Till work do we part

Physician couples conducting a simultaneous job search need to be patient, open-minded and willing to compromise.

By Vicki Gerson | Fall 2012 | Feature Articles

 

STORY 1

The right location is key
Michelle A. Potts-Griesser, M.D., MPT is a Pediatric Physiatrist at Nationwide Children’s Hospital in Columbus, Ohio. Her husband, Michael J. Griesser, M.D., is an Orthopaedic Sports Medicine Surgeon at Clinton Memorial Hospital in Wilmington, Ohio.

“Whether you are seeking a residency position or a job, the couple has to determine who will have a more difficult time finding the position and give that person priority.” —Michael Griesser, M.D., and his wife, Michelle A. Potts-Griesser, M.D., MPT, at Nationwide Children’s Hospital

“We were both looking for a job at the same time,” says Potts-Griesser, “but I knew where I wanted to be. I wanted to stay where my fellowship was, at Nationwide Children’s Hospital.” Potts-Griesser found her dream job and was offered her position in October 2011. Potts-Griesser also has a faculty position at Ohio State University Medical Center.

Griesser started his job search as soon as his July 2011 fellowship started. He went on seven interviews and narrowed it down to three reasonable possibilities within a negotiable distance from the hospital where his wife would work. He had five job offers by February 2012, all within Columbus and surrounding areas. He signed his contract at Clinton Memorial Hospital in April 2012, and will be a hospital employee with an orthopedic practice within the hospital.

How they interviewed

This couple did not tell recruiters they were both looking for jobs. They conducted totally individual job searches within their geographic boundaries. Initially, they didn’t go on joint interviews or send out joint CVs to potential employers. Ultimately, they did two joint interviews, but only after they had gone though the individual search process.

One of the main questions that always comes up in two-person job searches is, “Whose job gets priority? Why?”

In this case, Potts-Griesser’s job search took priority because she is in a more specialized field with fewer jobs available. She had the opportunity to get a job where she was doing her fellowship, so Griesser adjusted his job search accordingly.

“Whether you are seeking a residency position or a job, the couple has to determine who will have a more difficult time finding the position and give that person priority,” he says.

Job-search advice

Potts-Griesser and Griesser advise candidates to be open and honest with potential employers in terms of your family’s location constraints.

“Be patient. Be open. Take your time, and ask questions,” says Griesser.
“Try not to get frustrated or jealous or feel you have to rush to find a job because your spouse has one. Employers may try to rush you because they want an answer, but don’t be rushed.”

On a few occasions, the couple was recruited by the same employer.

Even when this happens, Griesser recommends that physician couples evaluate each opportunity separately.

“What I’m clarifying is that you shouldn’t adjust your opportunity in order to work at the same hospital,” says Griesser. “It’s much better to find the best individual job for you within the location.”

The key point is that you both agree to the location.

“That is the one factor you can’t compromise on,” Griesser says.

Once the couple agreed on the general location where they’d conduct their job search, they were able to canvass one specific area for opportunities.

Griesser ended up selecting a job about 45 minutes from home. That leaves Potts-Griesser with the responsibility of getting the children to daycare and school.

“You may have to accept that, within your geographic limits, you may not find your perfect job…the job you were dreaming of while you were growing up,” Griesser says. “But you will be able to find something pretty darn close. Adjustments are in order to make it work as a couple.”

 

STORY 2

Small-town living provides a perfect fit

Lindsy Alons, M.D., is an OB/GYN at Ottumwa Regional Health Center in Ottumwa, Iowa; her husband, Sandro Younadam, M.D., is an Internist. Their new practices suit the couple, whose goal was to work together.

Alons is joining the hospital employed OB/GYN group. The group is aging and had been looking for the right fit for a new physician. Younadam will be establishing a group practice in Ottumwa to which the hospital is currently trying to recruit more physicians.

Ottumwa Regional Health Center is a trauma and referral center with 217 beds providing medical care to the residents of southeastern Iowa and northern Missouri. There are 70 physicians representing 30 specialties of medicine. The city is in a family-oriented community with a population of
25,000 in the city and a service area of 125,000.

Initially, the couple focused on practicing medicine in Jacksonville, Fla., where Younadam’s parents live. They soon realized it was important to expand their search due to better job offers and a better call structure elsewhere.

How they interviewed

Alons and Younadam each had three interviews. They always brought their two children to the cities where they interviewed and arranged for family to watch the children during the actual interview time.

The couple informed recruiters and prospective employers that they were searching for work together. They always asked if there was a need for each of their specialties and sent in their CVs at the same time.

“We arranged our interviews to occur on the same day so we would both go together,” says Younadam. “We visited as a family. We felt it was important.”

The couple didn’t have any friends who were physician couples and didn’t ask in-house recruiters for any advice. As a result, “we figured out what we should do on our own,” says Younadam.

The couple started their search in Alons’ last year of residency. “We felt it would be wise to search for both of our jobs at the same time so we could obtain work in the same city,” Younadam says. “Neither of us wanted to commute long distances. We were lucky because we got our jobs at the same time.”

Job-search advice

Alons and Younadam recommend that physician couples start their search with wide parameters. Initially, they limited themselves to a small region. Their philosophy changed when they realized there were numerous opportunities they would be missing if they didn’t expand their search.

Younadam advises to not judge the job before interviewing or visiting the location. After visiting a place, you may realize that you like the area more than you thought you would.

It’s also important to know what is important to you and your family, and know what amenities you need. Do your homework. Research the area so you know what it has to offer.

“Always look for a place that will make you happy in all aspects of life:
work, play, relaxation, family and hobbies,” Younadam says. “It is not just about the job, but rather the whole picture.”

 

STORY 3

An island job may be the perfect place

“Talk and share the thought process. It’s never healthy to ‘play the martyr’
or to make sacrifices thinking you are making it better for your spouse or the
family. If you’re not happy with your decision, it will likely lead to resentment later.”
—Li-Duen Clark, M.D., on the shores of Oahu with her husband, Jean-Paul Clark, M.D.

Jean-Paul Clark, M.D., and his wife, Li-Duen Clark, M.D., are both OB/GYNs who practice together at Windward Obstetrics and Gynecology LLC in Kaneohe, Hawaii.

How they interviewed
Although the couple graduated in June 2011, they started their job search in the fall of 2010. Focusing exclusively on finding two positions, they either wanted jobs in the same place or geographically suitable so they could at least live in the same house. In addition, they didn’t want a commute that would be more than 30 minutes.

Without any strong geographical ties, Hawaii seemed like the perfect place to live. The couple looked at the other Hawaiian islands, but it became apparent that Oahu, with its denser population, would provide the greatest opportunity.

“When it’s harder for one of you to find a position, then it¹s fine for one of you to have a permanent position while the other takes a temp position and continues the search,” says Li-Duen Clark. “Talk and share the thought process. It’s never healthy to Oplay the martyr” or to make sacrifices thinking you are making it better for your spouse or the family. If you’re not happy with your decision, it will likely lead to resentment later.”

The couple stated their goals to potential employers in a cover letter that introduced both of them. However, they kept their CVs separate. They stayed together for all but one interview. If they weren’t together for the formal interview, they had dinner together with the potential hiring doctor.

“Some recruiters/employers think when a couple is presented, they have reasonable concerns,” she says. “They don’t know if the couple gets along, or what happens if there is a later dispute. Employers wonder, will they lose both of them or create an awkward work situation?”

Private practice was the Clarks’ answer.

The couple spent one week in Hawaii doing interviews. The final interview was the right fit, and from there they moved forward, using hospital assistance to set up a private practice together.

“In a way, we both thought we were crazy for starting a private practice, which we had not experienced or had any training for,” says Jean-Paul Clark.

Their typical agreement consisted of a period of guaranteed income followed by a promise to stay in the area for a certain amount of time while repaying the amount of Castle Hospital assistance. “The hospital had every incentive for us to succeed,” says Jean-Paul Clark. “The hospital was making a judgment in recruiting us, believing it was an opportunity for a win-win situation.”

The couple saw their first patient on Sept. 6, 2011, and have no regrets.

Job-search advice

There is little preparation for simultaneous job searches in residency. Get all the help and advice you can from people who have completed these steps.

Private practice, for example, is not for the faint of heart, but perfectly possible for a couple with strong determination.

Most importantly, don’t underestimate the “feel” of a work environment. It can affect not only your day-to-day life, but also shape your future. Trust your gut and ask around.

When you’re working together, divide and conquer as much as possible. Try to avoid overlapping work, which can reduce friction. “If you feel as if you can each run the clinic without the other, that’s a success,” says Jean-Paul Clark. “The clinic is not dependent on either of you, and you’re not overly dependent on each other.”

“Not everything will go smoothly,” says Li-Duen Clark. “It’s important to keep communication open through the process. It’s hard enough for one job search; it’s harder for simultaneous job searches. Be open and flexible, and be sure to support each other during this stressful process because no one else understands the situation better than the one going through the exact same process.”

Survey says…

“Attracting a newly trained physician also means that the community must meet the needs of his or her family. In an increasing number of cases, that may include another physician.

67%  More than two-thirds of the respondents said that their practice opportunity choices are dependent on the interests of their spouse, significant other or family member.

24%   Nearly one-quarter of respondents have a spouse or significant otherwho is also a physician.”

Source: Cejka Search 2012 Resident and Fellow Survey

 

Your same-time job search

To find the right or “near perfect” job opportunity for both you and your other half, Erin Wainwright, a physician recruiter at RegionalCare Hospital Partners in Brentwood, Tenn., has this advice.

Couples searching for physician opportunities with different specialties need to make one search the priority and focus on that one first. The priority usually goes to the specialty for which opportunities are harder to find.

“For example, at a facility in Iowa, RegionalCare Hospital Partners was able to successfully recruit an OB/GYN and an Internist. The couple knew the area was looking for both specialties and contacted us, but the OB/GYN was the priority,” she says. “They wanted to make sure that the OB/GYN opportunity was a good fit because there was only one practice to join.

There were several Internist/Hospitalist opportunities in the area for the Internist to select.”  Recruiting couples for physician job opportunities is not much different than recruiting one physician. Typically, recruiting the spouse physician is just as important to the organization. Wainwright’s goal is to find physicians ready to commit to the area and who are looking for a place to call home.

When Wainwright interviews one physician, she often interviews the second physician also seeking employment opportunities. Whenever possible, her organization tries to recruit both. Therefore, both physicians should always submit their CVs when looking for jobs together.

 

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A Physician’s Guide to Employment Contracts

Getting a contract - then evaluating it with confidence - are the important steps in your employment journey.

By Bruce D. Armon | Fall 2012 | Feature Articles

 

“Congratulations!
Today is your day.
You’re off to Great Places!
You’re off and away!”
–From “Oh, The Places You’ll Go!” by Dr. Seuss

Dr. Seuss had it right. The journey relating to a new job can be just as exciting as the job itself. For residents and fellows in their final year of training, the fall is the time of year when there is no shortage of optimism about the wonderful opportunities that await when summer arrives.

For those physicians who have more than a year left before their training is complete, the time between now and when you start that first job will come sooner than you think, and there will likely be lots of twists and turns on the way.

If you are already employed as a practicing physician and considering a change in jobs (hopefully by your own choice and not that of your employer), you have already been through this drill and may have a bit more savvy and a bit more apprehension because of your current experience.

There is no one right job, no one way to get a job, and no one thing that makes any physician the perfect candidate for a particular job. Though being in the right place at the right time is certainly important, there are certain things any physician looking for a job should do to put themselves in the best position to land the ideal job.

It is very important to set your expectations early and to know, in advance, what is most (and least) important to you as it relates to job responsibilities and what is included in your employment contract.

In every negotiation, it is important to understand what the other side is looking for and hopes to achieve. Though not every term is negotiable, you may be surprised by the compromises you can achieve that can help you in both the short and long term.

Understanding certain basic principles can make you a more attractive candidate to a prospective employer when you are preparing for and then going through the interview process.

There are two parties to every job negotiation‹the employer and the employee. Your job is to give the prospective employer the comfort in knowing you are the right candidate for the job. This is not always an easy proposition.

Getting a new job is exciting and exhilarating‹and can be physically and mentally exhausting for both the employer and the prospective hire.
Understanding the motivations and sensitivities of the prospective employer is critical.

There are three typical employers for physicians: private practices, hospitals and private practices in hospital-based settings. There may be different opportunities and challenges in negotiating for employment in each of these settings. Each of these employers has different relationships it needs to nurture, and prospective physician hires need to do their homework to prepare accordingly.

Before you get to the contract stage… Have you completed the fundamentals?

 “You have brains in your head.
You have feet in your shoes.
You can steer yourself
Any direction you choose”

In many respects, getting the proposed employment contract is the last step before you can accept the opportunity.

Before you even step foot in the door of a prospective employer for an interview, you will be screened in multiple ways.

Depending on the size of the prospective employer and the type of health care provider, the mechanisms employers use to screen candidates may be very different.

However, the items a potential employer wants to know about you before bringing you to meet them are likely going to be very similar.

Drea Rosko, Assistant Vice President of Physician Services for St. Luke’s Physician Group, St. Luke’s University Health Network in Bethlehem, Pa., is responsible for screening the qualifications of potential physician hires.

One of the mechanisms Rosko uses to determine if a candidate might be a good match for an opportunity is a Physician Applicant Qualifications Report adopted from a form prepared by the Association of Staff Physician Recruiters (ASPR).

St. Luke’s reviews a prospective hire’s CV with regard to four specific criteria: 1. Is the applicant an M.D. or D.O. from a United States recognized or ACGME accredited medical school? 2. Has the applicant completed both an internship and residency in the United States? 3. Has the applicant completed a residency or fellowship in the specialty for which the candidate is applying? 4. Is the applicant board certified or board eligible?

Rosko studies the candidate’s CV and supporting materials to identify “red flag items.”

Some red flags are gaps in education, multiple moves in a short period of time, a poorly formatted CV or grammatical errors in the cover letter.

If the candidate passes this initial test, she calls the candidate to get answers to questions that may not appear on the CV. Assuming that telephone interview goes well, the hiring process continues.

Just as employers investigate your “red flags” before extending an offer or contract for employment, so should you, too, consider any red flags you encounter regarding the potential employer.

These may include: excessive professional and administrative turnover; inability to grow a practice; and lack of commitment to capital and equipment improvements. Be prepared to ask questions of a potential employer so that you understand their vision for the future and that it is compatible with your expectations.

Related: What questions should you ask? ow.ly/dOhvG

Your employment contract may be influenced by the practice’s location. “We make sure candidates realize that we actually get busier during the summer and peak vacation time because of the influx of visitors and urgent urological needs that cannot wait until the individual returns home,” says Frank Wren, M.D., president of Jersey Urology Group, which has offices near Atlantic City.

Frank Wren, M.D., president of Jersey Urology Group, a large urology practice based in New Jersey with several offices near Atlantic City, says his group tends to rely on referrals when screening candidates.

Because urology is a fairly small specialty, a person’s reputation–good or bad–can travel far and wide. “Knowing where the candidate trained and who trained the candidate is critical to our analysis,” he says. “We believe we know who has a good reputation and that helps us effectively winnow candidates.”

 Location’s role in your contract

“You’ll look up and down streets.
Look ’em over with care.
About some you will say,
‘I don’t choose to go there.'”

Once you pass the initial screen, the prospective employer will likely bring you to the community.

If the opportunity is in a community that’s a temporary stop en route to your ultimate desired living situation, you may not be concerned with a contract’s post-employment restrictions such as restrictive covenant and non-solicitation provisions.

If location is your main priority, understand how broadly the prospective employer defines the “community” and what options will remain if you are no longer employed by that organization.

If your spouse is also a physician, you’ll also want to make sure that a non-compete restriction that one of you has does not mean both of you will be forced to switch jobs if one of you changes employment.

Employers, too, try to ensure that their location matches a candidate’s goals before the contract stage.
“We know we are not the ideal location for every candidate” says Teresa Mitchell, executive director for Lafayette Radiology, a hospital-based medical practice in Lafayette, Ind. “It is very important to us in a buyer’s market that we only make an offer to a candidate who we think wants to be in our community for the long term for the right reasons.”

Your contract may include provisions relating to special geographic circumstances.

Wren’s practice is located minutes from the New Jersey beaches.

“We enjoy being a part of a great community and do not take for granted our proximity to the beach,” he says. “At the same time, we make sure candidates realize that we actually get busier during the summer and peak vacation time because of the influx of visitors and urgent urological needs that cannot wait until the individual returns home.”

Taking extended vacation in the summer may not be a realistic option in a beach community. Similarly, an employer may place restrictions on you taking extended vacation in a skiing community in the middle of winter.

Assuming the prospective employer believes you want to be a part of the community for the right reasons and they find you acceptable professionally, personally and socially, the next logical step will be offering you employment.

 What should be in your employment contract?

“I’m sorry to say so
But, sadly, it’s true
that Bang-ups
and Hang-ups
can happen to you.”

First, make sure you get an employment contract. A handshake is not sufficient. A properly drafted contract will protect both you and your employer. The contract delineates your respective rights and responsibilities.
“We have given a lot of thought to what we include and do not include in our employment contract,” says Wren. “As we have grown over time, we have made modifications to fulfill expectations and protect our practice.” There are certain key elements that you should look for in any contract you receive:

√ Term and termination
√ Salary and benefits
√ Work schedule
√ Post-employment restrictions

“Our contracts are carefully drafted. Every section is included for a specific reason,” says Robert Wax, senior vice president and general counsel for the St. Luke’s University Health Network.

Term and termination

Term and termination is important to you and the employer. Though a job could theoretically last “forever,” the reality is often different. From your perspective, you should understand the length of the initial term and any renewal terms. Understanding how and when you can leave an employment situation is important.

Assuming you do intend to stay, and your employer wants the same for you, the term and termination provisions may help clarify opportunities for advancement by job title and/or by compensation.

For instance, an initial contract with a term of three years may delineate whether you become an “owner” of the practice at the end of the initial term, or promotional opportunity if you are in an academic medical center
environment.

From the employer’s perspective, they want to ensure a timely separation if the agreement is not working as expected. It can be awkward for everyone if it is clear you are no longer welcome and your continued presence affects office dynamics, patient relationships or referral patterns.

Salary and benefits

Do your homework to ensure your salary is competitive for your specialty and the geography. Supply and demand becomes an important consideration with respect to salary.

“As a large employer, our employee benefits are worth thousands of dollars a year,” says Rosko.

You should understand the scope and effective date of each benefit. Is family health insurance provided, or is it only for the individual employee? Is short-term and long-term disability insurance available? What sort of retirement benefits are provided?

Will the employer reimburse you for your moving expenses or provide a signing bonus? What is the annual vacation and continuing medical education allotment?

There are no guaranteed benefits that you should expect to receive. Keep in mind that the cash equivalent value of the benefits offered combined with a “mediocre” salary can make for a very generous job offer.

An important (and expensive) benefit is professional liability coverage. Depending upon whether the insurance is occurrence-based or claims-made, you will have different considerations regarding professional liability coverage if this employment ends. In addition, many states require a physician to have certain levels of professional liability coverage and coverage during the period of time covered by the state’s statute of limitation in which a suit can be brought. Your contract should specify the type of coverage offered.

Work schedule

Understanding your expected work schedule and call coverage is an important part of your contract.

“We pride ourselves that each physician‹no matter how senior or junior‹has the same work schedule and call obligations,” notes Wren. “It shows that we are all in it together.” You should know the locations where you are expected to work and the “regular” office hours and rounding responsibilities.

Post-employment restrictions

No one should knowingly start a job expecting to leave that employer and then stay in the community as a competitor.

An employer has a legitimate right to protect its business interests. You should understand the length of restrictive covenant and the scope (e.g., miles, zip codes, counties) and the impact that it will have on whether you need to move your residence if you leave that employment.

If your spouse or significant other is also a physician, you may have two sets of noncompete provisions that you need to consider.

Getting help on the employment contract

Wax, Rosko, Mitchell and Wren agree that it is important to have an attorney involved in the contract process for you and the employer.

“We use our attorney to draft our employment contracts because we want to make sure we draft the document correctly and are acting fairly,” says Wren.

Each of the employers also expects that the prospective hire may contact an attorney to review the employment contract.

“We have no problem dealing with a physician’s attorney,” says Wax. “We do find it preferable if the attorney has real health care experience and is genuinely interested in looking for opportunities to make the deal work as opposed to finding reasons to nix the deal. That works to the benefit of the prospective hire in the short term and long run.”

Related: How to negotiate like a 5-year-old ow.ly/dgiIB

A physician looking to hire an attorney should ensure the attorney understands health care legal issues and physician dynamics. In addition to appreciating the details of the contract, your attorney should serve as your advisor to help guide you in making the correct decisions.

“If someone is completely distrustful and skeptical of every provision in a contract, we question whether that individual really wants to be a part of our health care family,” says Rosko. “Establishing trust is a two-way street, and the attorney can be helpful in that regard.”

As you consider hiring an attorney, talk to colleagues for recommendations. Hire someone who you want in your corner to explain the contract terms and who can negotiate on your behalf if you choose.

You should feel comfortable asking the attorney how he or she charges for their services and an expected price range for the engagement. Dealing with an attorney whose specialty is health care law and who has negotiated physician contracts is essential. An attorney who does not understand health care fraud and abuse laws, appropriate scope of a noncompete and licensure and bonus provisions will not serve you well.

The attorney you hire should not be someone looking to kill the deal, but should be comfortable telling you if something is a less-than-ideal opportunity. There may be situations where it is better for you to walk away from the offer and bide your time until a better opportunity presents.

Your attorney should be able to put you in the most competitive position and prioritize the contract issues that are most important to you and your family.

 Taking the journey

“And will you succeed?
Yes! You will, indeed!
(98 and 3/4 percent guaranteed.)”

Depending on when you are actually offered employment, the process may only take days or a few weeks.

Ideally, you are considering multiple opportunities at the same time so you can weigh the advantages and disadvantages of each offer. The earlier you get the opportunities in the job cycle, the more latitude you may have in negotiating terms that are important to you. Though nothing has to be forever, you ideally do not want to be switching employment multiple times in a rather short period of time.

Despite Dr. Seuss’ good wishes and unbridled optimism, you may not reach the level of success in Oh, The Places You’ll Go. You will increase your opportunity for success, however, by understanding the goals and objectives of your prospective employer in looking to hire you, applying for jobs that truly interest you, and making a great first and lasting impression with everyone with whom you interact during the interview process.

Understand each element of your proposed employment contract and use an outside advisor to help guide you through the process.

With each of these tips in mind, you will find plenty of opportunities for the places you can go.

Bruce D. Armon, Esquire (barmon@saul.com) has helped negotiate and draft hundreds of employment contracts for physicians and employers. He is co-chair of Saul Ewing LLP’s health law practice and managing partner of its Philadelphia office.

Personality matters

No one wants to hire a horror story waiting to happen.

“We do not want to have belligerent or unprofessional physicians employed by our organization,” notes Robert Wax, Esquire, senior vice president and general counsel for the St. Luke’s University Health Network. “Respect for one another and for yourself are hallmarks of our organization.”

“We need to make sure the prospective hire’s clinical skills are at the level we expect. However, the evaluation does not end there. It is very important that we understand their personality, their extracurricular interests and their sense of stability,” says Teresa Mitchell, executive director for Lafayette Radiology in Indiana.

Mitchell generally meets with a candidate first. Then the candidate meets with each partner in the group and key hospital administrators, and tours the hospital space. “Everyone’s impression counts when we interview a candidate,” she says.

Since the practice is intrinsically connected to its hospital through a services agreement, the practice cannot risk having a physician as one of its employees who would or could do anything that would jeopardize that relationship.

“I remember one candidate who I took to lunch and I could not find anything which we could discuss, regardless of whether we even agreed upon the subject. The lunch was socially awkward, and I recommended to my physicians that we not extend an offer,” Mitchell recalls.

You have to sell yourself and realize your clinical skills alone do not make you an ideal candidate. There may be multiple candidates interviewing for the same position. Personality matters.

 

Download and share this helpful sidebar at ow.ly/dPUmi
Negotiation tips

By Kyle Claussen, JD, LLM

Negotiating an employment agreement can be a nervous and stressful time for many physicians. These agreements are worth hundreds of thousands of dollars and will define when and where you practice medicine. Here are a few tips that will reduce your anxiety.
Negotiations start immediately.

The moment you begin speaking to a recruiter, you are negotiating your position. It is important to be open and honest with an employer. You should not commit to any specifics regarding salary requirements or work schedule until you have evaluated the offer as a whole. It is best to discuss compensation only after an official offer has been made and after you have evaluated the facilities, support staff and benefits package.
Remember that even “standard” contracts that “every physician has signed” can be changed.
Prioritize your needs.

Every physician has unique needs in their employment. A four-day workweek may be the most important factor for a new mother. A resident with large amounts of student loan debt may need to maximize compensation. Only you know what your needs are, and you should communicate to the employer which terms of the proposed agreement are truly “deal breakers” during your first round of negotiations. Contract terms to consider include:

€ Compensation
€ Call schedule
€ Malpractice tail coverage
€ Equipment
€ Non-competes

Know your value.

Underestimating your value can substantially reduce your compensation. It is rare that the first offer made is the best you can receive. Conversely, overestimating your value can lead to an offer being pulled and a relationship with the organization destroyed. To determine your value, consider geographic specific salary data, competing offers, length of time the position has been open, total revenue you will generate, and the number of candidates being considered for the position.
Keep “Plan B” alive.

As Yogi Berra said, “It’s not over til it’s over.” You should never turn down an offer until you have determined with 100% certainty that you will not be accepting the position. Negotiations can take many weeks and occasionally will turn sour. If this happens, you will need to have another option or two for consideration.
Get professional guidance.

Any contract (employment or otherwise) that is worth a significant amount of money should be analyzed by a professional. Attorneys specialize in practice areas just like physicians. You would not go to an orthopedic surgeon for a colonoscopy, and you should not go to your cousin (or brother, aunt, etc.) who practices family law to review your employment contract.

Find a health care attorney with experience reviewing physician employment agreements. As Benjamin Franklin stated, “an ounce of prevention is worth a pound of cure.”

It”s absolutely critical that you find out what the practice expects of you in terms of minimum productivity levels. What do you have to do to earn the base salary? At what level does the productivity bonus kick in?

 

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What’s it worth to you?

How physician compensation trends and realities affect your income potential.

By Timothy W. Boden | Fall 2012 | Feature Articles

 

Earning a lot of money won’t make you happy, but not earning enough can sure make you miserable! But how do you know how much is “enough”? Finding the answer that’s right for you begins with understanding your own financial needs, goals and dreams.

Only you can determine how much money you’ll need to take care of your financial obligations, provide a comfortable lifestyle and achieve your family’s longer-range financial goals. Figure out how much you need to pay bills (like student loans) and establish your home. At first you’ll likely be more concerned with what kind of house and car you can afford than with how to build an investment portfolio or retirement account.

But even a rough budget will prove helpful as you head out into today’s physician job market. You will find a very broad range of compensation packages out there. Different medical specialties provide different levels of earning potential, of course, but compensation also varies widely within the same specialty.

What are you worth?
As you search for your dream job, what can you reasonably expect in terms of compensation? What constitutes a fair offer? Your ability to answer that question depends on your willingness to do some research.

Start your quest by simply asking around. Talk to your friends and fellow residents. Ask them what they’ve found out there in the market. But recognize the limitations of anecdotal data. Job offers are a little like
snowflakes: No two are alike. Dozens of factors affect job requirements, salaries and benefits packages. You have to go deeper to gain a more realistic picture.

Marcella Gravalese, director of practice development at Vohra Wound Physicians, says, “Graduating residents have to do their own due diligence”‹carefully studying each opportunity for themselves.

Over the last two decades, a number of organizations have developed reliable benchmarking data that prove useful in determining the “going rates” for physicians serving in a variety of practice settings spread across the country’s diverse geographical regions. The Medical Group Management Association’s annual Physician Compensation and Production Survey has become the virtual “industry standard” for benchmarking doctors’ incomes and outputs. A complex and somewhat expensive report, it breaks the data down by the major factors that differentiate income opportunities (geography, gender, practice size and ownership, single- or multi-specialty and more).

Cleveland’s Case Western Reserve University School of Medicine, for example, uses the MGMA surveys extensively. According to Family Medicine & Community Health Department Chairman George Kikano, M.D., the school and health system use the data to set productivity expectations and to make sure physicians’ salaries remain competitive.

All over the map
Your research will quickly reveal great differences in compensation between different regions of the United States.

This year’s Medscape survey showed average annual salaries (for allspecialties) ranging from $204,000 in the Northeast to $234,000 in the upper Midwest.

Figure out where you want to live and work before setting your compensation expectations, suggests Aaron Lear, M.D., a family and sports medicine specialist at Akron General Sports Medicine in Ohio.

Aaron Lear, M.D., a family and sports medicine specialist at Akron General Sports Medicine in Ohio, recommends that graduates figure out where they’d like to work and live first. Then they can adjust their expectations according to location. “Busy urban and suburban markets generally have a good supply of candidates–so their pay rates will usually be lower,” he says.

Package components
Many surveys only provide data on direct compensation: salary and bonuses. Indirect or deferred compensation varies considerably, and typically includes insurance (health, malpractice, disability) and retirement plan contributions.

Study how each recruiting practice plans to pay you. Ask fundamental questions like: “How will my salary and bonuses be calculated?” and “How much can I reasonably expect to earn?”

Typical compensation today includes a base salary plus some kind of performance bonus. The base salary portion is especially important in the early years, because it provides your income floor while you build your practice.

Determine if the base meets your own minimal requirements, and get answers to the following questions:

• How did the organization set the amount? Did it use acceptable survey data? Is the number based on median figures, or did the practice set the base low in order to incentivize your production?

• Does your base salary rise or fall over time? Practices emphasizing fixed salaries usually increase the base as you gain seniority. But these days, more practices‹including hospitals and health systems employing physicians‹actually taper the base salary over time. This makes the physician more and more reliant on productivity pay. Many groups eliminate the base in year two or three, resulting in a pure productivity compensation plan.

• How will the practice fund your salary until your production grows enough to cover it? Is it relying on a hospital guarantee? Physician career coach Jack Valancy says, “I’m not a big fan of hospital guarantees for physicians recruited to private practices.”

Compliance with federal laws require hospitals to treat income guarantees as loans to doctors they don’t directly employ.

A first- or second-year guarantee “loan” may be forgiven over time (three to five years) as long as the physician remains on staff at the hospital. In other words, if it turns out that you can’t produce enough revenue to cover your personal income, you might personally owe the hospital some big bucks (Valancy says $300,000 is not unusual). And if you decide you want to leave the area before the forgiveness period is complete, you’ll have to pay it back.

“Despite these risks, should the physician feel strongly about the opportunity, he or she should perform due diligence to assess how his or her practice might develop, estimate the loan balance at the end of the guarantee period, and anticipate whether he or she can maintain, if not increase, compensation,” Valancy says. “This requires a degree of financial disclosure that is typically absent from such arrangements.”

When is enough…enough?
It’s absolutely critical that you find out what the practice expects of you in terms of minimum productivity levels. What do you have to do to earn the base salary? At what level does the productivity bonus kick in?
Valancy advises job candidates to make sure that the expected productivity and the base salary are in sync.

For example, if the base salary is based on the 25th percentile level reported in the MGMA survey, make sure the minimum required productivity is also at the 25th percentile. If your productivity bonus doesn’t start until you rise above, say, the median level, you will in effect get nothing for your output between the 25th percentile and the median.

Understanding how a recruiting practice calculates physician bonuses can be far more confusing than its base-salary standards. While you¹ll see a lot of different ways to do the math, productivity bonuses are designed to award physicians a share of the revenue they generated by treating patients. To find out what your share will be and how you can earn it, ask:

• How does the practice measure productivity? Few practices today use gross charges as the measure, because there is hardly any connection between what you charge for a service and what you can collect for it. The emerging standard is total work RVUs. RVUs are more objective than net collected fees, because different sources pay different amounts for the same service.

• How does the practice convert physicians’ work output into compensation?
If, for example, your new employer awards a quarterly bonus based on your RVU production, how much money will you receive per RVU? If the practice doesn’t have a set dollar/RVU rate, ask to see historical data–what was the average for the past year?

• What percentage of your total direct compensation depends on productivity, and how will that change after your initial term of employment?
Related: How can you calculate your worth as a physician? ow.ly/dge7o

Getting paid for other things
Find out if any of the salary is based on hours worked. Ask whether you get paid for night and weekend call duty, or whether the group simply participates equally. A departure from years past, an increasing number of practices offer opportunities to take pay reductions for more time off, or increased pay for more clinic or on-call time.

Ask whether the practice offers financial incentives for other measures besides productivity. Most physician employers have started incorporating quality measures in their compensation plans. An increasing number of practices conduct patient-satisfaction surveys and award cash bonuses to physicians for good ratings. Doctors in some practices receive additional compensation for so-called “good citizenship”: participation in administrative duties, marketing and public relations, and other time-consuming activities.

Fringe benefits
You can expect some fairly standard fringe benefits, too. Health insurance may include family coverage‹but you may be responsible for the additional premiums to cover dependent family members. Most practices offer participation in a retirement plan–usually optimized for physicians to defer the maximum allowed in pre-tax contributions.

Practices sometimes offer better-than-average disability benefits, but doctors typically supplement the company-offered plan with a personal policy to protect their high earning potential. You can expect a professional development allowance, too. Practices usually allow time off for CME events along with a financial allowance to pay for associated costs (like tuition, travel, subscriptions and membership dues).

Time off can vary considerably between practices. In a pure (non-production-based) salary position, you can expect a set limit for paid time off (vacation, sick days and personal days). But groups that pay on a purely production basis may allow more generous time off–after all, you will pay for it with reduced productivity pay.

Case Western’s Kikano says, “I hardly track time off anymore–if our physicians are meeting productivity goals and service standards, what difference does it make if they take a few more days off for vacation or CME?”

Upfront money
Depending on the competition for your chosen specialty, you might see some generous upfront incentives from practices hoping to attract you to their opportunities.

Signing bonuses have become a fairly standard recruitment strategy Payment schedules can vary, too. They might write one big check when you sign on the dotted line, or pay part of the bonus at signature and the rest after you start working.

Still others agree to monthly stipends for second- and third-year residents who have an employment agreement well before graduation.

New graduates entering the job market today feel oppressed by the sizeable student-loan debt they have accumulated while in school. Recruiting organizations sometimes offer to repay the loans as incentives to accept a position.

Most practices provide some kind of moving allowance‹about $10,000 on average.

Watch for…
Medical practice brings its own unique set of issues to be cautious about. New recruits should pay attention to issues such as:

• Malpractice tail. Make sure you understand how your malpractice premiums will be paid. It’s especially important to understand what will happen if you leave the practice. Even if you quit medicine altogether or leave the state, a patient can bring a claim against you later. Most states have a three-year statute of limitations with even longer periods in pediatric cases. Typical “claims-made” policies don’t cover you after you leave the practice and cancel the policy, so insurers offer an optional extended reporting endorsement, commonly called “tail coverage.” Tail coverage for the three years can cost up to two-and-a-half or three times your last annual premium. If you leave the practice, who is going to pick up that hefty tab? Some doctors feel trapped in their situations because they would be personally responsible for their own tail premium–and that could easily top $200,000 in some situations!

• Signing incentives. When you look at those tantalizing incentives like signing bonuses and generous upfront offers, always consider the downside.

Sometimes you have to think like a lawyer and ask, “What’s the worst that could happen?” Make sure you know what happens if you accept upfront money but things don’t work out as planned. There’s a reason they refer to such generosity as “golden handcuffs.” Valancy suggests taking a look at the upfront money being offered and asking the practice to reduce some of those amounts and add it to your base salary. If you don’t need thousands of dollars to get started, you’ll find more value in the long run by setting your salary’s starting point at a higher level.

• Ownership track. If you’re joining a physician-owned practice, spend extra time understanding how you can become a partner or shareholder in the group. Some practices still offer a reduced income for the first few years in exchange for a lower buy-in down the road.

But what happens if you don’t end up as a partner? You might be better off to take more salary now and start saving for the larger buy-in price down the road. At least that way you’ll still have those funds if you decide not to stay and join the shareholders.

Sage advice
Lear tells about a graduating fellow who had big plans to work in a busy, urban practice somewhere. During his search, however, the fellow became aware of an opportunity in a more rural setting. When they showed considerable interest in recruiting him, he proposed an “outrageous” salary–at least 50 percent higher than other places he had visited.

During the compensation negotiations, he decided to keep pushing‹almost daring the recruiting practice to bail out. But they kept saying “yes,” and he ended up modifying his definition of the “ideal” practice in exchange for a four-day workweek and a very generous income. Clearly, the trade-off was worth it to him.
Lear still cautions job-seeking residents to keep lifestyle preferences and professional satisfaction at the top of your priorities.

And Kikano, who has participated in countless recruiting efforts through the years, advises new doctors not to make money the centerpiece of negotiations.

Finding a candidate who fits well with the culture is much more important. “Who cares how much money you make,” he asks, “if you don’t like what you do?”

Timothy W. Boden (TBoden@aol.com), CMPE is an experienced author and editor, a certified member of the American College of Medical Practice Executives and more. Read more about our contributors on page 12.

Job offers are a little like snowflakes: No two are alike. Dozens of factors affect job requirements, salaries and benefits packages. You have to go deeper to gain a more realistic picture.

It’s absolutely critical that you find out what the practice expects of you in terms of minimum productivity levels. What do you have to do to earn the base salary? At what level does the productivity bonus kick in?

Major Physician Compensation Methods

For all the technical language, physician compensation schemes are usually built with the following components. While some plans use a single component (flat salary, for instance), most employers use a combination of two or more. Here are the major methods:

€ Salary based: A set amount paid per work period (weeks, months, years).

€ Productivity based: A variable amount paid based on the physician’s work output (measured in RVUs, collected revenues, patient visits, charges).
€ Profit based: A variable amount paid based on the physician’s share of net profits (revenue minus expenses).
€ Performance based: A variable amount paid for the physician meeting predefined goals (quality measures, patient satisfaction scores, quotas, hours).

 

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On the Move

The motivation and search for a new practice can take a variety of directions

By Karen Childress | Feature Articles | Summer 2012

 

We are a transitory society, and physicians are no exception.

According to a four-year study by health care research firm SK&A, an average 14.2 percent of physicians make a move, retire or die each year‹with some specialties more mobile than others.

It’s obvious that doctors continue to move around for a wide variety of reasons, leaving hospitals and clinics clamoring to recruit their replacements.

Tommy Bohannon is the Divisional Vice President for Hospital Based Recruiting with Merritt Hawkins. “The most prevalent demographic we see contacting us about making a move are those two to five years out of training. They haven’t made partner or bought the big house, and the kids might not yet be in school, so they are more portable,” says Bohannon.

“Right out of training, most doctors settle within 50 miles of where they grew up, where they trained, or where their significant other has family,” he says. “That move often doesn’t work out, so they shift their focus more to the position itself, but they still give significant consideration to community makeup.”

The second most likely group to consider a career change are doctors in the last third of their career. “The kids are grown, and they’re more financially able to make a move,” he says.

On the other hand, older physicians might be looking to step away from leadership or management responsibilities and take a job where they’re employed, even if they earn less and give up some autonomy, in order to live where they’ve always dreamed of.

Physicians in the middle of their careers move for different reasons, says Bohannon. “These doctors contact us essentially saying, “I love where I live, but I don’t love my job.” Rarely, he says, is it the other way around. The middle-age physician often makes a career move for professional or financial advancement, although today many also move to be closer to aging parents or after a second or third child arrives and they realize the benefits of being closer to family. Even in this scenario, however, the details of the practice are a primary concern.

There are many ways to accomplish the goal of reinventing oneself within the realm of medicine, so there is no reason to become professionally stagnant and feel like toughing it out until retirement is the only solution.

These physicians share what propelled them into a career move.

Retiring the uniform

Col. Jonathan Briggs, M.D., began his career as an optometrist. After a year of practicing, he joined the Air Force.

Though he enjoyed employing his skills as a military health care provider, Briggs soon became restless. “I wanted a broader scope of practice,” he says. “I was able to go to medical school at the Uniformed Services University in Bethesda and remain on active duty.”

He finished his internship year, performed military duties as a flight surgeon in South Dakota for one year, completed his ophthalmology residency at Lackland Air Force Base in San Antonio, then did a civilian fellowship in Miami while remaining on active duty.

This was followed by a long military career where he served on the faculty at the residency training program back in San Antonio and became the chief consultant to the U.S. Surgeon General for ophthalmology. “I sort of had two full-time jobs,” says Briggs.

Col. Jonathan Briggs, M.D., used PracticeLink.com and a
specialty-specific job board when looking for a practice after leaving the military. He started his job search two full years in advance of his discharge date.

Taking what he now recognizes as excellent advice, Briggs started his post-military career job search two full years in advance of his discharge date. Briggs and his wife wanted to settle in the Northwest where they both have family. He used PracticeLink.com and the American Academy of Ophthalmology job opportunity website to target his search in that area.

After considering only two positions, Briggs joined the Wenatchee Valley Medical Center in Wenatchee, Wash., in May, 2011, where he practices with three other ophthalmologists. “I knew I didn’t want to open a practice or join a small group because of my stage in life,” says Briggs, who is now 51. “Wenatchee Valley Medical Center has everything I was looking for. It’s a physician-led group, which is important in terms of leadership and perspective, and it’s been around for a long time. We have the infrastructure that will allow us to adapt to changes we know are coming.” The medical center has more than 200 physicians on staff.

Briggs says he would encourage other physicians considering a career transition to think not just about where they want to be in a year or two, but to take a long view. Briggs feels fortunate to have found a practice that works for him. “There have been no issues or surprises, which has been a blessing,” he says. Location is also a critical factor, according to Briggs. “If you’re not where you want to be living, it will be harder to adapt to any difficulties that may arise. We love it here. We like the smaller town and the outdoor activities that are available.”

Related: Interested in making a career move to the military? ow.ly/b9wo2

Family matters

For Arie Marancenbaum, M.D., the motivation to make a career change was largely family related. Upon completing his residency at San Jacinto Methodist Hospital in Houston, he accepted an academic position there and enjoyed teaching, particularly obstetrics. But Marancenbaum’s family had its own obstetrical event unfolding at the time. “My wife was pregnant with baby number three, and that triggered us to realize that we wanted to be closer to family,” he says.

Related: The Trailing Family: Tips to ensure a smooth and happy transition for everyone. ow.ly/aPE6j

Marancenbaum had attended a wound care presentation during residency and became intrigued with how hyperbaric therapy was used to treat chronic and difficult wounds. While interviewing for positions during residency, Marancenbaum had become acquainted with Dr. Han Pham Hulen, who operates Hulen Wound Care Professionals.

“She called me recently about an opportunity to work with her in a clinic about 20 minutes from Dallas, in Rowlett, Texas,” says Marancenbaum. With most of his family and friends living in that area, the decision to leave academic family medicine and accept this new opportunity was a relatively easy one.

Though he misses certain aspects of family medicine and obstetrics, Marancenbaum says he’s happy with his decision to relocate and work in a cutting-edge field of medicine. “It’s very satisfying work. Some of these patients had no hope. They had wounds for months and nobody could heal them, but we can,” he says.

If it sounds like Marancenbaum takes major change in stride, it may be because he’s used to it. Having grown up in South America, he immigrated to the U.S. where he did his undergraduate work at Southern Methodist University in Dallas before completing medical school in Mexico.

When his previously well-to-do family fell on hard times due to business difficulties, rather than going into residency, Marancenbaum returned to Bolivia for a number of years, where he worked odd jobs to help support his parents. While there, he managed to complete several years of surgical training, but political and economic conditions in Bolivia became untenable.

“There was a lot of turmoil, the streets became dangerous; Bolivia was in an economic depression,” says Marancenbaum. He decided it was time to return to the States.

Arie Marancenbaum, M.D., moved closer to Dallas with his family after his wife became pregnant with their third child. “Change is good,” he says. “Sometimes you get too comfortable where you’re at. When you move, it’s an adventure. …The sky’s the limit.”

His parents, now back on their feet in Dallas, had heard about teaching opportunities opening up in Texas. Marancenbaum returned to the Dallas area where he taught first and second grade for several years while studying to apply for a residency in the U.S. “I loved teaching at Routh Roach Elementary in Garland, Texas. A lot of the kids were from broken homes and were low income, but most of them were reading 150 words a minute by the end of the first half of each year,” says Marancenbaum. His teaching career ended when he was accepted into a family practice residency program at the age of 33.

Now 38, Marancenbaum tells other physicians considering making a career change to go with their gut. “Change is good. Sometimes you get too comfortable where you’re at. When you move, it’s an adventure. You’ll meet new people and make new friends. Most of all, believe in yourself. The sky’s the limit,” he says. It’s easy to imagine Marancenbaum offering this same bit of wisdom to his first and second graders. Some sage advice simply applies across the board.

Back to training

For Dan Lee, D.O., making a career change involved a commitment few practicing physicians are willing -or able- to make. After training as a family physician and completing a surgical OB fellowship, he worked for three years with a small group in Harlingen, Texas, where he had C-section privileges and practiced high-risk obstetrics. But something just wasn’t quite right.

“I was not getting the satisfaction out of practicing medicine that I thought I would,
says Lee.”I was getting burned out on the family practice part of it.”

Lee had originally considered an OB/GYN residency, but as medical school came to a close and he surveyed the landscape around him, he came to the conclusion that the demands of the specialty were inconsistent with a healthy family life.

“To me it looked like a career that ruined families because of the hours,” says Lee. ³But a lot has changed in the past 10 years. With the new work hour regulations, families do survive.

“It was a conversation with his uncle, a gastroenterologist, that made Lee seriously consider leaving practice to train in OB/GYN. “I thought it would be an insurmountable thing to do. He really encouraged me by telling me that I was still young and that four years would go by quickly,” says Lee, who was 34 at the time.

With his wife’s full support, he decided to apply to residency programs and see what would happen. Lee was accepted to several, and chose Oklahoma State University Medical Center, where he’ll complete his second full residency in June and return to Texas to practice in the same small town where he originally worked.

“Given there are not a lot of subspecialists there, as a generalist OB/GYN I’m excited about managing complex cases and doing a lot of surgery that I wouldn’t be able to do in a larger city,” says Lee.

One major concern for Lee in making the decision to do a second residency was financial.

He intentionally chose a program that allowed him to use his family medicine skills to moonlight in urgent care centers and rural emergency departments. “That gave me confidence going in,” says Lee. “It’s unrealistic to have a family on a resident’s salary.”

He and his wife, Sarah, have two small children. Sarah works part time as an occupational therapist. Lee has been chipping away at his medical school loans, and is happy with the fact that he’ll be able to pay those debts off more quickly now that his earning capacity will be higher as an OB/GYN.

“I didn’t do this for the money, but there is a difference,” say Lee.

Lee offers a couple of precautionary notes related to returning to residency. “If you’re promised that you’ll get some credit toward residency for years that you’ve practiced, get that worked out prior to starting the program,” he says. “I ended up doing the full four years.”

He also says doctors should be prepared to receive no special consideration for having been in practice. “It kind of surprised me that first year that I was treated like an intern,” says Lee. “I still had to follow the chain of command. That was a little frustrating. It felt sort of like the faculty wanted to make sure I knew who was boss.”

Asked what advice he might have for physicians considering changing course in terms of specialty, Lee recommends paying attention to sustained desire.

“If it’s not a fleeting idea, you’ll make it work,” he says. Though he has experienced some stress during his second residency, Lee says it’s been much easier than the first time around.You know how to manage patients more efficiently and your knowledge base going in is much better,” he says.

Though this does make for better time management, Lee admits his hours are long, but says his satisfaction level is high. “My wife tells me I seem much happier now, even though I’m working more hours than when I was in practice.”

Following a call

Upon completing his OB/GYN residency at Parkland Memorial Hospital in Dallas, Victor Obregon, M.D., was in private practice in Seattle for 15 years, during which time he and his family made medical missionary trips to Papua New Guinea. “When we were there for the second time, we knew we’d be back longer term,” says Obregon.

After much prayer and several years of planning, Obregon closed his practice in 2007 and he, his wife, Lori, and son, Alex, then 12, embarked on a four-year mission sponsored by the International Church of the Foursquare Gospel to Papua New Guinea. During his work on the island, located just north of Australia, Obregon and a team of medical professionals (including Sarah, who is an RN), worked with locals to set up medical outreach programs. “We ran them at first, then together with the local people, and the last year or so we were just helping out to get them to the point where they could function on their own. A lot of what we did was networking with the local government and fundraising,” says Obregon.

About once a month, the team would go into remote areas of the island for three to four days at a time to provide medical care. “We did mostly ambulatory tropical medicine and an occasional minor procedure,” says Obregon.

Knowing that he’d eventually return to the U.S., Obregon maintained his Washington State medical license and board certification status. As his missionary work came to its inevitable end, Obregon began contacting health care organizations around the Seattle area. “MultiCare got back to me right away,” he says. It took several months upon returning to the U.S. to complete the interviewing and credentialing process, and he started working for MultiCare, a nonprofit health system with numerous clinics and hospitals in the greater Seattle area, in April of 2011.

It was an adjustment returning to the U.S. after four years abroad, and practicing within a large system required an adjustment after being in private practice. But Obregon is happy with his decision.’

“Thankfully, I’m working with a good team,” he says. Because he had been out of mainstream practice for several years, Obregon initially had a proctor who operated with him and observed his obstetrical work. But after just a few months, he was granted full active hospital privileges. “Had I stayed out longer, more than five years, I would have needed to be retrained,”says Obregon.

For physicians considering taking a break from traditional practice to do volunteer work, Obregon says they should be thoughtful in their decision-making. “If you have an idea that a change is coming, take your time. Make sure that everyone in the family is on board,” he says. “Seek counsel from people who have done it, and make sure it’s the right time financially by going over everything with your accountant.”

Obregon, now 52, says he misses the friends he made in Papua New Guinea and still finds himself thinking in the language of the island.

“This was the most important thing we’ve done in our lives,” he says of his experience abroad. “I have incredible memories…caring for sick babies who probably didn’t make it past their first year, but at least they got to be held and sense that they were loved. They got to see what compassion looked like.”

Stepping up to leadership

Relocation isn’t always necessary for a physician seeking a career change. Sometimes you can grow right where you’re planted. Such is the case for two physicians at Boice-Willis Clinic, one of the oldest private multispecialty groups in North Carolina.

Rheumatologist Nicholas Patrone, M.D., has practiced at Boice-Willis for 22 years. For 13 of those years, he’s worked in an administrative capacity, most recently for five years as chief medical officer and president of the organization, while also providing direct patient care.” This year, I’m transitioning out of being CMO, but will continue as president for another three years,” says Patrone.

At 59, Patrone says it’s time to work a little less. Until recently, it wasn’t unusual for his workday to begin as early as 5 a.m. and end with an extra hour or two at the end of each day to keep up with all of the administrative work. “As president, I’ll deal with policy issues, work with the three local medical schools, and deal with interdepartmental issues,” says Patrone. Over the course of a year, day-to-day CMO duties are gradually being handed off to internist Martha Chesnutt, M.D. “If we’ve recruited another rheumatologist by the end of this year, I may cut back to two to three days a week of patient care,” says Patrone. “I’m ready to have some free time.”

Chesnutt completed her residency at the Greenville Hospital System in South Carolina in 2003 and has been with Boice-Willis ever since. “I was attracted to the fact that it’s a multispecialty clinic where good doctors practice good medicine,” says Chesnutt. “I knew pretty quickly that I had an interest in clinic operations.”

Chesnutt pursued leadership education by attending courses offered by the American College of Physician Executives; through the clinic’s medical liability carrier where she learned about risk management, disruptive physicians, and doctor-patient communication; and through her state medical society. Chesnutt began serving on the Boice-Willis executive committee in 2009.

Taking over the role of CMO feels both exciting and challenging for Chesnutt. “We’re going to be making a lot of changes to meet new requirements,” she says. “I foresee that quality will be a big indicator for reimbursement.” Chesnutt views the fact that Boice-Willis is a freestanding multispecialty clinic as both a strength and a potential weakness, given the changing health care environment. “When we’re together on issues, we’re unbeatable. When we get fractionated, we need to find a common goal to reach,” she says.

Related: Do you need more training in the business of medicine? Learn more about physician MBA programs: ow.ly/b9A3k

Chesnutt has assumed responsibility for a number of departments within the clinic, and by the end of the year-long transition will be managing all of them. She and Patrone meet weekly to ensure an orderly transition. “He’s my mentor,” says Chesnutt.

The somewhat daunting task of getting more than 50 health care providers to embrace change and new technology is interesting to Chesnutt, as is recruiting. “We’re always looking for family physicians, and right now we’re recruiting someone for pulmonary and critical care, as well as for a rheumatologist,” she says. “In the past, we’ve not used many physician extenders, but we’re getting our doctors used to that.”

Ultimately, Chesnutt will spend 30 to 40 percent of her time in the CMO role and continue to see patients during the remaining time. “I would not have credibility if I weren’t still seeing patients,” she says. “If I’m going to be managing physicians, it’s crucial to have a clinical practice.” She advises any physician interested in taking on a management role to avail themselves of the many resources that are available, such as serving on hospital committees to gain leadership experience and taking courses through the ACPE and specialty societies.

For his part, Patrone is delighted to be passing the baton to his younger colleague. “I’m from a different generation of doctors,” he says. “This is such a relief to me. As I phase off responsibilities to Martha, I feel like storm clouds are being lifted off my shoulders.”

The last article Karen Childress wrote for PracticeLink won the 2012 Gold Award for Best How-To Article from the American Society of Healthcare Publication Editors. Read the winning article, Your Ultimate Job-Search Guide, at ow.ly/aPCYR.

 

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Love where you land

By Teresa Odle | Feature Articles | Summer 2012

 

Justin F. Klamerus, M.D., thought he would be content to remain at Johns Hopkins after his medical oncology training and join the hospital’s lung cancer faculty.

Like many young physicians, Klamerus’ plans changed, and he returned to his roots in northern Michigan, where he’s putting his skills and training to good use as director of cancer services for a collaborative group of cancer centers that includes Northern Michigan Regional Hospital in Petoskey.

Plans change for many reasons. Sometimes the reason comes out of the blue, or in an unexpected job offer, or when a young physician realizes a year or two into their first job that it’s not a good fit.

Elizabeth Bell, Director of physician services, Corvallis Clinic

Preventing a problem from occurring in the first place saves time, money and trouble for everyone, especially if a physician leaves soon after they’ve joined. “It’s really hard on patients, particularly with primary care providers,” says Bell.Often, it’s as simple as the weather or distance from home and has nothing to do with colleagues, patients or the work. No matter the reason for the disillusionment, poor fit with both the employer and the community often can be prevented.

The best way for young physicians to prevent repeating mistakes made by those who’ve come before is to learn from colleagues and pause to prepare for job interviews and transition to practice.

“As with most anything in life, including when a medical student makes the transition from classroom learning to learning with patients, there is a big leap,” says Klamerus. “I think the same leap exists for young physicians entering their first job.”

Retention wreckers

Employers understand the damage caused by physician turnover. Keeping physicians happy is a big priority. And most physicians enter their first job searches with big ideas about long-term relationships.

Still, there are too many variables and unknowns for every first job to work out right.

Derrick R. Ward, M.D., became a partner at Kansas City Allergy & Asthma Associates, P.A., after two years. “You have to know the situation you’re getting into when you join a practice,” he says.

“Most people have no idea what questions to ask, how to go about the process, and how to figure out for themselves what sort of environment they really want to be in.” says Lawrence D. Ward, M.D., MPH, FACP, an internist who recently began a position as vice chair for clinical practice at Thomas Jefferson University Hospital in Philadelphia and is current chair of the American College of Physicians Council of Young Physicians.

In his previous position on Temple University’s faculty, Ward helped conduct yearly meetings to talk with residents about timelines for applying and focusing on practice choices. He has heard young physicians talk about issues such as lack of support or flexibility in their first jobs.

Of course, it can be tough to make the transition from residency to practice, and that can be compounded when a job doesn’t turn out quite as expected, when expectations are misaligned, or when the community turns out to be a poor fit.

“You have to know the situation you’re getting into when you join a practice,” says Derrick R. Ward, M.D., a board-certified allergy, asthma and immunology specialist with Kansas City Allergy & Asthma Associates, P.A.

He has been with the five-physician practice—his first job—for nearly five years, and became a partner after two years.

When Derrick joined the Kansas City practice, he says he felt confident clinically, but less prepared for the day-to-day operational aspects of running a business. “I feel like you don’t really get that in medical school,” he says. “You’re trying to learn everything else, and there’s not a lot of time to learn business at the same time.”

Preventing problems

Make the most of the support you have while still in residency to prepare for your job search and prevent some future surprises and disillusionment.

“Read articles that tell you the questions you need to ask and think about,” says Lawrence Ward. (See sidebar at right.)

Derrick Ward says it helps to talk with physicians close to your age who understand the current climate and who have been hired recently. They can help you understand average salaries and current bonus structures, relocation and how most practices handle weekend call with new physicians.

“You need comparable numbers and comparable experiences,” Derrick says. He adds that when he started looking for a job, he sent e-mails to graduated fellows he knew and talked to others. “And I have tried to do the same thing for people who have come to me after I left training.”

Deborah M. DeMarco, M.D., FACP, associate dean for Graduate Medical Education at the University of Massachusetts Medical School, says that her administrative director often helps young physicians out.

Related: What to do when starting somewhere new: ow.ly/aPx9y

The university also offers practice management workshops for all of the university’s 500-plus residents to help with skills such as looking at a contract and what to look for in a practice.

Formal help from programs to prepare you for your job search and the reality of practice vary.

Klamerus says that the Association of American Medical Colleges has recognized the need for business training by putting forward core competencies that address system-based practice issues. How formal the business preparation is depends on the residency training program, says DeMarco. “For example, family medicine programs have as part of their accreditation requirements that they have to have a practice management curriculum.”

Take advantage of the resources offered while you’re in training. The University of Massachusetts Medical School, where Deborah M. DeMarco, M.D., is associate dean for Graduate Medical Education, offers practice management workshops for residents.

The recruiters and other contacts you meet when interviewing can also help.

“Obviously we all tend to sell our organization, but we’ve got to be transparent about what young physicians will experience when they get here,” says Bell. “Because if they get here and it’s not what they understood it to be, they’re going to leave.”

Once you start at the practice, it’s often up to you to seek help from mentors and others.

Derrick Ward says he is fortunate to have an excellent administrator who helped explain to him how to read financials, for example. Some employers have formal orientation and mentoring programs to provide resources to new physicians.

Bell says Corvallis Clinic believes in a team approach. “We have a group of people, not just a physician, be mentors to our young physicians,” she says. The formal program includes checking in with the physician regularly on issues such as staffing and information technology.

The clinic even provides new physicians a “cheat sheet” at the end of orientation with photos of key staff and contact information to make it easier for them to get help. A practice development committee meets quarterly to review the young physician’s progress. You can take informal steps on your own initiative to garner similar support at a new job.

Give pause

Katherine Pryor, senior physician recruiter for the UMass Memorial Medical Center in Worcester, says that in spite of repeated visits and discussions with physicians and their spouses, some just find the location unsuitable.

“We tell them to first talk to each other about where they want to be,” she says. For instance, do they want to be near their parents?

Bell says that the number-one reason her practice has lost first-time physicians is because they had moved away from their families.

Klamerus emphasizes that, before selecting practices to talk with and forming questions to ask, you should pause for self-reflection.

“I think a lot of young trainees make decisions to go to undesirable areas they don’t want to live in, their family doesn’t like, or that are too far from their family—yet they take the job because it pays well or because of some short-term gain from the decision,” he says.

Pryor agrees, adding that some young physicians “go for the gold” partly because of enormous loan debts. “I don’t know if they give enough thought to: Do I want to live here; can I get along with these people; do I want to work with these people?”

The self-reflection period before the search begins definitely should involve those most impacted by the decision, namely spouses. “We encourage physicians to bring their spouse or significant other to our practice management seminar,” says DeMarco. It also helps to include a mentor—the peer who can help keep you grounded in the reality of today’s practice and offer expectations.

When it’s not working

Self-reflection can help if you feel trapped in a bad first job, too.

Klamerus advises people to pause and “think about the reasons for their dissatisfaction, what those really are.”

Sometimes, there are issues that physician leaders can address, such as compensation or weekend time off. Other issues are not so easy to fix—like the area’s climate or geography.

“A job is not like a residency,” says Lawrence Ward. “You’re not locked into it.” He says young physicians should go into the job search with this frame of mind: If you get into the position and realize you have made a mistake, first try to work it out. But if you can’t do so professionally, realize you can leave. Ward says knowing it’s OK to change takes some of the pressure off.

“They feel so much anxiety in choosing that first job, and they want to get it perfect. Sometimes it’s just not perfect. And sometimes it’s necessary in a professional way to change jobs.”

(Before you make a decision to restart job search, do be sure you fully understand the implications of ending your agreement.)

Self-reflection can also help you decide if any disillusionment is from general adjustment to practice or specific to the practice, colleagues or situation.

Unless you based your decision purely on compensation or geographic location, there probably were some characteristics about the practice and physicians that attracted you in the first place, and it might be time to reflect on those as well.

If the decision was based purely on compensation, that’s a lesson for your next search.

Derrick Ward warns against making a decision based purely on geography if possible. He says young physicians who do should be sure they have not signed a contract with a non-compete clause. “These can really hamstring you if you leave the practice; there’s a good chance that you’ll have to leave town because the clause can lock you out of the geographic area.”

Most of all, physicians who are unhappy should work with the practice to correct whatever is fixable and maintain the same openness and transparency that’s most valued during the job search, even when departing.

With all that Bell orchestrates at Corvallis to help new physicians, some still have issues, but remain silent about their concerns.

“I check in often with new physicians,” says Bell. “I invite them to my office for coffee, have lunch with them; we talk a lot. In spite of that, I occasionally get people who are unhappy after 18 months, but have never said a word.”

Bell says that all young physicians should talk about their concerns and give the organization an opportunity to fix things for them. She adds, “You need to be really frank with people about how things are going for you, and if they’re not receptive, you’re in the wrong place.”

Klamerus says that carefully thinking about long-term goals before the initial job search can help prevent much turnover among young physicians. “What are your five-year, 10-year and 25-year goals?” he says. “It sounds cliché to say that, but it should be in every part of the decision you make.”

And if the first job doesn’t work out, Klamerus adds: “Life is too short to be in a job that you’re not fulfilled by. You should remedy that because you won’t be good to us if you’re not satisfied.”

Related content

For more on managing your first year of practice, these PracticeLink articles can help.

Who’s the happiest?

10 signs of a well-run practice

Setting up a new practice

Create a free physician profile: PracticeLink.com/Physicians

For more helpful career content, please visit PracticeLink.com/Magazine.

Teresa Odle’s last feature for PracticeLink Magazine was “10 signs of a well-run practice”. Read it here.

 

 

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What Employers Want

The small details that can help you land the job you want

By Karen Edwards | Feature Articles | Summer 2012

 

When Linda Welniak, M.D., left residency, she went to work at a family medicine practice in Milwaukee, where she happily worked for the next 15 years. When the economy tanked a few years ago, however, the small group she worked for had to downsize. “I was let go, and for the first time since residency, I had to look for work,” she says.

Not only did Welniak face contractual restrictions, but she found herself competing for jobs with younger physicians. “It wasn’t easy,” she says.

Downsizing, a competitive specialty, a spouse relocation, a move closer to family, completion of training, or other circumstances may have you, like Welniak, joining the ranks of job-seeking physicians. And when that happens, you’ll want to be ready.

But let’s face it. There is a physician shortage today, and just about any resident will tell you they spend almost as much time fielding job offers as diagnosing patients.

However, when you’ve got your eye on a particular location, employer or experience, you’ll want to set yourself apart from the competition. That’s when it pays the most to consider the small details that can make a big difference in hiring decisions.

Here’s what employers really want.

Lara Pierce, M.D., left some old but relevant information on her CV to show potential employers that she had ties to the area. Local ties can move your CV to the top of the stack.

Candidates who know what they’re looking for

Before starting your search, the first thing you should do is sit down—with a significant other if you have one—and determine what kind of job you want and what kind of place you want to work in, says Patrice Streicher, an associate director with Vista Staffing Solutions.

“Assess what you want, then you can better target your search,” she says.

What you should look for is a cultural fit with your personality. Just knowing if a place is right for you, she says, will affect the way you approach the interview and ultimately the job.

Lara Pierce, M.D., a third-year family practice chief resident at Clarkson Family Medicine in Omaha, made location her first job-search priority. She knew she wanted to return to her home state of Texas, in a rural practice close to the Fort Worth area. She also knew she wanted to do obstetrics. Determining all that ahead of her job search was helpful, she says. “It helps you weed through the phone calls and emails you receive once you begin residency,” she says. “I called clinics and hospitals in the area where I wanted to move and asked if they would have positions opening soon.”

Well-organized documents

Once you’ve decided what you want, your next step is to polish your résumé or CV. A résumé is not a curriculum vitae, although most physicians and recruiters use the term interchangeably. The résumé is a short, one- to two-page listing of skills, experience and education.

The CV is a summary of educational and academic backgrounds, teaching and/or research experience, publications, presentations, honors, awards, affiliations, etc.

“If this is your initial contact with the employer, use a résumé,” says Streicher. “Then follow up with a CV.”

Before sending a résumé or CV, Eric Dickerson, managing director for Academic Physician Recruiting Practice, suggests having others review it first. “You’re more likely to catch typos and spelling errors, which can turn off prospective employers,” he says.

Another turn-off is a disorganized CV.

Debbie Gleason, in-house recruiter for The Nebraska Medical Center

Debbie Gleason, in-house recruiter for The Nebraska Medical Center, suggests listing work positions in reverse chronological order so your current position is at the top. Put your training in sequence as well so your medical school training doesn’t suddenly appear in the middle of your residency.

“You don’t want an employer to pull out a sheet of paper to figure out your CV,” says Gleason.

Related: Is your CV helping you? ow.ly/aPnGH

Candidates with ties to the area

If you really want to make an impression, add what recruiters refer to as “BLT” to your CV or cover letter.

“It stands for born, licensed, trained,” says Scott Manning, director of provider recruiting at District Medical Group in Phoenix.

If you’re looking for a position in a certain area, list any of the BLTs you may have in that community. Manning says your résumé will move to the top, as most recruiters are looking for long-term employees and a tie to the area reassures them you’re likely to stay.

When Pierce went looking for her job in Texas, for example, she deliberately left some old but relevant information on her CV. “My husband and I had both worked for an ambulance company in the area,” she says. “I thought it would show I knew the area and had worked with some of the doctors there.”

Of course, such information could also be included in a cover letter or the email you send introducing yourself and telling why you’re interested in the position.

Writing a cover letter will also force you to take that initial soul-searching step, says Ronald Kanner, M.D., residency training director at North Shore-Long Island Jewish Medical Center. “In it, state why you’re seeking the position and what you can bring to the table,” he says.

“List a BLT or if you know someone who works here—that can mean a lot too,” says Manning about a cover letter.

Don’t think you have a connection? “Check professional networking sites to see if you know someone who works in the place where you’re seeking a job,” suggests Streicher.

Instead of relying strictly on the interview process, consider moonlighting at the place you’d like to work like Nate Alvis, D.O., did. “It turned into a working interview,” he says.

Nate Alvis, D.O., a family medicine resident who will soon practice in Iowa, did just that. “I called a local doctor I knew who worked at the place I wanted to work,” he says. But rather than ask him for a recommendation, Alvis let his colleague know he’d like to moonlight there. “It turned into a working interview,” he says.

Welniak did something similar. She had been turned down—twice—by a place she wanted to work. So when a recruiter called and told her about a locum tenens position there, she took it. “Within a few weeks, they were asking me to stay,” she says.

By then, she had accepted another position, so when the locum position ended, she left. “If you can let the employer see what you can do and how you interact with the staff, it might lead to a permanent job,” she says.

Related: Create a free physician profile at PracticeLink.com/Physicians to connect with recruiters at 5,000 facilities.

Good references

“References are important and have to be impeccable,” says Sally Mounts, president of Auctus Consulting Group. “Just be sure you approach people with good verbal and writing skills and the enthusiasm to recommend you.”

Reference letters can come from someone in your current practice’s leadership, a peer you’ve worked with, and maybe a subordinate.

It’s called 360-degree feedback. “And it’s increasingly important in business today,” says Mounts. “Employers want to know you’re a team player and that you work well with everyone.”

When you ask someone to be a reference, help them out by reminding them of when and how long they’ve worked with you, why you’re currently looking for a job, and why the employers you’re considering are attractive to you. That information will be helpful whether they’re writing a letter or simply speaking with your potential employer on the phone.

Manning doesn’t put much stock in reference letters. “Did you ever see a bad one?” he asks. “They’re helpful and I’m happy to take them, but I’ll still want to call your referrals so the responses aren’t so crafted.”

“I didn’t gather referral letters,” says Ariz Anklesaria, D.O., chief resident at Wright State University Department of Psychiatry in Dayton, Ohio. “But I did ask people if I could use them as references. I think it’s a good idea to tell them what aspects of yourself you’d like them to ‘sell’ during a call.”

RELATED: Will you do me the honor? How to get the best references: ow.ly/aPo3R

Sometimes, those making the recommendations will ask you what they should say. “When I asked physicians if I could use them as referrals, they asked me about the kind of work I was looking for,” says Pierce. She told them she wanted work in a rural practice—so when a small Texas community called, her references knew what to say.

If you ask others to serve as referrals for you, remember to ask the person first. It’s more than good manners—it’s one of those small details that can make a difference.

“I once called someone who didn’t know they were listed as this applicant’s reference,” says Gleason. “It didn’t make a good impression.”

Candidates who have done their homework

Once you’ve landed an interview, your work has just started. Remember, it’s the small details that will move you ahead of your competition, so go online and learn everything you can about the organization, the staff and the community.

“It’s unacceptable today to know nothing about the organization to which you’re applying,” says Manning. “Go through every piece on the Web site about the organization.”

You should know the size of the hospital, the makeup of its staff, and what procedures they do and don’t do.

Daniel Ahoubim, M.D., a chief resident who will soon serve a sleep medicine fellowship in Miami, goes a step further. He says he makes a point to read research papers written by medical staff before the interview. “It shows you’re interested,” he says.

In addition to online research, Dickerson suggests applicants put together a list of 15 to 20 quality questions to ask at the interview.

Remember that an interview is as much a fact-finding mission for you as it is for the employer. Determine what you need to know before going in for an interview, and don’t leave until you have the answers to those questions.

Anklesaria says he puts together a template for each place he interviews. On it he lists salary, location, the number of patients he’ll be expected to see, etc. If those points aren’t raised during the interview, he’ll ask about them. “I then create a table for comparison purposes,” he says.

The last bit of prep work to consider is rehearsing answers to what are typical interview questions. “Practice them,” says Kanner, “But don’t recite them like they’ve been memorized.”

Marissa Oller-Cramsie, D.O., a chief resident in neurology at North Shore-Long Island Jewish Hospital, says her mother and her husband both give her practice interview questions before an interview. “My mother interviews at her job, so she asks some pretty good questions,” she says.

Professionalism and honesty

“The moment you close your car door in the parking lot, you’re interviewing,” says Streicher. That means being professional with everyone from the valet to the front office staff.

You might even be careful en route to an interview. You never know if the person sitting behind you on a flight, for example, is connected to the hiring organization.

In addition to acting professionally, arrive early. “Today’s hospitals can be like labyrinths,” says Dickerson, “So arrive at least 15 to 20 minutes early. It may take that long to find where you need to be.”

If you’re serious about the position, you’ve arrived well-groomed and conservatively dressed. You’ll turn down the alcohol at dinner—or stick to just one drink, and only then if everyone else ordered one before you. When it comes to the interview, make eye contact with the interviewer and offer a firm handshake to continue the process on a positive note, says Mounts. “These may be small details, but they can make a difference.”

“During the interview,” Mounts continues, “be positive, outgoing and interactive.”

Lean forward when you respond to questions, suggests Kanner, and of course, “Answer every question truthfully and honestly.”

RELATED: Questions to ask during the interview process: ow.ly/aPr2V

That’s especially true if you have red flags somewhere in your background. If you’ve been sued for malpractice, or your license has been placed on probation, you can be sure the recruiter will eventually find out.

“It’s always better to hear that information from you. Don’t let us drag it out of you,” says Manning.

“Be open, honest and transparent when addressing red flags,” says Dickerson.

Mention them early in the interview process—preferably during a pre-screening phone call, says Gleason.

Also remember, patient satisfaction is important today—as is marketing and awareness of how your practice habits can affect an employer’s bottom line. Give the interviewer the impression that you understand these areas and you know how to be a team player, says Gleason.

Arrogance, nonchalance, anger and any signs of disrespecting another’s time and position are examples of interview turn-offs to avoid.

“For me, the deal-breaker is disrespecting a patient,” says Kanner.

Thoughtful follow-up

In most cases, interviewers will end the interview. At that point, thank them for their time, and if you know, tell them you’re interested in the job. “Don’t leave me wondering if you want the position or not,” says Gleason. Again, a small detail that’s too often overlooked.

If you haven’t received an interviewer’s business card yet, now’s the time to ask. And don’t leave until you’ve also asked, “What’s the next step?”

“You want to have another encounter scheduled before you leave,” says Streicher. “If not, you won’t know what to do next.”

If the interviewer gives you a timeline for a decision—two weeks, for example—and you haven’t heard anything by then, it’s all right to call or email to ask if a decision has been made.

“Two weeks can become four weeks in a busy place,” says Gleason. Welniak agrees. “Hearing back from an interviewer often took time,” she says. When she did check in, though, she says she was more likely to receive responses to emails than phone calls.

After the interview, send a thank-you card or email. If you are rejected for a job, accept it graciously. “You might ask what deficiencies precluded you from the position,” says Dickerson. Or you can simply ask the interviewer if it’s acceptable to stay in touch.

“You don’t know what position might come up in the future, so it helps to stay on that person’s radar screen,” says Mounts. Don’t be a pest about it, she warns, but a quarterly follow-up should be fine. And it will give you a jump over any potential competition.

Finally, when it comes to a job search and the small details that will land you the position of your dreams, there are really only two pieces of advice to remember, says Streicher: Be yourself—“That way you’re comfortable with every part of the process,” she says—and know yourself. “A sure way to succeed in a job search,” says Streicher, “is to apply only for those jobs in which you’re interested and for which you’re best suited.”

Karen Edwards is a frequent contributor to PracticeLink Magazine (PracticeLink.com/Magazine).

 

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Ask the right questions the first time around

By Teresa Odle | Feature Articles | Summer 2012

 

“First is knowing what questions to ask, and second is knowing what to do with the answers,” says Lawrence D. Ward, M.D., MPH, FACP, of Thomas Jefferson University Hospital in Philadelphia and the American College of Physicians Council of Young Physicians.

Once you ask the questions that will help you make an informed decision, it helps to have someone you can bounce the answers off of. “If they tell me in the interview that I get one nurse per five physicians, what does that mean,” says Ward.

Here are a few questions to ask:

• What sort of staffing support will I have (nursing, billing, transcription, marketing, other)?

• Do you have an Electronic Health Record (EHR)?

• What is your payer mix?

• Do any of your physicians have flexible schedules to account for outside endeavors or family commitments?

• Will I have any inpatient responsibilities? If so, how are my office patient responsibilities managed during that time?

• Will I be purely a consultant physician or have admitting privileges?

• How often will I take evening and weekend call, and what is the usual volume of calls?

• Are there evening or weekend office hours?

• What is your compensation plan based on (work units, reimbursement, straight salary), and for how long is my salary guaranteed?

• Is there a path to partnership?

• What are the benefits, including retirement? How long until I am fully vested for retirement?

• What type of governance structure do you have, and how do physicians fit in the structure?

• Is there a succession plan in place for new physicians?

• Will my clinical responsibilities include traveling to other facilities (such as satellite offices or nursing homes), and how far or how often?

• What kind of orientation, support and mentoring do you have in place for new physicians?

• How are new physician schedules altered to gradually acclimate them to the practice and EHR?

• What is the current real estate market like in the community?

• Does the community offer access to my family’s religious, educational and extracurricular needs?

Download and share these questions online at ow.ly/bBZQU

 

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Soft spot for technology?

Make it your career focus

By Wendy J. Mayeroff | Feature Articles

 

Technology can open up new career paths for physicians or supplement your career in ways you might not have expected. Jennifer Thomas, M.D., after all, wasn’t planning to become a social media expert.

Mehul Sheth, D.O., who now wears two different hats, took another path. He recently moved to Chicago and became a medical consultant for Allscripts. He also provides input to EarWell, a manufacturer of devices for correcting ear deformities. Among other things, they’re considering before/after videos that can be placed on YouTube, or maybe a practitioner’s website.

Nareesa Mohammed-Rajput, M.D., may be one of the most typical changeovers: doctors who transition into medical informatics. She was originally trained in primary care.

“They had an EMR at the hospital I was at, but it wasn’t complete. So I started creating my own template,” she says. Her program director noticed, and offered a job after residency in which she helped with anything relating to EMRs—including rollouts, documentations, and sharing data with the outpatient group.

This eventually led her to Hopkins. In 2011, she completed National Library of Medicine’s (NLM) medical informatics program.

Edward H. Shortliffe, M.D., Ph.D., president and CEO of the American Medical Informatics Association (AMIA), encourages doctors to explore such training, using NLM, AMIA, and other institutions’ programs.

As of September 2011, the American Board of Medical Specialties recognizes medical informatics as a subspecialty, and Shortliffe expects the first board exam, to be offered through the American Board of Preventive Medicine, to be available as early as Fall 2012.

AMIA’s national conference in October 2011 showed attendees a wide range of possibilities for careers, including consumer health informatics. Exhibitors ranged from institutions like the U.S. Army and the University of North Carolina-Chapel Hill—happy to train you in informatics—to major corporations like 3M seeking to recruit you post-training.

The latter are hoping to capture the kind of innovation shown by practitioners like Peter Stetson, M.D., chief medical informatics officer at ColumbiaDoctors, Columbia University Medical Center in New York City. Stetson designed a patient hand-off to improve communication at the change of shifts. “It’s a hot topic in patient safety, and there are JCAHO requirements for institutions to have a hand-off project,” he says.

In the past decade, an increasing number of physicians are assuming the mantle of Chief Medical Information Officer (CMIO).

In a September 2011 article, Healthcare Informatics noted that although 56 percent of these officers are age 50 and older (indicating many didn’t begin until mid-life), 44 percent are between ages 30 and 49.

Stetson still keeps his internal medicine hat and says, “It’s hard to be on call” while acting as CMIO. But he tells the students he’s training in this career option: “There’s no replacement for working with patients while using the systems that you deploy, to see how they work.”

 

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Medicine 3.0

How to use your passion for technology in your job search

By Wendy J. Meyeroff | Feature Articles | Spring 2012

 

“Two years ago, a physician or practice with a Facebook account was unusual. Now if you’re a doctor without one, you’re considered archaic,” says Mehul Sheth, D.O., who practiced as a pediatrician in Milwaukee before becoming a medical consultant in Chicago.

Physicians can use social media to receive alerts about new treatments or connect with patients. That connection is especially important when patients are faced with long wait times and short visits, says Mehul Sheth, D.O.

Today’s physicians need to be more savvy about non-medical technologies than ever before. More and more, EHRs, social media and mobile computing are just a few of the trends that physicians and practices can’t afford to ignore.

And if you’re preparing for a job search, you can use your grasp of technology as a selling point.

Website development

The lesson: Building your own website
makes you the go-to resource and can attract
potential employers.

Jennifer Thomas, M.D., a pediatrician practicing at Lakeshore Medical in Franklin, Wisc., has shown how a website can be more than just a place to list your address and office hours.

“When I got my first job out of residency in 1998, I was the first new hire in at least a decade, and they had a number of layers patients had to go through to reach a health professional—nurse triage, phone triage, etc. I wasn’t very busy, so I started to hand out my email address, which not many people had at that time,” she says.

By the year 2000, she says, pretty much everyone had an email, and she found herself answering the same questions over and over.

So she set up her own website, drjen4kids.com, and put up notices on her business card and in her exam room.

“One day, the CEO came in and asked, ‘You have a website?’ and I said ‘Yes,’ waiting to be chastised and beg forgiveness. Instead, I got an email saying ‘Good work,’” she says.
In fact, her website was one reason her current employer recruited her.

It’s no secret that websites are often the first place people search for information on a practice. Think of the opportunity lost if a patient searches for a particular physician and finds nothing at all—or several listings, but no real information.
The best case scenario?

“The [searcher] finds an engaging, user-friendly website, one that tells the story of the people of the practice,” says Tom Ainsley, CEO of Baltimore Media Group in Maryland. He emphasizes the importance of your site’s “About us” link: “It gives the reader your credentials, personality, provides a sense of ‘Would I be comfortable in their care?’” he says. Consider videos allowing visitors to view the office and even “meet” individual physicians.

“Purchase [YourName].com (you can do it for about $10 on GoDaddy.com) and set yourself up as an expert. You can publish information and post your comments about a new treatment, or something you saw at a conference,” says Ainsley. Such commenting may help enhance your value to a practice.
Questions that come into your site can be your bellwether on local patients’ concerns, especially if you’ve moved to a new community.

more »

 

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Playing Financial Catch-Up

By Marcia Layton Turner | Feature Articles

 

With the median annual primary care physician salary reportedly at $202,392, and the median salary for physicians in medical specialties at $356,885, according to the most recent Medical Group Management Association’s Physician Compensation and Production Survey, it would be easy to assume that physicians leave their money woes behind following medical school and residency.

Once those high salaries kick in, it might appear that doctors immediately become wealthy. In fact, it may take some time to get past onerous student loans and onto easy street. The good news is that it will happen—just not as quickly as most physicians hope.

Certainly, the salary jump from resident to full-time physician provides significant added income. But that additional money is already spoken for, to a large degree, thanks to student loan debt hovering above $161,000 for the medical school class of 2011. In fact, 86 percent of graduating medical school students have student loan debt, according to the Association of American Medical Colleges, with 78 percent carrying at least $100,000 in debt and 59 percent carrying more than $150,000. It is not unusual for physicians to have monthly student loan payments of $2,000 to $3,000 or more.

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