learn some leadership basics. She says they should do so “as early in their careers as possible.” Once there’s an “M.D.” or “D.O.” after your name, people will expect you to guide them, regardless of your age. Many of these people—including the nurses, MAs and other staff you’ll work alongside—provide essential support for patient care. Working well with this team will require training you didn’t receive in medical school, and some of what you learned might even be counterproductive.

Unlearning the superhero myth

According to Dike Drummond, M.D., CEO of TheHappyMD.com, many physicians enter the workforce with misguided expectations. “In medical school and residency, there are no leadership courses. You learn by osmosis, and here’s how it works: you see patients, reach a diagnosis and write orders, and the rest of the care team waits on you,” explains Drummond. “You’re taught subconsciously that only you have the answers. But what kind of leadership style is that for team-based care?”

As a result, Drummond says that most doctors internalize a “Lone Ranger, workaholic, superhero, perfectionist ideal” in medical school. This mindset not only burdens physicians; it also makes it harder for staff to help. Nurses and others will follow your lead. If they’re always waiting for your orders, they’ll be underutilized and probably less motivated, too.

And when staff members don’t feel supported as part of the care team, patient safety can be affected. “It’s been proven in numerous studies that a lot of people feel too intimidated to say anything to a physician—even if it’s a life-threatening issue,” adds Chandler. “Leadership training can help physicians learn to create an atmosphere of teamwork.” In a culture where staff feel comfortable raising concerns, patient care improves.

To build team leadership skills as a physician, Drummond says the critical first step is learning to listen and ask questions. “Your staff can always help,” he explains. “They want to help. But they’re not going to elbow you out of the way.”

Once you start asking staff how they can assist, Drummond says they’ll likely respond with many useful ideas. When you enable them to take on more meaningful roles, they’ll be happier and more engaged, too. That means more support and less stress for you as a physician, more attention for your patients and higher career satisfaction for the entire team.

New clinical and economic approaches are making the ability to lead diverse teams more critical than ever. Patient-centered medical homes require high-performing care teams, and alternative reimbursement models—with evolving definitions of value and quality—require physicians to lead change, sometimes in tandem with administrators.

Chandler says physicians don’t always see these opportunities as being directly tied to patient care. “Many doctors think of taking on leadership responsibilities and roles like serving on committees as a chore,” she says. “All some of us want to do is see patients—like a surgeon who’s tied up in an OR 80 hours a week and inadvertently gives up their input.”

But she says by getting involved in leadership, physicians can impact more patients while helping hospitals and health care systems make better decisions and reduce costs.

Don’t wait for an official title

In the business world, budding leaders learn the art of managing up, down and across—or in other words, finding ways to influence the workplace even when they aren’t in charge. Physicians can benefit from learning to do the same. This starts with recognizing opportunities to help not only their patients and their subordinates but also colleagues at all levels.

Mark Deshur, M.D., MBA, vice chair of operations in the department of anesthesiology, critical care and pain medicine at NorthShore University HealthSystem in Chicago, has found this to be true in his own career. He says he knew from the beginning that he would eventually seek some sort of leadership role, explaining, “I knew I wanted to be part of the decision-making process, not just subject to others’ decisions.”

Deshur learned early on that you don’t have to wait until you have formal authority to contribute ideas to improve your workplace. “We have so many people in my practice who are leaders without titles,” he says. “Even without a formal role, you can make a difference in how things are being done. You see an opportunity to do something a little differently and a little better, and that improves things for everyone else.”

And making suggestions isn’t just good for others. It’s also good for you. “It creates more career satisfaction and better engagement in the practice because everyone wants to feel that when you’re going to work, you’re making the place better,” Deshur explains. He adds that phrasing a suggestion as a question is a good way to persuade others without putting peers and senior colleagues on the defensive. “For example, you could say, ‘Do you think if we tried X, it might be an improvement?’”

At practices that welcome this type of input, younger physicians get to develop their leadership potential and prepare for formal management responsibilities down the road, Deshur says. He recommends assessing prospective employers by asking recently hired doctors if they’ve been allowed and encouraged to suggest changes.

Managing upward can be especially challenging in the medical world. Physician training favors on-the-spot decision-making, and this tends to develop reactive management skills rather than proactive ones. As a result, some supervisors only communicate with their subordinates when there’s a problem, which can be discouraging for young physicians who want to do well. Scheduling a regular check-in with your boss can help you confirm you’re on track.

Mentors provide invaluable guidance

If you nurture relationships with your boss and other experienced physicians, you may find they become long-term mentors. These mentors can be invaluable as you navigate key career decisions. “I’ve been very fortunate to have several mentors I’ve leaned heavily on,” Deshur says. “Even though my career trajectory was different than theirs, they helped me take a step back and think about what my strengths and weaknesses are and what am I interested in.”

Deshur didn’t have to look far for his mentors. He found them in his direct managers. “I was lucky that I had them right in front of me,” he says. “But if you don’t have mentors readily available, seeking out one or two people who can give you feedback and advice is so important. So many people have tremendous experience to share that you can learn from.”

Finding mentors may require effort and creativity, but one easy way to start is to keep in touch with older physicians you admired during your training. If your job takes you to a different part of the country, ask them to introduce you to respected colleagues in the area.

Joining your local medical society can also help you form relationships with physicians from a range of specialties, especially since society leaders are often interested in becoming mentors. The nurses at your new hospital are another great resource as they undoubtedly have insights about which doctors are most admired.

To MBA or not to MBA?

Deshur says finding mentors helped him prepare for another major step in his leadership plans: pursuing an MBA. “It was in the very back of my mind, since I’d taken business classes in college. But I kind of forgot about it during the early years in my practice,” he says. “Then my boss, who was also a mentor, told me how he’d gotten an MBA mid-career and asked me if I was interested in it.”

Deshur’s mentor urged him to enroll in the executive MBA program at Northwestern’s Kellogg School of Management. Because the program was located nearby and designed for working professionals, Deshur could enroll without leaving his practice. He credits his employer and fellow anesthesiologists for helping him through.

“You can’t do it in a bubble. You need the support of your practice,” he says. “My boss was very supportive. He helped me get the time off that I needed and encouraged the other 50 people in the department to support me.” Deshur’s colleagues ensured he was able to attend required classes on Friday mornings and swapped call schedules with him as needed.

“As a department, we’d benefitted from the leadership of my boss, who had attended the same program,” Deshur recalls. “So I think people thought, ‘If we help Mark take on more, that can help our entire group.’”

Often, the entire organization benefits when a physician earns an MBA, so your employer may also help pay for it. This is especially true if you’re promoted to a role that requires advanced leadership or negotiating skills, such as heading up a department, says Gregg Bass, communication and marketing specialist at Auburn University’s Harbert College of Business. And when tuition assistance from your employer isn’t available, you might be eligible for financial aid.

Auburn’s Physicians Executive MBA Program is pioneering a new wave of MBA offerings tailored to busy physicians who go to school while working full time. “The majority of our program is distance learning,” Bass says. Physicians can access the curriculum online on their own schedule. Five short residencies on campus at Auburn are required, but students get these dates in advance so they can plan ahead.

Chandler believes a physician shouldn’t put off pursuing his or her MBA. She says, “It only took me two years of being out of training [and] seeing patients to realize there might be something more I’d want to do later, besides only seeing patients for my entire career. The worst case is you wait so long that you realize the opportunities you’ve missed.”

The growing number of flexible MBA programs makes it easier to pull the trigger, even while working as a full-time physician. “They make all different shapes and sizes of MBA programs now,” Chandler says. “There are fully online programs, one-year programs, hybrids, evening-weekend programs—all kinds of options to fit the needs of people.”

Another reason not to delay: the skills and professional connections you’ll develop in an MBA program can open new doors. If you’re facing a career change or just feel ready for one, an MBA can be a powerful catalyst.

“We’ve had physicians who are taking on leadership roles in hospitals, physicians who want to leave practice to work in pharma” says Bass. “Recently, we had a trauma surgeon with many years of experience who realized he wouldn’t be able to do that physically demanding work forever and wanted to prepare for something new.”

New opportunities might also come in the form of entrepreneurship. Bass says several physicians in the Auburn program turned their class projects into real-life business ventures. Similarly, Deshur says getting his MBA encouraged him to turn a software program he wrote as a resident into a product. Today, hospitals and practices all over the country use his on-call scheduling solution.

If you already have a great idea that can really make a difference in the industry, Chandler says you might need business training to make it a reality. “I knew a couple of intensive care docs,” she recalls. “They were five to 10 years out of school. They were trying to help save lives by bringing telemedicine to rural areas where intensive care resources were scarce. I said to them, ‘You need MBAs to take this thing and make it big.’ They both enrolled while still practicing and building their venture. It’s hard, but if you’re motivated enough, you can do it. Knowing why you’re doing it—to achieve a goal, to learn a new set of skills—can make it easier to stay focused.”

Creating a healthier health care industry

Vidya Bansal, M.D., started a group for physicians of South Asian decent-a community that has helped her develop her own leadership skills. -Photo by Rachel Moore

Vidya Bansal, M.D., started a group for physicians of South Asian decent-a community that has helped her develop her own leadership skills. -Photo by Rachel Moore

Chandler believes pursuing an MBA is worthwhile not just for the career advancement but also for the personal development. It’s intellectually invigorating. “I found I missed school, missed learning,” she explains. “Doing the MBA while working was hard, but it filled the education void. If you’ve only studied medicine, it’s so intriguing to study something else.”

She adds that an MBA program is just one way to be a lifelong learner. Other development opportunities can also help physicians enjoy their careers. “I get emails from physicians who are many years into practice who are burned out,” she says. “I think one remedy to burnout is to give yourself additional skills so you have options. Your options can be in all different directions.”

Chandler believes today’s physicians can and must take on more leadership roles to improve the profession and make it appealing to the next generation of talent. “It’s like we’ve had blinders on,” she explains. “But we have to think about how to compete over the long-term with other employers who want smart, talented, young employees.”

Pediatrician Vidya Bansal, M.D., has found a way do just that—helping other physicians while developing her leadership skills. Early in her career as a pediatrician, Bansal wasn’t sure where to look for support. So she turned to Facebook and started a private group for physicians of South Asian descent: Desi Physician Moms. When Bansal first founded the group in 2015, it had only 14 members, but she’d struck a nerve. The group soon took off, and today more than 7,000 physicians are members.

“I started it for personal reasons, to find support,” Bansal explains. “I wanted a place where I could share and not feel alone.” What began as a hobby quickly became a lifeline for women physicians dealing with issues like domestic abuse and harassment at work. Over time, the group has evolved into a dynamic nationwide community with an annual conference, a subgroup to support single moms, and mentorship opportunities for medical students. Recently, it launched a foundation to help to women of all professions who are struggling with abusive relationships.

Along the way, Bansal has seen her leadership skills blossom. “To build the foundation, we had to build a team,” she explains. And in order to manage that team while building the foundation and keeping up with full-time clinical work, she’s had to learn to lead others and delegate tasks. Most of all, she says, she’s learned the value of speaking up for herself and for other women.

“What we don’t teach anywhere in medical school or residency is how to be your own advocate,” Bansal explains. “It comes down to being in control of yourself and what you will expect and accept. I feel great for the residents in our group who have a network of colleagues to tell them these things now. You have to find it from within. That’s what we’re trying to teach each other to do. It’s about unity and paying it forward and about fixing what we see that needs fixing in medicine and in women’s lives.”

Chandler emphasizes that everyone can find enrichment from learning at least a bit about leadership. It might not look the same for everyone, but whether you learn from an MBA program, a book, mentors or other activities, leadership training will benefit you professionally and personally.

“Developing a leadership mindset helps bring out some qualities you might not otherwise tap,” Chandler explains. “It allows you to express other talents. Learning about leadership and learning about business gave me a lot of personal satisfaction. You start to see the whole pie, not just the perspective of medicine.”

Laurie Morgan is a partner at Capko & Morgan, a boutique practice management consulting group.

 

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What physicians make (and why)

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

By Chris Hinz | Fall 2018 | Feature Articles

 

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

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

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

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

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

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

Specialty

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

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

RVUs lead the way

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

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

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

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

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

Winds at selective backs

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

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

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

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

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

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

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

Practice type

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

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

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

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

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

The nuanced ins and outs

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

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

Geography

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

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

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

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

Mega trends at work

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

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

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

Final thoughts

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

 

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