Contracts with benefits

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

By Debbie Swanson | Fall 2018 | Feature Articles


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

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

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

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

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

Seek a resource

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

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

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

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

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

Some parts are simple

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

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

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

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

Ease the burden of moving

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

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

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

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

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

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

Upfront cash

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

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

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

Know what’s expected of you

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

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

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

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

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

Plan for time off

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

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

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

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

Reimbursement of CME expenses

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

Planning the end of your employment

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

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

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

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

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

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

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

Post-termination considerations

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

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

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

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

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

Understand any restrictions

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

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

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

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

Protect your other income

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

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

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

Protect your future

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

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

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

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

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

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

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

Moving up the ladder

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

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

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

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



Contract negotiation – what recruiters want you to know

Understanding the ins and outs of contract negotiation can make the process smoother for everyone involved.

By Anayat Durrani | Fall 2018 | Feature Articles


“I called at least 30 hospitals and recruiters just inquiring about the need, compensation and getting a real feel for what my market was,” says Adam Parker, M.D. -photo by Andrew Welch

“I called at least 30 hospitals and recruiters just inquiring about the need, compensation and getting a real feel for what my market was,” says Adam Parker, M.D. -photo by Andrew Welch

Contract negotiations aren’t taught in medical school or residency, so many young physicians feel unprepared. With a lack of negotiation experience, they may hesitate to make requests. But experts say new physicians shouldn’t feel shy about asking questions or negotiating for better terms. Read on for answers to a few common questions about contract negotiation.

What terms are up for negotiation?

One common mistake young physicians make is accepting the first offer, even when there are points you’d like to discuss. Certain parts of your contract could be up for negotiation —or at the very least, raised in conversation.

“The most obvious components deal with salary, signing bonus, moving expenses, but several more subtle aspects can be discussed—including length of contract, expectations regarding number of patients to be seen daily or RVU goals,” says Zachary P. Castle, D.O.

Castle worked with an in-house recruiter to land his current position as an outpatient family medicine physician for a branch of Midland Health in Texas. He says the experience was terrific but adds that not everything is negotiable. “There are sometimes where things are not able to be changed due to legal reasons or possibly hospital and/or company policy,” he says.

Of course, what’s up for negotiation varies among hospitals and health care systems.

At Columbus Regional Health in Columbus, Indiana, physician recruiter Kaelee Van Camp says term length and compensation are both negotiable. Term lengths start at five years, but the health system will consider terms as short as three years.

Nicola Frugé, a physician recruiter at Rush Health Systems in Mississippi, says Rush considers requests to adjust base salary, fixed compensation, RVU, encounter rate, sign-on bonus and loan repayment terms. However, Frugé says Rush will not negotiate vacation days, standard benefits, relocation reimbursement, contract lengths, the non-compete clause or termination rules.

“For contracts, most physicians have used an attorney to review their contract, so we have received minor changes to the wording. Generally, we do not change much with our contracts. They are standard,” says Frugé.

Cheri Spencer, physician recruiter for West Tennessee Healthcare, says her organization doesn’t negotiate on the medical education loan repayment program or relocation allowance. “We would be open to negotiate the transition bonus or salary if the physician can make a strong case for a higher amount. Our goal is to reach a fair agreement where both parties feel satisfied with the results,” says Spencer.

If an employer isn’t willing to explore the clauses most important to you during a negotiation, it may be a sign that the position isn’t a good fit. The opposite can also be true: If an offer looks too good to be true, it probably is. “Beware of a salary that is much higher than other offers received,” explains Van Camp. “Is it a number you will be able to maintain when you convert to a productivity model?”

How should physicians prepare for negotiation?

When you’re applying for a position, it’s important to learn as much as you can about the organization and the department ahead of time. Maycie Elchoufi, M.D., says preparation is key in advance of a negotiation. Elchoufi, who is board certified in internal medicine, says you can learn a lot through a few well-targeted internet searches. Get an understanding of the organization so that you can ask questions in person about the organization’s leadership, its strengths and weaknesses, goals, challenges, competitors, funding and turnover rate.

“These types of questions are important because you need to have a clear understanding of whether this organization’s trajectory is aligned with your own professional and personal goals,” she explains.

Frugé says this background research shows when candidates respond to offer letters. She says some candidates are “very savvy on business and economics of hospital vs. private employment models” while others are not. She recommends that physicians read about compensation models and try to understand RVUs, contracts and other pertinent details. (See page 47 for a start.)

Adam Parker, M.D., just completed his internal medicine residency. He prepared for his job search by first getting a feel for the landscape: “I started early in the fall of my last year in residency and began by using PracticeLink and other such websites to find available jobs for my field in my area and in adjacent states.”

“I cast a wide net to get the best possible offers,” Parker says. “I called at least 30 hospitals and recruiters just inquiring about the need, compensation and getting a real feel for what my market was.” Parker worked with Frugé and began a position with Rush Foundation Hospital this summer.

Spencer suggests physicians just coming out of training speak with a colleague in a practice setting similar to the one they’re targeting. She often works with residents or fellows who only get advice from physicians in academic settings, and she says this advice does not always transfer well to private practice or hospital employment models.

Spencer says she always reminds newly trained physicians that they are not expected to know contract language. She encourages them to hire attorneys if they are uncomfortable negotiating. “I also tell them to know their worth and pay attention to the need of the practice or hospital,” she says, adding, “Negotiation is largely supply and demand.”

Elchoufi says she’s always hired an attorney review her contracts. “[Attorneys] can point out items that might become problematic later, language that may need to be modified and areas in which [employers] may be more or less amenable to negotiation,” she says.

However, Elchoufi didn’t ask her attorney to attend the actual negotiation process, as she felt prepared to do so on her own. Researching salary data was an important part of this preparation, and Elchoufi says physicians should know their numbers. It’s not enough to tell an employer that your friends and colleagues are getting offers in a particular range.

“Use data from sources such as MGMA [Medical Group Management Association],” recommends Van Camp. “Be willing to share the details of an offer you have already received. Know how compensation in your particular specialty is commonly calculated.”

Elchoufi says that in her experience almost everything is negotiable. But in order to negotiate, physicians need to know their own value—and how other physicians in similar positions are typically compensated.

“For example, if you are offered a salary of, say, $250K but you really wanted $400K, you need to know ahead of time what salary range is the industry standard for that position,” she explains. “If the salary that you have in mind is not in that range, then what is it about your experience and skill set that makes you feel the additional $150K is a reasonable request?”

Spencer says that before every negotiation, she tells each physician two things: what items are not negotiable, and what requests can’t be accommodated. That way, candidates know if trying to make both sides happy is like trying to fit a square peg in a round hole.

Ultimately, Elchoufi says, physicians should remember negotiation is just a conversation. “Getting a ‘no’ to your request is not necessarily a dead end,” she says. “Ask open-ended questions. Try to get the other party to share what it is that they need, what problem are they trying to solve. Then you can gear your responses accordingly.”

As Andrew Gowdey, M.D., prepared to leave training and find a urology practice, he turned to a health care attorney, other physicians and an in-house recruiter. -photo by Savannah and Philip Kenney

As Andrew Gowdey, M.D., prepared to leave training and find a urology practice, he turned to a health
care attorney, other physicians and an in-house recruiter. -photo by Savannah and Philip Kenney

How long does the hiring process take?

From interview to contract review to negotiation and more, the hiring process involves several different steps. The timeframe for each can vary depending on the size and type of employer—as well as how much negotiation you end up doing.

Castle interviewed in early November. He received a letter of intent outlining basic terms shortly after. “I signed and submitted this in January and received the full contract a couple weeks later,” says Castle. “From that time, I believe it took about a month to sign it. So the total process from start to finish took about four months.”

According to Spencer, a draft contract typically arrives two to four weeks after the interview. She recommends that physicians complete negotiations within a week to 10 days.

Once when Elchoufi was applying for a new position, she says she went from initial phone call to seeing patients in under three months, but she adds that this is uncommon. In her experience, four to six months is more typical.

“It really depends on how much the employer needs someone with your qualifications, as well as logistics such as obtaining state licensure, getting credentialing completed, etc.,” Elchoufi explains. “In any case, don’t be in too much of a rush, even if you end up needing to do locums for a while. If you’re rushed, you’ll have a tendency to jump to something that may not necessarily be an optimal fit.”

Frugé says every candidate is different. Typically if she gets good feedback from the specialty group and the rest of her administrative team after an interview, they extend an offer letter within a two-week timeframe, but it can vary.

“Once the offer letter is signed, we begin on the contract which usually takes about two weeks,” she says. “The actual contract negotiations can go quickly or slowly depending on the candidate and his or her attorney. Overall, I would say the whole process can take four to six months from beginning to end.”

Van Camp and her team make it a goal is to provide an offer within 48 hours of any interview, but this doesn’t always happen. When multiple candidates are interviewing for one position, her team can’t get back to every candidate as quickly as they would otherwise.

“We will always communicate that to all the candidates,” she adds. Don’t be afraid to ask what the timeline is for the decision-making process if it is not given.

In Parker’s experience, the process typically takes between two to four months. He says this timeframe gives physicians enough time to “search out several options, talk to several different recruiters and get an idea of what situation fits you the best before making a hasty decision.”

How do in-house recruiters work with physicians and attorneys?

Of the hospitals Parker spoke to during his job search, he says only two (including his future employer) were represented by in-house physician recruiters. He says he preferred working with in-house recruiters because they have a vested interest in recruiting applicants who are good fits for their hospital systems.

“In addition, since they were local to the area of the hospitals, they were able to provide in-depth, special and more appealing responses about their local areas,” says Parker. “I felt the larger recruiting firms just Googled a town and told you about it or told me to do that myself for research.”

When it comes to the negotiation itself, both Van Camp and Frugé say they like working directly with candidates when they can. Though Frugé sometimes works with candidates’ attorneys and reviews contracts with attorney edits, she generally prefers to communicate directly with the candidates. Frugé says candidates often email her questions or ask questions about their contracts via conference call.

She adds that she never minds if a candidate asks lots of questions about the contract, saying it’s “better to be thorough and understand everything upfront rather than be surprised by something after the deal is done.” In fact, she appreciates when candidates show thoroughness and attention to detail.

Van Camp advises physicians to do the negotiation themselves. “Your attorney is an excellent resource for the data to back up your request, but you should understand the contract and your requests well enough to negotiate yourself,” she says. “The negotiation process is one more opportunity to see if the employer is someone you can work with.”

Spencer says she always tells a physician to make all of their requests in the first pass and encourages them to use an attorney at least when negotiating their first contract. Spencer says she tells candidates that this is a time where they won’t know everything but that she’s there to help.

Castle says he spent a lot of time carefully reading through the details of his contract. He regularly discussed the terms with his wife. After familiarizing themselves with the contract, they asked an attorney to read it. He says the attorney explained things they did not understand and suggested potential changes.

“After discussing our thoughts with my employer, they made most of the changes to make us more comfortable with the contract, and we moved forward from there,” says Castle.

Andrew Gowdey, M.D., who is in his fourth year of urology training, signed a contract with Rush Hospital where he will begin working next year. He consulted an attorney to review the initial contract and also spoke with practicing physicians who had been through the process.

“I made specific changes and then went over with my attorney on the details of the contract that were not evident to me upon first review,” he says. “Personally, I think it is important to consult an attorney and be actively involved in the process of contract negotiation.”

Parker for one did all of the negotiation himself and didn’t think an attorney was necessary. “It is an added cost, and in general, they do not understand what a particular physician brings to the table, so to speak. And I felt I was better suited to sell myself than they were,” he explains.

What can’t an in-house recruiter help you with?

In-house recruiters are invaluable resources, but you’ll still have to do some additional research yourself.

“Recruiters in general—including in-house recruiters—may not necessarily know that, say, the community wellness department at their organization is in need of someone to spearhead employee health initiatives,” says Elchoufi. “Or that there might be talks of starting a pre-op clinic for the orthopedic department to streamline referrals and efficiently clear medical patients for surgery in order to increase revenue, decrease wait times and increase patient satisfaction scores.”

That’s where a little legwork on the physician’s part is valuable. Elchoufi suggests physicians talk to recruiters at various organizations. Sometimes speaking with one recruiter will spark questions to ask other recruiters in the future. And if there’s a particular hospital or a city you’re interested in, Elchoufi says to reach out directly to an in-house recruiter there and find out what opportunities might exist for your specialty.

Remember, negotiation is about give and take

No matter what terms you hope to negotiate, it’s important to establish a strong working relationship with your future employer. Good communication habits will also improve the negotiation process.

Gowdey says recruiters help build a bridge of trust between employers and prospective employees. When he negotiated his compensation allocation and specific day-to-day obligations, he says the hospital was very receptive to his requests. And the terms they asked him to agree to in turn were also reasonable.

“If a recruiter and hospital can be transparent on the front end of negotiations, then it will make the process much easier,” says Gowdey. “I would encourage physicians to be upfront with their concerns.”

Frugé agrees that a good negotiation is all about communication. She says the process “helps to build trust and helps [physicians] to get to know their employer better as well as for me to get to know them better.”

She likes to hear back from candidates after interviews, even if they choose jobs elsewhere. This keeps the communication lines open for employment opportunities in the future.



Your best health care cv

Your CV creates your first impression with an employer. What does yours say about you?

By Debbie Swanson | Feature Articles | Summer 2018


Imagine you’re about to make a speech before a distinguished gathering of professionals. While you’re being introduced, you wait nervously—knowing that this introduction will make or break your presentation. Depending on what they hear, audience members will either perk up or tune out.

Your curriculum vitae has that same power. It can portray you as a desirable candidate or cause your reader to yawn and flip to the next applicant in the pile.

Whereas resumes are typically shorter and used for standard job applications, a CV is required for many fellowships, residencies, research positions, graduate schools and more. It’s also the standard job-seeking document for most health care professionals. Keeping an up-to-date version on hand can mean the difference between submitting an application early or scrambling to complete paperwork at the eleventh hour.

Part 1: What to include

Treat your cover letter as your personal sales pitch, recommends physician recruiter Heather Peffley. · Photo by Hillary Muelleck

Treat your cover letter as your personal sales pitch, recommends physician recruiter Heather Peffley. · Photo by Hillary Muelleck

Because it is so comprehensive, a CV is divided into sections. Academic history, work experience and research experience are standard, but other sections may also be included if relevant. Academic sections typically come before professional ones.

Information should be presented neatly and consistently. Begin each section, except for your identification, with a header. List dated entries in reverse chronological order (using a month/year format) and use alphabetical order for undated items, such as interests or skills. Sections include:

Identification: Include your name and contact information at the top of the page.

  • Details to include: Your formal name, address, city, state, country and country code. Provide at least two means of contact: email address, home phone number and/or cell number.
  • Tip: Be sure to include M.D. or D.O. next to your name so recruiters don’t have to hunt for it.

Personal statement: Some career advisers recommend including a personal statement about your goals, while others say a cover letter is a better place to relay this information. If you do choose to include a personal statement, keep it to one concise paragraph.

  • Details to include: Two to three sentences explaining where you are in your career, what your goals are, and why you are a good fit for the position.
  • Tip: Include a personal statement if you’re using a recruiting service, as it helps recruiters identify you and understand your strengths.

Education: Only include schools where you earned a degree or certification. If you transferred or withdrew from a school, you should omit this from your CV but be ready to provide details if asked.

  • Details to include: List the institution’s full name, the degree/certification obtained, month/year bestowed, major and minor(s), thesis or dissertation (if applicable), city, state and country.
  • Tip: Include the dates of your degrees. “This provides [verifiable] confirmation of your credentials and demonstrates experience or rank, often required for positions,” says Heather J. Peffley, PHR, FASPR, physician recruiter at Penn State Health in Hershey, Pennsylvania.

Professional certifications and licenses: List all of your current medical accreditations, certifications or licensures.

  • Details to include: Name of the accreditation, state (if applicable), year it was bestowed and expiration date.
  • Tip: There’s no need to include license numbers on your CV.

Awards and honors: List any honors and awards you have received, such as volunteer recognitions, academic distinctions, professional recognitions, military decorations and scholarships. Don’t overlook anything that might be relevant. “Were you a chief resident?” asks Peffley. “If so, include that.”

  • Details to include: Name of the award/honor, the year you received it and the granting organization. Include a one-line description if necessary. If an item is self-explanatory, no elaboration is needed.
  • Tip: “From a resident perspective, I wouldn’t go past college,” says Zachary Kuhlmann, D.O., OB-GYN residency program director for KU School of Medicine-Wichita. “For practicing physicians, I’d stop at college/medical school and residency.”

Professional experience: Provide a complete timeline of all your paid employment since medical school. If you served in the military, you can include it here or in a separate military experience section.

  • Details to include: Dates, job title, employer name, city and state for each position. Describe the role—including clinical experiences you gained, skills you developed and results you helped to achieve. If you have changed careers, highlight skills that will transfer to the medical field.
  • Tip: Use a month/year format for dates, advises Peffley. “This is a requirement for foreign nationals [who] require visa sponsorship and has been adopted as a best practice on CVs,” she says.

Research experience: List any research you have conducted or assisted with.

  • Details to include: Dates, funding granted, the name of the research leader, your role/title and a brief summary of the project and your responsibilities.
  • Tip: Review your research outcomes before your interview. “If you have research listed, be sure to know about it so if someone asks you about it, you can tell them,” Kuhlmann says.

Publications: List all published work you authored, co-authored or contributed to, including journal articles, abstracts or presentations. Your CV should become an archive of all your publications.

  • Details to include: Title of article or presentation, type of item, your role, date presented or published and where it appeared.
  • Tip: Jot down each presentation as it occurs, so you don’t forget. “In residency, you lose track of some of the presentations you may give,” says Stephanie Kuhlmann, D.O., associate professor of pediatrics at KU School of Medicine-Wichita. “You forget about all the little things you do. Even though they’re kind of small, they can get you a promotion. Every little thing you do can go on you CV.”

Teaching experience: Include any involvement in teaching, tutoring, classroom assisting, curriculum development or similar activities. Training fellow undergraduates, through peer mentoring or student orientations, may also be applicable.

  • Details to include: Name of the institution where you provided instruction, your role, the subject and month/year.
  • Tip: Teaching is a valuable skill in the medical profession. Adding teaching experience to your CV may give you an opportunity to talk about it later during your interview.

Volunteer experience: List unpaid work and community involvement. If your volunteer service includes sitting on more than one board or you have a highly relevant board appointment, consider creating a separate section for board memberships.

  • Details to include: Name of the organization, type of organization (if necessary), your title, dates involved and a brief description of your contribution.
  • Tip: Trim this section by including only the most significant or relevant positions. Including brief volunteer stints or unrelated items could detract from more impressive endeavors.

Extracurricular activities and interests: Include non-professional pursuits, such as participation in sports, music and art as well as any certifications.

  • Details to include: List each item and be ready to discuss. These items also make good small talk over lunch or in meetings.
  • Tip: Use this area to demonstrate that you are a well-rounded individual and to showcase relevant skills. For example, distance running can demonstrate self-discipline, and performing in an orchestra requires teamwork. “I’m OK with putting some eclectic things on a CV, but phrase it in a professional manner,” Zachary Kuhlmann recommends.

Professional affiliations: List career-related groups, committees or societies you have participated in.

  • Details to include: Name of affiliation, dates involved and position or role.
  • Tip: Typically, it’s best to focus on current affiliations. If you do include lapsed memberships, be prepared to explain the reason you left. It may come up in an interview.

Other qualifications: Provide non-medical talents or skills, such as foreign language fluency, cultural experiences, personal interests or special motivators.

  • Details to include: List a brief summary of each item. Be prepared to verify and discuss.
  • Tip: “When I reviewed CVs from medical students, what I remember most was their life experiences,” says Jacqueline Huntly, M.D., president and founder of Athasmed, LLC in Savannah, Georgia. “If you have experiences that aren’t typical or things you achieved or overcame, it can help give a feeling for you as a whole—not just data on a resume.”

Part 2: What to know

Some of the most memorable CVs Jacqueline Huntly, M.D., has reviewed included unique accomplishments or interests. · Photo by Amber Jasso

Some of the most memorable CVs Jacqueline Huntly, M.D., has reviewed included unique accomplishments or interests. · Photo by Amber Jasso

Some parts of preparing your CV are common sense, but other important considerations aren’t so obvious. Here are some do’s and don’ts to keep in mind.

Don’t go it alone

Even if you have first-rate medical credentials, grammatical errors or poor organization could jeopardize your chances of being taken seriously.

“If there are grammatical errors or inconsistencies in the personal statement or publications, you’ve got to wonder how that will reflect in basic care,” Kuhlmann says. “Will they miss something?”

Whether you enlist assistance from the start or do so later while reviewing your first draft, it’s smart to bring in a set of trained eyes. A career counselor or writing professional can make sure your material is polished. Plus, industry standards change frequently, and a professional will ensure your document reflects current best practices.

In addition, you should seek the opinion of one or two people who know you well. Consider family members, mentors or trusted colleagues. They can help you project an authentic tone and personality. They may even point out strengths and skills you’ve overlooked.

Perfect your language

Tone and word choice play important roles in shaping a reader’s first impression of you. Huntly explains, “[Your CV] must convey that you’re a professional with good use of language.”

Reviewing example CVs can give you a sense of the right language to use. Get samples by contacting your medical school’s alumni office, asking colleagues and mentors or looking online.

Some tips for achieving a professional tone:

  • Use strong verbs. For example, “executed” and “spearheaded” make powerful alternatives to “worked.” To get ideas, consult a thesaurus or search online for “resume verbs.”
  • Replace buzzwords or jargon with simpler language.
  • Avoid repetitive phrasing or overused words. Variety will make your CV more compelling.
  • Define project names and spell out acronyms.
  • Minimize superlatives. Words like “very” or “best” rarely add value, and when overused, they reduce your credibility. “Don’t embellish. What you put down should speak for itself,” says Huntly.

Dealing with employment gaps

Your employment timeline is one of the most scrutinized sections of your document. Prospective employers hope to see a flawless record, beginning with medical school. But that may be unrealistic.

Instead of worrying or trying to hide lapses in employment, it’s best to address them, according to Kelly Sennholz, M.D., an emergency medicine physician in Denver. “Put it all out on the table, because it will come up,” she says. Two or three weeks are insignificant, but any lengthier gaps should be documented and labeled with a neutral or positive descriptor, such as educational travel, cultural pursuits, relocation, etc.

Early in her career, Sennholz took time away from medicine to start a company, which she documents on her CV as “time creating a business.” “I keep the description simple, so they can’t decide if they like or dislike it,” she says. “I have answers ready if they ask, and they always do.”

Be ready to talk about any employment lapse if an interviewer asks. Take the opportunity to present it in a flattering light. “For example, if you traveled to Africa and you toured some medical facilities, perhaps there’s a story or vignette you could use [about] what you were learning while traveling,” Sennholz suggests. “They’re looking for red flags, personal flaws, so don’t give them one.”

Even a less-than-ideal career gap can be presented positively. “It’s not a career death sentence,” says Zachary Kuhlmann of a gap. “But be prepared to discuss it and how you’ve grown and how that experience made you better.”

Scattered work history? Don’t worry

Not every physician follows a straight path from college to practice. Some start in a different area of health care, while others may initially pursue a non-medical career. So don’t worry if your work history seems lacking. Instead, put a positive spin on what you’ve done.

Some candidates feel non-medical employment isn’t worth mentioning, but that’s not always the case. For example, a former school teacher could emphasize teaching, multitasking and time management skills, all of which are useful traits for physicians.

If you’ve been hitting the books for several years without accumulating much work experience, you can still emphasize how you learned and grew during that time.

“There are ways to demonstrate initiative and leadership skills even though they occurred in an educational setting,” Peffley says. “Include details about your ranking, any accolades or awards you received, etc. These elements may be translated into skills also earned through work experiences.”

Whatever your background, the key is to shine a spotlight on your achievements and skills, while showing how you’ve spent your years productively. “Trust who you are and respect the decisions you’ve made along the way,” says Huntly. “Even if you’ve made a mistake, focus on what have you learned from it.”

What not to include

Though your CV is a highly detailed document, it’s not completely comprehensive. A few pieces of information are best left out. Omit personal details, such as age, sex, gender identity, family structure, religious affiliations or marital status. “By indicating this information, you are essentially inviting someone to make an assumption about you and/or your abilities—and not always in a positive light,” says Peffley.

Immigration status is another area that may provoke a biased reaction, but applicants requiring visa sponsorships may need to open that conversation anyway. Peffley explains, “You may simply add ‘citizenship status: requires visa sponsorship’ on the CV.”

Most experts suggest you leave off the names and contact information of your references. This protects their privacy and enables you to share the most current information with prospective employers. Including “references available upon request” is unnecessary, as it’s assumed applicants will supply references.

Finally, never include anything that’s not 100 percent accurate. False or intentionally misleading information has no place in a professional document and can permanently damage your reputation.

Part 3: The cover letter

In addition to your CV, you’ll need one other document: a cover letter. This letter should be uniquely targeted to every opportunity. Peffley suggests you consider it your personal sales pitch, explaining, “[Use it to] illustrate why an employer interests you, and how you may positively contribute to—more importantly, impact—their organization.”

Letters are usually one or two pages and have a friendlier, more personalized feel than the CV. They are organized in three sections:

The introduction: A short paragraph that explains where you are in your career, touches on your goals and identifies the opportunity you are applying for.

The body: One to three paragraphs that identify what makes you a good fit for this position, mention any mutual connections and highlight any unique qualifiers. Peffley suggests explaining where you get your motivation and drive. “Outlining what inspires you may prompt the reader to want to learn more,” she says.

This can also be the place to put a positive spin on any potentially questionable areas in your CV. “Letters can be an appropriate spot for addressing issues,” Huntly advises. “If you’ve followed a different path or changed directions, give reasons why that was part of your journey and convey that you are committed now.”

The conclusion: A paragraph thanking your readers for considering you, reiterating your interest and expressing enthusiasm about hearing from them.

As with your CV, a cover letter with grammatical errors, inaccurate statements or poor word choices will work against you, so it’s best to consult a professional. To save time down the road, formulate one or two generic versions, which you can later tailor to suit each application.

Loosely translated from the Latin for the course of one’s life, a curriculum vitae should be a comprehensive record of your noteworthy accomplishments. Creating this document can feel daunting. But if you reach out for help and update your CV annually, you’ll maintain a current CV that reflects your achievements and presents you as a desirable candidate.

Debbie Swanson is a frequent contributor to PracticeLink Magazine.



Notes from the other side of the interview desk

Ever wonder what’s happening on the employer’s side? An in-house physician recruiter shares notes.

By Therese Karsten | Feature Articles | Summer 2018


Over my three decades of working in health care and countless physician interviews, I’ve learned that the job-search process looks a little different from my side of the interviewer’s desk. I wanted to roll back the curtain to show physician candidates what happens on the recruiter’s side, so I polled others in the field for their take. Their answers can help you land and plan your interviews.

We will probably Google you

A recruiter’s Google search of Brent Herron, M.D., illuminated the “why” behind his request for an atypical schedule: charity work that made him a great candidate. · Photo by Jamie Rubeis

A recruiter’s Google search of Brent Herron, M.D., illuminated the “why” behind his request for an atypical schedule: charity work that made him a great candidate. · Photo by Jamie Rubeis

After reviewing your CV to confirm that you meet the basic criteria, there’s a good chance a recruiter, administrator or physician will turn to Google before inviting you to interview. This isn’t an attempt to dig up dirt; employers simply want to connect the dots. We’re looking to confirm that you’re a promising candidate, and we’re crossing our fingers that we don’t to see any red flags.

At some organizations, an online search is a routine part of the vetting process; at others, they’re conducted unofficially. For example, a curious senior partner might look while reviewing CVs on her home laptop.

Checking out social media profiles is still a hotly debated practice. Some hospital systems prohibit recruiters from searching anything other than official databases.

“Google searches incur the risk that the recruiter will turn up photos or indications of age, gender or country of origin that could be used as grounds for discrimination,” explains Christy Bray Ricks, MHA, FASPR, senior director of physician recruitment for LifePoint Health. One of Ricks’ former employers prohibited online searches not only to prevent inadvertent exposure to information associated with an equal opportunity protected class, but also because information on social media can present a skewed picture.

“There simply isn’t a way to forget information about extramarital affairs on a blog. No way to un-see the small town newspaper’s lurid and detailed account of a patient death,” Ricks says. “That information may not be accurate or relevant to the employment decision, so better to avoid it entirely.”

Not all organizations play by those rules. Many contend that anything that pops up in a search engine is fair game for review. Whether you agree with the practice or not, the smart thing to do is to prepare to be Googled. Open a browser window in incognito mode, Google yourself and see what pops up. Do a search for every name and nickname that might be associated with you, and don’t stop at the first page of entries. Then ask a tech-savvy friend or family member to do the same and see what they can find.

Look at your public footprints through the eyes of the senior partners at your previous employers. If you’d be proud to show a photo to those physicians, then it’s fine to keep public. Pictures of you with your dog, out with friends, even holding a glass of wine are all great. But no photos, posts or memes about alcohol impairment or recreational drug use should be publicly visible.

With the legalization of marijuana in several states, many younger physicians assume it’s no big deal to post memes and photos implying recreational use. Not so. Health care employers in Colorado, Oregon and California are worried about adverse selection—individuals who want to move to their states for unlimited legal access to their drug of choice.

Candidates should also delete photos that are distinctly unflattering, disturbing or sexually suggestive. Ask friends and family not to tag you in any posts that they would not show a prospective boss. I recently saw a female resident whose teenage cousin had tagged her in a string of selfies with zombie and witch filters. The photos weren’t scandalous, but they showed tongues out, strange hand gestures and cleavage—the kind of thing a 17-year-old’s friends would love. Thankfully, the resident removed the photos within a few days, but even that brief posting could have cost her an interview invitation if a physician interviewer had picked that week to Google her.

Bruce Guyant, Director of Provider Growth and Integration for Novant Health in North Carolina, also warns physicians to think twice before posting about their political or social activism. “With my previous hospital system, we had to back away from a candidate who blogged and posted extensively about a particular hot-button issue,” he recalls.

It was a tough decision. “At the end of the day, though, the CEO could not shake the concern that this physician’s weekend and evening activities would attract attention and impair her ability to build a practice in a conservative community,” Guyant says. “They worried that her activism could result in isolation for her—and evening news footage of protestors in front of the hospital.” He acknowledged that she would fit beautifully in more politically diverse markets, but her public expression of her views could make her and the facility a target.

Google results aren’t always a deterrent for employers. Sometimes a search reveals unique stories that help a candidate be successful. For example, I’m working with Brent Herron, M.D., a family medicine resident. Herron wants an atypical schedule: working late some days and taking some Fridays off to train for triathlons and manage endurance sports events. Typically, that kind of flexibility is earned over time, and practice administrators worry about priorities when a candidate asks for Fridays off even before interviewing. Several practices passed on Herron without reading anything other than his schedule criteria.

So I asked a hospital-employed practice to take a second look at Herron and sent along a link about his community involvement. Before going to medical school, Herron started a nonprofit that helps endurance athletes raise money for the nonprofit of their choice. He explains, “The inspiration came from my father being diagnosed with multiple sclerosis and my realization that everyone has a ‘multiple sclerosis’ in their life that motivates them.”

The practice considering Herron cares for a large, urban, younger adult demographic—exactly the kind of working adults who would value weeknight appointments. Once his prospective employers understood why Herron made the request, they began to see how his schedule could work well for their practice.

Another kind of Google hit that makes our day? An engagement announcement or wedding website. It’s wonderful to see pictures of a happy, glowing couple, and the narrative about what you enjoy doing together in your spare time usually confirms what we have already heard about why you’re a good fit for our community.

Google searches can also fill in the blanks for employers. I once had a terrific practicing candidate with a three-month gap on his CV. Gaps like this can be a red flag because they are often associated with substance abuse rehab. He had quit his job and listed his availability date as three months in the future. After a Google search, everything made sense. He remains unnamed here because he prefers that no one on planet Earth remember he was (excruciatingly briefly) a contestant on reality TV show “The Bachelorette,” which required him to stop practicing for three months.

We’ll talk to more than just your references

“There is an extended, diverse pool of people involved in vetting a candidate,” explains Brian Pate, M.D., chair of pediatrics at KU School of Medicine-Wichita. “You can’t predict who they might know at your training facility.”

Pate says it’s common for other department physicians, staff or facility administrators with ties to your training institution to have feedback about a candidate’s reputation. “The important thing to know is that, unlike formal references from your program director and faculty, the informal opinions afford 360-degree exposure,” he says. “If a physician is accountable and professional only to those above him or her…we often learn about it.”

Once during a hospital tour, Pate says a faculty member recognized a candidate as a former peer. “We unexpectedly received detailed feedback of how this individual was perceived as difficult to work with by peers, learners and hospital staff,” Pate says. “This information contributed to the overall impression of the applicant.” He encourages physicians in training to remember that preparing for a successful interview begins with a daily commitment to professionalism and best practices in their current positions.

Ricks agrees. “It surprises me that candidates don’t realize how much networking goes on in physician recruiting,” she says. “Most health systems are on a shared candidate management system. …If a candidate interviewed at a sister hospital in another state and didn’t get the job, I can call my colleague and find out how that interview went and get details that might not have made it into the database.”

It works the other way, too. “Networking can be a real plus for candidates who have made a good impression,” Ricks says. And a referral from a trusted colleague grabs a recruiter’s attention.

Shared databases can also reveal discrepancies between a candidate’s account of competing offers—and the truth. For example, physician recruiter Christopher Link recalls a candidate who was considering one offer from a group in the Midwest and another from Link’s employer in a different state—both HCA facilities.

“Maybe [the candidate] simply didn’t believe us when we told her that we stay in close touch as soon as we see that a candidate is engaged with another HCA hospital. It simply doesn’t make business sense for two hospitals in the same system to get into a bidding war,” Link recalls. “[The candidate] repeatedly tried to leverage our offers against each other using partial truths and omissions about the other offer in an attempt to secure better terms.”

We’re evaluating you on your presentation

Personal, handwritten thank-you notes to his interviewing team helped Sultan Mahmood, M.D., stand out—and get the job. · Photo by Danielle Shearon

Personal, handwritten thank-you notes to his interviewing team helped Sultan Mahmood, M.D., stand out—and get the job. · Photo by Danielle Shearon

When recruiters and administrators talk about “presentation,” they don’t mean beauty, style or media-perfect diction. But how you choose to present yourself when you make a first impression matters—because your judgment is what’s really on display.

According to Mary Wine, administrator at Advanced Orthopaedic Associates in Wichita, Kansas, overly casual attire sends the wrong message. “I haven’t had anyone show up in scrubs yet, but I have seen candidates show up for a formal interview in khakis and an open collared shirt,” she says.

Unless you have explicit instructions to the contrary, you should interview in a suit and tie or the female equivalent. “First impressions are lasting,” Wine says. “Effort shows that you are serious about wanting to join my group. Formal business attire demonstrates that you will know how to dress on the day I need to take you to meet hospital administrators with whom we have important contracts.”

Interpersonal skills are also important. Guyant says that if an applicant mumbles in a phone message, there will be no call back. “I am assuming that you are putting your best foot forward when contacting a prospective employer for the first time,” Guyant explains. “Accents are not an issue, but clear and comprehensible verbal communication is a job requirement.”

“The first opportunity a candidate has to demonstrate that is on a phone message to the recruiter,” he says. “If you mumble, whisper or speak so fast I can’t understand you, it’s likely that my patients and medical staff would end up confused and frustrated with you. I will put my time to more productive use, and I instruct my recruiters to do the same.”

Another element of professional presentation is the post-interview thank-you note. Since most communication today takes place by email, an interview panel takes notice of handwritten notes.

“Dr. Sultan Mahmood, a gastroenterologist I recently signed, sent thank-you notes to everyone on his itinerary, including me,” recalls Marci Jackson, FASPR, physician recruitment manager with Marshfield Clinic Health System in Wisconsin. “The front of the note was a family picture: the physician, his physician wife and his two children. With each note, he thanked that person for something specific.”

Mahmood says taking notes throughout the interview day was the key to personalizing these notes. Otherwise, minor details about each interviewer fade quickly from memory. “Having been on the receiving/interviewing side as a fellowship interview,” he says, “I knew that a personalized note can make a difference.”

Jackson agrees. “During an interview, it’s difficult to get the full measure of someone’s personality,” she says. “The courtesy and warmth demonstrated by Mahmood’s special thank-you note lent depth to our final impression of him. …I think it was important in the department’s decision to offer.”

We get wary when you say you’re open to any location

Andrew Walker, CMSR, FASPR, director of physician recruitment and contracting for CarePoint Healthcare, says recruiters get skeptical when physicians say they’re interested in 10 or more states. “I just know what I will hear when I screen this physician. He’ll say he is open geographically and is really focused on finding the right job,” Walker says.

There are other reasons physicians may give. One might say that since he doesn’t have family in the country, he’s able to settle wherever he finds the best job. Another might say she’s spent her whole life on the East Coast and is ready to experience something new.

However, we recruiters interpret these explanations in the context of our own experience. We speak to hundreds of candidates—month after month, year after year. And we’ve learned it’s easier to attract a candidate who is interested in a specific region. “If I’m recruiting for my site in Utah, I know that the candidate likely to accept if offered and put down roots in my community is the one who has a good reason to want to live here,” explains Walker.

That reason does not necessarily have to be family, but there had better be a well-articulated explanation if decision-makers are going to take the candidacy seriously.

“Recruiters know from experience that physician candidates underestimate the pressure they will get from family about living a 10-hour travel day away,” Walker says. If your extended family lives near each other—but five states away from your job—the pressure to move home and raise your kids near family will only intensify over time. Your remote job will probably last a few years, at most.

Recruiters can tell when a candidate is all-in for the long-term—hell-bent on becoming partner and gunning for a department head job in five years. Great cultures are built by these passionate physicians. “If my group has two candidates with roughly equal credentials … the one who is fired up about building a life here and genuinely excited about our practice is going to have an edge,” says Walker.

Candidates can jump to the top of employers’ hot lists by adding details in their cover letter to explain their interest in the area. For example, a candidate might write: “I’m interested in this job because my older brother and his family live in [suburb name], and my best friend from college lives downtown. Our wives are also friends, and we visit or vacation together almost every year.”

Or perhaps: “I have no ties to [city name], but I visited twice for medical conferences, and my husband and I simply fell in love with your city. Everywhere we looked, everyone we met reinforced the feeling that this was our ideal home. We are also looking at [other city] and [other city], but your city is our No. 1 choice, and we are excited about starting to explore.”

We can’t tell you everything

Most employers won’t tell you why you didn’t get the interview or the job. Typically, hiring managers and recruiters can only say they are moving forward with another candidate. This zipped-lip protocol developed as so many rules do: through lawsuits.

Any further discussion runs the risk of an EEOC complaint or, at the very least, unpleasant discussions with legal counsel, internal ethics committees and HR executives about a candidate’s complaint. Even at small practices that aren’t subject to EEOC regulations, the rationale for hiring decisions isn’t shared with the candidates.

Another thing employers and recruiters won’t tell you? Any troubling details about the practice itself or the local economy. Ricks wishes more candidates would do their due diligence on the job market instead of blindly trusting a prospective employer’s projections.

“Operational leaders call it ‘optimization’ when they eliminate unsustainable practices,” says Ricks, adding that this euphemism often means that “the physician is out of a job or has to move to another community.” To avoid getting “optimized” out of a job, Ricks recommends asking your interviewers: “Have you laid off or decided not to renew any physician contracts in the past five years?”

Before accepting a job, you should be sure that the employer is financially sound and that the area can support another physician in your specialty. Google the hospital system to find out what other news outlets, patients and employees are saying about an employer. You can also ask neutral third parties, such as the local chamber of commerce, to verify demographic trends.

We want you to find a good fit

Even though we can’t tell you everything while you’re interviewing, physician recruiters and employers want you to find a good fit. We’re always working to make the application and interview process easier to navigate. Once you understand what the process looks like from our side of the interviewer’s desk, you can put your best foot forward—and help us help you land the right job.

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



10 Questions to ask in your next interview

Is this new opportunity the right practice for you? Asking these can help you decide.

By Karen Edwards | Feature Articles | Summer 2018


During the interview process, Jennifer Allen, M.D., recommends getting a feel for how much time will be spent on nonclinical activities— not just call. · Photo by Scott Patrick Myers

During the interview process, Jennifer Allen, M.D., recommends getting a feel for how much time will be spent on nonclinical activities— not just call. · Photo by Scott Patrick Myers

It took the premature death of his father to convince Josh Valtos, M.D., to leave a thriving cardiac surgery practice and move closer to family.

Amy Canuso, D.O., made a similar decision when she moved her family from Guam to Iowa. Although she was not unhappy with her practice in child and adolescent psychiatry, “For us, it was the right decision,” she says.

For Jennifer Allen, M.D., it was the end of her family practice residency that spurred action.

Though each of these physicians had different motivations, each found a job search squarely in their future.

Looking for work is hardly a new phenomenon these days for physicians—or anyone else. According to The Balance, an online publication that covers personal finances, the average person changes jobs 10 to 15 times over the course of his or her career.

Physicians aren’t exempt from work transitions. And with that comes the biggest question: Will the change be a good move…or not?

“It’s an employee market out there for physicians,” says Valtos. The market needs you. But how can you decide if a job offer is the right one for you and your family?

Certainly, completing residency or fellowship or deciding on a geographical move are among the many reasons why physicians look for work. But they’re not the only reasons. Pinnacle Health Group conducted a survey several years ago to learn why physicians change jobs. We will look at some of the reasons they compiled as a way to prompt questions you should ask before accepting a job offer.

No matter what questions you decide to ask, however, one thing is clear: The more questions you ask before, during and after the interview, the more likely you will be to find the right fit for you and your family.

Compensation questions

First on the Pinnacle Health Group survey on why physicians change jobs (or opt not to take them in the first place) is the need for a higher salary.

“Of course, in a job interview, physicians are primarily focused on getting the job and how much the job pays,” says Jeff Decker, division president, locum tenens for the recruiting firm AMN Healthcare. “Because of the debt level they assume while training, they’re programmed to get out there and start working as soon as they can for as much as they can. If they’re motivated to pay down debt, though, they can jump into a job too fast without taking other factors into consideration.” But yes, he continues, salary is going to be a substantial part of any job interview.

Before entering any interview, you need to determine your salary needs. There are other questions on this topic that you may want to ask:

1 Do you have the resources to meet my salary needs now and in the future?

“Physicians who join a private practice may not be given as high a starting salary as physicians who are employed by a hospital or health system, but they may receive supplemental incentives, like relocation, student loan assistance and sign-on bonuses,” says Chris Corde, system vice president of physician recruiting for OhioHealth.

“However, physicians who enter private practice may have a greater long-term earning potential because they can have ownership or are able to retain a greater share of their work.” Before your interview, consider your financial goals and make sure you learn about your long-term salary prospects from any potential employer.

Allen suggests asking about the employer’s overall financial health. “With so many mergers taking place and hospitals going under, you’ll want to know what the employer’s financial strength is,” she says.

Decker agrees. “Don’t be afraid to ask these kinds of questions,” he says. “Ask about the economic health of the business and ask if there are things down the road that could be problematic.” You don’t want to accept a job offer if the hospital is prepared to do lay-offs in the months ahead.

2 What will my income look like in the first year—and after?

“Income guarantees” are becoming a thing of the past. “With this type of contract, the physician is assured a base income, usually for one or two years. But it is really a loan that has to be paid back,” says Decker. However, the loan is usually “forgiven” in exchange for the physician staying in the community for a certain number of years.

“In the early days, most of our contracts featured income guarantees. Now, it is about three or four percent, as almost everyone recruited today gets a salary,” he says. “After a year or two that may segue into pure production, so you have to be prepared for that.”

If that is the case, Decker recommends asking during the interview what kind of loads other physicians carry. “You can deduct in your head the number of patients you will need to see to meet your compensation goals,” he says.

“Those types of contracts (salary with no payback and bonuses paid when care metrics are met) turn the clinician to a salary employee,” says health care consultant Tom Davis, M.D. “But that’s what a lot of them want.”

If you’re not sure what the best compensation arrangement will be for your practice and family long-term, you can try asking a question to help you understand the review process involved.

Canuso recommends: “Can I re-negotiate pay after my contract ends?” If the answer is “no,” at least you can decide on the job opportunity with that knowledge.

3 Is compensation here driven by volume or quality?

“That’s one question to ask that will help you determine some answers,” says Decker. Different employers have different values, so it’s a good idea to determine what drives an employer before accepting a position there. Salary, productivity, even academic systems have their pros and cons. “You need to know what system you are most comfortable working under, and choose the job accordingly,” says Canuso.

Lifestyle questions

"As we grow older, we need to ask ourselves, 'have my priorities changed?'" says Valtos. Doing so can help you determine if a new practice will better fit your needs. · Photo by Morgan Knight

“As we grow older, we need to ask ourselves, ‘have my priorities changed?'” says Valtos. Doing so can help you determine if a new practice will better fit your needs. · Photo by Morgan Knight

Also ranking high on the Pinnacle survey are several items that translate to lifestyle. Lengthy hours or a high call schedule are two reasons many physicians opt out of a job offer or the job itself. Other lifestyle reasons include underutilized medical skills and an unmet need for growth and upward advancement.

“As we grow older, we need to ask ourselves, ‘have my priorities changed?’” says Valtos. After you have paid off medical school debt, your focus may shift from money to lifestyle. Again, that means you need to first establish your priorities before looking for work. With priorities in mind, your questions can focus on what’s important to you. If lifestyle is at the top of your priority list, here are a few questions you might want to ask a prospective employer:

4 What’s the call schedule?

If you are interested in maintaining a work/life balance that works for you and your family, this is an important question to ask. You will not only want to know what hours you will be expected to work, but where you will be expected to work. Some facilities have satellite clinics where you may be assigned, so even if you do not object to the late-night or early morning shift, you may have a different perspective if you need to factor in a 45-minute commute to the satellite facility.

“If you’re applying at a hospital that has a network, ask if there are ancillary facilities you’ll rotate to,” says Decker. That’s true whether the work is during regular hours or on-call shifts.

It’s also a good idea to ask if you will take call from community-based providers, says Corde. If so, how will that impact you? It is conceivable you might be taking on all the late-night work from community providers who would rather not work outside their regular hours.

Another question to pose is, “Can I take scheduled vacation?” Hospitals with high patient volumes may not be thrilled with the idea of new physicians scheduling vacations in the first year, but, says Decker, if vacations are frowned upon as a general rule, you will want to know about that policy upfront.

5 How much time will I spend on nonclinical activities?

“One question I wish I had asked during the interview is, ‘How much time will I spend finishing charts?’” says Allen. “Electronic records didn’t work, so I was spending an hour and a half beyond my scheduled time to complete charts each night,” she says.

Davis says the complaint is not uncommon, so he urges job applicants to ask about time commitments needed for all non-clinical activities, including completing records.

“Ask about any meetings you’ll be expected to attend as well as any additional training that will be required,” he says.

Know before you sign up for the job exactly what kind of hours will be required to complete each day. “If you find yourself working outside of your regular hours, you might ask, in the case of completing records, if you can leave the hospital and remote from home to finish your work,” says Allen. If it appears you will be expected to spend your own time on non-clinical tasks, she adds, “ask if you will receive some sort of compensation for the extra time in terms of cash or vacation, or if it’s simply expected of you.”

Have a potential employer walk you through a typical day at the facility. “Ask ‘What will my first week be like?’” says Corde. Then go further. “Ask ‘What will my first month be like? My first year?’” This will give you a better idea of the employer’s expectations and how they match up with your priorities.

“I ask for details of the day-to-day job,” says Allen. The information you learn will help you better decide if this is the right practice fit for you.

“Will I see mostly inpatients? Outpatients? Will there be a mix? I ask myself, ‘In what sort of setting do I enjoy practicing the most, and with what patient demographic?’” says Canuso. The answer will help you with your job decision.

6 What kind of growth opportunities will I have?

If advancement opportunities are important to you, remember to ask about them during the interview. “Ask ‘How can I make partner?’ if this is a path that interests you,” says Valtos. Or if your goal is to rise higher in hospital leadership, ask “What is the pathway to medical director?’”

“Many new physicians will sign up with an employer in a part of the country where they want to live, work there long enough to pay down their debt, and then decide their career move,” says Davis. So, before you ask an employer about growth opportunities, make sure the job and community is a place where you see yourself and your family staying long enough to advance your career.

Questions for the family

Number 10 on the Pinnacle survey on why physicians leave (or do not accept) jobs involves the family and its comfort level in the community.

“My family was entrenched in our community, so when I looked for work, I decided not to move them. It was better for everyone if I commuted to work,” says Allen. That meant she needed to restrict the area in which she searched for a job, but it was a solution that worked best for everyone. “I was already commuting for my residency. The job I found was actually closer than my previous commute had been.”

If you do have family, like Valtos, you will want to spend as much time as possible learning about the community before you step foot into the interview.

“My wife and I are pretty good researchers,” says Valtos. Before moving from Missouri to their new home in northeast Alabama, they went online to find the best community fit for their family. “We looked up the health of the community, school rankings and school performance records, crime statistics, even weather reports,” he says. By the time of the interview, you should not have many questions left to ask about the community, he says.

Still, here are a few you might ask to help determine if you and your family will feel comfortable there:

7 What is the community’s demographic?

If you’re looking to surround yourself and your family with people of similar ages, what part of town would be best for you to look in? What activities are available? Are there places for colleagues and friends to meet outside of the workplace? Whether you are interested in fine dining and theater or professional sports and barbecue, you need to know if this is a place where you and your family will fit in for an extended period of time, says Allen.

Says Valtos: “You want to ask yourself if you can see yourself here in 30 years.”

Also, says Decker, ask what the pace of the community is like. “An urban environment is going to be a different pace from a rural or even a suburban environment.” Which pace best suits you and your family?

8 What help do you offer families?

It is not unusual these days for hospitals to work with realtors who can help find homes for physicians moving into the area. The realtors are familiar with school districts and can likely introduce you to school administrators as well as provide up-to-date information on school performance records and rankings.

Canuso, who recently moved from Guam to a small Iowa community, says, “When I interviewed for my job, the hospital administrator even arranged for us to tour the schools and meet with the principals.”

Help with house hunting as well as school introductions can be a significant asset for new physicians. So can job placement services that can help a spouse find work in the new community. Hospitals often tap their networks to find employment opportunities for trailing spouses who left their jobs behind.

If any of those services would be helpful, ask about them during the interview.

9 What help do you offer to new physicians?

During the interview, Allen suggests asking if there is a support system in place for new physicians. If networking and collegiality is important to you, then ask if the physicians mingle outside of work, says Allen. Becoming familiar with other staff members, even making friends, can be a crucial part of fitting into a new workplace.

Before you accept a job offer, it can also help to talk with physicians who work or have worked at the facility.

“I asked to speak to a few physicians who work for the hospital,” says Canuso. “I also wanted to meet the clinical managers and nurses on the inpatient ward. Ultimately, you are going to spend more time with co-workers than you do with family, so I wanted to get a sense of potential for mutual respect and general temperament of potential co-workers. This is a rural hospital, so the professionals who work there want to be there—and that means a great deal to me.”

You can also get help from your hospital’s recruitment team. “Recruiters can also be phenomenal in terms of research,” says Valtos. “They can give you insights into the job, the employer and the community you can’t get anywhere else.”

10 What about…?

Of course, any question you ask during an interview will be unique to your own situation. The questions already covered are general in scope and will benefit most applicants. Here are a few questions that are slightly more specific. Chances are, you’ll want to ask a few in your interview:

  • What are your turnover rates? How many new hires stay after the first year? Davis says this will give you a feel for how satisfied employees are who work there. Valtos also suggests asking the employer about turnover rates. “Ask the recruiter how many physicians have come and gone from this location and why. Or, ask the employer why they’re looking for a new physician,” he says.
  • How long has the job been posted? If the employer has been looking for a while, says Corde, you may want to ask why.
  • Is there a non-compete clause? You’ll want to understand any restrictions if you choose to look for another job in the area in the future.
  • What is the employer’s mission? Do they have serving community at the top, or is it focused on profit? Ask how the mission affects daily life at the organization.
  • When can I expect to hear back? Candidates can forget to ask this following the interview, says Corde. Ask what the next step is before you leave.

“Don’t be afraid to ask questions,” says Valtos. “After all, you’re the one who is ultimately going to work at this place, in this culture and live in this community. Make sure you ask all of the questions you need to help you make the right decision.”



Your job-search timeline

Learning of other physicians’ job-search journeys can help you anticipate, plan and execute your own.

By Marcia Layton Turner | Feature Articles | Spring 2018


“Much of the education on searching for jobs was acquired in passing while talking with those ahead of us in training and through each other as we went through process,” says Sunny Jha, M.D. Photo by Dawn Bowery Photography

“Much of the education on searching for jobs was acquired in passing while talking with those ahead of us in training and through each other as we went through process,” says Sunny Jha, M.D. Photo by Dawn Bowery Photography

Until you get to your job search, the path to a career in medicine is quite regimented: Study a pre-med curriculum. Apply to medical school, then to a residency program. After residency, you either apply for a fellowship or begin looking for a job. And that’s when the systematic, methodical process vanishes, leaving some physicians unsure of how exactly, or when, to begin their job search.

“The search process lacks any sort of formal structure, so it is unlike anything most young physicians have ever experienced,” explains Sachin “Sunny” Jha, M.D., MS, assistant clinical professor of anesthesiology at the University of Southern California (USC) in Los Angeles. “I had an idea that the job process would be a long exercise with varying degrees of uncertainty and unpredictability,” he says. “Prior to this point in medicine, everything more or less had a process.”

The path to a new opportunity doesn’t come with a pre-written map or compass. So it can help to hear what other physicians’ job searches looked like as you chart your own course.

“Like many aspects of medical education, this is one of the things that you don’t formally ‘learn,’” says Jha.

The success of your search, and the order in which you uncover and pursue opportunities and resources, is largely dependent on timing. Allow yourself ample time to explore all the jobs that may be available to you so you can negotiate from a position of strength, rather than being rushed and under pressure to accept anything that’s offered.

Design your plan

Zachary Liner, M.D., started his job search 17 months before he would be available. Photo by Michael Caswell Photography

Zachary Liner, M.D., started his job search 17 months before he would be available. Photo by Michael Caswell Photography

When it comes to looking for your first or next job, “Start early,” advises Zachary Liner, M.D., an interventional radiologist with North Oaks Imaging Associates in Hammond, Louisiana. Liner began his job search in the middle of his first fellowship after residency and before he had even started his second fellowship—17 months before he knew he’d be available to start.

According to the 2017 Survey of Final-Year Medical Residents conducted by Merritt Hawkins, a national health care search and consulting firm, 72 percent of medical residents start their job search within or before a year of finishing residency; 28 percent wait until they are six months from completing their training before beginning their job search in earnest.

Patty Shipton, physician recruiter with Penn State Health in Hershey, Pennsylvania, says that a year is just about right for a physician’s job-search process. Physicians in their last year of residency or fellowship generally start looking for a position in early fall, she says. That’s when recruiters begin attending career fairs and conferences armed with a general idea of upcoming openings that will need to be filled. Shipton also collects CVs for unexpected openings that occur from time to time.

Chris Mason, D.O., MS, is regional medical director for the Western region of American Physician Partners and is based in Albuquerque.

Mason points out that, thanks to the fact that there are “far more physician jobs than there are candidates…it’s a resident’s market.” (He’s quick to point out that this varies by specialty and location, however.)

The earliest a resident can commit to a job is right after their intern year. And while that’s not typical, it’s possible, he points out. To entice physicians to sign as soon as they’re eligible, employers may offer incentives including sign-on bonuses, stipends and loan forgiveness.

The major downside to signing a contract so early in the job-search process is that you’re committed to work somewhere long before you’re finished with residency. During that time, you may make all sorts of decisions that could interfere with that employment arrangement. For example, you might decide you want to live elsewhere in the country, you might get married to someone who wants to live somewhere else, or you might decide you want to work for a specific practice or even switch specialties. A lot can happen over the course of several years of training.

Zero in on desirable locations

By early fall, most physicians usually know where they want to be geographically, says Shipton. She finds that they often they want to move to be closer to family. Or they’re clear about whether they want a big city or small, urban or rural setting, mountain or beach, or a specific region of the country.

Many have also started to research which hospital systems or practices have openings in their specialty—or are likely to soon.

Liner’s medical specialty of neurointerventional radiology is what he calls a “super subspecialty.” “There aren’t a lot of people who do what I do,” he explains, which means that there aren’t as many programs or spots available, and “once spots are filled, they’re filled,” he says. “I had to start early to have a chance of getting one of those openings.”

Making his job search even more challenging was that not only was Liner looking for a position in a field with very few openings each year, but he also had a very small geographic target area. Most interventional radiology jobs exist in major cities, he explains, but he and his wife had decided that after living in New Orleans, Texas, San Francisco, and Rochester, New York, they wanted to make southern Louisiana home—where he and his wife had grown up. He knew that his odds of finding an interventional radiology opening in southern Louisiana were slim, so he wanted to start introducing himself to anyone in Louisiana who might have a need for a physician with his skillset.

“It was constantly on my mind that the job I wanted wasn’t open—that I had to create it,” he says. Few programs were looking for a doctor with training in both body and neurointerventional radiology. “It’s a unique skillset that sets me apart,” says Liner, but with so few hospitals and practices actively looking for someone with such unique training, he was aware that his job search could be difficult. It was likely he would need to convince a practice that he would be a valuable addition, and work with them to create a new role rather than take over an existing position.

Be aware of established milestones

Depending on your specialty, there may be opportunities at specific times of the year, such as at educational conferences and medical association meetings, to be considered for upcoming openings.

Jha, who was looking for a position in academic medicine, discovered after the fact that many academic departments interview graduating residents at the ASA (American Society of Anesthesiologists) annual meeting in October. Looking back, he says he should have started earlier and taken advantage of this interview opportunity.

Ask your colleagues if your own specialty’s conference has a similar setup. If so, try to attend.

Mason recommends networking through various local and national chapters of your specialty’s professional organizations. Take advantage of residency events and physician groups that provide opportunities for residents to mix and mingle with health care representatives. “Get involved,” Mason advises, to get to know attending physicians who can serve as referral sources and connectors to your dream practice.

Take a proactive approach

Don’t hesitate to be proactive.

“If there’s a place you’re interested in, don’t be afraid to reach out to the recruiter,” Shipton says. “They may know of a future opening coming up.” Most in-house physician recruiters serve specific departments, so it’s useful to identify which recruiters are responsible for hiring physicians in your specialty at the employers you’re targeting. In-house physician recruiters are uniquely qualified to represent the opportunity and community for which they’re recruiting, as they are directly employed by the facility. It’s their friends and family whom you’ll be treating.

Another option is to retain the help of an agency or staffing firm in your search. An agency may be able to alert you to jobs at multiple specialties through one point of contact.

Liner decided that he needed the support of a professional adviser to help track down a potential employer that would meet all of his criteria. He chose Jeff Hinds, MHA, of Premier Physician Agency in April 2016.

Liner worked on a cover letter and updated his CV to be sent out to prospective employers. He then sent out “feeler emails” to about 40 practices that Hinds had identified in cities and towns in Louisiana, Texas, Alabama and Mississippi to see what kind of interest there might be in a doctor with his training and experience. He also checked physician job boards and applied to a few opportunities.

Almost immediately, Liner began receiving phone calls in response to his campaign. Although most recruiters said, “We don’t have a place for someone with your skill set,” they also told him they would keep his materials on file in case something opened up later. Liner then followed up later with those that had expressed an interest to check in. Back-and-forth phone calls from the feeler emails continued for about six months, says Liner.

Among the many “we don’t have a spot for you” phone calls were six calls from practices that were interested in speaking with Liner, three of which were in Louisiana.

Jha describes his initial job search activities as passive, as he applied and interviewed “broadly” for jobs in both academic medicine and the private sector. “I had been passively searching for jobs in both environments, collecting contacts within different departments,” says Jha.

Then at around the midpoint of his fellowship year, he began directly reaching out to different departments and groups he was interested in. “The department where I did my fellowship kept a list of key contacts within groups around the country, which was instrumental in securing many of my interviews,” he says. In addition, some physician job boards and physician recruitment agencies also provided outreach ideas.

His proactive approach worked. “I actually got my job by directly emailing the chair of my department,” he says.

You can be proactive even without having a name provided. On, for example, you can search by specialty, zip or employer, and reach out directly to the in-house recruiter representing the opportunity or organization.

Schedule site visits

For the next five months, from August 2016 to January 2017, Liner flew out to interview with six different groups. He had one interview in August, three in September, one in November, and one in January. Many took weeks to schedule because he had to travel from his fellowship in San Francisco to the south during times he wasn’t required at the hospital. Finding common schedule availability was challenging.

Liner had a strong sense that practices that initially said “no” because they didn’t have any openings at the time might eventually turn into a “yes” if a partner decided to move or retire. So he made a habit of staying in touch with all the practices and hospitals in his geographic search area.

As he scheduled first visits with some groups, he was also scheduling second visits to two practices that had made offers following the initial site visit. He completed those two visits in January.

After reviewing CVs gathered at conferences in September and October, Shipton’s next step is to schedule on-site visits to see if there may be a fit. During October and November, she typically invites the top in for a first on-site visit. Based on those in-person interviews, the interview team and department leadership collectively decide whom to invite back for a second visit, often with their families. Those generally occur in November and December. Offers are then made between December and February, she explains.

Liner made it known to the practices he was considering that he was going to take his time in making a decision. Because he had started his job search so early, he had the luxury of time to thoroughly research each practice and speak with different people and departments within each practice.

While there is a standard recruitment process and timeline, Shipton says, there are factors that can slow it down or speed it up. For example, the availability of a physician to start work can drive how quickly the process concludes. If he or she finishes residency on June 30, the earliest possible date they could start would be July 1. “But many people want to take some time off [after residency], to move and get settled,” says Shipton, “and that can affect when they start.”

Likewise, candidates who are especially responsive can move the process along faster than normal.

Negotiate a contract

As his second site visits were underway in January 2017, Liner began receiving offers. Over the next two months, he began negotiating with three practices. Most contract negotiations don’t take two months, says Liner, “but we were all cautious,” he says. “No one wanted to make any snap decisions.”

Twelve months after he started his job search, Liner accepted a job offer from a practice in Louisiana.

Be prepared for credentialing

In order to prevent any delays in receiving your hospital credentials or medical license, make sure you have quick and easy access to the personal information your employer will need, suggests Jha. That means collecting recommendation letters as soon as possible, keeping accurate and up-to-date procedure logs as you go through training, and scanning personal documents, such as identification, degrees, other licenses and immunization records so that you can send them at a moment’s notice, he recommends.

“Be patient and start early so you can begin working on time,” Jha advises.

Shipton says that credentialing, which can include a background check, review of letters of reference and other documentation, can take anywhere from one to three months depending on the state in which you’re applying.

Make your own timeline

While there are common timelines for finding, considering and accepting a new position, there are also many extenuating circumstances. The typical timeline is just that: typical, but not the rule. Liner was looking for the equivalent of a needle in a haystack in Louisiana, so his timeline was extended. You can take a different approach, or operate at a faster or slower speed. It’s up to you.

You can decide for yourself how much time to invest in identifying potential employers, researching programs, sending out CVs, talking to recruiters, visiting hospitals and practices in person, negotiating a contract, and preparing for your new role.

Based on his job search, Liner recommends holding out for the right job. Don’t rush the process, he says. “You can find the right group; you just have to allow yourself the time to find it.”

You’ll also make a better decision if you do your own due diligence before signing any contracts. Ask lots of questions—“you can’t ask too many,” Liner says—to ensure you’re making the best decision for you.

Marcia Layton Turner is a frequent contributor to PracticeLink Magazine.



Where should I work?

Decide what practice setting is right for you by taking a close look at your options.

By Debbie Swanson | Feature Articles | Spring 2018


Shoshana Ungerleider, M.D., counts a variety of specialists and continual learning opportunities as benefits of working at a large organization. · Photo by Mischa Photography

Shoshana Ungerleider, M.D., counts a variety of specialists and continual learning opportunities as benefits of working at a large organization. Photo by Mischa Photography

The job search can be all-consuming, with countless criteria to consider. But before you begin to think about location or benefits, you should decide what type of practice you’d like to join. Whether you see yourself at a big city hospital, a specialized clinic or a group practice, evaluating where you fit best will help you make up your mind about other factors.

Throughout your medical journey, you’ve glimpsed many practice settings. Rethinking each is valuable as you begin your career search. This overview of practice settings will help illuminate your options as you start looking for a new practice.

Solo/private practice

Opening a solo practice was once the dream for most aspiring physicians, but it’s now the road less traveled. Between 1983 and 2014, the percentage of physicians practicing solo dropped from 41 to 17 while the percentage of physicians in practices larger than 25 rose from 5 to 20, according to the American Medical Association.

There are many reasons for this drop in private practice. Complying with government regulations can be difficult, and many physicians prefer a setting where they can expect a stable income and steady hours. Additionally, private practice involves more administrative work than some other settings.

However, some physicians are still drawn to the autonomy of private practice. Fayne Frey, M.D., a dermatologist based in West Nyack, New York, chose being a solo practitioner for the control she has over her patients’ care and her own schedule.

“I can see as many or as few patients as I want and adjust my schedule as needed,” Frey says.

But Frey admits there are drawbacks. For instance, she says private practitioners have less leverage when it comes to negotiating with insurance. “They’re not as interested in me as they are a big group,” she says.

Group practices

Physicians opting for group practices find a setting that provides more leverage with insurance companies, greater profitability and improved quality of patient care. Group practices vary in size and scope. Single-specialty groups tend to be smaller, employing an average of eight physicians, while multispecialty groups employ an average of 25 physicians.

Single-specialty groups can be a prime environment for learning more about your specialty and fine-tuning your skills.

However, because every physician in the group practices the same specialty, referrals rarely come from within, and a practice’s existing patients tend to gravitate to whichever physician they have seen before. A new physician may need to be proactive about getting his or her name out and building a client base.

The amount of autonomy varies widely in this setting. At some single-specialty groups, physicians are highly involved in setting standards and procedures. At others, physicians have less say. And while single-specialty groups often have more leverage with insurance companies than solo practitioners do, smaller groups still face similar struggles with insurance agencies and regulatory compliance.

Multispecialty groups tend to employ more physicians than single-specialty groups, and they also offer a wider spectrum of services. Most multispecialty groups are general in focus, but some revolve around a certain area, such as diabetes or cancer care.

“It’s common to see some type of primary or family care included [in a multispecialty group], as well as several other specialties,” says Philip Masters, M.D., FACP, vice president of membership and international programs at the American College of Physicians and an adjunct professor of medicine at the University of Pennsylvania School of Medicine.

Masters believes this diversity benefits physicians. “With several doctors within a group, a multispecialty practice offers built-in support and consultation. It’s easier to send patients to other doctors or to consult with and get guidance yourself,” he says. “Overall, the process is streamlined for patients and easier for the doctor.”

However, multispecialty groups don’t always offer as much autonomy as smaller group practices. With more clinicians, these practices require more protocols for smooth operations. Those protocols may be developed by executive management, not physicians themselves. And as you’d expect, workplace dynamics can sometimes be difficult when multiple specialties are involved.

When interviewing at either type of group practice, consider whether a hospital acquisition is likely and whether that affects your interest in the group. According to the Physicians Advocacy Institute, hospital ownership of group practices increased 86 percent from 2012 to 2015—representing a 50 percent increase in the number of physicians employed by hospitals.


“It gives me a feel good feeling that they’re not just after profits, but to serve and to help,” says Michael Burdi, M.D., of working at a religiously affiliated hospital. · Photo by KLK Photography

“It gives me a feel good feeling that they’re not just after profits, but to serve and to help,” says Michael Burdi, M.D., of working at a religiously affiliated hospital. Photo by KLK Photography

Hospitals remain a popular work setting for physicians. According to Physicians Advocacy Institute, hospital employment of physicians steadily increased between 2012 to 2015, with regional growth rates ranging from 33 to 59 percent across the nation.

Most hospitals offer a complete spectrum of medical and surgical procedures on both inpatient and outpatient bases. But beyond that, hospitals vary greatly in terms of size, affiliation, specialty, patient population, levels of emergency and trauma care, for-profit or nonprofit status and more.

As an employer, a hospital offers physicians some of the same advantages as a large multispecialty group practice. You’re among a large, diverse medical population, and the environment is usually intellectually stimulating and modern.

“Having many different specialists, as well as fellows, available at all times is a benefit of working in a large institution,” says Shoshana Ungerleider, M.D., an internal medicine physician at California Pacific Medical Center in San Francisco. “There are also numerous monthly opportunities for continued learning through lectures, grand rounds, events and conferences.”

With round-the-clock, year-round staffing needs, hospital employment allows physicians to choose shifts that suit their lifestyles. “From early in my residency training, I enjoyed working the night shift. Now as an attending, working nights affords me many days off to do the other things I enjoy outside of medicine,” she says.

Teaching hospitals not only provide hands-on clinical experience to medical students, but also enriching opportunities for practicing physicians.

“Teaching [other] doctors, along with taking care of patients, pushes me to stay up on all of the latest data on diagnostics and treatments for patients,” says Ungerleider, adding that she also enjoys the opportunity to give back.

Faith-based hospitals are also common. MergerWatch reports that the number of Catholic owned or affiliated hospitals in the United States grew by 22 percent between 2001 and 2016, and 14 percent of acute care hospitals in the nation are owned by or affiliated with the Catholic Church.

Michael Burdi, M.D., an orthopedic spine surgeon at Mission Hospital Regional Medical Center in Mission Viejo, California, enjoys the altruistic mindset of his religiously-affiliated hospital. “I do get a sense of service to the community. It gives me a feel-good feeling that they’re not just after profits but to serve and to help,” Burdi says.

While working for Mission, Burdi has been able to spend time treating underserved populations. “Years ago, I took trauma calls at the Camino Health Center, a clinic which provided care to those who couldn’t otherwise afford it,” he says. “To me, that’s an example of what a faith-based hospital does.”

Stephen Tocci, M.D., chair of the orthopedics department at Mission Hospital, adds that religiously-affiliated board members keep the hospital grounded in their mission. “We have nuns serving on the board who bring a great deal of experience and provide a balance of humanitarianism and compassion,” he says. “Having them present at the leadership level provides an ongoing sense of service and upholds the hospital’s defense of the underserved.”

Some faith-based hospitals restrict care and referrals for certain types of services, such as reproductive and end-of-life services. If you’re considering employment at one, make sure you’re informed about their policies.


Many sectors of the government employ physicians as well. For example, the Veterans Health Administration is the largest integrated health care system in the United States, providing care at 1,245 facilities and serving more than 9 million enrolled veterans each year.

Physicians who work for the VA find it rewarding to care for patients who have served our country. “These are some of the best patients in the world,” says Shereef Elnahal, M.D., Assistant Deputy Under Secretary for Health for Quality, Safety and Value. “I’ll never forget some of the patients I have treated.”

Jennifer MacDonald, M.D., Director of Clinical Innovations and Education in the Office of Connected Care, agrees. She says, “The vets are extremely grateful for their care. …They have a lot of pride, and that makes it very rewarding as a provider.”

Because many of their patients have undergone physical or psychological trauma, VA physicians are trained to take a holistic approach. They screen for mental health, lifestyle issues and substance abuse among other health concerns.

The VA is also highly focused on research and innovation. In 2017, the Department of Veterans Affairs ranked 17th on Reuters’ list of the world’s most innovative research institutions.

MacDonald says the VA also provides telehealth. “To follow up on someone who was discharged, I can call up a video visit, [which easily] fits into my day and doesn’t require the vet to drive in to see us,” MacDonald says, adding that in FY 2016, more than 2 million patient visits were conducted via telehealth.

Correctional medicine

Correctional health care is another growing opportunity for physicians. It may sound like a difficult work environment, but Mohammad Khan, a board-certified psychiatrist in Dallas, says that providing medical care in correctional facilities offers variety and new challenges.

“It was quite rewarding to diagnose and treat them,” he says. “The combination of personality disorders with mental illness was quite high in adults. In the juvenile facilities, the biggest problems were lacking a stable home structure.”

Khan found correctional services to be vigilant when it came to ensuring physician safety, and he enjoyed working alongside other medical professionals, such as counselors and therapists.

Federally Qualified Health Centers

Physicians can also find enriching government opportunities at Federally Qualified Health Centers (FQHCs). These clinics and health centers provide comprehensive care to uninsured and underserved populations. And because it is often financially and logistically difficult for their patients to access medical care, FQHC doctors quickly learn to wear many hats.

“From a professional perspective, [you’ll encounter] many medical and psychosocial issues that may be less commonly seen in other practice settings,” says Masters, who worked at an urban FQHC setting early in his career. “Since centers are required to provide comprehensive care, you’ll work closely with other medical professionals.” He adds: “It is [also] nice to know that you are helping in a place where good care may be difficult to find.”

Locum tenens

Medical practices have extensive staffing requirements—and physicians sometimes get ill or go on leave. That’s when locum tenens physicians step in. Locum tenens physicians take over when a doctor is unavailable for as briefly as a day or for as long as several months.

What it lacks in job permanence and stability, it makes up for in variety. Physicians are attracted to locum tenens work because it allows them to explore different practice settings and locations.

Planning your next move

Identifying your preferred setting can help with your job search, but it’s also smart to remain flexible. You never know how a practice might surprise you. For example, you may find a small group practice where management determines procedures or a large practice where physicians have a lot of say. Remain open to possibilities.

Like most major decisions, the practice setting where you’ll fit the best often comes down to a gut feeling. The environment that appeals most to one physician may sound completely unappealing to another. So do your research, talk with your advisors, and reflect on your goals. In the end, you’ll find the answer by listening to your true calling.



6 Questions you must ask in your job search

A physician’s job search is full of questions. Asking yourself these along the way will help you find your dream practice.

By Chris Hinz | Feature Articles | Spring 2018


Job Search Chart with keywords and icons Flat Design

The job interview process involves a lot of questions. You’re trying to find the best match for your experience, work style and skills. Meanwhile, your future employer is trying to find the best match for its culture and staffing needs. But the most important questions you ask throughout the process may be the ones that you ask of yourself. In a job market flush with opportunities, it’s important to direct your job search, narrow your options and quickly determine what setting is best for you.

David Hass, M.D., is course director for the Young Physician Leadership Curriculum for Connecticut State Medical Society/Yale New Haven Hospital and a physician with Gastroenterology Center of Connecticut. He explains, “You can’t cast a wide net and hope that every opportunity that draws you in is going to be the perfect opportunity. Instead, you need to set parameters for yourself as to what you think will really make you happy both personally and professionally.”

Start with these six questions to help clarify—then achieve—your goals.

Question 1: What do I want out of my job?

The culture of the community and practice was an important factor for Michael Antolini, D.O., in his job search.

The culture of the community and practice was an important factor for Michael Antolini, D.O., in his job search.

As you start looking for opportunities, consider who you are personally as well as where you’re headed professionally. Focus not just on your strengths and weaknesses, but also on your personality and preferences. That will help you define what practice type, size, configuration and culture will work best for you.

Ask yourself: What do I want my work and private life to look like? Would I thrive as an employee or as an independent practitioner? Do I prefer working with other specialties or just my own? What would make me happy, confident and energetic at work?

“I tell residents, ‘It’s both a good and bad [thing] that you basically can go anywhere because there are so many job options,’” says Heather Gavitt, provider recruiter for AtlantiCare in Atlantic City, New Jersey. Zeroing in on a practice type can narrow the virtually unlimited choices. “It can help you cut down on the places that you’re looking at so that you have a manageable pool before you move further and overwhelm yourself.”

When Joshua Cohen, M.D., wanted a career change, he took inventory of his skills and asked colleagues and friends for input. They told him he had a knack for taking charge and would thrive in a leadership role.

Cohen came up with two goals: 1) to help a lot of people, and 2) to tackle a variety of challenges in his day-to-day work. “I wanted something that was going to be different every day,” he says. “I wanted a challenge or project that I’d have to learn how to do and then integrate into my job.”

He found the perfect opportunity at Teva Pharmaceuticals in Frazer, Pennsylvania, as global medical director and medical lead for migraine and headache.

This role allows Cohen to be involved in leadership and tackle new challenges every day. Most importantly, he can focus on his passion: improving the lives of migraine sufferers. “I really wanted to do something that would be meaningful to the patients I had treated for all of these years,” he says.

Question 2: Is the work environment at this practice right for me?

Your search isn’t over once you find a practice that matches your criteria. You need to evaluate the offer—beginning with the work environment. Do administrators foster a supportive environment? Will you be able to flourish as a physician and maintain a healthy work-life balance? You can get a sense of the workplace dynamic from your interactions and observations throughout the interview process. If prospective colleagues are genuinely content, you’ll feel, see and hear it.

You can ask a few questions to help assess the environment. For starters, why is the practice hiring? Longevity speaks volumes about the practice leadership, as does high turnover.

“Sometimes physicians are blinded by the things that look good,” says Wanda Parker of The HealthField Alliance in Danbury, Connecticut. “But why have six people, for instance, left this practice? There could be some red flags.”

You should also ask about workload and policies. How much time will you be spending at the office, and will you have enough time left over to enjoy your personal life? Is it a democratic environment where everyone has a say, or is the decision making top-down? And what about the management style? Whatever the case, you want to know that the structures and environment will suit you.

Michael Antolini, D.O., asked these sorts of questions before accepting an offer for a family practice position with Access Health in Lochgelly, West Virginia. Lochgelly is near Beckley, where Antolini had completed medical school rotations and had family. Antolini enjoyed the practice’s collegial atmosphere, and he had met several of its physicians during his rotations. “It’s always been nice to walk down the hall and bounce ideas off of people who you know and trust because they taught you what you know,” he says. “I now participate in training other residents the same way.”

Parin Patel, M.D., is targeting her job search by looking for an academic or hospital setting. She’s now a fourth-year obstetrics and gynecology resident at The University of Texas Medical Branch in Galveston. She’s excited to merge clinical duties with teaching, and she also wants to motivate younger doctors to become leaders in their specialties. As president of the American Medical Women’s Association resident division and an active participant in American College of Obstetrics and Gynecology, Patel enjoys being a voice for the profession.

Wherever she ends up, Patel hopes to find a practice with colleagues who share her commitment to the underserved. “I want to work with people who understand and are supportive of someone who wants to provide care to patients potentially not able to find it anywhere else,” she says.

Question 3: Can I be professionally successful here?

For a profitable, satisfying career, you need to find a position where your skills are in demand. Consider the local community and its patient population. You’ll want to know not only how your competition stacks up, but also basic information about the local economy. Will it support a stream of patients for your specialty?

Examine the professional opportunity at the practice itself. If you’re replacing another physician, you’ll likely have a patient base ready when you arrive. But if administrators plan to use your skills to grow the practice, you’ll likely have to start building your patient base from scratch.

In either case, make sure you understand how the group intends to launch you, and if they’re willing to invest in equipment and support services. If you’re a surgeon with expertise in robotics, for instance, you don’t need to bother with a practice that won’t purchase the equipment for you to do your job. “You have your skills,” explains Jane Born, CEO of Born & Bicknell in Boca Raton, Florida. “You want to bring them to a facility that truly wants and needs them.”

You should also ask about travel. If you’ll be practicing at more than one facility, consider how that travel time might affect your ability to see patients. Productivity impacts compensation, and splitting your time among several locations might reduce your efficiency.

“You need to ask yourself, ‘How much time am I spending in my car or away from the office?’” says Patrice Streicher, associate director and professional development coach at VISTA Staffing Solutions in West Allis, Wisconsin. “How much of my life will be spent doing that compared to what I really love: practicing medicine?”

Zach Lopater, M.D., considered these sorts of questions in his last job hunt. Since radiation oncologists depend on referrals, he wanted to make sure his future employer had enough connections with other providers for him to attract patients. He knew he’d need physicians to send patients his way in order to produce consistent numbers. “The key was: ‘Am I going to have enough patients?’” he says. “‘Was I stepping into a hostile practice that was going down the drain, or was it a strong practice?’”

At Radiation Associates of Macon in Georgia, Lopater found exactly what he was looking for. The practice already had a close relationship with a medical oncology group in the same building, so sharing patients and information was an established routine. “It’s been a very strong practice with very good relationships,” Lopater says. He now enjoys a steady stream of patients and sees a variety of cases, from breast, lung and prostate cancer to head and neck cancer.

Question 4: Is this the right community for my family and me?

It’s natural to focus on your employer during a job search, but you shouldn’t overlook the town you’re moving to. If the area is a total mismatch to your personality or your family’s personality, it can deplete your energy and drive—and make everyone unhappy.

Ask yourself and your significant other how the setting will work for you and your family. Are there professional opportunities for your spouse or partner? Plenty of activities for your children? Do the schools in the area offer what you’re looking for? Finally, does the place offer the lifestyle you want? “One exam room looks just like the next,” Streicher says, “so your questions should be based on what occurs in your life and your loved ones’ lives outside of that room.”

Finding a geographic location that supports her family’s religious needs is an important piece of post-residency planning for Parin Patel, M.D.

Finding a geographic location that supports her family’s religious needs is an important piece of post-residency planning for Parin Patel, M.D.

As Patel and her husband, Nikul, look for their next home, they are prioritizing proximity to a major airport nearby. And while they’re willing to live outside the Northeast, they want visiting family to be relatively easy.

It’s also important for them to be able to worship their Hindu faith as members of a BAPS temple. BAPS congregations are scattered across the country, and Patel is using their locations to direct her search. As a result, she’s expanded her options to cities that she hadn’t previously considered.

Because the denomination is closely knit, Patel anticipates knowing people already or meeting people who are familiar with her temple in New Jersey.

Question 5: What do I want my future to look like?

Think about your job not only in the short-term but also in the future. Having a sense of where the position might take you can help determine if it’s truly the best fit. Will the environment sharpen your skills? Do you expect to stay put, or is it a stepping stone to another place?

“Physicians should ask themselves, ‘Where do I want to be professionally and personally in five and 10 years?’ says Emily Glaccum, recruiting principal at The Medicus Firm. “Then they need to figure out what characteristics of a practice opportunity will most likely help get them to those goals.”

Lopater, for instance, put autonomy and partnership at the top of his wish list. He not only wanted a pleasant work environment, but also some control over business decisions. His biggest must-have was a written guarantee that he’d make partner in two years if he showed his worth. “I wanted a position where I could stay long term and not have to uproot my family once I settled in,” he says.

Other opportunities offered higher initial pay, but Lopater believed Radiation Associates had a long-term interest in him. They were willing to make a firm commitment. In turn, he was willing to make a little bit less at first because he was confident he’d be a partner in year three. It was a busy organization, and the practice recently made good on their two-year commitment by making him partner.

Question 6: What’s my fallback plan if this job doesn’t work out?

As you enter the home stretch with any offer, you’ll likely have high hopes for the future. You’ve done your homework and made informed choices. And if your initial vibes are positive, it’s hard to envision everything crashing around you. But what if things don’t unfold as nicely as you envision? Do you have a plan B? It’s smart to anticipate your next steps if your new position doesn’t live up to your expectations.

“Physicians should do what I call ‘fear setting,’” says Streicher. “They should ask themselves, ‘OK, if I take this job and it isn’t what I was told it would be—or the people aren’t what they appeared to be—what would I do? What are my outs?’ I think that’s really a very practical step in making a decision.”

Your backup plan should lay out your options if you leave the position you’re considering. Where would you go next? What sort of practice would you look for?

If you want to remain in the same community even if you leave your job, make sure your contract has a favorable out clause. And if you’re not excited about an opportunity from the get-go, perhaps you should reconsider your acceptance. “Chances are it’s not going to work for whatever reason if you already have those feelings,” says Parker.

Even if you love your job and don’t plan to look elsewhere, it’s smart to have a contingency plan. Since starting his job, Antolini has sought additional leadership roles. As medical director of four nursing home facilities, he sees 80 elderly individuals each week in addition to his clinic hours. He loves his job and the location, but he wants to have options if his circumstances change. With geriatric medicine on his CV, he’s confident.

“If it all came crashing down tomorrow, I feel good about just presenting what I’m doing,” he says.



Mission medicine 2.0

These medical missions make it possible to give back even with a busy schedule.

By Jane Brannen | Feature Articles | Winter 2018


Shortly after emigrating from Italy to Washington, D.C., in the 1940s, Joseph Aloi, M.D.’s grandmother and her brother became ill.

“They were taken care of by physicians—providers that volunteered their time to take care of people without resources in Washington, D.C.,” says Aloi, who is chief of endocrinology at Wake Forest Baptist Health. “I’m very much aware that my family experienced the generosity of strangers, so I feel that it’s important to help pay that back.”

Aloi has been able to do just that after finding a nonprofit health organization that made volunteering possible with his busy schedule. He has served annually for almost a decade and a half, proving that even with a full-time workload, physicians can find ways to volunteer. Read on to learn more about three organizations helping physicians serve patients across the world—even from the comfort of their own homes.

Reaching the world: International Medical Relief

Lynette Morrison, M.D.

Lynnette Morrison, M.D., went on her first medical missions trip in 2011—and has traveled with IMR five more times since.

From booking travel plans and learning about another culture to getting the proper licenses and ensuring safety, there is a lot to do to prepare for an overseas medical missions trip. It can be daunting for many first-time volunteers who want to give back, but who don’t know where to start or who don’t have time to do all the legwork themselves.

That is what inspired Shauna King, MPH, to found International Medical Relief (IMR). She was working for a nonprofit health care system in Colorado at the time and realized there was a need for simple, worry-free ways for physicians to volunteer. “I had a lot of doctors looking for opportunities to serve and was just trying to find one that was a really simple way for them to give back,” she says. “It became a calling to start the organization.”

King now leads a team that makes overseas missions as turnkey as possible.

Lynnette Morrison, M.D., saw this turnkey experience firsthand when she first traveled with IMR to Ghana in 2011. “I was so impressed by their organization—just how everything was set up,” she says.

Morrison was a medical school student at the time. That first experience with IMR influenced her career path. “I actually went to a rural family medicine program because I was inspired by the work overseas,” she says. “In rural family medicine, it’s more like what we do in the mission trips. You don’t have specialists. You’re relying on what you can do, what you have access to.”

Since that trip to Ghana, Morrison has traveled with IMR five more times: twice as a resident and three times as a practicing physician. It has taken her around the world, including Uganda, the Philippines, Panama, Zambia and Senegal. She says these experiences have made her a more well-rounded physician for her patients back home, where she works as a family physician with a specialty in wound care at MedExpress Urgent Care in Springdale, Arkansas.

Her mission work has also influenced her personal outlook on life. “It really is rewarding,” she says. After seeing families in developing countries make do with so little, she has found herself focusing less on material goods.

IMR offers a wide variety of trips, some more rugged than others. “We work with a lot of indigenous tribes, so when we do that, we are obviously in a much more remote area,” explains King. “But then we work in some locations where they have really, really beautiful accommodations or resorts. There’s still a lot of need, but team members can be more comfortable.”

For each of these trips, IMR prepares its volunteers ahead of time. “We want our teams to go into the field feeling comfortable and confident,” says King. “We do a lot of pre-field training.” King and her staff use online training and conference calls to help team members prepare. These calls, along with Facebook groups, also allow team members to get better acquainted before they travel together.

IMR offers continuing education credits through pre-field training, so some employers may reimburse part or all of the cost of the trip. A trip with IMR can cost anywhere from $2,500 to $4,500 per person, according to King. Some physicians pay these expenses out of pocket and view it as a donation, while others raise funds for their trips.

“We actually have a customized fundraising portal,” says King. “It already has a sample letter in it, so they don’t need to do anything except send it out. And then 100 percent of the money that they raise goes directly into their account to offset their trip.”

Most of IMR’s clinics have a primary care focus, but physicians of all specialties are needed. “We take physicians of all capabilities and varieties,” says King. “Our clinics are really basic…so if a physician has been specializing in a particular area for a long time, they might be getting back to the basics of the grassroots of medicine.”

A typical IMR trip lasts just seven to 10 days, but IMR maintains long-term relationships in the area to ensure continuity of care. “We want to have sustainable solutions for the communities that we serve,” explains King. “We have long-term solutions with short-term opportunities.”

This flexibility allows many physicians to work with IMR who would not otherwise be able to serve abroad. “I’ve talked to colleagues that have said, ‘I really want to go, but I don’t have the time,’” says Morrison. “I would say, ‘Go on one. Just go on one. It doesn’t matter where. Just go on one and have that experience.’ It’s very good to go somewhere that’s out of your comfort zone. You’re going to see things that’ll help you practice.”

For more information about serving with IMR, visit

Serving stateside: The Health Wagon

Ernani Sadural, M.D.

Ernani Sadural, M.D., serves central Appalachia through The Health Wagon. Of the experience, he says: “One comes back enriched and invigorated, hopefully even renewed in their faith in their life’s work and purpose.”

You do not have to go overseas to make a tangible impact in the lives of patients who lack access to health care.

The Health Wagon, a nonprofit based in southwest Virginia, is just one of the many organizations working to provide free, accessible care. They offer a wide array of volunteer opportunities that do not require international travel, and are ideal for a physician’s busy schedule.

“We serve the most vulnerable in our population that do not have access to health care,” explains Ashley Fleming, outreach coordinator for The Health Wagon. “The Health Wagon, with its mobile clinic and two stationary clinics, has remained a pioneer in the delivery of health care in the central Appalachian region for more than three decades.”

“The Health Wagon is probably the gold standard as far as the volunteer free clinic,” says Ernani Sadural, M.D., director of global health at RWJBarnabas Health and co-founder and chief medical officer at LIG Global. “It’s just run by extremely dedicated, compassionate people, then add in the southern charm of the people that work in The Health Wagon with the beauty of the landscape of Appalachia.”

The Health Wagon’s largest annual event, a three-day health clinic, happens every July in Wise, Virginia. They find creative ways to work with the resources available. The event is held at a community fairgrounds, providers see patients in barns, and the pharmacy is in an 18-wheeler. Patients come from all over Appalachia to be seen. Some even spend the night in the parking lots for a chance to see a doctor.

“They’re very appreciative, so that’s a big reward of being a provider there,” says Aloi, who has served with The Health Wagon annually for almost 15 years.

“The fact that we were able to practice medicine just for the pure sake of medicine for the fellow man without respect to compensation … makes for a purely enjoyable experience, whether it’s for one day or one week,” says Sadural. “One comes back enriched and invigorated, hopefully even renewed in their faith in their life’s work and purpose.”

To allow volunteers to make a big impact in a short amount of time, The Health Wagon stays highly organized. “It’s remarkably efficient,” Aloi says. “Your time won’t be wasted.” Because The Health Wagon has a permanent presence in the area, they are able to help with continuity of care after a physician’s trip is over.

“We tailor patient schedules to fit the needs of our volunteers,” says Fleming. “Volunteers can come for a few days or for a couple weeks—whatever works best for them.” Plus, physicians from all specialties are welcome.

Volunteers cover their own travel and lodging, and out-of-state providers must have a temporary volunteer medical license through the Virginia Board of Medicine. The Health Wagon recommends allowing two or more weeks for this. Aloi says the state of Virginia typically makes licensing a smooth and fairly inexpensive process. “For people coming out of state, it’s very easy to stay licensed.”

Volunteering with The Health Wagon or a similar stateside organization is a chance to learn more about life in other parts of the U.S. and develop a deeper understanding of others.

“I’m originally from Chicago,” says Sadural. “I’d never been to Appalachia, and I admit that I had my own preconceived notions.” Volunteering with The Health Wagon opened his eyes to what life was like for patients who did not qualify for Medicaid, yet could not afford health care premiums.

“I gained a deeper understanding and appreciation of these people” Sadural says. “For me, that was the biggest joy—being accepted into their community and allowed to learn from them.”

For more information about serving with The Health Wagon, visit

Making a difference without making a trek: The MAVEN Project

If you are looking for a flexible opportunity closer to home, you can’t get much closer than volunteering right from your laptop. New telehealth technologies have made that possible, and innovative nonprofits like The MAVEN Project are using them to overcome geographic barriers and fill gaps in health care access.

“What we’re trying to be is meets Peace Corps for volunteer doctors,” says Lisa Shmerling, JD, MPH, executive director of The MAVEN Project. “We’re really targeting health care organizations where a primary care provider is accountable for the care of uninsured and/or Medicaid patients that have a problem getting access.”

The time commitment is a minimum of just four hours per month, with no travel time required. By pairing volunteer physicians with understaffed clinics, The MAVEN Project helps rural and low-income patients who normally wouldn’t get timely access to health care. In many cases, timing makes all the difference.

Shmerling recalls the story of one hematologist volunteer who realized a patient had a treatable form of cancer. “The patient was going to go into renal failure within days if they didn’t get seen,” says Shmerling. “We were told that the patient was scheduled to see an oncologist, but not for another month. So, that was an example where we really escalated the issue, and the patient was seen within days.”

David Hurwitz, M.D., a California-based rheumatologist who has logged over 100 volunteer hours with The MAVEN Project, echoes this. “The patients have been waiting forever to see a rheumatologist, and they’re very grateful for getting a consultation,” he says. “Both the clinic staff and the patients seemed on the whole very grateful for my help.”

Hurwitz says volunteering through the The MAVEN Project has helped him carry out his passion for treating patients who otherwise couldn’t see a provider. “I’m a big believer in extending medical care to the population as a whole,” he says, adding that often there simply aren’t enough physicians to see all the patients who need to be cared for. “I saw that there was some way to help meet that need, which is what MAVEN was structured for.”

Depending on what each clinic needs and whether a volunteer physician is licensed in the same state as the clinic, MAVEN volunteers may serve through direct consultations, curbside consultations or mentoring. In direct consultations, the physician builds patient relationships and consults on individual cases. This typically happens with more complex cases and requires a physician to be licensed in the same state as the patient.

A day before each direct consultation appointment, Hurwitz says he typically gets a summary from a secretary, as well as access to electronic medical records. “A nurse would bring the patient in and introduce the patient to me,” he explains. “Then I’d see the patient, and a doctor would come in, and I would discuss the diagnosis and the plan with the doctor.”

In curbside consultations, however, a volunteer physician is not directly involved with an individual patient. Instead, he or she offers advice about a panel of cases. “Each state defines it differently,” says Shmerling. “It’s as if you were in the office and you’re getting a walk down the hall and you ask your pal, ‘What do you think about this case?’”

In mentoring relationships, a seasoned physician volunteer offers expertise to help clinic staff improve their services. “You get paired up with a nurse practitioner, for example, on a regular basis,” Shmerling explains. Mentees can use the sessions to learn about specific medical issues, get business advice or simply ask questions they have never had a chance to ask elsewhere. Says Shmerling: “Our ultimate goal is to increase the capacity at the health center.”

Shmerling says the organization works to make the technological side of things easy for volunteers. “We use a technology called Zoom,” she explains. The HIPPA-compliant application is quick to download, and it allows physicians to video conference, see patients and even share screens.

The MAVEN Project also smooths the process by covering malpractice insurance. Any physician who has been in practice for at least two years is welcome. Some of The MAVEN Project’s volunteers are retired physicians who want to continue making an impact.

Without the barriers of travel time, insurance costs or technological difficulty, you can easily get involved and help fill gaps in health care availability across the U.S.

Shmerling, who has been with The MAVEN Project since it was founded in 2013, hopes the number of physicians who regularly volunteer with health care organizations like hers will continue to grow. She says, “We would like to see a trend where someday everyone who’s in practice gives back by volunteering for some of these most vulnerable populations.”

For more information about serving with The MAVEN Project, visit



How to triage your debt

Your income—and your outflow—are high contributing factors to your family’s overall quality of life. From student loans to mortgages, this guide helps you get your debt under control.

By Debbie Swanson | Feature Articles | Winter 2018


Caleb Butts, M.D.

A shared focus and commitment to the end goal helped Caleb Butts, M.D., and his wife, Tricia, pay off student loans in just a little more than four years.

When Caleb Butts, M.D., was visiting his alma mater, the University of South Alabama College of Medicine, he made a quick stop into the financial aid office.

“I’d been in there so much as a student, asking questions about loans, that I thought I’d stop in to say that I’d finished paying my loans back,” he says. His visit was unexpected by the financial aid officer. “She cried,” says Butts. “She knows all these medical students taking out loans, and never hears how it turns out.”

What was even more noteworthy than his visit was the speed with which Butts reached debt-free status: 4 years and 4 months after starting repayments. Butts credits the discipline and goal-oriented mindset of both himself and his wife, Tricia.

“We wanted to aggressively address the loans now, rather than let them linger,” he says. They based their budget on one income, despite their dual-income status. “We didn’t want to have to go backward [after having children], so we lived off one income, and used the other to pay down the loans.”

Whether you’re just getting started or you’re unsatisfied with your present payback plan, there’s a wide spectrum of approaches to use to pay off your educational loans. Key to success is knowing what’s available, and choosing the best plan for your family.

Devising a plan

It can feel overwhelming when it’s time to repay your medical school loans. But rest assured: Most physicians start their professional careers in the exact same situation.

Three-quarters of medical school graduates leave school with a significant amount of debt, according to the Association of American Medical Colleges. The AAMC’s survey shows that in the class of 2016, 76 percent of new medical school graduates began their career with loans to pay back, with the median educational debt level for that year’s graduates at $190,000. Thirty-two percent of graduates carry debt from undergraduate school, while 73 percent accumulate debt in medical school.

“Despite the high cost of education, it is absolutely possible to pay off [medical school] loans and have a perfectly nice lifestyle,” assures Julie Fresne, the AAMC’s director of student financial services. “There’s strong job security and excellent income potential with the career.”

If you’re searching for the best approach, start by brushing up on the programs available to you. The AAMC’s website is a good place to begin, and they also offer counseling at many different medical schools. Your medical school may also have financial experts or counselors on site, or provide referrals to trusted advisors.

One thing to keep in mind: The best payback options that may have existed for your mentors or even colleagues not much older than you may actually cost you thousands if used today.

“The menu of options is much broader than it was 10 years ago, when graduates had lower debt and rates were variable,” notes Jason DiLorenzo, founder and executive director of Doctors Without Quarters (, a firm that helps early-career physicians approach their student loan repayment strategically. “The newer income-driven options make the most sense for many of today’s house staff, federal forgiveness is now available, and the private marketplace offers lower rates in many cases.”

Justin Kribs, CFP, counsels medical students and recent graduates at Oregon Health and Science University. He says there’s no one-size-fits-all advice for managing your debt.

But there is a solution to fit everyone’s situation, Kribs assures, and tells students to start by making an evaluation of their goals and plans. “You’ve worked hard to get this far, now look ahead to what is in your future: buy a house, retirement, household obligations? What are your career plans?”

The right plan will be a balance of your own priorities and the best available payback solutions.

Public Service Loan Forgiveness

Erica Marden, M.D.

Resident Erica Marden, M.D., chose a repayment plan that maintained her eligibility for PSLF.

If you’re planning to go into public service, you may be eligible for Public Service Loan Forgiveness (PSLF). Eligible borrowers in this program make 120 qualifying monthly payments toward their federal direct loan over 10 years, after which any remaining principal and interest is forgiven. According to the IRS, the amount forgiven through PSLF is not considered taxable income. Repayments can begin as early as residency. Presently nearing it’s 10-year anniversary, PSLF is approaching the first year anyone could be eligible for forgiveness.

PSLF appeals to Erica Marden, M.D., a second year psychiatry resident at the University of Vermont. She is currently making payments through a PAYE repayment plan.

“These payments will count as qualifying payments toward PSLF,” she says, adding that she hopes to receive forgiveness after 10 years.

While PSLF presents a great opportunity for those whose professional plans align with the program, new participants should proceed carefully. Thoroughly research what constitutes a qualifying position, and remain informed. Changing legislation (or changing jobs to a non-qualifying employer) could affect your participation.

If you’re concerned about Congress changing the PSLF rules, consider making large payments to cover the debt in an accessible vehicle. Then, if the benefits change unfavorably, redirect the investment toward your loans.

The standard route

All federal student loan borrowers are eligible to enroll in the default standard repayment plan. This simply calculates your total amount due over 10 years and derives a monthly repayment amount.

This plan offers the lowest overall cost to the borrower over any other repayment plan when loan forgiveness isn’t an option, but it comes at the cost of a potentially high (and for trainees, likely untenable) monthly payment. For those who carry a low balance, have an achievable plan for making the payments, and aren’t considering career options with loan forgiveness available, this could be a good option.

Butts chose to tackle his loans with the Graduated Repayment Plan, which begins with a lower monthly payment, then increases periodically over the next 10 years. “I was able to make the monthly payment, but most months I planned to add extra. Also at the end of the month, whatever we had left over was used to further drive down the principal.”

Though the standard payment plan can work for some, many physicians seek other, more accommodating options.

Income-driven repayment plans

Income-driven repayment plans are critical for physicians just starting out.

“These plans are based on income, not debt. And if you keep to the plan, after time, the balance is forgiven,” says Fresne. “The payment amount is usually comfortable, something which most residents can make.”

In 2007, as a result of the College Cost Reduction and Access Act, Income-Based Repayment (IBR) was created. It went into effect in 2009. The Pay As You Earn (PAYE) program came later, in 2012. Under these plans, you can calculate your monthly loan payment based on a percent of your discretionary income.

Pay As You Earn (PAYE)

Pay As You Earn (PAYE) usually offers the lowest monthly payment, which is set at 10 percent of your discretionary income. According to the Federal Student Aid website, “your spouse’s income or loan debt will be considered [for PAYE] only if you file a joint tax return.”

After 20 years of making qualified payments, any remaining debt is forgiven.

Federal Student Aid reports that, to be eligible for PAYE, you must be a new federal borrower on or after October 1, 2007, have received a Direct Loan disbursement on or after October 1, 2011, and demonstrate financial hardship.

Income-Based Repayment

IBR determines your monthly payment based on your discretionary income. For borrowers on or after July 1, 2014, payments are based on 10 percent of your discretionary income, with a repayment term of 20 years. Those who borrowed prior to this date are capped at 15 percent for a 25-year repayment term. You must demonstrate financial hardship to qualify. (Most residents and fellows will meet this requirement.) Stafford Loans, PLUS Loans and Federal Consolidation Loans are eligible. Loans refinanced with private lenders aren’t eligible for IBR.

Revised Pay As You Earn (REPAYE)

The most recent option, created in 2015, is the Revised Pay As You Earn (REPAYE) plan. Borrowers who have a Direct Loan and financial hardship may qualify, regardless of the loan origination date. REPAYE calculates monthly payments no higher than 10 percent of your discretionary income. Payment is calculated over either 20 or 25 years, depending on if the loans were for undergraduate study or graduate/professional study.

“The most attractive benefit of REPAYE is that only half of outstanding interest is charged during periods of negative amortization,” DiLorenzo says.

With all income-driven payment plans, you need to supply documentation to verify your income and profile, and resubmit this each year, even if your financial situation hasn’t changed. Failure to do so risks losing your plan and being converted back to a standard plan.

If you qualify for PSLF, payments made under these income-driven payment plans are presently considered qualifying payments.

Balance forgiveness

Another benefit of the income-driven plans is balance forgiveness. At the end of your payback period of either 20 or 25 years (depending on your plan), any remaining debt is forgiven.

While that is enticing, it’s not completely without warning, says James M. Dahle, M.D., founder and editor of The White Coat Investor (, a financial blog for physicians.

“That forgiveness, unlike PSLF, is taxable—meaning you’ll owe a tax bill that could be substantial,” says Dahle. “For most docs with anything but a terrible debt-to-income ratio, the debt will have been paid off in less than 20 years anyway, so there won’t be anything left to forgive.”

Shopping around: refinancing

Interest rates on federal loans are not always the most competitive, so physicians often refinance to a private company to gain a more attractive rate.

A note about refinancing: to qualify for Public Service Loan Forgiveness, you’re required to remain with a federal loan program.

In his blog, Dahle says a determining factor to consider in refinancing is at what point you are in your career. If you’re an attending physician who is not pursuing PSLF, refinancing could save you significant interest. Residents, however, should usually only refinance private loans that are ineligible for income-driven repayment plans (see the sidebar on page 45).

“If you are a resident, the government REPAYE program is often a better choice than refinancing as it effectively subsidizes your interest rate to an amount less than you can currently refinance the debt to,” he says. Plus, once you refinance your loans with a private lender, you cannot go back to the income-driven repayment programs or PSLF.

Frugal living

For Butts, good, old-fashioned frugal living was his route to repaying quickly.

“It may seem like simple advice, but live on less than you earn, use the rest to pay back loans. Make a budget every month with what’s coming in and what’s going out,” he says.

Dahle suggests that, rather than upgrading your lifestyle in parallel with increases in income, you delay lifestyle upgrades, and instead direct new income toward your educational debt.

“It will be far harder to cut back your lifestyle later than never to have upgraded it in the first place,” Dahle says.

Delaying repayment

Rather than defaulting on your loan, which will have lasting negative consequences, some physicians have considered one of two programs that permit temporary pauses in payments: deferment and forbearance.

Deferment is granted based upon certain issues, including financial hardship and status as a student. When loans are in deferment, you do not have to make payments, and you aren’t responsible for any interest that accrues on subsidized loans. You must apply for deferment and supply documentation to support your case.

Forbearance is another option that may sound appealing, but keep in mind that your loans will continue to accrue interest during this time, which will capitalize once the forbearance period ends. Over years, your loan balance will significantly increase.

Lynn M. O’Connor, M.D., M.P.H., now director of the Women’s Colorectal Care Program at ProHealth Care Associates in New York, used forbearance while in residency at The Johns Hopkins Hospital and Union Memorial Hospital in Baltimore. However, while in forbearance, the compounded interest added up— increasing her balance due when it came time to begin paying.

“I needed to put a large lump sum towards my loans just to bring my loans out of arrears [and] get them to a point where they could be refinanced,” she recalls.

That’s why DiLorenzo doesn’t recommend forbearance for physicians starting their careers now. “You don’t want all that interest accruing and capitalizing against you. Loan forgiveness and the reduction of accruing interest is much more favorable using income-driven repayment rather than forbearance or deferment.”

With an income-based repayment plan, DiLorenzo points out, your payment amount in residency can be as low as $0—and still position you for loan forgiveness while reducing accrued interest.

Protecting yourself and family

Whatever your loan balance, consider how your family would manage an unforeseen loss of income.

“It’s important to have a risk management plan in place,” says Kribs, advising that the ideal components include disability insurance, life insurance, health insurance and umbrella insurance. Read your employment contract carefully to understand what is offered, and if any additional coverage is needed.

During loan repayment, the more important elements are disability insurance and life insurance. Some advisors recommend you purchase the maximum amount of individual disability insurance you qualify for, which provides a tax-free benefit of about two-thirds of your income in the event of total disability. They also recommend purchasing 8 to 10 times your income in term life insurance. However, many residents find it difficult to afford as much insurance as they need at this critical time in their careers.

Though no one likes to think about life insurance, it’s essential if your payback plan is based on a dual income.

“Honestly, it is usually the spouse that is under-covered; if the individual with the loans passes away, then the loans could possibly be discharged due to death. However, if the spouse passes away, then the person with the loans still has the loans,” Kribs says.

Buying a home

Educational debt and minimal employment history often present obstacles to new physicians hoping to qualify for mortgages. That’s why lending institutions have created doctor’s mortgages, often offering:

  • A lower down payment, often under 10 percent
  • No required private mortgage insurance
  • An employment contract in lieu of pay stubs as proof of employment

Doctor mortgages may carry a higher interest rate, and typically require you to use some of the bank’s other services, such as a checking account. But if you are set on making a home purchase with less than a 20 percent down payment, it can make a lot of sense, freeing up cash that can be used to pay down student loans.

Most physicians eventually establish a doable method for getting ahead of their medical school debt.

“Use the resources at your medical school or residency to educate yourself as much as you can,” says Marden.

And don’t feel you have to have it all figured out; as your career evolves and federal programs change, reevaluate your situation and adjust your plans accordingly.




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