New practice? Now patients!

After your job search is over, the challenge becomes marketing your new practice.

By Laurie Morgan | Feature Articles | Spring 2013


You’ve made the big decision: joined a health system, hired on at an established practice, or hung out your shingle. What’s left? Attracting patients—and that means marketing.

Until relatively recently, many physicians were reluctant to even talk about marketing, much less embrace it. “Even 10 years ago, advertising in any capacity was considered taboo,” says Eric Chang, M.D., a plastic surgeon in private practice in Columbia, Md. In today’s fast-changing market, Chang notes, newly graduating physicians may be more aware of the need for marketing, but they also must take responsibility for learning the marketing ropes. “Because there are so many local differences,” Chang adds, “you can’t just read a book” to know what will work. Employed physicians will also find that practices and health systems have different preferences, policies and expectations.

Plastic surgeon Eric Chang, M.D., advises that physicians market themselves as a way to build confidence and awareness among patients and other practitioners.

Employed? Learn what’s expected

If you’ve been hired into a practice that’s overflowing with new patients and urgently needs you to fill in the gap, you might assume that drumming up interest in your services would be a low priority. But even if your new practice was previously overbooked, the excess is probably insufficient to completely fill your schedule. What’s more, if you’re relying solely on overflow from others in your practice to keep busy, you won’t establish a flow of new patients to keep your practice productive in the future.

“I think an employee joining a practice may feel, ‘The practice markets itself, why do I need to market myself?’” says Chang. “But the truth is, referral patterns have to be solidified for you as a new practitioner. The referring doctor has to feel confident in your skills—not just those of your boss.”

Large health systems with sophisticated marketing programs also count on their physician employees to make personal connections with the community and reinforce local ties.

Nick Crespo, a physician recruiter with Sutter Health in Northern California, agrees. “Participating in local activities in the communities where they’ll be living is key for our physicians, especially in our more rural locations. Radio interviews, tree plantings, health fairs—all of these sorts of activities help build the trust of our local communities.”

On the plus side, it’s easier to figure out what to do in a large organization, because marketing professionals are usually readily available to help newly employed physicians understand what’s expected and promote their practices. “My one word of advice, for almost any health system, is that there’s going to be at least one point person in PR or marketing,” says Sally Foister, director of marketing at Greenville Hospital System (GHS) in Greenville, S.C., who is responsible for guiding newly hired physicians through GHS’s marketing programs. “Talk to them before you do anything because they are there to help you achieve your goals.” Working with internal marketing professionals also helps to avoid unintentional missteps, such as violating the organization’s social media policies or inadvertently contradicting the marketing team’s messages.

What if you’re joining a practice that is too small to have full-time marketers on staff? Outside consultants can fill the gap and help you learn the basics.

“I was lucky that my practice had brought in a consultant to start marketing my practice before I even arrived,” says Ella Lindwall, M.D., a rheumatologist with Advanced Rheumatology in Thousand Oaks, Calif. “When I went with the owner of my practice to meet the physicians at the local hospital, fliers had already been distributed telling everyone about me. I was also already being promoted to the practice’s patients.” Lindwall advises asking for this support if your new practice doesn’t have marketing expertise in-house. “I think it is important to have someone with experience guide you on marketing and take the lead initially because we don’t learn anything about marketing ourselves in med school.”

Buddy up

If you’ve decided to set up a solo practice or have joined a small group and have no marketing department to rely on, figuring out what to do first can be daunting. Connecting with other local physicians at the same career stage can be a great way to accelerate your learning, build your referral network, and identify trustworthy resources like consultants and web developers. Plus, you’ll gain invaluable moral support.

“When I first started out, I called family practitioners and internal medicine doctors, showed up to their offices with lunch and hoped that they would send me patients. I did it for five months before I realized I got almost nothing,” says David Ghozland, M.D., an OB/GYN who set up his private practice in Santa Monica, Calif., in 2007. The problem: Ghozland was newly affiliated at two hospitals where more than 200 established OB/GYNs were already well-connected with the local primary care physicians—and absorbing all of their referrals. Ghozland’s creative solution: He formed his own networking group. He invited other young physicians from a variety of subspecialties to join the group, and they agreed to meet weekly over dinner. Over the next few years, they helped each other build their practices—sharing referrals, inviting new members to join and exchanging ideas.

When Eric Chang left employment with a mid-sized practice to start out on his own, he sought support from a friend, a dermatologist who had set up her private practice just a few years before. “She was not a competitor to me; my presence in the community could actually be helpful to her,” Chang says, noting that dermatologists and plastic surgeons frequently cross-refer. Ultimately, Chang’s friend didn’t just connect him with the community of dermatologists in his area; she became a trusted confidante he could bounce ideas off of as he built his practice. “Knowing that she’d done it herself made me confident that I could do it, too.”

David Ghozland, M.D., dedicates a day each week to running the business of his practice. “I go into the office. I have a to-do list. Every month, I have a goal.” While revenue may be lost in the short term, Ghozland is investing in his practice for the future. “I may lose money that day by not seeing patients, but in the long run, it’s better for my practice.”

Build your network

For most specialties, building your network in order to attract referrals from other physicians is critical for attracting patients. If you’re not comfortable with reaching out the way Ghozland and Chang did, take heart. Educational events provide some of the best—and most natural—ways to connect with other physicians. “Rheumatology has been revolutionized in the last decade with new, highly effective treatments for diseases like rheumatoid arthritis, psoriatic arthritis, vasculitis, and osteoporosis,” says Lindwall. Part of Lindwall’s outreach to local PCPs, geriatricians and dermatologists and other adjacent specialists is to give talks to help them stay abreast of continuing advances in care she can offer patients. These presentations allow her to offer valuable information to other physicians, helping her earn their support.

Attending seminars and presentations for your own education is another relatively painless way to meet more colleagues who could refer you.

“Sometimes people are reluctant to spend $1,000 on a conference—but it’s a write-off, and you never know who you’re going to meet,” says Ghozland.

Attending events can also spark your creativity, helping you think differently about your practice and how to promote it. “If you’re in a room with people who are a little outside the box, your wheels start turning, and you’re suddenly thinking outside the box, too,” adds Ghozland. Even pharmaceutical presentations, notes Lindwall, are opportunities to meet other physicians from a variety of specialties.

“I was lucky that my practice had brought in a consultant to start marketing my practice before I even arrived,” says Ella Lindwall, M.D. “When I went with the owner of my practice to meet the physicians at the local hospital, fliers had already been distributed telling everyone about me.”

Personal interests and non-medical talents can help you make connections, too. For example, Lindwall plans to join a networking group for women doctors in her new community in Southern California. And Ghozland found that he could gain a few referrals from local consulates for emergency care by letting them know he spoke French and Hebrew in addition to English.

Public presence: Start with the web

Referrals from other physicians are still the leading source of patients for most specialists, but even specialists need to communicate directly with the public in some fashion. Today’s educated patient will frequently turn to the internet for more information about a physician before following up to make an appointment. And for primary care physicians—the top of the referral funnel—attracting patients directly is essential. For specialists and primary care alike, a website is usually the best place to start.

“If you’re 25, 30 years old, coming into the market as a physician and trying to attract a patient base, you have to have a web presence,” says Chang. “It’s almost like you don’t exist if you don’t have a site.”

Jamie Cesaretti, M.D., a radiation oncologist with Orlando Physician Specialists in Winter Park, Fla., learned firsthand how marketing to patients online could help build his prostate cancer practice. When he moved into the market a few years ago, Cesaretti learned that even patients who had already been offered treatment somewhere else were still going online to learn more about local radiation oncology practices, and that they carefully considered the information they found on his site. “They were concerned with very specific problems and were going online to explore their options,” Cesaretti says. When patients found his site, many were attracted to Cesaretti’s practice because the site educated them about his local group’s specific expertise in prostate cancer.

Cesaretti’s experience underscores the importance of not just having a site with the information patients need for decision-making, but also having one that ranks highly in search results for your specialty. He and his partners frequently refresh their site’s content and post articles elsewhere online to bring traffic back.

Chang agrees, noting that aesthetics are just one component of a good site. “It’s one thing to make a site that looks nice; it’s another to make a site that looks nice that people can actually find.” He advises colleagues to spend a bit more to get a site that has been designed to rank well for search terms related to your practice. “Everyone wants a site for $300, but when you invest $3,000, you’re paying for expertise behind the design to get the site found.”

The process of making your site rank well on Google and other search engines, known as search engine optimization (SEO), depends heavily on how well your site content meshes with search terms patients use to find your specialty in your area. Regularly updating your site with high-quality content helps ensure your search engine rankings remain high.

Creating at least some original content (for example, by adding a blog to your site) is the best way to ensure the content is personalized and high quality. Says Cesaretti, “Marketing groups write content for practices, but Google has gotten better at discerning which posts are ‘vanilla’ marketing. If it’s genuine content by a real, local doctor, it will show up higher.”

In a large organization, you may not have a separate website for your practice, but you’ll usually have a page or even a multi-page profile on your employer’s main site. Often, there are opportunities to add personal touches that will help you express your care philosophy and connect with prospective patients. At Greenville Hospital System, for example, each physician’s website profile includes several pages with background information, a picture, and an introductory video that is also posted on YouTube.

Related: Medicine 3.0

Embrace directories and ratings sites

When patients search on a specialty in a state or city, it’s not unusual for the top results not to be physician sites at all. Listings from Google Places and the biggest physician directory and rating sites (Healthgrades, Vitals) often appear in search results higher even than the major health systems and payers in the area. But because these directories rely on public databases that may not have current data, it’s not unusual for a physician’s information to be incorrect, causing hassles for patients that rely on the data and undermining physician marketing efforts.

Fortunately, these directories make it easy for physicians to claim their listings and correct erroneous contact information and other problems. Claiming and updating your directory listings also allows you to spiff up your listing with a photo and even add a link back to your web page (an excellent SEO boost). And claiming and updating your directory listings is free, so it’s something every physician should do.

Another advantage of claiming your listings: many of the sites will use your registration information to notify you if patients have added new ratings or comments. For those that don’t—and to monitor what’s posted about you elsewhere on the web—sign up for the free Google Alerts service, which tracks keywords you select and alerts you via email when related postings appear.

When medical rating sites first appeared on the web a few years back, many doctors were nervous about the prospect of patients reviewing them and publishing their opinions online. The prevailing attitude among many doctors was to ignore the sites and hope they’d go away. But that view has shifted as the ratings sites gained popularity. Now, physicians are starting to see the benefits of embracing patient ratings. Positive ratings can be a real boon for referrals.

“Patient feedback is one of the most cost-effective ways of advertising these days,” says Chang. “Directory sites are becoming more useful and more targeted.” Chang encourages his patients to review his practice online, especially on a directory called RealSelf, which is focused on plastic surgery.

Give a little bit

Getting patients to talk about you and your practice positively online or to their friends is perhaps the most powerful way to expand your patient base. But in a 15-minute visit, it can be a challenge to make an impression worth talking about.

One way to be memorable: Establish a personal connection. “I knew a doctor who said that in the first 60 seconds of the visit, he can make the patient feel like they’ve been with me for 15 minutes,” recalls Ghozland. “He did it by remembering little details about the patient, and taking chart notes to ask them about at their next visit.” Ghozland applied the ideas to his own practice. “It’s about really making your patients enjoy coming to you, making yourself open. That’s how you get referrals.”

Charitable opportunities can also lead to new patients and more procedure revenue, and they can be found at organizations of all sizes. For example, free screenings are a way to give back to patients who might otherwise not get tested for disease. And in some cases, testing will lead to a need for treatment and new revenue for the physicians who donate their time. “Our practice is working with one of our hospitals to create a free prostate cancer screening test program,” says Raul Hernandez, urologist and partner in Golden Gate Urology in San Francisco. The NFL and American Urological Association’s “Know Your Stats” program provided the template for their efforts and has made it possible for urology practices and hospitals of all sizes to piggyback on the program’s publicity and provide free screenings to thousands of men who might otherwise go untested.

Going social

By some estimates, nearly 70 percent of Americans have a Facebook page and nearly 15 percent of American internet users use Twitter. So it’s no surprise that physicians are exploring social media as a tool for connecting with patients. “They hold almost limitless potential,” says Chang about Twitter and Facebook. “It’s a matter of spending the time and energy and making sure that you’re addressing the correct market.”

The time and energy required, though, are no small matters—especially for private practice physicians. It’s important to know what you’ll be getting into if you decide to connect with patients via the social web. “Facebook and Twitter are extremely time consuming and can put you at risk because you may not seem caring if you don’t answer a post fast enough,” says Hernandez. Information you post may also be interpreted as medical advice, so it’s imperative to have clear guidelines about what can be posted on your practice’s page and to monitor patient postings to be sure none unintentionally breach their privacy.

Theresa Varughese, practice liaison with Carolina Cardiology Consultants, a wholly-owned practice of Greenville Hospital System, found that a team approach enables her practice to manage the fast-response demands of social media. The team monitors the practice’s page for patient requests or comments that need a response. “We can quickly respond to issues patients post—‘I’m really sorry you had this experience, can I call you to talk about it? I’d like to get your feedback’—and avoid the patient feeling ignored.”

A physician champion, a sports cardiologist whose practice serves many young athletes, is a key member of Carolina Cardiology’s social media team. He is an avid user and early adopter of social media who’s fully comfortable using it every day. “He recently spoke at a national conference, and he tweeted about it the entire time,” says Varughese.

Becoming your practice’s social media champion can help you build your own panel and boost your practice’s profile. Some large organizations even compensate physicians who help with social media. The key is to work with others in your practice, especially marketing professionals, to stay within practice guidelines. “If one of our physicians wants to set up a practice Facebook page, we help them figure out what is appropriate and what isn’t. We have guidelines covering legal issues and things like, ‘don’t have an argument online,’” adds Foister from GHS, who also notes that problems are rare.

Besides establishing content boundaries, just finding enough content can be a challenge, especially for specialty practices. Varughese and her team solved it by supplementing their in-house postings with a purchased stream of cardiology content from UbiCare.


One of the biggest challenges for physicians in marketing their practices—much as with all things business—is maintaining interest and commitment. Too often, physicians set up their websites or hand their marketing programs off to a consultant and think, done. But marketing is never really done. Websites must be repeatedly optimized, directory listings regularly updated, and you must participate in your community continuously to be known to potential patients moving into your area.

Related: Don’t let your next IT project crash your practice

“Doctors have trouble following up” on business goals, says Ghozland. “We get busy, hire others to help with marketing, but then fail to follow up and the leads drop off.” He solves the problem by dedicating a day each week to running the business of his practice. “I go into the office. I have a to-do list. Every month, I have a goal.” While revenue may be lost in the short term, Ghozland is investing in his practice for the future. “I may lose money that day by not seeing patients, but in the long run, it’s better for my practice.”

Laurie Morgan, MBA, is a medical practice management and health care industry consultant with Capko & Company.



Finding a practice that fits your life

A myriad of practice options await depending on the kind of lifestyle you’re looking for.

By Karen Childress | Feature Articles | Winter 2013


Whether you’re looking for your first practice opportunity or your fifth, options abound. What constitutes the “perfect job” depends entirely on your practice style, personality, values, and how hard you want to work.

Edgar Bulloch, M.D., provides care to the uninsured, low income or medically underserved. A volunteer experience at a free clinic in med school piqued his interest in this kind of practice opportunity.

It’s no secret that more physicians are opting for employed positions today, viewing them as more secure and having a lower hassle factor. But even within the realm of employed opportunities, there is a wide variety of choices offering greater and lesser degrees of autonomy, security, recognition and income. And each comes with its unique challenges and benefits.
In this article, we profile five physicians working in five very different settings: the military, locum tenens, a rural clinic, correctional medicine, and in a big city clinic caring for underserved patients.

Their stories illustrate just how varied careers in medicine can be and underscore the fact that doctors have plenty of latitude when it comes to how and where to practice.

Serving the underserved
As a medical student, Edgar Bulloch, M.D., volunteered at a free clinic where he treated uninsured patients who might not otherwise have been able to afford medical care. This experience piqued his interest in working with underserved populations. “That’s what initially drew me in. I had very good mentors in that program. They were doing so much for patients, for no compensation,” says Bulloch.

When he completed his OB/GYN residency at Texas Tech University Health Sciences Center in El Paso two years ago, Bulloch, 35, considered an academic career where he would have been both teaching and caring for underserved patients. But as he began exploring practice options, he heard about an opening at Family Health Centers of San Diego (FHCSD). A nonprofit federally qualified health center (the second largest in the country), FHCSD was founded in 1970 and has 33 sites, including 13 primary care clinics, in and around the San Diego area. Their mission includes providing comprehensive care for uninsured, low income, and medically underserved patients.

“It was the first interview I went on and I really enjoyed everyone I met,” Bulloch says.

After going on a few other interviews, Bulloch decided that Family Health Centers was the best fit for how he wanted to practice medicine. “FHCSD has great support staff and I felt that I could do everything needed for the patients,” says Bulloch.

Too often, low-income pregnant women receive little if any prenatal care and simply show up in hospital ERs in active labor—a less-than-desirable situation to be sure. “Here, they’re getting comprehensive visits throughout their pregnancies and we have a better understanding of patients when they go into labor. This means safer deliveries and better outcomes,” says Bulloch.
At FHCSD, patients have access not only to physicians, but also to health educators, nutritionists and social workers. “Each patient has a case manager,” says Bulloch. “If they need help finding insurance or getting on MediCal, they’re not alone. There are so many resources available to patients and I really like that.” Bulloch is fluent in Spanish, which serves him well in caring for a large Hispanic population. Translators are available for caregivers who are less fluent in the wide variety of languages spoken throughout San Diego County.

Due to inflexible work schedules and lack of transportation or childcare, ensuring continuity of care can sometimes be a challenge for doctors working with low-income patient populations. Bulloch says compliance is not a big problem at FHCSD. “We have a young, healthy population of pregnant women and most patients trust you and do what they need to do.” It helps that FHCSD has unique incentive programs for women that encourages them to receive comprehensive prenatal care. Patients receive Baby Bucks when they keep appointments, “money” they use to buy everything from diapers to baby clothes at FHCSD’s Baby Boutiques stocked with items donated by the community. Women also receive a free car seat for their newborn if they attend all of their prenatal appointments.

FHCSD has nine OB/GYNs on staff who rotate through all of the system’s clinics that provide obstetrical services. This allows women to meet each doctor at least once over the course of her pregnancy so that when it’s time to deliver, she is in the capable hands of a physician with whom she’s familiar. Bulloch holds privileges at several area hospitals. His practice is about 75 percent obstetrics and 25 percent gynecology.

Bulloch finds his work so satisfying that he’s helped recruit two OB/GYNs who were a year behind him in training to join FHCSD. Because of the system’s status as a federally qualified health center, professional liability insurance is covered by the government. This allows FHCSD to offer competitive salaries. “I could probably earn a little more working in another group, but that’s not why I went into medicine,” says Bulloch. “The program of care here is so integrated that I don’t have to worry about business and can focus on finding the right diagnosis and treatment for each patient. It’s very rewarding.”

Duty to country
When he’s not serving his country on the other side of the globe, Lt. Col. (Dr.) James Sebesta, M.D., practices general and bariatric surgery at Madigan Army Medical Center in Tacoma, Wash., where he lives with his wife, Janelle, and their six children. Sebesta, 48, always planned to go to medical school, but he didn’t necessarily have his sights set on a military career. “A friend was going to check out the Uniformed Services University of the Health Sciences in Bethesda and I went along, thinking it would be a free trip to D.C. I fell in love with the school,” says Sebesta.

Following medical school, Sebesta did his internship year at Madigan and then went on a two-year tour as a medical officer before returning to Madigan to complete his surgical residency in 2002. He’s been there ever since, but again, this was not necessarily his original plan.

“I thought I’d do my payback time and then figure out what to do next,” he says. But as that juncture neared, Sebesta did some career soul searching. “I broke out a piece of paper and wrote down everything I wanted in a job. I wanted to train residents, do research, and take care of patients how I thought they needed to be taken care of. I realized that I had the perfect job, that I was doing it right now,” says Sebesta. He’s now been a physician officer for 10 years and enjoys caring for members of the military, their families and military retirees.

Sebesta appreciates the fact that, even though there is a certain level of bureaucracy associated with being in the military and budgets are often tight, he doesn’t have to deal with the business side of practice. “I get to focus on medicine,” he says. His schedule is not unlike that of a civilian physician. “We divide call up between partners. There are 10 of us now because no one is deployed. I take call one weekend a month or every other month and three to four weeknights a month,” Sebesta says.

Having been deployed four times (once to Iraq and three times to Afghanistan), Sebesta says deployment is both the best and the worst part of being a military doctor. “They send you to bad places and you’re in harm’s way, but you get to do amazing things to save lives. Being away from the family is hard, but it’s an adventure, sort of like a six-month camping trip,” he says. Physicians who serve in the Army are not permanently attached to a single unit for deployment. Instead, when they’re needed to go overseas, they’re assigned to a unit for a period of time. Sebesta’s deployments have been between six and eight months in length.

Related: Military careers for physicians
Dr. Red, White and Blue

Returning stateside after a deployment is an interesting experience. “The practice side is easy. You just jump back in and start working,” says Sebesta. At home, re-entry can be a bit more challenging. “The family has figured out their own rhythm of doing things. You slowly move yourself back into that and figure out where you fit in,” he says.
Sebesta advises physicians considering a military career to get in touch with a recruiter.

“Based on the needs of the Army, the doctor’s skills, and how long they’ve practiced, they get a rank, go through officer basic training, learn how to put on the uniform, and start practicing medicine,” he says. Basic training? For doctors, it’s not like you’ve seen in the movies. “I stayed at the Holiday Inn,” says Sebesta. “They’re not yelling at you or shaving your head.”

Sebesta is passionate about his career as a military physician. “It has its challenges with deployments and budget issues, but the vast majority of us love being here,” he says. “For me, it’s a great place to practice medicine.”

On the road

Kristen Kent, M.D., works as a locum tenens physician.

Kristen Kent, M.D., is 37, single, enjoys traveling, and is taking full advantage of the fact that at this stage in her life she has the flexibility to practice medicine on her own terms.
Kent completed her emergency medicine residency at the University of Massachusetts Memorial Medical Center in Worcester in 2006. While in training, she moonlighted as a locum tenens physician and enjoyed it enough to go that route full time upon completing her training. “Then I joined a group in Cincinnati and worked with them for a while before going back to locum tenens,” says Kent.

“I feel like I have a lot of flexibility with my schedule,” says Kent. For example, she had no issues taking time off recently to go on a cruise with her dad.

Kent currently works in two locations—one near her home in Ohio and the other on Cape Cod—through and Vista. Her assignments generally run for at least three months, and she’s had offers to stay on permanently several times. For now, she’s keeping her options open and continuing to work locums. “I get to practice in different environments and I get to travel,” says Kent, who is hoping to work in Alaska next summer and will likely accept engagements in Illinois in the meantime.

Kent typically works between 100 and 140 hours a month, which is considered full time for emergency medicine. “I still work nights and weekends and holidays, but I have flexibility with my schedule,” she says. “I can fit in other things while I’m working. In Cape Cod, I work for four days and then have four days off.”

The biggest challenge of working locum tenens, says Kent, is getting to know the culture and systems at each new location. “Every place is a little different in how they manage patients. Some have hospitalists and some have private physicians who admit,” says Kent. “And things are not always as they were presented. You have to be flexible.”

RELATED: Will work for travel
Career move: Locum tenens

Kent says any physician considering locum tenens should give it a try. “It’s an excellent opportunity. You get to travel wherever you want, even outside the U.S.,” she says. “I moved a lot growing up and I like seeing different places, regions of the country and cultures. My friends joke that I can sit in an airport and guess where people are from based on their accents and shoes.”

Care without judgment
Internist Norman Johnson, M.D., was in private practice in 1994 when he first became acquainted with correctional medicine. “A friend worked in a prison and when he had patients who needed to be hospitalized, I’d admit them,” says Johnson. He quickly recognized that prisons and jails needed better systems for delivering care to their unique patient populations, and in 1995 he co-founded Health Professionals LTD.

In 2002 he founded Advanced Correctional Healthcare, a company that designs programs and provides risk management services for correctional facilities. In the interim, Johnson worked in jails and prisons for 15 years and continues that practice on a part-time basis today.

Johnson says the ideal doctor to work in a correctional facility is a primary care physician who has the ability to demonstrate empathy and also be somewhat parental.

“These patients are less likely to participate in their own care, and we’re charged with giving them everything they need, sometimes whether they want it or not,” says Johnson. “We have to do the right thing, while keeping in mind the cost to taxpayers and governments, both in dollars and in time.” Johnson’s philosophy is that individuals who are incarcerated, regardless of whether or not they’ve been found guilty of a crime, deserve quality medical care and respect.

Caring for incarcerated patients has challenges and rewards. “These patients come in on inappropriate drugs and they’ll want narcotics for minor problems,” says Johnson. “Many of them had doctors on the outside but they may have been non-compliant and not paying attention to their health. We get a shot at educating them. Patients in our jails get healthier. Their diabetes and hypertension improve while they’re inside,” says Johnson, adding that even “frequent flyers” who are released and then return to jail often come back in better health than when they were first seen within the system.

RELATED: Career move: Correctional medicine

“As the economy has worsened and states have done away with mental health programs, a lot of mentally ill patients are pouring into jails. Many of these people shouldn’t be there,” says Johnson. In this case, the goal is to get them on an appropriate drug regimen and link them with community services. “We cannot legally advocate for them, but we can work with the legal system to give them mental and medical health parameters so that they can sort things out,” says Johnson.

In the world of correctional medicine, prisons and jails are quite different. “Prisons are large and doctors usually work 40-hour weeks,” says Johnson. “Nurses line everything up, patients are pre-screened, protocols are followed, and if anyone gets really sick they’re sent to a hospital.” Physicians working in prisons do take after-hours call, except in facilities that are large enough to have doctors on duty 24/7.

Most jails are smaller than prisons and a full-time correctional physician might cover several facilities, traveling between as many as 25 over the course of a week checking in on and caring for inmates. “These doctors don’t see as many patients face-to-face because they’re spending time traveling,” says Johnson.

Interestingly, jail doctors tend to earn more than their colleagues who work full time in a single prison. “Correctional doctors earn based on the number of hours they work,” says Johnson. “If they’re in a prison, they’re likely salaried and earning in the range of $120,000 to $170,000 a year. Jail doctors are in the $150,000 to $200,000 range.”

Johnson says burnout among correctional physicians is not as high as one might imagine. Most facilities have nurses on staff and systems in place that make practicing medicine in the setting quite manageable. “You learn how to work with these patients,” says Johnson. “You cannot allow yourself to get hardened and think that everyone you see is manipulating you. You’ll miss something if that happens.”

The rural life

The idyllic setting of Northern Idaho is the perfect location for Troy Geyman, M.D., and his rural practice. Geyman, wife, Luann, and their 12 children enjoy living on their ranch—away from big cities but in close relationship with the people he treats.

Family physician Troy Geyman, M.D., practices medicine in keeping with what your imagination likely conjures up when you hear the term “country doctor.” He covers his own practice in Bonners Ferry, Idaho, 24 hours a day, seven days a week, every day of the year. “It’s part of the job. You just do it,” he says of his practice choice. Geyman has admitting privileges at his local 20-bed critical access hospital and completes rounds each morning. He does get coverage from another local doctor for inpatients when he leaves town, but even then remains available by phone for calls about patients. “I don’t do house visits though. The county’s too large for that,” says Geyman.

Following medical school at the University of Arizona in Tucson, Geyman completed his family medicine residency at Self Memorial Hospital in rural South Carolina and then worked at a community health center in rural Michigan before settling in northern Idaho, about 20 miles from the Canadian border. He’s been there for 10 years. “I like doing the full range of practice,” says Geyman. He typically sees 45 to 50 patients a day, holds places in the schedule for walk-ins, and performs a wide range of procedures. Obstetrics is the one aspect of family medicine Geyman does not offer because the service is not available at his local hospital.

RELATED: Rural medicine: You can go home again

Geyman appreciates the community-oriented aspect of practicing medicine in a rural area. He takes care of entire families and everyone in Bonners Ferry pretty much knows everyone else. “In more populated areas most people don’t even know their neighbors, let alone have a lot of relatives in the community,” says Geyman. He sees his patients around town outside the office on a daily basis. “That’s more positive than negative,” says Geyman, who does occasionally get medical questions from patients when he’s out and about. He takes that in stride. “I enjoy seeing patients and having that interaction,” he says.

Rural living suits the entire family. Geyman and his wife, Luann, have 12 children ranging in age from 4 to 22. Luann homeschools the children and everyone pitches in to take care of their sizable mountain ranch that features sheep, cattle and a pond. “The kids have responsibilities and chores and raise animals that depend on them,” says Geyman. “We have the ability to hunt and fish and hike out here. I can work in the morning and be on a mountain peak two hours later.”

“Some people come out here to vacation for a week, but we want to live like this every day,” says Geyman. If he and his wife want to get away to enjoy something that a city offers, they drive a couple of hours to Spokane or Coeur d’Alene. “We look at the big picture of living rural, what that means, like not having easy access to shopping,” says Geyman. “I might have to avoid hitting a deer or elk or moose driving to work, but I’m not fighting traffic and dealing with road rage.”

Karen Childress is an award-winning freelance writer who contributes regularly to PracticeLink Magazine.



Job searching? How to use

Feature Articles | Winter 2013


1 Start your job search today at Registration is not required. If you do choose to register, you’ll be able to manage all of your recruiter messages from one central dashboard. We’ll also email you the new openings in your specialty so you never miss an opportunity. Your profile also lets you easily save and respond to the jobs that interest you most.

2 Call our friendly Physician Relations Team at (800) 776-8383 for free job-search help with no placement fees, ever.

3 Find easy access to employers actively recruiting for your specialty in PracticeLink Magazine.

4 In print, online, mobile…the career resources of PracticeLink are available anytime, anywhere. Search “PracticeLink” for our free Android or Apple app.

5 Send us your job-search questions! Email with any of your questions about PracticeLink or your job search.



The qualities of a winning physician CV

Tailoring a CV toward your employer and lifestyle needs can set you on the fast track to a new position.

By Anish Majumdar | Feature Articles | Winter 2013


A physician seeking a job out of residency or fellowship. A veteran emergency medicine M.D. seeking a locum tenens assignment. A plastic surgeon trying to join an established group.

What do these people have in common? All will, in attempting to develop careers within an industry in flux, come face-to-face with hiring practices that are changing just as rapidly. Nowhere is this more true than in the case of a physician’s CV. Make no mistake: Regardless of specialty or background, the days of simply listing your training and contact information on a sheet of paper, sending it out, and expecting the phone to start ringing are over.

“The factors that go into who to hire have changed as the relationship between physicians and the entities that write their paychecks have changed,” says Tommy Bohannon, divisional VP of hospital-based recruiting for Merritt Hawkins in Dallas. “Now that the industry has moved toward hospital or large group employment of physicians, it has definitely become more of an HR-type corporate vetting process. They’re looking for more of a fit from a personality and culture standpoint.”

In my capacity as a Certified Professional Resume Writer (CPRW) and owner of, a career development firm, I’ve had the opportunity to work closely with physicians across the United States in developing job search documents that both communicate unique value and present it within a format that’s preferred by recruiters and employers.

It can be a challenging process. For one thing, the gap between possessing experience and successfully presenting it on the page can be large indeed, particularly when dealing with a business document that comes with a daunting set of rules and standards. Oftentimes physicians will contact me after having pulled their hair out for weeks trying to write a CV themselves, shoehorning as many (frequently contradictory) “CV best practices” they could before realizing the document just didn’t hold together.

“There’s no one format,” says Arlene Macellaro, director of physician recruitment at Augusta Health in Orlando. “I’ve seen all lengths and approaches. If the right qualities are there, I’ll be contacting you.”

Quality 1

Sense of self
Richard Sheff, M.D., author of Doctor Confidential: Secrets Behind the Veil, has traveled a unique road over the course of 30-plus years practicing family medicine. In addition to being a published author and former professor at Tufts University School of Medicine in Boston, he is currently serving as chairman and executive director of The Greeley Company, a health care consulting and education firm. Though the particular challenges he’s faced have varied widely, the impetus behind all of them remains the same. “I had

Throughout your entire job search, keep your passion for medicine at the forefront. “It’s not about employment, it’s about being the solution.” — Richard Sheff, M.D.

a moment of clarity back in med school that family medicine was what I needed to do. Everything I’ve done since that point has come out of real love for the specialty and wanting to contribute in a meaningful way.” He urges physicians entering the health care industry to keep that passion at the forefront of their search efforts. “It’s not about employment—there’s a physician shortage on the horizon; you will be employed. It’s about being the solution.”

RELATED: CV essentials

Develop an opening paragraph
Creating a succinct and focused opening paragraph at the start of a CV is an excellent way to establish a framework for the document and communicate what sets you apart.

“Start with the basics: specialty, subspecialty and training,” advises Macellaro. “Also, if you have a work visa issue or won’t be available until a certain date, I need to know that too as soon as possible.”

Beyond the basics, it’s a good idea to highlight three to four key areas of excellence that can then be expanded upon within the work history section of the document. For candidates with a limited work history, it is perfectly acceptable to offer a quick rundown of particular areas of interest. Here’s an example of an effective opening paragraph for a physician seeking a Non-Invasive Cardiologist position:

Board-certified Non-Invasive Cardiologist with 7 years’ experience launching successful Cardiac MRI and Cardiac CTA programs, recruiting physicians and medical staff, and implementing viable protocols and Standard Operating Procedures (SOPs). Specialist in deploying a multidisciplinary approach to addressing patient needs such as heart disease, diabetes and metabolic disorders. Internal Medicine Residency: University of Alabama. M.D.: University of Oklahoma. Available 4/13.

Be bold in expressing accomplishments
“I should be able to look at a CV and tell, at a glance, what the distinguishing characteristics of a physician are,” says Macellaro. “The easier it is for me to pick out these details, the more time I’m likely to spend evaluating it.”

Making strategic use of bullet points throughout your work history detailing noteworthy accomplishments is an effective way to differentiate yourself from the competition. Even without a lengthy work history, taking the time to highlight a special project you completed or a professional experience that had a profound impact sends a clear message that you’re a candidate on the rise. Here are three examples:

• Founded full-service anatomic laboratory within highly competitive market through developing physician referral network, delivering excellent patient care, and offering 24-hour turnaround time for test results versus 72-hour regional average.
 • Served in clinical supervisory capacity for implementation of 320 slice Toshiba scanner at ancillary hospital as part of overall cardiac CTA program.
• Developed focus on outcomes-based, resource-conscious medicine and received specialized training in outpatient minimally invasive gynecologic surgery.

Personal interests have a place
“I have definitely seen physicians land jobs because one of the key decision makers in the hiring process was a fellow member of an organization they’d listed on the CV, or else they shared a passion for a particular sport or activity,” says Bohannon. Though non-professional details should never constitute the bulk of a CV, including a “personal interests” or similar section at the tail end of the document can be a shortcut to making a connection, particularly when your candidacy relies heavily on perceived potential (read: limited work history). “One or two interesting details can make having a follow-up conversation that much more natural,” says Bohannon.

RELATED: Is your CV helping you?

Quality 2

The oftentimes complex credentialing process a new physician hire must undergo necessitates full accountability on a CV. “Our credentialing process takes six months,” says Sharon McCleary, physician recruiter at Summit Health in Harrisburg, Pa., who recommends that residents and fellows allow themselves at least a year for the job search. “The more upfront a candidate is within their CV, particularly with regards to their career timeline, the easier the process becomes.”

List professional experience in reverse chronological order
Structuring your work history in reverse chronological order (most recent to least) is a proven way to quickly establish legitimacy. Think of every position as its own mini-section and include the following information:

√ Name of employer
√ Location (City, state)
√ Employment dates (Month/Year – Month/Year)
√ Approximately three to six lines describing unique responsibilities. An expert strategy is to expand upon some of the areas of excellence outlined in the opening paragraph.
√ Accomplishments (If available)

Address all work gaps longer than one month
“Any breaks in employment or training that aren’t addressed raises an immediate red flag,” says McCleary. “The truth is, leaving an uncomfortable incident off the CV doesn’t mean it disappears. It just means you’re giving up the opportunity to control its impact.”

Inserting a one or two-line “Career Note” directly within the work history or “Education” section of your CV is a simple way to address gaps. Here are three examples:

Career Note: Addressed family responsibilities while maintaining current knowledge of industry standards and practices (9/12-12/12).

Career Note: Completed rigorous physical training for Ironman Triathalon and attained personal goal of finishing (9/12-12/12).

Career Note: Traveled throughout Brazil and
Argentina, developing new friendships and expanding worldview (9/12-12/12).

Quality 3

Aligned with employer’s needs
Mark Friedman, M.D., cofounder and chief medical officer at First Stop Health, an online and telephonic health concierge service, is a master at projecting the right professional image to secure both clinical and non-clinical positions.

In addition to the above, Friedman is assistant clinical professor of emergency medicine at Quinnipiac University’s Frank Netter School of Medicine in Connecticut and actively pursuing locum tenens assignments.

Related: 8 quick tips for landing the job you want

He knows from experience just how widely the requirements of business, academic, and clinical roles can vary, and cautions physicians against using a “one size fits all” strategy for their CVs. “I’ve found it very helpful to use an ‘outside-in’ approach,” he says. “What’s the impression you want to leave? Yes, being thorough is important, but how you choose to present that information will set the stage for how you’re perceived.”

Use separate versions of your CV for different job targets

Arlene Macellaro, director of physician recruitment, Augusta Health

“It’s frequently easier for me to evaluate a physician with a limited work history as opposed to someone who’s been practicing for decades, because where the former might send me a two-page document outlining the basics, the latter might send me a 10-page document listing every aspect of every engagement and fellowship,” says Macellaro. “On a typical day I’ll deal with somewhere in the vicinity of 70 calls and 200 emails. Unless you make it clear exactly what you’re going after and why you’re a great fit, I’m probably not going to have the time to discern it.”

When applying for clinical positions, it is essential to emphasize board certifications, clinical qualifications and clinical engagements within the first page of the CV. It is also important to de-emphasize non-clinical experience within the work history section. A good approach here is to use the reverse chronological format for all relevant positions, followed by a “non-clinical experience” or similar section briefly summarizing this work in bullet points.

When applying for non-clinical positions, a candidate has more leeway in terms of what skills he or she chooses to emphasize in the opening paragraph and work history. However, it should be noted that clinical expertise carries weight regardless of the particular position being sought, so it should play a role no matter what opportunity you’re seeking.

“Often what I’ll do is attach my clinical CV to the end of the business résumé when submitting for a non-clinical position,” says Friedman. “That way I feel like all the bases are covered.”

Identify and integrate industry keywords
The key takeaway from a job market that is increasingly reliant on technology is the importance of developing a document that makes it simple for a reader to identify relevant industry terms and facilitates a positive decision about your worthiness as a candidate.

• Gather five to 10 relevant job postings to which you would seriously consider applying. Analyze the job description: Which skills are called out time and time again? At which of these skills are you particularly proficient? Jot down a quick list. For example, a Non-Invasive Cardiologist might end up with a list that looks something like this:

Cardiology program development
Protocol and SOP development
Medical and administrative staff leadership
Multidisciplinary coordination
Cardiovascular diagnostics and therapeutics
Staff recruiting/mentoring
Community partnerships
Patient management

• Insert a “Core competencies” section near the start of the CV that lists the keywords you’ve identified. This simple step both increases the odds of your CV passing a quick scan while enhancing the overall focus of the document.

• Be sure to elaborate on the keywords listed in your “Core Competencies” section within the work history section of your CV. This will provide the context a recruiter or hiring agent will be looking for when they review it for the first time. “If you take the time to ascertain your strengths, then figure out how they mesh with our needs and highlight that, you’re several steps ahead of the competition,” says Bohannon.

“Don’t tie your hopes to any one position. Be flexible. My story isn’t what I imagined it would be when I started as a physician: It’s better.” —Anthony Youn, M.D.

In his memoir, In Stitches (, renowned plastic surgeon Anthony Youn, M.D., details the good, bad and frequently absurd experience that is medical school.
Like many young physicians, he entered the job market convinced that the hard years were behind him.

“Wrong!” he says during a call from his office at Youn Plastic Surgery in Troy, Mich. “I wanted to work in this area, so I sent my CV out to about 25 different groups. Nothing.” Faced with a nightmare scenario and the looming specter of more than $200,000 in student loans, Youn was forced to find the opportunity in adversity and bootstrap his own practice. Following some lean years that included renting office space from an anesthesiologist to see patients and bringing breakfast to the offices of family doctors for possible referrals, he broke through with an appearance on the reality show “Dr. 90210” in 2004. Appearances on many other shows followed, including “The Rachael Ray Show” and “The CBS Early Show,” resulting in rapid growth and establishing Youn as an expert in the field. “None of it would have happened if I hadn’t been able to find a job,” he says. “Don’t tie your hopes to any one position. Be flexible. My story isn’t what I imagined it would be when I started as a physician: It’s better.”

Anish Majumdar is a Certified Professional Resume Writer (CPRW) and owner of



Picking up your life…and moving it!

Nothing influences your quality of life as much as where you choose to live. But how can you relocate with minimal stress?

By By Anayat Durrani | Feature Articles | Winter 2013


Loss of a job. Divorce. Illness. Death of a loved one. All rank high on the list of the most stressful life events.

And then there’s moving.

It’s so stress-inducing, there’s even an “I hate moving” Facebook page to vent about it. YouTube is full of videos of people lamenting about their dreaded move.
Most will agree that moving is no fun. But with every move there are lessons to be learned—lessons that can improve your next one.

Moving wasn’t too bad for David V. Evans, M.D., an assistant professor at the Department of Family Medicine at the University of Washington School of Medicine. Evans spent 15 years practicing family medicine at Madras Medical Group in Madras, Ore., before he, his physician wife and their two kids uprooted and headed for Seattle in April 2012.

“The relocation was as easy as it could be considering we had lived in Madras for almost 15 years. We sold our house without much difficulty. That was fortunate especially given the economy in Madras,” says Evans. “The major challenges were being away from (my wife) Suzy and the kids for two and a half months and finding a house in Seattle.”

Thinking about moving? ‘‘Don’t fly in one day and out the next if you are unfamiliar with a place. Stay for a few days if you can. If you are still unsure, ask for a second interview even if the employer is ready to hire you.’’ — David Evans, M.D.
Evans and his family moved to Seattle from Oregon last year.

Evans says his new employer paid for the bulk of the move. His employer also picked the movers, who “thankfully” packed the family’s boxes. They were given a moving allowance, which Evans says they exceeded, though they were “willing to pay the extra to do less work.”

In his new job, Evans teaches family medicine in the residency program in addition to having a medical practice. Evans says he and his wife feel it was the right decision to move, adding, “so far so good.” He enjoys the challenges of his new job as well as the people with whom he works.

For other physicians facing relocation, Evans recommends taking some time at both the job site and the community to see if the move is right for them. He points out that observing the work environment is important as well.

“Do people seem happy? Is it unnecessarily chaotic? Talk to staff, not just docs. Talk to spouses. Talk to patients. They often have a different insight and can tell you about living in the community,” he says.

He also suggests asking to tour with a realtor as part of the interview. This allows time to discuss and discover community aspects such as schools, churches, activities and other factors that matter in the new location.

“Don’t fly in one day and out the next if you are unfamiliar with a place. Stay for a few days if you can,” says Evans. “If you are still unsure, ask for a second interview even if the employer is ready to hire you. You are interviewing them as much as the other way around.”

More physicians relocating
Of the physicians placed in 2011, 93 percent relocated to a new community for their new job, according to The Medicus Firm. That year, signing bonuses were offered to 88 percent of physicians placed, and relocation allowances increased.

When Julie Zacharias, D.O., was preparing for a move, she packed in a wedding as well. Zacharias moved from North Carolina to Nevada in 2011 to join Touro University Nevada College of Osteopathic Medicine (TUNCOM) as an assistant professor in the primary care department. Zacharias serves as a practicing physician providing on-site care at assisted living facilities, skilled nursing facilities and private homes.

How did her move go?

“Overall it was OK. I did not expect my belongings to take as long as it did to move out from North Carolina to Nevada—approximately two and a half weeks. It worked out OK because I had an extended stay in Texas,” Zacharias says. “I got married in between moving from North Carolina to Nevada. I also was lucky to have someone on the receiving end to let the movers in. My fiancé had already settled into our new house and was available to sign for my belongings.”

RELATED: Site visit savvy

Zacharias had planned to move to Las Vegas because her then-fiancé (now husband), who is in the military, was assigned there. She visited with a few of the faculty of Touro prior to interviewing and connected well with two physicians she met. She then set up an interview. Next was the move. She researched several different moving companies online, then arranged to have all her belongings shipped from North Carolina to Las Vegas.

“I had packed most of my belongings the week before the movers were supposed to arrive and placed all the boxes in my extra bedroom. I did have the movers pack dishes and picture frames,” she says. “The actual move was pretty painless with movers. My fiancé flew out to North Carolina to help drive.”

But like most moves, sometimes things don’t always go smoothly. She suggests letting movers pack most belongings. “It turns out that I am not the best packer, and a few things I packed ended up broken,” she says.

She notes that even if the movers pack all your things, she would still recommend packing and transporting your important documents and jewelry yourself.

RELATED: How to avoid a relocation nightmare

She also wishes she had hired someone to professionally clean the townhome she was renting in North Carolina. “My fiancé and I spent several hours cleaning after the movers left, before an 11-hour drive,” Zacharias says.

The total cost of her move was $1,100. She highly recommends that physicians do their research and compare prices when planning a move, adding, “It makes a big difference.”

Prepping for the move

Caroline Steffen, physician recruiter for DuPage Medical Group

Physician recruiter Caroline Steffen, with DuPage Medical Group in Illinois, says physicians should call at least three moving companies before deciding which to use. Request estimates and references, and make sure they are bonded.

“A typical moving allowance is $7,500 to $10,000 to cover the cost of the move,” Steffen says. “True costs can vary depending on how far you are moving and to what region of the country.”

Steffen says that, in many cases, practices and hospitals in metropolitan areas will not provide physicians a relocation allowance. Nor if the physician is already living in the area, or if the relocation is because of a spouse’s new position. Rural and medium-sized communities, she says, are more likely to have a relocation allowance in their standard employment offer.

“Physicians who are moving to join a new employer need to remember that their move is the second transaction they are having with their employer; the first is negotiating the employment agreement,” says Steffen. “How a physician handles the move with the employer can set the tone of the first few days at work.”

Yes, moving can be stressful. But, Steffen says, physicians who are demanding, spend too much on their move, or have excessive special requests “can put a bad taste in an employer’s mouth and make them question if they hired the right individual.”

Physicians with unique needs when moving should not expect their new employer to cover moving expenses of a sailboat, antique car or pool table, for example. Any special requests, she advises, should be brought up during the contract negotiation process so that it’s clear what will and won’t be covered in the moving allowance.

“Many employers have moving polices. Ask for a copy during contract negotiations so you have a clear understanding of what you are being offered in your moving allowance, and any restrictions there may be as well,” Steffen says.

Fawaz Ahmad, M.D., just relocated from Baltimore to Chicago in July 2012 to join DuPage Medical Group as a hospitalist. His start date was a month later, following completion of his boards. Ahmad received a relocation stipend and picked his own movers. However, he realized after talking to several moving companies that many were unable to accommodate the dates he needed, despite his scheduling a month in advance, due to high demand during the end of the month. Ahmad used Yelp and other online reviews to research moving companies but ended up with a few that could accommodate his schedule.

“From a previous personal bad experience with in-town moves, I would highly recommend using an online review to research the movers you are hiring,” Ahmad says. “I only packed our valuables and the few items that we would need through the month before we could move into our apartment. Everything else was packed by the movers.”
Ahmad says it’s “very difficult to have a completely hectic-free relocation experience.” His biggest unexpected surprise was that he was not able to find an apartment that he liked for the move date that he wanted because the rental market in Chicago was so competitive.

“And because we had to give two months’ notice with our current landlord, they had already leased our apartment and could not extend our lease,” he says. “We ended up having a month overlap between our move-out and move-in date. This resulted in having to find temp housing for a month as well as having to negotiate storage costs for a month with our movers.”

Expect the unexpected
When moving, anything can happen.

Sharon Dionne, a physician recruiter for St. Joseph Hospital in New Hampshire, has heard her share of moving horror stories from physicians. She recalls one physician who had extensive damage during a move. Another had water damage on items in storage. These events, however, happened years before the hospital entered into a national moving agreement. Now they work with United Van Lines through local carrier Diggins & Rose.

“They provide us with a discount and allow the physician to have them direct bill us to their max benefit,” says Dionne. “The most important factor is to deal with a reputable mover, as mistakes can happen that can really be a problem, such as damaged goods and delays in schedules.”

Sometimes things arrive broken or don’t go according to plan. She recommends that physicians purchase protection as part of the cost of their move to cover any damages.
“We have that automatically included in our agreement with United Van Lines. Normal packing and moving are included along with a car carrier, temporary housing, storage, etc., as long as they do not exceed their total benefit,” Dionne says.

With so much focused on moving and unpacking, little time is often left for physicians to get settled in and acquainted with their new location. Ahmad had the advantage of already being familiar with Chicago, but says, “because of the boards, I haven’t had much time to enjoy Chicago or get settled in yet.”

Evans, who moved with his wife and kids to Seattle, says they are still exploring the area. From previous experience, he says, “It takes about a year to really get settled into a new town.”
Zacharias planned ahead so that she would have time to relax before she jumped into her new job in Las Vegas. “After I had officially moved in, I had planned to have about three weeks off prior to starting my new job, which helped quite a bit,” she says. “Also, my husband had been in Las Vegas for several months already, which was great. In regards to work, Touro was great having the first few weeks be a settling-in period. I met with HR and had a few sessions learning the EMR, which helped when clinic started.”

Adriana Tobar, M.D., has moved from Ecuador to New Jersey to Illinois, where she now calls home. Finding a support system in your new town, she says, is a huge benefit.

Moving with family
Adriana Tobar, M.D., is a family medicine physician who lives in Illinois and commutes to her job at Dean Health System in Wisconsin. She originally moved with her husband and then-3-year-old daughter from Ecuador to New Jersey in 2001 to study for the boards. They lived in New Jersey for two years, then moved to Illinois in 2003. Though she did get a bonus when they moved to Illinois, they decided to pack themselves to save money and shipped a few items they had from New Jersey.

Moving was not entirely easy on her family.

“For physicians or residents who move, I think there are several stressors the family members struggle with that tend to be overlooked,” Tobar says. “My husband helped quite a bit with exploring around, but it was very difficult initially for him. I was at work as a first-year resident, my daughter was at school, and he couldn’t work or study for six months until the visa was approved.”

A support network helped them ease into their new location.

Often, joining activities and clubs, church groups, sports and cultural centers can help smooth a transition into a new town.

“When we arrived, there were three doctors—one from Dominican Republic, one from Venezuela and one from Argentina—who really helped us to not feel so alone and to settle down,” Tobar says. “They were like family. I think it is extremely important to find a support system to help with the transition: church, sports, etc.”

Moving can sometimes be tough on the family. That’s a topic “Jane” has blogged about on her anonymous blog, “From a Doctor’s Wife.”
She started the blog during her husband’s fifth year of residency as a way to reach out to other wives and significant others who don’t have support networks, and also “as a way to scream into my pillow.”

RELATED: How to avoid relocation shock

Her family recently moved for a fellowship over the summer. She has a countdown clock widget on her website counting down the days, hours, minutes and seconds until the fellowship ends.
“We have moved three times in eight years, with our fourth move coming next summer. For me, the worst part of moving has been driving across the country. Packing and unpacking is the easy part,” says Jane. “I start the process earlier than most would, but it has proved invaluable every time. More work in the beginning means less work at the end.”

For her last move, they sold their house a few months before they needed to relocate. Her husband stayed in student housing and she and their four kids went out of state to stay with family. The hospital for fellowship didn’t cover moving expenses, so they used PODS. They were provided a container to load and unload. She and her husband packed their own boxes and saved money using spare boxes her husband brought home from the hospital.

RELATED: The trailing family

“They drop off a box, we fill it over the course of several days, they pick it up, store it, and deliver it when we need it,” Jane says. “For us, this method fit our budget, our storage needs, and meant we didn’t have to drive a truck or move between a storage unit and moving truck. In the end, our moving expenses for storage/transportation of the POD came in at about $3,200. We were very pleased.”

Jane says moving so far has been fairly easy on her kids, ages 1 to 7, because they are still young. When they first arrived in their new city, the family made sure to explore the area and see all the fun things near which they lived.

“We sought out our church community as soon as we arrived, and have made friends there for ourselves and our children. Finding a local network of people to help you navigate a new city is priceless,” says Jane. “We found out the best days to hit the children’s museum, what times to avoid grocery shopping, where to pick up the kids’ school uniforms inexpensively, and info on free things to do around the city.”

Their next move will be for her husband’s first post-training job in summer 2013. Being super-organized has paid off. Having either donated unwanted items or boxed up, labeled and put aside items not in use, Jane doesn’t feel concerned or stressed about the next move.

“We did so much work this last time I think we will be in a position to say, ‘Box it up, it all goes,’” says Jane. “Movers will most likely be included in our offer, but we could easily do it ourselves—and honestly, we probably will. I like knowing what is in the boxes!”

Keeping a positive outlook and sense of humor can help keep the moving woes at bay. So can keeping in mind that moving is a temporary situation that will bring you to your next stage in your career and life. Being well-organized and preparing in advance can go a long way in making the move smoother and less stressful.



Your before, during and after moving guide

Relocating can be overwhelming, but by planning ahead and breaking it down into manageable tasks, you can assure a smooth transition into your new home.

By John Boozer, Nilson Van & Storage/Mayflower Van Lines | Feature Articles | Winter 2013


Part I

Well before your move…
• When getting quotes, show the representative from the moving company everything that will be moved including items in the attic, basement, garages, storage areas, sheds, etc.
• Once you have chosen your carrier, obtain and read the three “pre-move required documents” from your carrier. These documents include your “Rights and Responsibilities” and Ready-to-Move brochures. These are required documents for every interstate shipment.
• Take an objective look at what you own. Decide what must go and what can be left behind. Books you’ve read and will never read again? Do you really need the pan with the broken handle or the children’s long neglected games? Remember: extra weight costs more money.
• Carry valuable jewelry with you. If you’ve hidden any valuables around the house, be sure to collect them before leaving.
• Animals cannot be moved in a moving van. If you’re not taking your pets by car, make other transportation arrangements. Because some states require up-to-date health certificates and rabies inoculations, it’s a good idea to take your pets to the veterinarian prior to the move to ensure that you have the proper documents.
• Leave your plants behind. state laws prohibit the entry of house plants, and most plants will not live through being transported in the moving van. Consider giving your plants to a friend or a local charity if you cannot transport them yourself.
• Send change-of-address cards to national newspapers and magazines. Cancel delivery of local newspapers, and settle your accounts.
• Make final packing decisions. Clean and clear your home, including closets, basements and attics. Check with your carrier representative for a complete list of items not to pack.
• Transfer all current prescriptions to a drugstore in your new town.
• Check your safety deposit boxes. You also should call your bank to find out how to transfer your accounts.
• If you plan to pay for your move by credit card, you must arrange it with your carrier representative because authorization is required prior to loading the van.


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Part II

RIGHT Before your move…
______ Schedule to have your utilities (electric, gas, phone, etc.) disconnected or transferred to the new owner the day after your scheduled move-out.
______ Empty, defrost and clean your refrigerator and freezer and clean your stove—all at least 24 hours before moving to let them air out.
______ Prepare a “Trip Kit” for moving day. This kit should contain the things you’ll need before your belongings arrive at your new home. Some suggested items are soap, toilet paper, travel alarm clock, snacks, bottled water and a first aid kit.
______ On move-out day, be on hand when the movers arrive. If you are not able to be there, it’s important to have a trusted adult on hand who will authorize decisions about your move. Let your carrier representative know the name of the person who will be there on the day of your move. Be sure that the spokesperson you have chosen knows exactly what to do.
______ Provide your new phone number and make sure to bring your carrier representative’s contact information. The driver will contact you 24 hours prior to their expected arrival.

On move-in day…
• Be sure you are there when the movers arrive. You or an adult representative will need to be there to accept the delivery and pay the charges. You will be asked to note any changes in the condition of you goods indicated on the inventory at the time of loading and to note any missing items at the time of delivery.

√ Plan to sign the following paperwork:

Inventory of Goods: This document is a description of the condition of your belongings. You’ll be asked to sign it to acknowledge receipt of your goods upon unloading.
Bill of Lading: This is the shipping document that establishes the legal terms of your moving service.
Additional Services Performed: This is used to verify the services the carrier performed other than loading and transporting your things. Please examine it carefully before you sign, making sure that you understand what you’re being charged for.

John Boozer ( is director of corporate accounts for Nilson Van & Storage/Mayflower Van Lines.



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



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.”



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.”



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.



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


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?

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

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

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 ( 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.


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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?



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?

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 (, 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).



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 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 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?

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.

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:

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




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