You + Them: Creating a Deal That Works for Both of You

Understanding what’s negotiable—and what’s not—will help you focus your energy and your conversations.

By Marcia Layton Turner | Fall 2017 | Feature Articles

 

You’ve likely heard that the key to negotiating a physician employment contract successfully is research. That includes learning the industry standards for compensation in your specialty and geographic area, identifying what you bring to the table in terms of experience and expertise, and assessing “the landscape of the organization,” says Jeffrey Vogel, M.D., M.P.H., attending physician in occupational medicine with Cambridge Health Alliance and instructor of medicine at Harvard Medical School in Boston. “People will take you seriously if you’ve done your homework,” he says.

Recognizing that not all aspects of an employment agreement are negotiable is also important. This ensures that you focus on modifying terms that will actually benefit you without coming across as difficult or unrealistic.

Studying potential employers is smart, but it’s only half the equation. It’s also important to consider your priorities, says Bonnie Mason, M.D., retired orthopedic surgeon and founder of Beyond the Exam Room, which educates physicians about business and financial concepts not taught in medical school or residency training. What do you want a position to provide? What’s important to you?

Mason devised a phrase to represent the factors physicians should consider: Your DALAR Profile (pronounced “dollar”). DALAR stands for decision-making; amount of autonomy; lifestyle; altruism or volunteer opportunities; and revenue or income. What do you want in each of these areas? “Employers are clear about what they want [in an employee],” says Mason. It’s important that physicians are equally clear about their professional and personal priorities.

The compensation package

Bonnie Mason, M.D.

Considering negotiating? Start with evaluating your priorities, recommends Bonnie Mason, M.D. What do you want a position to provide? What’s important to you?

Through salary should not be the only—or leading—factor you consider, says Mason, the overall value of the total compensation package is one way to quantify the value a potential employer is offering. It is a way to compare the different employment options you may be presented. The elements of a standard compensation package may include some or all of the following:

  • Salary: Including base pay and bonuses (signing and/or based on productivity)
  • Benefits: Health insurance, life insurance and disability coverage, among others
  • Continuing medical education (CME): Money to pay for required CMEs
  • Leave: Paid or unpaid vacation, sick time, maternity leave
  • Student loan forgiveness/repayment options
  • Moving expenses
  • Cell phone expenses

Start by assigning a dollar value to each item on this list. “Once you understand the basic compensation package, you can try to move the values around,” says Mason. For example, if you don’t need moving expenses paid, you can ask to trade that for something else, like a signing bonus or more vacation time. Or maybe you can ask for more CME money instead of a cell phone plan.

What is not possible to negotiate, says Vogel, are the benefits that are rolled out organization-wide, such as health insurance plan options and 401(k) plans. It is neither feasible nor legal, in some cases, for an organization to create a customized health plan or 401(k) offering just for you. So don’t waste time or energy trying to convince a practice to switch its insurance carrier or up its retirement plan matching percentage. It’s not going to happen.

Know your numbers

You can expect potential employers to be helpful and collaborative because they want to hire you. But that doesn’t mean you’ll get everything you ask for.

Before you start setting arbitrary minimums as far as your desired salary is concerned, it will be helpful to know what the industry standards for compensation are for your specialty, says Vogel. Research what the salary is for the 25th, 50th and 75th percentiles in your specialty to get a realistic framework for what you may be paid. Vogel’s experience negotiating his employment contract was very positive. He was also well prepared for the discussion, having researched appropriate salary expectations for his specialty and the hospital system in advance.

Also find out the hospital baseline average, to know how it compares to other locations. If you discover that the average salary hospital-wide is $300,000, you shouldn’t expect to be offered close to that one year out of residency, Vogel says.

That baseline number can be useful for negotiating if you learn that the organization you’re talking to is currently paying under the 25th percentile. Your goal should then be to try to convince the hospital to pull its entire baseline up in order to increase your potential starting offer. That is an easier sell if your research uncovers that doctors are leaving due to dissatisfaction with the salary.

The conversation might sound something like: “I see that your retention rate is below the national average. Now might be a great opportunity to re-evaluate your baseline in order to retain more of your experienced staff.” That approach turns your recommendation regarding an across-the-board salary increase into a benefit for everyone, including the hospital.

Understand the business side

Understanding how much it costs to recruit and hire you, how much revenue you’ll be generating for the organization, and what you can do to increase that revenue can aid your negotiations with for-profit organizations.

A note about academic contracts

 Jeffrey Vogel, M.D., M.P.H.

Jeffrey Vogel, M.D., M.P.H., suggests researching the industry standards for your specialty’s compensation. Identify the salaries in the 25th, 50th and 75th percentiles to get a realistic framework for what you might expect to be paid.

It is often possible to negotiate an agreement that meets your needs for compensation and benefits and helps you achieve your long-term career goals. The same is true within an academic setting, though the process is different because the role you are applying for is not solely revenue-generating. You’re there to teach and conduct research that elevates the reputation of the hospital or university, in addition to contributing to creating a new income stream for the organization. For that reason, there are fewer elements of the contract that can be modified, less that can be negotiated. But the differences in process are evident from the start.

To begin with, the contract itself is typically issued by the chairman of the department in which you’ll be working, rather than a recruiter. It should outline your responsibilities and the associated compensation, says Virginia R. Litle, M.D., FACS, professor of surgery and chief, division of thoracic surgery at the Boston University School of Medicine. Most initial contracts are for a three-year term and are subsequently renewed on an annual basis.

When applying for your first job in academic medicine, there is not much room to negotiate, says Litle. There are guidelines for what assistant professor positions pay, based on geographic location. There is little room for variation, she says. On the research side, however, it may be possible to request research support on top of your salary. Called “start-up money,” this research funding is a set amount granted for a set period of time, such as $25,000 or $50,000 for three years. Potential new hires can ask for more research funding or for a different length of time, though such funding typically aligns with a professor’s contract term.

You may also be able to ask for more “protected time,” or the time set aside for research. For example, 10 or 20 percent of your workweek may be designated for research work. That’s the protected time. Early in your career, it may be more difficult to be granted more protected time, however, and typically you want to be operating and applying your skills at this stage.

You could also ask for a research coordinator, depending on your research interests. Even if you share the coordinator with others, the role is integral to completing most clinical research for consenting, maintaining databases and processing institutional review board paperwork.

If you’re applying for something other than your first job, you will want to take a step up, which may include seeking a promotion or a program director position. In evaluating your request for a higher salary, more research funding and perhaps more lab space, the university will likely look at your skills and reputation, your research track record, and the number of publications you’ve contributed to, says Litle. “The higher you rise, the more negotiating you can do,” she says.

In academics, some physicians stay at the associate professor level for the remainder of their careers, though 8 to 10 years is more typical, she explains. The speed with which doctors are promoted typically reflects their publication and funding record.

Sometimes to get what you need, you have to make motions to leave. As with any job, you don’t want to do this unless you actually have an offer from another institution that meets all your needs. But having an offer in hand from another university can make you that much more desirable to your current employer and allows for negotiations with both parties, explains Litle. Jumping from one university to another is not considered a negative. According to Litle, “People move around a lot in academics.”

Intellectual property rights

Another difference between academic and hospital or private practice jobs is the rise of contracts demanding rights to supplemental income earned by physicians. It has long been customary in academic settings to include a provision in the contract that stipulates that any supplemental revenue the physician makes while an employee is the property of their employer, says Mason. “However, we’re seeing more private practices, not just universities, writing into contracts that any supplemental revenue that the physician generates—from speaking, intellectual property or stock dividends, for example—belongs to the employer.”

Mason says that [for] “employers [to] collect revenue from work done relevant to clinical responsibilities and patient care is reasonable.”

After all, you are their employee, she points out, and most employment contracts lay claim to new ideas developed during the workday. In the case of an independent idea, however, you may want to claim ownership.

In general, you “want to retain the right to create, innovate and problem-solve” for your own benefit, she says. “Practices are often willing to negotiate this point,” she says, but you need to be aware of it and how best to modify it to meet your personal goals and objectives.

Terms to understand

Beyond the compensation package, there are other elements of your employment agreement that you’ll want to hone in on, says Mason. The big three include duties and responsibilities, noncompete clauses and termination clauses. These are sections that you will be unable to remove completely, but you may have room to ask for minor changes.

Duties and responsibilities. In this section you’ll find information on the amount of time you’ll spend working each week, the frequency of call you’ll be required to take, whether you will have time for research and other specifics about your job responsibilities.

Though you can’t negotiate basic responsibilities, such as seeing patients or teaching hours, you may be able to ask for less call—or more call in exchange for more admin support.

Noncompete. Most practices won’t negotiate this clause out completely. However, you can ask for the terms to be reasonable in scope and duration.

For example, not being permitted to practice within a 10- to 25-mile radius rather than 25 to 50 miles, or having the noncompete in place for one year rather than five.

In many cases, the willingness of a practice to negotiate may hinge on the population density of the area. In larger cities, the scope of the non-compete can be smaller, due to the larger number of patients in a small geographic area, whereas in more rural practices, the non-compete radius may be larger because there are fewer doctors in general and your moving practices could cause a major shift in the marketplace.

Termination. Most contracts reserve the right to terminate you without cause, just as many states are employment-at-will states that require no cause for termination.

You can ask, however, to be given a notice of termination within a certain number of days, just as you may be required to give a 90-day notice before leaving.

You should also ask for payment of tail malpractice insurance to cover any claim made after you leave; payment is typically due within 90 days.

While you may be able to modify some of the specifics surrounding these elements slightly, you will not be able to change them materially.

Tread carefully

Though many aspects of your employment agreement are negotiable, attempting to negotiate every little detail “can make an employer leery,” cautions Steven Jacobs, physician recruiter with WellSpan Health in York, Pennsylvania.

You can ask lots of questions and push back on some requests, but not on all of them. “Three or four requested changes are typical for WellSpan,” says Jacobs. “More than that and we’ve got a problem. That’s a red flag to the practice.”

At that point, you risk coming across as very difficult to deal with, and employers may decide you’re just not a good fit.

“Ninety-five percent of the time, contract negotiations go smoothly,” says Jacobs. Which means that odds are good your negotiation will go just as well, as long as you don’t nitpick.

Pick your battles. When something is truly important to you, make it clear that you’re pushing hard for the change because you intend to remain on staff for many years—so terms will impact you for years to come.

In the end, “everyone wants the same outcome,” says Jacobs. So “be collaborative in the process, not adversarial…. The negotiating process is not there to hurt you,” it’s there to help you get what you need to be successful in your career.

 

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Moving for work? Read this first

Physicians looking to relocate for a new practice have even more to do throughout their job search. This guide breaks it down.

By Karen Edwards | Feature Articles | Summer 2017

 

Janet Young, M.D.

Janet Young, M.D., relocated twice in four years—once from California to Chicago, and once back.

For Janet Young, M.D., an emergency medicine physician, it made sense to relocate. The large group practice where she worked had offered her an opportunity at its Chicago location that she knew would benefit her professionally in the long term. So in 2008, she packed her bags, and along with her two preschool-aged children and an au pair, moved from Oakland, California, to Chicago. Her husband remained in California a while longer.

“I didn’t know anyone in the Midwest. I’d never even been there,” Young says.

The move would not be a long-term engagement. Less than four years later, Young and her family relocated again, back to Oakland.

Young is hardly alone in this relocation exercise. New physicians who train far from family and friends often return home once their training is complete. And more and more physicians are choosing to relocate even after a few years in practice. A 2016 report issued by health care data analysts SK&A found that nearly 14 percent of health care providers made some type of professional move within the past 12 months—keeping pace with what the U.S. Census Bureau says is the percentage of Americans who relocate each year.

It’s possible that new physicians relocate in even higher numbers. In 2011, Today’s Hospitalist stated that as many as 70 percent of physicians change jobs within their first two years. Jeff Hinds, president of the physician consulting firm Premier Physician Agency, believes this trend may be because, “early in their careers, most young physicians do not know how to fully evaluate their job options, nor at that point, even know which practice settings or locations are most conducive to meeting their professional and personal goals.” But relocating closer to family, or even moving for more opportunity, like Young, can also explain the frequent exoduses.

As anyone who has ever moved can tell you, however, relocating is not easy. That’s why it deserves careful consideration. Your experience, of course, will be unique, but their suggestions may provide you with a road map to make your relocation a bit easier.

1. Know your contract

Alexander Zaslavsky, M.D.

Alexander Zaslavsky, M.D., recommends applying for a license in your new state as soon as a relocation is in your future. It’s a process that “can take up to four months or longer,” he says. “Start early.”

First, understand the consequences of leaving your current job. “Physicians need an adequate exit strategy before making the decision to relocate,” says Hinds. “They need to review their contracts to fully understand the termination process and potential risks.”

It’s possible you’ll have to return at least a portion (if not all) of any signing bonus if you leave before your contract term is up. “Responsibility for purchasing malpractice tail coverage could also be tied to completion of the full contract term,” Hinds adds.

Any of these factors may play a part in your decision to leave—or at least in your timeline to relocate. “Seeking legal advice to help determine your ideal exit strategy is very important,” says Hinds.

2. Visit before you decide

In other words, “Don’t Skype the interview,” says Edie Webber, owner of Pinnacle Relocation Services. “You really have to go and visit in person.”

That’s the only way you will pick up on what Webber calls intangibles—the feel and culture of a place and the people who live and work there. “A place should make you feel welcomed and wanted,” says Webber, and that’s especially true of your potential workplace. “You’re going to spend a lot of time here with these people, so make sure you’ll feel comfortable before you choose to relocate,” she says.

A visit is also the best way to learn about the community where you hope to live. “Learn about the schools, about any work opportunities for your spouse if he or she will also be looking for a position, and seek out information about any cultural or recreational activities that you and your family enjoy,” says Hinds.

And just because you have lived in the area before doesn’t mean you can skip this step, says Ron Davis, senior vice president of MD Preferred Services, a website that helps physicians find professionals like realtors, attorneys and accountants. “Even if you lived or grew up there, unless you’ve made recent trips back to the area, don’t assume the place you left will look the same.” As he points out, training can take a while, and if you’ve added a fellowship on top of that, chances are the place has changed. “You need to visit it again if you haven’t seen it in a while,” he says.

Ying Hui Low, M.D., an anesthesiologist who recently moved from North Carolina where she trained to Lebanon, New Hampshire, suggests bringing along the important people in your life to visit a new location. “You want people to visit you, so it lets them become comfortable with the area, too,” she says.

3. Establish a timeline

Relocating involves a lot of moving parts happening simultaneously. Once you have the move scheduled on your calendar, you’ll need to establish a timeline so the transition will be smooth.

“One of the first things to do is apply for your state license,” says Alexander Zaslavsky, M.D., who relocated from a hospitalist job in New York City to a new position in Maryland—then, when his employer opened a new location in New Jersey, he moved again. “The licensure process can take up to four months or longer,” he explains. “That’s lost time and income if you delay the process. Start early.”

This is also a good time to start your paperwork. Eleanor Hertzler, recruitment coordinator for Patient First, says that three months is generally a good rule of thumb for the credentialing process. Credentialing and licensing timing varies from state to state.

“The process is very state-specific, so do some research for the state you’re moving to and plan accordingly,” she says.

“You should also notify your current employer two to three months in advance,” says Jeffrey Tsai, M.D., a regional director with CEP America who has relocated twice—from Chicago to Atlanta and then home to California. “At least let them know you’re thinking about a move.”

Your professional liability carrier will also need to know of your move, and, if you’re currently in practice, don’t forget to notify the Drug Enforcement Agency, any vendors you work with and of course, your patients.

You’ll also need to find a place to live. Allow about a month for this step, Tsai says.

Other factors to include in your timeline: Time to locate a job for a working spouse and time to check out schools. “A lot of this can be done online,” says Debra Phairas, president of Practice & Liability Consultants. “But of course you and your spouse will want to visit any potential employers and schools in person.”

Young offers one more “must” for your timeline if you have children. “I was lucky that my au pair moved with me, but if you’re relocating, establish your childcare option in advance,” she says.

Finally, consult with movers, realtors and recruiters. These experts can help you fine-tune your timeline.

4. Dive into the area

Yes, you’ve visited the area, but now is the time to explore it.

Each time Tsai moved, he took a month of vacation, he says. He used part of that time to travel. “When you’re working, you don’t have time for many vacations,” he says. But that month also allowed him to explore the area thoroughly, to look for a place to live, and to unpack.

Low says she also vacationed in the area prior to relocating. “After all my exams were over, I visited the area and the hospital and took a look around both,” she says. “Check out the amenities, things that are important to your lifestyle.”

By staying in the area, you’ll not only become familiar with various neighborhoods but also gain a better idea of the real estate market and what kind of properties might be available in your budget. “You can [also] determine commute times,” says Low. Just because a house appears to be close to the hospital doesn’t mean you’ll be able to get there faster if traffic in that area is heavy at the times you’ll travel, Low explains.

Hertzler says when she works with relocating physicians, she gives them a list that’s filled with helpful resources. “As recruiters, we don’t endorse any outside business, but we give our physicians referrals for things they may not think about, like mechanics, vets and dentists,” she says. If you’re checking out an area, you might want to put together your own list of frequently used services, then look to see what’s available in the areas where you’ll spend most of your time.

5. Consider living arrangements

Finding somewhere to live, of course, may be the biggest challenge facing the relocating physician.

Zaslavsky suggests renting an apartment or small home for a year. “Make sure this is the place you want to be before buying a house,” he says. “You may find you don’t like the job or the area, then what?”

Hertzler agrees. “If you’re not familiar with the area, it’s a good idea to rent a place for six months to a year to see if this is where you want to live. You may get here and decide you like another part of town better. Unless you know the area, I’d suggest renting when you first arrive.”

One practical, economical option is to follow Young’s path. “I rented a furnished apartment for a year,” she says. That way, there was no need to move furniture twice when she decided to move somewhere else.

Webber, however, says that, depending on the market, it can be much easier and less stressful to find a home ahead of time. “In tight markets, shopping and making offers from your hotel can create a lot of stress. If you can arrange a home shopping tour ahead of time, before the move, then the contract to close can be done during your absence,” she says.

“If you rent first with the intention of buying a home in a year, the home may actually cost you more,” Webber continues. If, for example, you relocate to an area where there is a demand for housing, which is often the case in cities, chances are prices will rise over the year—while your options narrow.

If you’re selling a home before you move, Webber also cautions you not to rely on “off-the-cuff” estimates of your selling price. “Don’t assume you’re going to make a good profit from the sale of your house,” she says. Sellers often underestimate their costs, in addition to any buyer’s expenses they may have to pay. “Get accurate numbers so you know what you will net when you sell,” she says.

While you’re gathering information, it’s also a good idea to sit down and prepare a projection for all the expenses you’ll run into when relocating, says Hinds. In addition to moving costs and buying and selling a home, there will also be costs for trips to the area and for licensure. “Also consider costs of daycare and even the costs of living in the new location,” he says.

6. Make your move

Now that you’ve visited the area, established where you’ll live, seen to your paperwork and any childcare needs, it’s time for the move itself.

Low said the move, for her, was easy. “I didn’t have any furniture or big items to move.” But for many, a move can be stressful.

“Changing location is listed as one of life’s biggest stress factors,” says Webber. “Hiring experts can help.”

She suggests you talk to your employer’s human resources department and ask for referrals. Hinds agrees: “Most hospitals have realtor partners they work with and can recommend,” he says. Phairas adds that office and group practice managers can also refer you to realtors, movers and other experts in the area.

Young, however, took a more self-directed approach: “I Googled realtors in the area,” she says. And Tsai credits his wife for taking on most of the house-hunting chores. For Zaslavsky, “My wife and I were a team. We looked at homes together.”

“Most physicians are experts in their field, but novices when it comes to relocating,” Davis says. “And health care is way behind corporate America in successfully relocating people.” Hospitals can only do so much. “They may refer you to a realtor and tell you where to get three bids for movers, then you’re on your own,” he says. But relocating involves much more. “A consultant or relocating company can bundle services like mortgage contacts, financial advisors and attorneys,” he says.

Will you be reimbursed for your relocation expenses? It depends on the employer and the location. Hertzler says employers generally help relocating physicians by putting together a benefit package that will ease moving costs. Whether that’s a signing bonus or a stipend depends on each situation.

Tsai says his employer did not help him with moving expenses. “But our company does offer a loan to assist with the move or it sometimes offers a signing bonus,” he says. A typical amount of the loan or bonus is $10,000—which seems to be the going rate for relocation expenses when they are offered, adds Hinds.

Says Webber: “You never know whether or not you’ll be reimbursed unless you ask.”

7. Get settled

By now, you’ve found a home, unpacked your boxes, and are starting to know your way around the hospital and maybe around your new community as well. But don’t stop there.

“This is the time to network,” says Phairas. Go to hospital meetings to meet your colleagues, and to medical and specialty society meetings to meet other physicians in the area, she says. These physicians can become friends or referrals, and they can also let you know about restaurants, parks, hiking trails and other things to do in the community in your area of interest, or maybe those of your spouse or children.

“Networking is important, and not just from a business perspective,” she says.

Hertzler says Patient First often arranges a dinner where relocating physicians can meet with other physicians from the local Patient First urgent care centers. “It’s a time to meet colleagues and their families, and to learn more about the workplace and the area,” she says.

It’s also important at this time to keep the happiness of your family in mind. You may be delighted with the new location and job, but if your spouse or children are having a miserable time of it, you may have to re-assess your priorities.

“Relocating can be a real culture shock for children,” says Davis. “It’s why your family’s needs and feelings must be considered before you actually make the move.”

Young says she gave herself a timeline. “I told myself and I told my family that we’ll give the location and the job two years. If after that time we weren’t happy, we’d move back. I think it’s really important to have an exit strategy like that, an escape route,” she says.

Even more essential, however, is taking time to decide if the move is right for you. “Before you move, you have to sit down and ask yourself why you’re making this move,” she says. “If you’re not sure why you’ve put yourself and your family through this, it’s not likely to work.” But you can’t let fear of the unknown and the occasional unpleasantness stop you either. “Don’t be afraid to relocate,” says Young. “There’s no advancement without risk. You’ll become a better person for it.”

 

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Picking Your Position

Feature Articles | Summer 2017

 

You’re nearing the end of your medical training, and suddenly your email inbox is flooded with messages from physician recruiters alerting you to jobs that may interest you. Then the phone calls start, inquiring about your potential willingness to move from north to south, from east to west —and everywhere in between.

Though at first it can be exciting to feel so popular, that euphoria can turn to anxiety as you anticipate making long-term decisions about your career and lifestyle. But being in demand is a plus, as long as you can convert a practice’s initial interest into a job offer you’d like.

Your goal should be to express interest in certain opportunities without eliminating the possibility of others that may also turn out to be a good fit—while turning down those you’re not seriously considering.

Fortunately, there are strategies you can use to zero in on the opportunities you’d most like while not damaging the possibility of future work. That’s the trick to handling multiple expressions of interest in a professional manner.

Determine Your Career Priorities

Chandler Park, M.D.

“Perfect” may be attractive, but finding your “best fit” is a better goal in your job search. “The key is to remember that there is no perfect job and to keep in mind the factors that are most important to you and your family,” advises Chandler Park, M.D.

“It’s kind of a dance,” explains Chandler Park, M.D., board-certified hematologist and oncologist and clinical assistant professor at the University of Louisville School of Medicine. “The key is to remember that there is no perfect job and to keep in mind the factors that are most important to you and your family.”

Some of the major factors many doctors weigh—about both the job and the city—include:

  • Salary
  • Geographic location
  • Climate
  • Outdoor activities
  • Lifestyle fit
  • Public school quality
  • Proximity to an airport or train line
  • Call schedule
  • Academic practice, hospital employment, or private practice
  • Research opportunities
  • Opportunities for mentoring

Park says he has heard it said that, of the three overarching things doctors can choose from—money, lifestyle and location—only two are possible. That is, you can’t get your desired location and an exceptional salary and lots of free time for hobbies; you must pick your top two. For this reason, he put location—specifically, being closer to his hometown in Kentucky—at the top of his requirements, followed by the lifestyle choice to work in a hospital setting. Money was not a determining factor for him, though it was for several of his classmates. In fact, one colleague moved several states away in order to maximize his starting salary.

Regina Bailey, M.D., J.D., facility medical director at First Choice Emergency Room in Humble, Texas, says compensation was her primary concern when she took her first job. But she also knew it wasn’t a position she would have to keep long-term. “There is a huge shortage of emergency room doctors in Texas, so there are always options being thrown at you,” explains Bailey, who is also a clinical assistant professor at the University of Texas Medical Branch (UTMB) in Galveston. “So there is less pressure to choose something that’s perfect for the long term.”

Still, Bailey advises physicians to pursue positions that are good fits for their goals and lifestyles. For her, that meant good backup and flexible hours. With her full-time position squared away, she began looking for part-time work to fill in around her primary job. She found it two hours away at UTMB. Because Bailey had been upfront with the facilities where she interviewed for full-time work, she knew there would be no non-compete issues or scheduling problems if she decided later to take on additional part-time work. By being completely honest about her goals from the start, Bailey found the best fit for her.

Be Open to the Possibilities

Abhishiek Sharma, M.D., an attending neurosurgeon at Honor Health System in Scottsdale, Arizona, advises figuring out what you want in a position while keeping an open mind about other types of opportunities that may also be a good match.

The number of neurosurgeons, he explains, has not changed in the past few years despite increasing demand. The American Association of Neurological Surgeons confirms this trend, reporting in 2008 that, though the U.S. population had increased by 20 percent in the previous 15 years, the number of practicing neurosurgeons had remained static over the same period. The result of such a shortage, says Sharma, is that neurosurgery residents receive about three offers each.

Some of those interviews and resulting offers may be in locations you hadn’t initially considered—and that’s OK. The differences you encounter among areas and organizations can enrich your options or confirm your initial vision.

Learn How to Juggle

Regina Bailey, M.D., J.D.

Regina Bailey, M.D., J.D., found a good work/life balance by being open about her desire for a role with good backup and flexible hours.

There’s no question that physicians are in high demand. As a result, you may find yourself fielding inquiries from recruiters and hospital systems before you’ve done much evaluation of your career priorities and goals. Sharma reports having received an average of one or two emails per day listing positions available in neurosurgery. Bailey, too, received plenty of information on available jobs.

The information you’re sent will vary from personalized, detailed inquiries to brochure-like information. Much of the initial contact depends on the recruiter’s style, the organization’s approach, the confidentiality of the search, the urgency of the need, and other factors. After you’ve responded with interest, you may be invited to submit your CV if you haven’t already. A screening call is generally next, during which the recruiter continues to assess your fit and qualifications. If all goes well, more phone discussions or an invitation for a site visit may follow.

If sitting back and waiting for news of an opening in the city you want seems too reactive, be direct and go on the offensive—it can work.

One of Sharma’s friends decided to be proactive about his job search to increase the odds of landing a position in his hometown. Instead of sifting through incoming emails and taking phone calls as they came, the physician called the town’s main hospital and spoke with the in-house recruiter.

He said, essentially, “I know you’re not advertising an open position at the moment, but would you be interested in discussing future openings?” Given the low supply of available candidates in the specialty, the hospital was only too happy to begin a conversation. That call resulted in subsequent phone calls and, later, an invitation for a site visit, followed by negotiations for a new role created just for him.

Sharma looked at almost 10 places over the course of two years, narrowing that list to three based on geography: one in Wisconsin, where he was in residency; one in Chicago; and one in Arizona, which he ultimately took. All three jobs were appealing, so to break the tie, Sharma ranked each position based on three main factors: geography, the job itself, and intangibles about the opportunity. Then he weighted each factor, with geography counting for 30 percent of the decision, the job, 50 percent, and the intangibles, 20 percent.

With that formula, it became clear that Arizona was going to be the best fit for him.

Park interviewed at 12 places during the first round, focusing most on where he could become part of the community and be closer to family. He then whittled the list to three practices where he was confident he could be happy. After the interviews, he sent thank you notes to all the programs for taking the time to meet him; he was completely honest about whether he wanted to consider pursuing employment there.

“Some recruiters were surprised by my forthrightness,” he says, but he didn’t feel comfortable keeping hospitals hanging after he had determined they were not the right choice.

He advises physicians to be completely honest about where they are in their decision-making processes. Doing so enables you to uphold your professional reputation and avoid burning bridges you may need later in your career, especially since most physicians eventually move on from their first jobs.

That said, it’s also important to let a potential employer know when you just need more time. It’s OK to tell a recruiter you want time to check out more options. “No one goes on one interview and decides that’s it,” says Park. He says the typical number of subsequent interviews is two or three.

“Telling other practices that you’re considering other options doesn’t make you less appealing,” he says. “It actually makes you more appealing.” It means you’re a desirable candidate.

Simon Gordon, director of search operations and physician recruitment at Healthsearch Group, based in Westchester, New York, advises physicians to explore their options—but not to go overboard. “You can have too many [options],” he says.

If you want to have initial discussions with several organizations, that’s fine, but once you have enough information to determine you’re not seriously interested in a position, don’t string that organization along. “Don’t pursue a role you know won’t ever be your final choice,” says Gordon. That only leads to wasted time (yours and theirs) and potential irritation. For this reason, limit your site visits to only those facilities that are serious contenders.

Sending Signals

Investigating job opportunities is not an all-or-nothing decision, says Park—it’s a process. After an initial on-site interview, you may be invited back for a second interview. This lets you know that the hospital or practice liked you. If you also liked what you heard and saw on the first visit, you can accept the second.

“This allows you time to learn more about the program and tells the hospital that you’re interested. It lets them know how serious you are,” says Park. Similarly, declining a second interview conveys that you didn’t feel there was a fit and aren’t interested in continued conversations about the job. Don’t pretend to be interested once you’ve decided that you aren’t.

After an on-site interview, a recruiter may ask for feedback about the job opportunity. They may ask, “Is there anything you don’t like about our program?” Park strongly advises against getting specific about disadvantages you perceive early on, but instead wait for a second visit to bring up your concerns with their current physicians. If the negatives are significant enough to cause you to lose interest right away, however, consider reaching out to a physician to ask for their honest input about your concern.

Gordon recommends being transparent and honest throughout the process. If you saw something on your visit that concerned you, bring it up. Ask questions to better understand the internal operations; strive to learn more about the day-to-day activities you’d be part of. And when asked for feedback, it’s important to express enthusiasm and to explain why it’s appealing and what value you can bring (if you think you’d like to work there). You can let the recruiter know that you’re considering other opportunities as well, but conveying enthusiasm about the job is essential if you want it, he says.

Fielding Offers

Once you have an offer from a facility, it’s time to get serious about making a decision. Sharma took the opportunity to provide feedback as a step toward negotiating a more advantageous offer. To each of the three hospitals he was considering, he pointed out what he really liked and what, in particular, was holding him back from accepting their offer. He also asked if they could do any better. His script went something like this:

“I have an offer from another hospital, but I really like the opportunity at [your hospital]. One thing that concerns me is the amount of call you require. Would you consider giving me a physician assistant to reduce the amount of call I have to do?”

Or:

“I have an offer from another hospital, but I really like the opportunity you’ve presented. One thing that concerns me is that the salary you’ve offered is substantially lower. Can you do any better, or can you offer a signing bonus or cover my moving expenses?”

Gordon recommends letting a practice know if you have reservations about any aspect of working for them before you make your final decision. “They’ll be frustrated” if you tell them after you’ve accepted another offer and your complaint was something they could have addressed, he says. Long-term, that reaction could limit future opportunities at the practice, should you ever change your mind.

“Relationships are of utmost importance during schooling and the hiring process,” says Gordon. Developing and nurturing relationships with decision-makers, even if you don’t ultimately choose to work at their facility, can be beneficial for your career, especially if you determine you’d like to make a move a few years down the road. For that reason, it’s important to be considerate during your job search. “Don’t burn any bridges,” he underscores.

After the second visit, many physicians are offered a contract. Park recommends responding right away if you receive a preliminary term sheet. After several months of conversations, on-site visits and discussions, both parties should have a good sense of whether there is a match, and making a decision should not take several more months, says Gordon.

Timing is Everything

Although it can take weeks or months to get an offer, once you receive a contract, the hospital or practice will expect a decision within about a week. “They want an answer quickly,” says Gordon. As they’ve been carefully vetting you, you’ve been vetting them and must be interested in being employed there. Once you receive an offer, the decision to accept should be fairly easy—at least that’s the hospital’s assumption. Some physicians think that they can take their time deciding because the practice took so long to make their decision, but that’s not the case. “You have to be ready to move quickly at the end,” Gordon says. By the time they’ve extended an offer, they assume you’re as excited about working there as they are about hiring you.

When you’ve narrowed your choices to the top two or three, it’s important to let the other practices know when you’ve received an offer. That gives them the opportunity to expedite their decision-making and potentially make an offer as well. Some hospitals, however, can’t move as quickly, Gordon points out, and you may have to decide between accepting an offer in-hand and waiting for an offer that may never come. “You need to understand that, until you get a contract or a signed offer letter, it’s still just an opportunity, which could get derailed,” he warns. It’s not concrete until you get that offer. Given the amount of time required to secure a medical license and credentialing in other states, Park recommends that physicians start their searches early—like the middle of their second-to-last year of residency.

If you don’t start your search until the beginning or middle of your fourth year, you may not be able to start working until months after you finish residency. “The whole process is slow,” Park says, though some states are slower than others.

In neurosurgery, whose residency lasts seven years, physicians start receiving information about jobs in their fifth year. Since it takes 12 to 18 months to recruit a neurosurgeon, says Sharma, it’s rarely too early to start reviewing and evaluating opportunities.

Although much of the job hunt seems reactive—receiving emails and phone calls and following up with those that are of interest—physicians have a lot of control in the process.

Rising demand for health care services means physicians are often in the driver’s seat when it comes to considering job opportunities. This is especially true in locations such as Mississippi, Idaho and Alaska, which have the fewest physicians per capita according to a recent report from financial advising website WalletHub.

“Doctors have a fair amount of bargaining power,” confirms Sharma. As long as you stay in touch with the practices you’re interested in, communicate about where you are in your job hunt, and are honest about which positions may be a good fit, you’ll quickly become adept at juggling multiple job opportunities successfully.

 

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What’s Your Interview Style?

Physicians who know their natural conversation style are better able to tailor their interview skills.

By Debbie Swanson | Feature Articles | Summer 2017

 

Were you the one who always took charge of group projects in school—or the quiet confidant whom people drew aside for advice? Do you deliberately limit your social interactions, or do you become more energized when you spend time around others? Whatever your preferences, recognizing your natural tendencies and personality traits—and knowing how to make them work for you—can go a long way toward job interview success.

Start with a self-assessment

You’re probably already aware of your strengths and weaknesses, but when you’re facing a round of interviews, it never hurts to do a little introspection. A simple, informal method is to reflect upon what you already know about yourself. What have teachers always said about you? Friends and family? Which situations make you feel confident and comfortable, and which throw you out of your element? Reflect on your behavior patterns with a constructive, yet critical, eye.

If you need more direction or are interested in a more formal assessment, there are many personality assessment tools available. One is the Myers-Briggs Type Indicator, based on the work of psychiatrist Carl Jung and co-creators Katharine Briggs, and Isabel Briggs Myers. This popular tool evaluates personality based on the following four areas:

  • Extraversion or introversion: whether you prefer to spend time in the outer world or your inner world
  • Sensing or intuition: whether you like to focus on information gathered through your senses or apply your own interpretation and meaning to the information you receive
  • Thinking or feeling: whether you prefer to deal with principles and facts or people and circumstances when coming to a decision
  • Judging or perceiving: whether your goal is to reach a decision or explore information and options

Another popular assessment is the Big Five personality traits, developed by several different researchers over many years, starting with D. W. Fiske in 1949 and continuing through Robert McCrae and Paul Costa as recently as 1987. This theory focuses on five general areas, sometimes referred to with the acronym OCEAN:

  • Openness: characteristics such as imagination, insight, and abstract thinking
  • Conscientiousness: your propensity for organization, attention to detail, impulse control and goal-directed behaviors
  • Extraversion: whether you gain or expend energy in social situations
  • Agreeableness: your levels of cooperation and competitiveness among others
  • Neuroticism: your emotional resiliency and stability

Once you’ve assessed your personal style—whether formally or informally—consider how to make the most of your strengths and adjust for your weaknesses.

Are you all ears?

William Silber, M.D.

Active listening is a helpful interview skill. “People are willing to tell you what you need to know, if you give them the opportunity,” says William Silber, M.D.

Perhaps you’re known for being a good listener among your friends, and your patients seem to relax and readily share with you. Even so, being a good listener in an interview can be difficult. In addition to having nerves working against you, your mind may be distracted—anticipating the next question or meeting or mulling over the last topic discussed.

William Silber, M.D., a gastroenterologist from Dallas, makes a dedicated effort to focus on his listening skills at an interview, and he takes it a step further by asking targeted questions to draw out the information he needs.

“People won’t hear you until they’ve been heard,” Silber explains. “I want [interviewers] to tell me their situation, what they’re looking for from me, so I know if I can fulfill that. People are willing to tell you what you need to know, if you give them the opportunity.”

To fine-tune your listening skills, brush up in everyday life; listen more attentively to co-workers, your partner, even the radio. Another useful strategy is to practice mindfulness, which teaches you to remain focused in the moment.

Even with the best intentions, don’t panic if your listening efforts are derailed, either due to a wandering mind or an unexpected tangent. Refocus on the speaker, perhaps paraphrasing or asking a question to zero in on the topic again. “So you’re saying that… ” is a good phrase to use to steer the conversation back to the original topic.

Do you go after what you need?

Malika Fair, M.D., M.P.H.

Malika Fair, M.D., M.P.H., identified a key question she wanted answered during the interview process. Prioritize your questions so those most important to you are answered first.

Some people find it easy to ask questions; others proceed with caution, concerned they’re being a bother or coming across as too assertive. But asking questions—even the hard ones—is an expected part of any interview.

Malika Fair, M.D., assistant clinical professor and emergency medicine physician at George Washington University and senior director of health equity partnerships and programs at the Association of American Medical Colleges, recalls that when she was interviewing, she raised a question that provided valuable insight into an area important to her.

“I asked them to describe their commitment to diversity,” she said. “Not only did it get them to explain their commitment, but it enabled me to evaluate how comfortable the person was in answering the question. If a place looked great on paper, but the person was uncomfortable with that answer, that gave me valuable information.”

Fair says this input provided her with additional helpful criteria for ranking her options and determining where she’d feel most comfortable.

Experts agree that you should always arrive armed with a solid bank of questions. In addition to showing that you’re well prepared, having questions on hand ensures you’re ready for whatever is thrown your way.

Do you tend to ramble?

Being easy to talk to can be an asset in many walks of life, but in an interview, tread carefully—verbose responses can hinder success.

“If you provide too many details [or] your stories are too involved, you can’t tell if they’re interested or if they’re bored. Don’t overload them,” suggests Silber.

Whether you have the gift of gab or tend to ramble under pressure, practice providing short, direct answers to some common interview questions. Key in on your point early on. Studies show that the average listener remains focused for about 90 seconds.

Being observant can also help you gauge if you’re talking too much. Watch for clues that someone isn’t really listening: robotic nodding, detached responses such as “hmm” or “uh huh,” or stolen glances at the clock. Have some strategies in mind to pull yourself back if you digress—like smiling, pausing and revisiting the question asked. “So in summary, my favorite rotation turned out to be….” Or simply wrap up your answer, leaving the ball in their court to request more details.

Are you hard to get to know?

Some people have no trouble opening up and sharing personal details, while others are naturally tight-lipped, especially in a professional setting. But if you keep your conversation only on academic and professional topics, you’re missing the chance to make yourself stand out as a unique candidate.

“We need to understand what makes you tick,” says Laura Screeney, director of physician recruitment at New York-Presbyterian Hospital in New York City. “There are good jobs from coast to coast, so we want to know why us, why you’re here. The CV doesn’t tell us your whole story.”

If it’s hard for you to open up, plan ahead. Identify a few topics you’re comfortable bringing up that lend insight into you as a person. For example, location can be a starting point for conversation, says Screeney. Share what attracts you to the area at hand (or why you want to stay there)—whether you’re drawn by your passion for the ocean, making a move nearer to family or relocating to accommodate a loved one’s job.

“Showing your ties to the area is always helpful,” agrees Screeney.

Another talking point can be a pertinent fact or two about your family or significant others: children’s extracurricular interests, loved one’s jobs or educational pursuits, or special child or senior care arrangements. This information not only gives a glimpse into your world, but often prompts others to share details that could aid in your decision-making process.

“I once met with a candidate who mentioned his daughter was a talented dancer,” recalls Screeney. “My niece was heavily involved in this area, and I was able get information from her about teachers in the area and pass this along to him and his wife.”

Even if you’re much more comfortable sticking with your credentials, you can still do your best to bring your personality to life in these conversations.

“Use real-life examples or a personal story in your responses,” suggests Fair. “For example, if you’re asked [how] you deal with a difficult patient, you could give a canned answer—‘I keep my voice low, stay at eye level,’ etc.—or you could share an example: ‘Well, a couple weeks ago, I did this….’”

Though you shouldn’t go overboard about your personal life, do offer a glimpse into your non-work personality.

Do you always do your homework?

Research and preparation are second nature to some people, while others proudly tout their proven ability to wing it. Whichever has been your standard method of operation, experts agree that prep time is essential prior to an interview.

Christopher Ewing, M.D., emergency medicine physician at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, always goes into an interview armed with knowledge.

“I learned in residency that you really have to understand the people, environment and culture of a place,” he says. “Ahead of time, get the interview agenda to find out who you’ll meet and look up the names of people on LinkedIn and staff bios. This helps you anticipate the needs of the people you’ll be meeting.”

In addition to learning the who’s who of people you’re meeting, delve into the company—read about their strategic partners, special interests, planned growth or future direction and values. Look for both things that attract you and things you question.

Ewing recalls one interview where he used a potential concern to raise questions and generate a useful conversation.

“I used this as an opportunity to ask questions to learn about their process and think of ways to improve it,” he recalls.

Your research can also provide you with topics for side conversations. Make note of similar backgrounds, shared alma maters or mutual acquaintances, and pull these out when there’s a lag in conversation.

Are you a perpetual pleaser?

Do you often agree to things you don’t really want to do? Are you more likely to smile and nod politely than stir up controversy? Focusing too hard on trying to please can thwart progress in an interview. It doesn’t support a meaningful exchange of information and risks leaving your interviewers with a vague or false impression of you.

“Don’t put on a front and tell us what you think we want to hear. Answer honestly, even in situations where you think it’s not what we want to hear,” says Justin Sharpe, in-house physician recruiter at Tallahassee Memorial HealthCare in Florida. “For example, don’t be afraid to say, ‘This isn’t my first choice, but…,’ and then go on to tell us why you’re here, what ended up bringing you out.”

Experts suggest initiating further conversation, rather than quickly accepting, when something doesn’t quite mesh with your goals. Ask the speaker to elaborate, suggest a compromise or present an alternative. Your probing could result in a scenario that works better for both of you.

Do you avoid social interactions or seek them?

Do you thrive in group settings, drawing energy from people? Or do you crave time alone to recharge and prefer to work independently? Whatever your style, your comfort in social interactions can be a factor in an interview.

If you’re an introvert—with a preference for independent tasks and “me time”—your quiet, composed nature can be an asset in a professional setting. But at an interview, that same nature may be misinterpreted as stand-offish or detached. If you’re an introvert, try these tips:

  • Watch your body language. “Sit straight up, lean forward toward your speaker, and appear engaged and interested. Keep eye contact,” suggests Fair.
  • Schedule wisely. Book events at the time of day that works best for you and try to build in a window for down time to collect your thoughts and refresh prior to the meeting.
  • Show that you’re not all about isolation. Bring up examples of past successful team activities.

If you’re an extrovert—comfortable in groups and happier with exposure to people—an interview may seem like your ideal setting. But your social confidence may make you seem domineering or self-important. If you’re an extrovert, consider these factors:

  • Don’t go overboard. Keep your answers focused. Don’t ramble, go on tangents or hijack the topic.
  • Show stability. Discuss situations that depict your dedication and long-term commitments.
  • Be humble. Touting your strong points may come easily and can be a positive trait. Just don’t take it too far—express gratitude for past opportunities and give credit to people who have helped you.

Whatever your personality, most people find interviews stressful. Get an edge on your nerves through preparation. Understanding and working with your true nature can help you put your best foot forward.

 

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Who are the most important people in your job search?

There is no I in team—or job search. Enlist the help of others in your job search for a smoother process and a better outcome.

By Vicki Gerson | Feature Articles | Spring 2017

 

Allen Kamrava, M.D.

The chairman of his fellowship department helped Allen Kamrava, M.D., find opportunities. “To have someone with his stature speak on my behalf was important,” Kamrava says. · Photo by Rob Greer

Can you think of a person in your life—or perhaps several—without whom you wouldn’t be where you are today? Someone who encouraged you in residency, pushed you in medical school, or told you years ago that you had what it took? Maybe it was a family member, a friend or a mentor.

In the same way that other people helped you get to your current state, the best way to make it to your future goals—whether that’s your first practice or the next point in your career—is by enlisting the help of others. Think of yourself as building a job-search team: Which people should you draft?

Everyone’s team will look different to some extent—it will vary according to your personal contacts and the professional networking you have already begun. But for many, the most important job-search teammates include your residency mentors and colleagues, in-house recruiters, your realtor, your spouse and local physicians.

Let’s take a look at how each of these players contributes to your job-search success.

Mentors and colleagues from training

Your colleagues and mentors from residency and fellowship are well-suited to join your job-search team because they have already been with you in the trenches. They know your interests, they know the field, and they can connect with you all of their own personal connections.

To start, make sure you’re taking advantage of any job-search training or prep that your program already offers, and try to facilitate conversations with colleagues and program directors about your post-residency job-search plans.

During his family medicine residency at Baptist Health in Madisonville, Kentucky, Zeeshan Javaid, M.D., gleaned a lot of advice from both program leaders and colleagues. His program director held one-hour directive sessions every month, covering topics like how to search for jobs, what to look for in a contract, how to determine where you wanted to live and how to interview. The program director also provided information about opening your own practice, including its pros and cons.

Similarly, Allen Kamrava, M.D., a colorectal surgeon in Beverly Hills, California, received support from his fellowship program during his first job search. Though Kamrava now works in solo practice, the chairman of his fellowship department at the University of Pennsylvania made a great effort to help Kamrava find a job early on by speaking on his behalf to find out who was hiring.

“To have someone with his stature speak on my behalf was important, and he helped me find my first position with a wonderful recommendation after completing one year of fellowship training,” says Kamrava.

Residency and fellowship colleagues are also some of your best potential job-search teammates because they are often job-seeking at the same time as you.

“Although it sounds like it’s competition, it’s not,” says Kamrava. “Others may know about opportunities through their searches that can help you and [may be able to] put you in touch with a job they didn’t take.

Javaid, too, received support from his colleagues. Six of his fellow residents were conducting job searches at the same time he was. They all shared their information and experiences so that others could see what kind of offers were coming in.

His friends in urgent care also provided good advice, even discussing what types of stipulations and financial offers were in their contracts. “We would discuss overtime and moonlighting policies at the hospital [or] clinic,” he says. “Some places don’t offer moonlighting … [and] if it’s not in your contract, you can’t modify it.”

In-house recruiters

Another important member of your job-search team is the in-house recruiter for any position you’re interested in. In-house recruiters, also known as staff physician recruiters, are employed directly by hiring organizations to fill physician opportunities. (They differ from third-party staffing agencies or headhunters in this regard.) Nearly every physician job in the country is represented by an in-house recruiter.

There are multiple ways to get in touch with these recruiters. One quick way is to fill out a profile on PracticeLink.com. This way, in-house recruiters can contact you directly, and you can reach out directly to them by using the contact information on any job posting, or applying through the site.

Another way to get in touch is through the PracticeLink Employer Directory. (Access it by clicking “View All Employers by State” on the PracticeLink.com homepage.) From there, you can click to any employer’s PracticeLink page and find an in-house recruiter’s contact information. (You can also see which specialties that employer is seeking.)

Even if a recruiter isn’t hiring for your specialty, you can ask if they can put you in contact with someone who is. In-house recruiters, networkers by nature, are often aware of the opportunities of other recruiters and can connect you with excellent job leads.

Once you find an opportunity you’re interested in, the in-house recruiter for that organization will be one of your best allies. He or she will be responsible for communicating with you, providing abundant information about the opportunity, and even lining up interviews and site visits if you progress in the hiring process.

Make the most of your relationship with in-house recruiters by asking as many questions as possible.

“Unfortunately, some physicians hoping to find a job that matches their objectives don’t ask the right questions, which leads to an unhappy and wrong placement,” says Rhonda B. Creger, DASPR, manager of physician recruitment for Genesis HealthCare System in Zanesville, Ohio. “They don’t ask important questions such as: ‘Is there enough clinical staff to support me?’ ‘How often will I receive feedback?’ ‘Is this a growth position, or is this job available because a physician left?’ ‘What can you tell me about the community?’

“Often physicians don’t understand how important it is to understand the practice support system in place to help the candidate achieve satisfaction in the placement,” she says.

Javaid, who is now practicing at Novant Health UVA Health System Urgent Care and Occupational Medicine in Centreville, Virginia, has had two jobs since he graduated from residency and used PracticeLink to find both of them.

After completing his profile and searching for jobs, he started receiving calls from in-house recruiters. Kirsten Quinlan, physician recruiter for Novant Health, helped him lock down his current job.

“She gave me important information about the company,” says Javaid. “The hospitals were nearby and had a good reputation among other hospitals and clinics in the area. She told me how the company was growing and made an offer that was more attractive than other offers I was receiving.” As an added bonus, the hospital was located near his mother and brothers in an area he wanted to live in.

Ken Dunham, M.D.

Psychiatrist Ken Dunham, M.D., took his wife and family’s interests into account when considering opportunities. He also looked for references from other area physicians. · Photo by Katie Dickson

Realtor

Though an in-house recruiter can help you nail down the right opportunity, any physician who is relocating for a job will also need a teammate to help him or her secure the right home. For this reason, a realtor makes a strong addition to your job-search team.

Some hospitals even have working relationships with realtors. Creger, for instance, works with Tamara Porter, a realtor with McCollister & Associates, also in Zanesville. For the past 10 years, Porter has been called upon to help physicians and spouses feel Zanesville is a great place to live and put down roots. After all, it is important for a physician not only to like the hospital but also to feel comfortable in the community.

“It is important to find out what is important to the couple and the type of dwelling they want,” Porter says. “Some want to rent, while others want to buy a home. If they don’t have children, I need to find out what they like to do for hobbies. If they do have children, it’s important to find the right school district for them, as well as the activities they want for their children,” she says. Your realtor will be well-equipped to answer your relocation questions and help you determine if a community is right for you.

Spouse

Your assessment of a community isn’t the only one that matters, however. Your spouse will likely be committing to make any move that you do, after all. For this reason, he or she is also an indispensable member of your job-search team and can be a great help in evaluating potential communities and neighborhoods.

“My wife wanted a large city that had good restaurants, and she had to be close to family. That would be important to her, especially when we had a baby,” says Javaid. “Because I spend most of my time on the job, she is meeting the neighbors and becoming part of the community.”

Chan Badger, M.D., a family medicine physician, and his wife Jenny lived in the mountains of North Carolina before they relocated to Greensboro for him to take a job with Novant Health. He’d decided he wanted better work-life balance than his last job afforded, a practice where he wasn’t on call 24 hours a day.

“I never thought we’d relocate till an opportunity presented itself with Novant,” says Jenny. “Because our two children are involved in activities and school functions, my husband wanted to be able to watch them participate. He felt the job opportunity in Greensboro, North Carolina, would allow him to spend more time with his family.” Since both parents were the product of public education, they also wanted excellent public schools and to put down roots in their new community.

Ken Dunham, M.D., a psychiatrist with Novant Health in Winston -Salem, North Carolina, echoes this sentiment. As part of his job search, he had to find out what was important to his wife. “Looking at every job opportunity, I had to rate the pros and cons of schools for the children, how far away would we be from the family and what specific geographic region my wife wanted to live in,” says Dunham.

Local physicians

In addition to looking for a community that would please his wife, Dunham carefully analyzed each potential job opportunity. Once he knew there would be a job interview, Dunham called the practice administrator to get more information. “I would ask them about the position, how it is supported, turnovers, staffing questions and financial questions,” he says.

In addition to his own investigation, Dunham depended upon references from other physicians in the area. These physicians could tell him their thoughts if they knew the medical group.

“Most of us are connected online in some way such as through Facebook,” he says. “They could tell me that I shouldn’t work there, especially if their information didn’t match what the practice administrator said.”

In Dunham’s opinion, it is also important to speak with every physician in the practice you’re considering—whether on the phone, in person or both. Being prevented from speaking with any physician could be a red flag. He advises physicians to ask questions such as “How happy are you with the practice?” “Do you feel you can trust the administration?” “How long have you been here?” and “Is this a growth position?”

If the opportunity is a replacement of a previous physician, find out why that physician left. You should be able to get your questions answered in 30 minutes to an hour with each physician.

If this is a health care system position, talk with one of the executives—the CEO, president or vice president—to get a feel for the system. Questions could include: “What are the challenges?” “Where do you see the practice heading?”

Dunham was extremely careful as he narrowed down his job opportunities to two or three potential positions. He also checked the contract to make sure what was said during the interview process had actually translated to paper.

Javaid, too, spoke with higher-ups in Novant before he committed to the job. In particular, the Northern Virginia physician leader for Novant Health UVA played an important role in the process. Javaid spoke with him three times and met him twice before accepting the job offer. “Besides being helpful, he was easy to reach,” Javaid says. After he started in the role, their relationship continued. “He truly was informative and truthful about everything I asked.”

That connection Javaid made with a colleague has continued to benefit him in his current role, and you may have the same experience. The connections you foster in your job search may help you land more than just your next practice—they may continue to benefit you in your career for years to come.

 

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6 Things Missing from Your CV

How can you ensure your CV stands out among the rest? Evaluate and improve it according to these six criteria.

By Anish Majumdar, Certified Professional Resume Writer | Feature Articles | Spring 2017

 

Daniel Cusator, M.D.

Tailor your CV to the role you’re pursuing. “At one point I had three completely different CVs in my toolbox,” says Daniel Cusator, M.D. · Photo by Cassie Lopez

Though the M.D. after your name does designate medical expertise and years of hard work, it does not give you a free pass on your CV.

You must still convey to employers what, beyond your degree, makes you a good candidate. This is true now more than ever as increasing numbers of physicians seek hospital employment rather than private practice opportunities.

“Increasingly physicians are working for somebody,” says John Murphy, M.D., CEO of Delaware Valley Urology in New Jersey. “They’re team members within larger organizations, and how they’re recruited has changed to align with hiring in other industries.”

Christy Bray Ricks, a physician recruiter for Banner Health in Greeley, Colorado, echoes the same point: “Moving from a landscape of lots of independent practices, where you might hire one person every 10 years, to filling hundreds of positions for health systems—the volume is significantly higher, which means the level of competition is also higher.”

John Murphy, M.D.

It’s OK to include a “special interests” section at the end of your CV. “Who you are has become nearly as important as the depth of your experience,” says John Murphy, M.D. · Photo by Jordan Brian

The competition is where I come in. As a resume expert, I spend my days helping physicians and others create the CVs they need to stand out in this new recruitment environment.

Over the years, I’ve identified six aspects every physician needs to evaluate about his or her CV—but that might be missing from yours. Succeed across them and you’ll drastically improve the amount of attention you receive during a job search.

1. Chronological Continuity

Clarity equals credibility in the world of CVs. No recruiter wants to open a physician’s CV and have to spend the next 20 minutes going line by line to figure out the timeline.

“I like to see a narrative in the CV with a clear sense of why an applicant has pursued particular education, training and opportunities,” says Vandana Madhavan, M.D., a pediatric infectious disease specialist who works for MassGeneral for Children at North Shore Medical Center in Salem, Massachusetts.

So how do you create that narrative?

Before I explain, take a look at Figure 1: a CV excerpt that fails to create a narrative. Can you spot the issues?

Figure 1

Figure 1

Here are some of the biggest errors:

  • Unclear timeline. When did training start and professional experience begin? How does one relate to the other? It’s nearly impossible to tell.
  • Inconsistency. Why is the work history going in chronological order when the education is in reverse chronological order? This looks sloppy.
  • Failure to answer the biggest questions. What is this physician doing now? You have to hunt through each line before realizing he currently holds a staff surgeon position with Bilbo Regional Medical Center.
  • Lack of detail about procedures and appointment specifics. “It’s important to highlight aspects of your experience that can’t be gleaned through your credentials,” says Daniel Cusator, M.D., CEO at Cusator Healthcare Consulting in Nashville, Tennessee. “How did you add value?”

Now take a look at Figure 2: a version that has been revised to address these points. What can we glean from this example?

Figure 2

Figure 2

  • Use reverse chronological order. This is the clearest way to convey your current status and history. Include start and end month and year. Address any gaps in the postdoctoral or work experience sections, and make it an unbroken timeline.
  • Simplify with sections. Split publications, presentations and research into three subsections, and include dates for all. Use reverse chronological order here as well.
  • Include professional affiliations and community involvement/volunteering. Dates are optional here.

2. A Plan For Addressing “Red Flags”

If you think you can hide potential deal-breakers with a cluttered CV, think again. All this will do is prevent you from being considered in the first place.

“Hopping around, spending less than two years at a position—that’s a definite yellow flag,” says Ricks. “It won’t disqualify you, but it’ll definitely be brought up during our first conversation.”

Avoid unnecessary confrontation by addressing your red or yellow flags upfront when possible—whether they’re work gaps, short stays in previous positions or visa status issues.

If you have a break in your work history, add a short “Career Note” (one or two lines) directly within the timeline of your CV to address it. Here’s an example:

CAREER NOTE: Took leave of absence between 2/08 and 2/09 to provide critical support to family members.

This not only answers the question of your timeline gap but also gives a glimpse into your life outside work.

If you’ve held multiple locum tenens positions, it’s usually a good move to consolidate them within a single locum tenens section. That prevents an at-a-glance impression that you’re a job hopper.

For non-locum tenens positions of short duration, it’s better to be prepared to explain during the interview. “Anything that is included on a CV is fair game,” stresses Madhavan. “Be prepared to follow through in detail.”

It’s also important for international candidates to be forthright about their visa statuses. “Many health care systems just aren’t in a position to support a visa, so it’s better for all concerned that you clarify this on the CV so we can focus on positions you can actually land,” says Wonona Davis, physician recruiter, western region, for HNI Healthcare in Southern California.

3. A Screen-Friendly Layout

Want to know the secret to a great resume layout? It’s not having a huge number of bells and whistles; it’s keeping the document clean and simple, thereby drawing attention to what matters most, the content.

“I can’t remember the last time I printed out a CV,” says Ricks, “but so many of the CVs I see are laid out in a way that would only work on the page.”

Can your CV pass close scrutiny when viewed on a computer screen or, increasingly, within the tiny confines of a phone screen? Here are some questions to ask to determine this:

Is my CV easy to open and download? Ease of use starts with a commonly accepted file format. In most cases, you’ll want to send your CV in PDF format because it’s more secure than MS Word. Avoid less-common software such as Apple Pages or WordPerfect—this can cause a host of viewing issues. Send over your cover letter and CV as one file when using email. It significantly enhances the chances of both documents getting read and makes it look like a package instead of just another CV.

Is my CV easy to read? Complex graphics and formatting can really tank a CV’s impact when viewed on mobile devices. Use easy-to-read fonts like Arial, Garamond, Verdana and Tahoma. Keep font sizes consistent throughout the document (e.g. size 14 for all titles, size 12 for all content). Stick to a white background and black text. Unusual colors draw attention for all the wrong reasons.

Have I included relevant links (and do they work)? One big advantage to mobile devices is that a recruiter or hiring agent can just tap on your email address or LinkedIn URL and send you a message instantly. Make sure the link to your email address is right at the top of your CV and that it’s functioning (see sidebar on adding a link to a PDF).

Is it easy to skim? Gigantic paragraphs don’t work on CVs. It’s an appetizer, not the main course. Keep lines short and action-oriented and use bullets liberally.

Here’s an example:

Thoracic Surgery Clinical Fellow

  • Performed a total of 450 thoracic surgery cases throughout fellowship, including critical care management of patients, advanced endoscopic treatment of malignant esophageal disorders, minimally invasive thoracic surgery (VATS wedge resections, VATS pleurodesis, VATS decortication), as well as lung transplant organ procurements.
  • Delivered hands-on training to junior general surgery residents and anesthesia residents in the thoracic surgery ICU.

Finally, once you’ve made these tweaks, email the CV to yourself and load it on your phone and other devices to see how it looks.

4. A Human Side

Your CV should show more than just your credentials, however. It’s also important to show a bit of your character.

“Culture fit is very important when it comes to vetting physicians,” says Ricks. “We ask a lot of behavioral questions, questions about patient-centered care, why you got into medicine. You’ve got to be able to articulate all of that.”

Addressing some of these points within the CV is a powerful way to make a great impression even before you get to the interview. Here are some ways to do it:

Include a “Doctor’s Philosophy” statement at the start of the CV that addresses how you approach the job. Examples:

Providing compassionate, quality cancer care and giving patients the knowledge to make the most empowered decisions about their diagnoses.

My philosophy of care is to treat each patient as I would treat my own family. I grew up watching my father, a surgeon, take as much time as necessary to build relationships with patients and their families, and establish trust. It’s a lesson I carry on today.

Include excerpts from patient surveys (anonymized). Examples:

“She takes her time with me, doesn’t rush me, and she explains everything very well.”

“James Wilson is great—the most caring and compassionate surgeon I have ever had! He gave me real hope for a successful outcome, which I so needed!”

Include a “Non-Clinical Interests” section at the end of the resume. Example:

Interested in organized medicine and advocacy; public speaking; non-profit organizations; health care delivery, cost effectiveness and quality; health care administration

Include a “Volunteering/Community Involvement” section at the end of the resume, and briefly elaborate on major initiatives and projects you took on. Example:

Spearhead our neighborhood’s annual ALS awareness fundraiser 5k run/walk. Participate in the Big Brothers program of Greater Chicago.

Include a “Special Interests” section at the end of the CV listing things you like to do outside of work. Example:

Mountain biking, classic movies, hiking, gardening.

These additions foster a connection with the reader and offer a glimpse of your life beyond scrubs.

“Who you are has become nearly as important as the depth of your experience,” says Murphy. “It’s something you’ll want to pay close attention to on the CV.”

5. Strategic Emphasis And De-Emphasis

Imagine for a moment that you’re conducting an interview and have just asked a candidate a question. Rather than simply answering it, this person proceeds to spend the next five minutes rambling on about everything except what’s relevant. You’d probably be a little peeved, right? The same principle applies to CVs. The more clearly you understand your goal and can tailor the document accordingly, the more effectively you can answer the questions any recruiter or hiring agent will have during that initial scan.

To understand your goal and answer their questions, you must identify, with precision, exactly what an ideal outcome looks like for you. Are you looking for a primarily clinical or academic role? Are you looking to join a small practice with a track towards becoming a partner, or a dedicated patient care role? Your answers here will determine what you highlight (and what you don’t) in the CV.

“I made a decision several years ago to move from a position that was largely clinical to one of physician executive leadership. Totally different jobs, with altogether different tickets to punch,” says Murphy, a certified physician executive who also holds an MBA and practiced as a reproductive endocrinologist before transitioning to the physician executive track.

Totally different jobs merit totally different CVs. You must cast a critical eye on your CV and ask yourself: Am I giving my audience what they expect? If you’re going after a role with zero research involved, then you probably don’t need those two pages of research credits on the current version of your CV. If you’re simultaneously going after more than one type of position, avoid the temptation to create a one-size-fits-all document.

“At one point I had three completely different CVs in my toolbox: one for academic roles, one for clinical roles and one for physician leadership, with the latter stressing behavioral aspects,” says Cusator.

Once you’ve considered your goal and recruiters’ expectations, expand on the positions related to what you want. If you’re seeking a physician executive role and your last position had a solid leadership component, don’t just leave it as “Attending Physician” and call it a day! If you helped attain a certification or launched a new medical service, insert bullet points that make this clear.

Similarly, consolidate the aspects of your work experience that stray from your current goals. If it’s not relevant, de-emphasize it to save both space and time.

6. An Effective Search Strategy

Now that you’ve worked hard to get your CV in tip-top shape, don’t blow it by blasting it out indiscriminately—or by never sending it at all! Here are some ground rules to keep in mind:

Know your preferred location. Send your CV to in-house recruiters in these areas. Every recruiter I spoke to brought up the importance of knowing where you want to land.

Do your research! It’s important to get the “lay of the land” when it comes to your targeted regions. Which organizations are the major players? Which do you want to work for? What’s the quality of life like in the area? “I love it when a physician can clearly answer why [he or she wants to work for an organization],” says Ricks. “It shows they’re looking to make a real investment in their next role, and employers love that.”

Put your CV online. By uploading your CV to physician job sites like PracticeLink.com or PhysicianCV.com, you can instantly get it in front of hiring recruiters looking for candidates like you. Think of your new CV like an online dating profile; all those details serve to help the right fit find you.

A great CV is a reflection of who you are and where you want to go next, and it highlights the aspects of your work history that are most likely to get you there. Investing the time to strip it to the bare bones and rebuild it according to these six aspects is what separates the 95 percent of candidates who land something from the 5 percent who land the very best. Evaluate what you’re looking for, evaluate your CV, and take the time to present what you do more effectively.

Anish Majumdar, CEO of ResumeOrbit.com, is a nationally recognized resume and CV writer, LinkedIn expert and interview coach. Surveyed physicians who worked with him report a 50 percent reduction in placement times and usually negotiate significantly higher offers.

 

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Building your job-search plan

Know when to start—and what you’ll need to provide—when it comes to licensing, CV, recommendations and the other foundational elements of your job search.

By Chris Hinz | Feature Articles | Spring 2017

 

Anastasia Benson, D.O.

A helpful online process—and a willingness to fully dig in to the details—helped Anastasia Benson, D.O., secure her Texas license with ease. · Photo by Kelly Williams

After years of training, you’re confident that you’ve done what it takes to practice medicine. Rightfully so! You’ve put in time and energy. You’ve amassed education. You’re ready to move forward with your career.

But there’s a lot to do before you and your employer ink a contract. You’ll have to network far and wide, craft an effective curriculum vitae and polish your interview skills. And don’t forget about licensure and credentials. Those nitty-gritty tasks can make or break a job search.

“Preparation is key for everything about your medical career,” says Kevin Caldwell, senior director of Federation of State Medical Boards (FSMB) in Euless, Texas. “Your training is one gauge of success, but you still need to understand and be diligent about the other measures. Remember, things don’t necessarily come to those who wait, so be proactive about them too.”

Be licensure-savvy

As a graduating resident or fellow, you might already have an unrestricted medical license in the state where you plan to work. If not, you’ll need to secure a license to practice independently. No matter what state you’re in, you’ll have to be proactive, organized, responsive and thorough to navigate the licensure process effectively.

Timeliness Counts. It’s never too early to get the licensure ball rolling. Whether you’re working with a medical or osteopathic board, staffers love candidates who prepare for the unexpected instead of expecting miracles. “There’s nothing worse than receiving a phone call demanding to know when a license will be issued, and we’ve had the application for less than a week,” says Dawn Thompson, licensing manager at Washington State Medical Commission in Tumwater, Washington. “Worse yet [is when] we haven’t received one at all.”

The licensing timeline varies on a state-by-state and case-by-case basis. If your application is uncomplicated—as is generally the case with new physicians—the process may take two to three months or even less. If your training and history is complex, however, licensure could take six to nine months or even longer.

For instance, although most Iowa Board of Medicine candidates receive their licenses within 60 to 90 days, the timeframe is usually a bit shorter for physicians just out of residency because there’s less to evaluate. “They just have thinner files,” says Natalie Sipes, director of licensure of the Iowa Board of Medicine in Des Moines, allowing for quicker processing.

The onus is on you to know your medical or osteopathic board’s schedule and meet it. In some states, staff members issue unrestricted licenses administratively, which means you don’t have to wait for a formal vote. Once they establish that you’ve met the criteria with no residual concerns, they can process your application relatively quickly. But if you’re dependent on direct board involvement, you need to pay even more attention to deadlines and schedules. Member-panels don’t always meet monthly and often break for seasonal and other reasons. Make sure officials have your file well in advance of the next session so you’re not left waiting.

Alexis Smith, D.O., learned that the hard way. She was scheduled to begin a women’s imaging fellowship at the University of Pittsburgh Medical Center Magee-Womens’ Hospital on July 1, 2013. But even though Smith submitted her paperwork in March, she had to wait an extra month to begin her program because the board still hadn’t issued its approval. Several scheduled breaks slowed down the process.

Smith advises other physicians plan ahead for breaks like these. “You need to be careful about the schedule and get started as early as you can,” says Smith, now director of breast imaging of Trinity Health System in Steubenville, Ohio. “Otherwise you could have issues.” Caldwell agrees, saying, “Get it out of the way early in case there are any hiccups.”

Organization is a must. Although you can’t control how long it takes for a medical board to review your credentials or for an employer to offer you a job, you can help expedite the process. Start by knowing what’s expected of you.

No matter where you live, licensure paperwork focuses on your core credentials: proof of your identity and documentation that you’ve successfully completed every phase of your training. This includes passing the United States Medical Licensing Examination (USMLE) or Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA).

Each state has its own requirements. If your target state is Iowa, you’ll have to complete a two-part package including the FSMB’s Uniform Application for Physician State Licensure covering the basics, in addition to a state-specific addendum. This addendum’s 23 questions ask about problems in medical school or residency as well as other salient issues: leaves of absence, malpractice charges, criminal histories and any impairments that might affect your ability to practice safely.

Depending on your state, you may also have to take a test or mini-course to demonstrate that you understand the state’s practice regulations and are up to speed on CPR and issues such as family violence, bio-terrorism, etc.

Most medical and osteopathic boards have online applications with forms and checklists for applicants and their primary sources. That’s one reason Anastasia Benson, D.O., had a relatively easy time securing an unrestricted license from the Texas Medical Board, despite its sheer volume of applicants. A graduate of Arizona College of Osteopathic Medicine, she initiated the process when she came home to Lone Star state to complete a family medicine residency. Everything she needed was posted online, including a required jurisprudence test.

Benson heeded others’ advice not to skim the website. She read the instructions thoroughly, which helped her get licensed and ready to launch her career. “I was in one of the hardest states to get a license,” she says, “but it wasn’t a traumatizing experience.” Benson now focuses on her practice, Paradigm Family Health, in Dallas.

Whatever your state, be prepared to get into the weeds. In addition to certified copies of documents, you’ll need to provide names, dates and contact information for verification. Since you’ll likely be asked repeatedly for the same history, it’s smart to create your own centralized folder. That way, you can quickly verify requests or correct information forwarded about you.

Brandi Ring, M.D., learned just how important an easily accessible credentials file is while she was moving to Colorado from Pennsylvania. In the midst of her process, she realized a form she needed was stashed in a moving van box. A member of Mile High OB/GYN Associates in Denver, Ring doesn’t skip a beat now when applying for new hospital privileges or clinical position/faculty appointments. Everything is within reach. “If you can, create a place where all of that information is easily organized and you can grab it in just seconds,” she says.

Brandi Ring, M.D.

When Brandi Ring, M.D., moved from Pennsylvania to Colorado, she realized that a key form was in a box on the moving van. Now, she recommends that physicians keep a file that’s well-organized and easily accessible.

Take advantage of FCVS. The Federation Credentials Verification Service (FCVS) can help you create a permanent, vetted version of your history. FCVS is a clearinghouse for gathering, authenticating and storing primary source-verified credentials. Its physician profile will centralize a confidential, lifetime portfolio that you can easily forward. Medical and osteopathic boards in 12 states now require FCVS profiles, and the remaining states plus the District of Columbia accept them.

There are some downsides to FCVS. A profile costs a $350 base fee plus surcharges, and physicians still have to complete their state’s licensure applications, which may include vetting credentials not included in FCVS. However, the system can be beneficial if you’re applying for multiple state licenses now or in the future.

The FCVS may also be useful if you graduated from a medical school outside the U.S. and Canada. Verifications from foreign countries, especially war-torn regions, are often difficult, time-consuming and costly, so having one entity collect, certify, disseminate and store your dossier helps. “With all of the upheaval, it’s really a smart investment to get those credentials out of the country and into the U.S.,” says Lynnette Daniels, chief of licensing for the Nevada State Board of Medical Examiners in Reno. “It a one-and-done process, and they’re held for perpetuity.”

Ricardo R. Correa Marquez, M.D., Es. D, FACP, CMQ, found that to be true when he applied to The Warren Alpert Medical School of Brown University’s Hallett Center for Diabetes and Endocrinology in Providence, Rhode Island. He had previously done verification paperwork in Florida, Maryland, the District of Columbia and Georgia without the FCVS.

When Rhode Island required Marquez to use the FCVS, he realized how useful the service was. He had a more complicated history than his American-trained counterparts. He had graduated from the University of Panama’s medical school and completed a research fellowship at home before securing a University of Miami/Jackson Memorial Hospital internal medicine residency followed by an endocrinology fellowship at National Institutes of Health in Bethesda, Maryland.

Even though the FCVS process was difficult initially, Marquez, now assistant professor of medicine and Hallett staff member, anticipates an easier process in the future. “They do the paperwork,” he says. “You only have to deal with things unique to the state.”

Promptness counts. Whatever your background, your cooperation is one of the biggest variable in the turnaround time. You’ll slow the process if your application is incomplete or you don’t reply adequately. After all, most medical and osteopathic boards are relatively small operations processing large volumes of information to vet applicants. For example, Thompson says her unit of four “dedicated licensing gurus” works tirelessly in servicing both physicians and physician assistants. Yet they can’t advance applications without cooperation.

“It helps the whole process if the person on the other end of the conversation communicates well and understands that our team licenses 2,500-plus practitioners per year,” Thompson says.

Do everything possible to accommodate board requests and work within their constructs and deadlines. Follow directions, respond quickly and give complete answers.

“We all understand physician applicants are busy,” says Caldwell. “But if you don’t respond, somebody can’t act.”

Be file smart

A good CV will help you secure a position that matches your abilities and aspirations, and hopefully, you haven’t experienced anything that casts doubt on your skills or your character. However, any number of issues can raise red flags for both boards and employers, so you can’t be content with just what you’ve put on paper. Just in case there’s a snafu in your background, it’s to your advantage to review what others might say about you.

Research like a sleuth. In a best-case scenario, you would have documentation of any dust-ups with superiors, brushes with the law or other potentially egregious acts, but don’t assume you know everything about your own record. “Sometimes physicians aren’t aware that anything negative exists about them,” Caldwell says. “Or they were told unofficially that an incident wouldn’t be reported if it were mediated, but it’s reported. What we often hear is ‘I didn’t know.’”

So how do you avoid surprises? The ideal time to sort out potential issues is when the experience is fresh in your mind, such as after medical school or when an event occurs in residency or fellowship. But it’s never too late to circle back to a program or primary source to make sure your interpretation squares with the record. “It’s like anything else, there can be human error,” says Craig Fowler, vice president of training, recruiting and public relations at Pinnacle Health Group in Atlanta. “You want to co-pilot yourself by verifying everything.”

The logical starting point is to talk to the people who will verify your credentials and discuss what they will report. If those conversations leave you concerned, you can meet face-to-face with anyone who influences your performance evaluations. This may be your best chance to clarify and correct erroneous information.

You have a responsibility not to hide, shade or lie about anything essential on your applications. Make your answers accurate and thorough. Don’t assume that the person processing your application will understand your intent. And remember, the disclosure is often as or more important than the original transgression. “From our perspective, it’s not always about the actual issue,” says Sipes. “It’s about the honesty and integrity on the application. It’s about being diligent in all of your answers.”

Pay personal attention. Professional matters aren’t the only issues that might interest medical boards or employers. Your private life demands honesty, too. If there’s a public record that you’ve been arrested, fined or otherwise sentenced, make sure the information is accurate and shows that you fulfilled your obligation to the court.

Being cited for disorderly conduct, public intoxication or driving under the influence may not mar your chances for licensure or a job. In fact, they may not even merit an in-depth discussion. However, if the record is wrong, you should move mountains to get it corrected and hire an attorney if necessary. If it’s accurate, offer a simple explanation as to what occurred and why it was an aberration.

For instance, Smith faced a disorderly conduct citation for underage drinking as an undergraduate. She paid the fine immediately and provided an explanation with documentation on every application. Smith sailed through each process with no follow-up questions, not even during her mandatory interview with a West Virginia licensing board member. Telling the truth helped, as did the fact that it was a minor offense in the distant past. “Because it had been so long ago and I hadn’t had any problems since, it wasn’t a big deal,” Smith says. “My explanation was more than enough.”

All is not lost. Setbacks in your past won’t necessarily derail your professional ambitions. Patient- and career-endangering patterns or serious felonies may keep you from getting licensed or hired. After all, the first order of business for every state medical/osteopathic board is protecting the public, and hiring gatekeepers don’t want inept or unscrupulous practitioners in their ranks.

But not every mistake is onerous enough to delay a license or nix a job. Neither will changing medical schools, switching residencies or taking a leave of absence from training. Board administrators recognize that intervening events happen.

Fowler, for example, recalls meeting residents who had legitimate gaps in their training because Hurricane Katrina forced them to leave Louisiana. As long as you have a plausible explanation and can show that you’re an otherwise stellar performer in good stead with your current superiors, an interruption or alteration won’t necessarily ring alarm bells.

However, anything that casts doubt on your professionalism, skills or abilities will raise questions from medical/osteopathic boards and hiring teams. If you’ve undergone repeated or extended remediation, your situation likely will trigger a higher degree of scrutiny and concern than if you were able to cure your training woes by correcting them quickly.

Even if you’ve veered off track and needed special monitoring, you aren’t necessarily out of luck as long as you’re candid in your explanation and your record is otherwise exemplary. “Probation is not a death knell in any way shape or form,” Fowler says. “It just means that you had a lapse. You mediated it. Then you moved on.”

Final thoughts

You have a full plate when it comes to building your job-search plan. You’ll need to update your CV, sharpen your interview skills and network through recruiters, job fairs, and other resources, and you should pay similar attention to essential tasks for practicing independently. Understanding licensing, credentialing and your work files should be at the top of your to-do list.

More alluring parts of your job search may demand your time and energy, but don’t ignore these bread-and-butter elements. As Fowler notes, “In launching your career, it’s easy to overlook the least exciting tasks of your search because you’re so focused on the obvious, more exciting ones. But in the midst of the chaos created by CVs, networking and interviewing, don’t forget your license, credentials and personal file. They’re critical to your next step.”

 

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The anatomy of a physician contract

Your employment contract can make or break your practice experience. This guide demystifies its terms—teaching you what to consider, what to negotiate and when to get a lawyer.

By Karen Edwards | Fall 2016 | Feature Articles

 

The contract looked good. Great, in fact. Compensation, vacation, even health insurance—all good packages—but before the physician signed on the dotted line, he consulted an attorney, Gary Sastow, J.D., with the New York-based law firm Brown, Gruttadaro, Gaujean & Prato.

Good thing he did.

If the contract had been left as it was, the physician would have been burdened with $160,000 of tail coverage upon leaving the practice. And he would have been responsible for paying all of it.

The biggest problem plaguing physicians when it comes to contracts, according to Sastow, is that they’re concerned primarily with only one part of a contract. “They want to know how much they’ll be paid,” he says. Though compensation is a significant part of any contract, it’s not the only part, and let the physician beware if he or she doesn’t keep the other sections in mind as well.

A rise in physician employment

Vaagn Andikyan, M.D.

Determining what aspects of a job are the most important to you will help you know where to spend the most time and energy in your contract review. For Vaagn Andikyan, M.D., a New York gynecologic oncologist, a non-negotiable restrictive covenant became a deal breaker. · Photo by Shaina Diaz

Let’s face it: These days, most physicians are looking at employment contracts. A recent report from the consulting company Accenture states that only one in three physicians will be in independent practice by the end of 2016. The report also states that the number of physicians in private practice declined from 57 percent in 2000 to 49 percent in 2005, with most of the physicians who left private practice seeking hospital employment instead.

For some time, physicians drove this trend as they sought to escape long hours, risky revenue streams and increasing regulations, but the 2010 health care reform legislation that gave rise to accountable care organizations also gave hospitals and physicians new incentives to work together. That means today’s physician is likely to be an employed physician, and that, in turn, has greatly increased your need to have at least a rudimentary understanding of employment contracts.

Today the average hospital employment contract is between 20 and 30 pages long and has been prepared by the hospital’s attorney, says Sastow. In other words, there’s a lot of confusing legal jargon that could trip you up, and, Sastow adds, the hospital’s attorney will have written the document to the employer’s advantage.

Gregg Bertram, founder of Pacific ADR Consulting, which handles mediation and arbitration disputes for clients, echoes Sastow. “The contract is not a neutral document,” he says. “Don’t assume it’s harmless.”

Evaluating your contract

So when you’re handed an employment contract, how do you proceed?

“Start any contract review by asking yourself first what you want from the contract and from the job. What’s important to you: Is it your schedule? Your track for advancement? Focus on your career goals, the lifestyle you want to create, and then you can better decide what things you want to negotiate,” says Mathew Parker, J.D., of the management-side labor and employment law firm Fisher Phillips.

Hospitalist Vanessa Frost, D.O., says she prepared a top-three list of things she wanted from a job, and that included pro-rating her sign-on bonus over a two-year contract—advice she received from a mentor. “That way, at the end of the second year, you only owe half of the bonus if you decide to leave. You’ve worked off the other half.”

Once you determine your top priorities, your next step is to look over the contract.

“Some people never read the contract they’ve been handed,” says Sastow.

It’s true many hospital contracts are more or less boilerplate documents, especially for new physicians, says Derrick Handwerk, managing partner of Handwerk Multi Family Office, a Philadelphia wealth management consulting company. Still, he says, “it’s a good idea to know what’s in them before you sign on the dotted line.”

Contract anatomy

Most physician employment contracts follow a similar structure, and though you’ll want to pay attention to the whole contract, the following sections are ones that may deserve special scrutiny:

Job Location and Job Description. “Every contract should have in it a list of your job responsibilities and duties,” says Sastow. And the contract should be as specific as possible—not only in your job description, but also in where you will work and what hours you’ll work.

Sastow says he will put in the specific address of the facility or facilities where his client will work—office locations, hospital locations, clinic locations, whatever might apply. That’s because an employer may close an office location, for example, and want to transfer its staff to a satellite clinic in a nearby town—or, if it’s a multiple-state entity, to a location in a different state entirely.

“There is a lot of consolidation going around,” says Bertram. A move, whether it’s 45 minutes away or several hours away, can have a significant impact on not only the physician’s lifestyle but also his or her wallet. “Be alert to these sections,” says Bertram. “If you are signing with a hospital that has multiple locations, it’s important to nail down the locations where you’re expected to work and ask for notice if they do plan to move you.”

Vaagn Andikyan, M.D., a New York gynecologic oncologist, says he looks for work locations in contracts. “It’s important to look at them before you sign, because you could find yourself spread too thin if the hospital or practice has more than one location and expects you to work at all of them,” he says.

The employer still has the option of making that request or transferring physicians, but if the contract lists specific addresses, such moves are likely to trigger new negotiations regarding call hours or commuting expenses, says Sastow.

Besides job location, Parker also suggests paying close attention to the job description itself. “Responsibilities should reflect those within your field of specialty,” he says. If the contract has a broader statement, such as “tasks as assigned,” that’s worth negotiating, he says. Otherwise, you might find yourself performing tasks that may be above—or beneath—your level of training.

These sections may seem boilerplate, but it’s still a good idea to read them and make sure they reflect what you want from the job.

Compensation. Most compensation guidelines these days are set by corporate boards and groups like the Medical Group Management Association, says Handwerk. “The larger the hospital or group, the more likely it is the compensation rate will be standard,” he says.

And, frankly, there isn’t much room for a new physician to negotiate larger increases. “Young physicians don’t have much in the way of negotiating power unless they are in a specialty that’s needed by the employer,” says Sastow—or they are needed in a specific location.

If salaries are set in stone, Handwerk suggests negotiating other benefits. An inflation rider, for example, is a way to keep your salary from deflating as you work. “…Without a regular increase for inflation, doctors can find themselves working for less and less money each year,” he says.

Also remember that compensation isn’t just about salary. It covers benefits such as paid time off, CME reimbursement, health and disability insurance, forgivable loans, 401(k) contributions and maternity/paternity leave.

“Typically, these benefits are part of a hospital’s policies and procedures manual,” says Parker. “It’s important to understand what those policies are, so if there is something you need or want, like paternity leave, and it’s not in the manual, you may be able to negotiate it into the contract.”

Negotiations are more likely to take place if the employer is a smaller hospital or group, says Sastow. “For larger hospitals, these are usually standard policy and not negotiable.”But, as Bertram says, you never know until you try.

Bertram says it’s perfectly legitimate to ask questions of your own. “Ask employers about the financial strength of the institution,” he says.“If a hospital or group has shrinking revenues, that’s something you should know before you sign up.”

Elizabeth Clark Libert DrPareshMane ElizabethClarkPhotography 36

Thoracic surgeon Paresh Mane, M.D., consulted with an attorney on his employment contract, but ultimately handled negotiations with his employer himself.  · Photo by Elizabeth Clark

“Also, ask the hospital about its volume and growth potential,” suggests Paresh Mane, M.D., a Boston thoracic surgeon.

Call Hours. Next to compensation, call hours may be the most important section for physicians. “On-call hours will affect a physician’s career path and lifestyle,” says Parker. As the new hire in the organization, you can usually expect to work the worst hours, but if they are worse than other new hires, Parker suggests opening a dialogue with employers for a better schedule. “Most employers want to be fair,” he says.

But here again, you might want to ask your own questions, says Mane. For example, “Ask what the hospital will do if you work more than a certain number of hours. What will they do if your cases are above that limit?” He also suggests negotiating administrative time into your schedule so you can carve a day out each week for paperwork. As a surgeon, he has also negotiated block time in the operating room.

In other words, propose the hours you want for the lifestyle you want—but be prepared to negotiate. As long as call hours are kept reasonable and fair, that may be the best you can expect.

Termination and Tails. Employers typically provide malpractice insurance while you’re working at their facilities, but what happens when you leave and a patient files a malpractice suit over something you allegedly did? That’s covered by tail insurance, and that part can be tricky, as the example at the beginning of this article shows.

“Who pays the tail coverage and how much they pay may be negotiable,” says Sastow. But that negotiation is likely to depend on why you’re leaving.

If the contract is up—usually after a year—and you’re moving on to another workplace or if you’ve been terminated with cause, you can expect to pay a fair share or all of the tail coverage. However, you might want to negotiate language in your contract that makes the employer responsible for paying some or all of the tail if you’re terminated without cause. “Who pays for tail coverage depends on the reason the relationship is ending,” says Sastow. He adds: “If you’re dismissed without cause, you should negotiate language that says the employer will pay for tail coverage.”

That’s why it’s also important to pay attention to the termination section of contracts.

“The length of a contract can be misleading,” says Bertram. “Generally, contracts are for a one-year renewable term, but it’s not an absolute. You may be terminated without cause with a 30-, 60- or 90-day notice.”

“All contracts have an out clause,” says Cindy Fiorito, director of physician recruitment for Eagle Hospital Physicians in Atlanta. “Our contracts include without-cause language with a 120-day notice,” she says, adding that they will consider other notice lengths.

Generally, termination-without-cause sections are not negotiable, though most attorneys will try to eliminate the language. If left in place, they are what they are, and you need to be aware that they’re there.

Mane says he was able to negotiate the without-cause, 90-day notice termination clause in his contract to a longer term. “If you’ve moved to the area and just started practicing, three months is not enough time to let you find another job and move again,” he says. His negotiated language called for a 180-day notice period. Six months is long enough to find a new job, he says, adding, “It works both ways. If you don’t care for the environment, you don’t want to lock yourself into place either.”

In addition to negotiating a longer notice, you may also negotiate language that says the employer will pay you a certain amount if you’re dismissed without cause. “Or you may want to negotiate the restrictive covenants part of the contract if you plan to stay in the area,” says Jay Levy, J.D., a Florida attorney.

Just be sure, in any termination-with-cause section, that the cause is defined in the contract, says Levy. “There should be a clear understanding of what constitutes cause.” There should also be a “notice of default” in the contract, he continues. That means the employer will allow you a certain length of time to fix the problem. “That could range from 10 days to 30 days,” Levy says. Unless the offense is so egregious that no repair is possible, a notice of default will give you a chance to fix whatever problem you have or may be creating.

Restrictive Covenants. Of all the terms in a contract, this one may be the most contentious. A non-competition restrictive covenant says that, if you leave a practice (with or without cause), you may not work within a given distance from that hospital or place of employment for a set period of time. A non-solicitation restrictive covenant prevents you from soliciting your former patients for a set period of time.

Restrictive covenants should be taken seriously, says Levy. “Some people think they’re not enforceable. They are.”

If you can look at them from the employer’s side, they make sense, Levy continues. “The employer has gone to the trouble of bringing you in, marketing its practice and building its patient base. They don’t want to lose those patients if you leave. A restrictive covenant protects their business.”

But what if the patient has a good relationship with the doctor and wants it to continue? “A non-competition restrictive covenant doesn’t mean that the patient can’t see you,” says Levy. Of course, it may make their visit geographically inconvenient, but that’s their choice.

“I was ready to sign with an employer until I saw the restrictive covenant clause,” says Andikyan. The employer refused to eliminate the clause, “so I walked out. I wouldn’t sign a contract with a restrictive covenant clause included,” he says.

“If they’re in a contract,” says Mane, “you need to know what the language says. Any hospital facility, including an office that’s 150 miles away, may be included in the restrictive covenant language.” That, he adds, can be crippling if you intend to stay in the area.

Fiorito points out, however, that restrictive covenants may be just as limiting for employers. “If you’re a hospitalist who came to us from another job and you’re working under a restrictive covenant, it can send up a red flag,” she says. “We need to know all of the places you aren’t able to practice, because we may unknowingly assign you to facilities where you won’t be able to go.”

“I learned noncompete clauses are common in contracts where the employer is in a large urban area,” says Frost. In her experience, they are not negotiable, but she says she was able to add language to a contract that allowed her to come back to the restrictive area if she changed her position or if she wanted to return for a fellowship. “I didn’t want to be penalized for either of those,” she says.

Review and negotiation time frame

Once you have your contract, the employer will give you time to consider the offer. In some cases, the amount of time is set in the contract. Frost’s contract, for example, stated she had 14 days to respond to the offer.

That should give you time to consult an attorney with a strong understanding of health care law. If you do choose to use an attorney, most will understand you need a prompt review. “Unless they’re in court or very busy, I would imagine most attorneys will turn around a review in a few days,” says Levy.

Sastow says a week to 10 days is average, and Parker says the review process may take up to two weeks, depending on the size and complexity of the contract.

No matter what the time frame is, however, consulting an attorney may prove to be a wise investment. (See the sidebar “Why Hire an Attorney?”)

Whether you decide to use an attorney or not, physicians should keep one thing in mind, says Parker.

“The contract is the beginning of a relationship, one which has the potential to be long-term and worth millions of dollars,” he says. “It’s easier to dialogue about the parts that are important to you, so decide on those first. When it comes to any negotiations, however, it’s good to take a step back and consider it from the other side. A contract should be beneficial to both sides. You want to build a relationship that goes beyond the document. Keep that in mind when you negotiate, and it will pay dividends down the road.”

Karen Edwards is a frequent contributor to PracticeLink Magazine.

 

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Breaking the chains

Looking for more from your compensation? Develop a strategy for your student loans, and you may free up more income sooner than you think.

By James M. Dahle, M.D., FACEP, WhiteCoatInvestor.com | Fall 2016 | Feature Articles

 

“The rich ruleth over the poor, and the borrower is servant to the lender.” –Proverbs 22:7

There is no greater financial frustration for a resident or young attending physician than a large student loan burden, and the lack of financial training in the medical education system compounds the problem. As Vlad Kononchuk, M.D., an attending psychiatrist in Dix Hills, New York, says, “Frankly I did not have much of a strategy for anything when in residency, at least not for financial matters. It is hard to make those plans when you have so many other things on your plate!”

The costs of attending college and medical school have skyrocketed over the past two to three decades. When I started medical school in 1999, in-state tuition at the relatively inexpensive University of Utah School of Medicine was just $10,000 per year. In 2015, a mere 16 years later, that number had nearly quadrupled to $36,000 per year. Out-of-state tuition was nearly twice as high.

That trend has affected essentially every M.D. and D.O. school in the country. Out-of-state tuition can be particularly problematic, as displayed by the price tag at Michigan State University’s College of Human Medicine, which averages $73,000 per year just for tuition and fees. The Columbia University College of Physicians and Surgeons topped the private school list in 2015, at about $56,000. New York City is also an expensive place to live, so the total cost of attendance (COA) there is estimated to be as high as $94,000 per year for MS3s.

On average, D.O. schools are more expensive than M.D. schools. According to the Association of American Medical Colleges (AAMC), in-state M.D. students average $34,000 per year in tuition, fees and mandatory health insurance. Private M.D. schools average $56,000 per year, and out-of-state M.D. schools average $58,000. The D.O. averages do not include health insurance, but clock in at $44,000 for in-state and $49,000 for out-of-state, according to the American Association of Colleges of Osteopathic Medicine. The average debt upon graduation of those who took out school loans, $183,000 for M.D.s and $229,000 for D.O.s in 2015—as reported by the AAMC and the AACOM, respectively—is actually pretty amazing considering the cost of tuition.

Ethan Handler, M.D.

Refinancing his student loans was like “kicking off the training wheels,” says Ethan Handler, M.D. Doing so, however, also helped him refocus on attacking the debt. · Photo by Kat Schleicher

However, those averages obscure the fact that, according to the AAMC, 32 percent of M.D. students graduate with more than $200,000 in debt, and 8 percent graduate with more than $300,000. In addition, since most residents do not even pay enough on their debt to cover the interest, many of those who start residency owing $200,000 finish owing $300,000 or more. So if you feel you are in a deep hole with your student loans, know that you are not alone. There is little you can do at this point about the depth of the hole, but there is a lot you can do to get out of it as fast as possible if you practice lifestyle control and proper debt management.

Although some physicians will have their debt paid off by their employers or forgiven by the federal government, the vast majority will eventually have to pay off their student loans themselves. The secret to doing this is to live a lifestyle similar to your resident lifestyle for a period of two to five years. For example, if you owe $200,000 and have an attending salary of $200,000, you can live on $50,000, pay $50,000 in taxes and put that other $100,000 toward your student loans, eliminating them completely within two years. In order to do this, however, you will need to resist the siren call you hear from peers, friends and family to grow into (or beyond) your income as soon as you can. With proper lifestyle control, most physicians can be out of debt within two to five years of residency graduation. It isn’t complicated, but it does require discipline.

Unfortunately, the other key to getting rid of your debt—proper student loan management—is far more complicated. In fact, it can be ridiculously complicated to determine the proper path during residency because a multitude of options are available to minimize interest accumulation, minimize payments and remain eligible for government forgiveness programs. Proper student loan management can even affect the best way to file your taxes and the type of retirement account to use as a resident. Much of this information I learned the hard way. As a resident who got sick of financial professionals ripping me off, I decided to educate myself on the basics of personal finance and investing. Since then, I’ve been sharing what I learned with other physicians—both in my book, The White Coat Investor, and on my blog of the same name. In this article, I’ll share some of that same information with you. Due to the complicated nature of the in-residency loan management process, this article will provide only brief general rules for residents while encouraging them to learn more about this complicated topic from other sources or to obtain professional advice. Prior to listing these rules, I’ll define the commonly used federal government programs residents need to know about.

The federal programs you need to know

Public Service Loan Forgiveness (PSLF) is a program that allows for complete tax-free forgiveness of your remaining federal Direct Loans after making 120 qualifying monthly payments, no matter how much debt you have left. The programs whose payments qualify include the standard 10-year repayment plan and the three income-driven repayment plans: Income Based Repayment (IBR), Pay As You Earn (PAYE) and Revised Pay As You Earn (REPAYE.)

Income-driven repayment plans have several common features, but the main one is that the payments are dependent only on your income (and family size) and not on the amount of debt you have or the debt’s interest rate. You can determine what your payment amount would be by taking your income and subtracting 150 percent of the federal poverty line for the size of your family. The remaining amount of money is called your “discretionary income.” IBR requires you to pay 15 percent of your discretionary income toward your student loans, while PAYE and REPAYE require 10 percent. For most residents, those payments don’t even cover the interest on the loans. The discretionary programs have a forgiveness feature too, but physicians rarely take advantage of it because it doesn’t apply until 20 to 25 years have passed, and even then, the amount forgiven is considered taxable income. REPAYE has an additional interesting feature in that half of the interest not covered by the monthly payments is subsidized by the government, effectively lowering your interest rate.

Rules for residents

With that brief introduction to the government programs, let us consider three general rules for residents trying to navigate through these complex decisions.

Rule 1 for Residents: If you hope to obtain PSLF by working for a 501(c)3 nonprofit after completing residency, then you want to stay in a government income-driven repayment program during residency.

Rule 2 for Residents: Minimizing payments, minimizing interest accumulation and maximizing loan forgiveness may be mutually exclusive. For example, the best way to minimize payments is to defer your loans until residency completion, but you’d better expect them to be a lot bigger at the end than they were at the beginning! The best way to maximize loan forgiveness is to make payments that are as small as possible during residency through one of the government programs. Which program will allow you to do that best, however, varies according to your marital status, spouse’s income and the type of student loans.

Refinancing your loans can help you to minimize interest accumulation, but it also turns the loans into private loans, which are no longer eligible for Public Service Loan Forgiveness. The private lenders who refinance loans for residents do, however, allow for very small payments ($0 to $100 per month) during residency. To make things even more complicated, the latest government income-driven repayment program, REPAYE, may partially subsidize the interest on your loans, effectively lowering the interest rate to a level below that which you would get from a private lender. This is because residents don’t typically qualify for the lowest rates from private lenders. Instead of the 2 to 4 percent an attending might be able to get, a resident will probably only be offered a rate of 5 percent.

Rule 3 for Residents: The best government program for most residents is the REPAYE program. There are two caveats to this, however. The first is that, depending on how much their spouses earn, married residents may be better off in the IBR or PAYE programs and filing their taxes as Married Filing Separately. The second caveat is that if you decide to go for PSLF after residency, you will likely want to switch from REPAYE into IBR or PAYE upon residency completion in order to maximize forgiveness. IBR and PAYE payments are capped at the 10-year Standard Repayment Plan payment, whereas REPAYE payments may rise above that level, depending on your income.

Decisions after residency

As an attending, the decisions become much easier. If you are directly employed by a 501(c)3 nonprofit or government employer, you should pick the income-driven repayment plan that gives you the lowest payment, pay the minimum on your loans, and obtain PSLF after 120 total payments. If you are not eligible for PSLF, you should probably refinance your loans with a private lender. Various terms and rates are available from at least 20 lenders, and what you qualify for will depend on your credit and debt-to-income ratios. You may be able to lower the interest rate on your loans from 6 to 8 percent in the federal programs to 2 to 5 percent, saving thousands in interest each year. Of course, just because you refinance doesn’t mean you want to forget about those loans and go on the minimum payment plan. You don’t get out of debt by taking on more debt; you get out of debt by living like a resident for two to five years and throwing a huge chunk of money at those loans every month—whether the interest rate is 7 percent or 3 percent.

Ethan Handler, M.D., an otolaryngologist and cosmetic surgeon practicing in Oakland, California, worried a little bit about refinancing his loans. He knew that he would “lose the government-provided safety blanket” to go into forbearance or have income-based payments in case something happened to his income. He ended up refinancing his loans at 3.5 percent and found that it was like “kicking off the training wheels. Once I refinanced and no longer had the safety net of hardship or forbearance, I took more responsibility for my debt. What had previously looked like a funny and absurdly high number ($240,000 upon residency graduation) on paper became something I’m working hard to erase.”

There is also some risk that the government could change the PSLF program. The Obama administration has made budget proposals that, if passed by Congress, would limit the amount of forgiveness to just $57,000.

Amanda Weinmann, M.D.

Amanda Weinmann, M.D., opted to live frugally while paying off her student loans—a choice that allowed her to pay toward her debt while in residency. · Photo by Tim and Madie Photography LLC

Amanda Weinmann, M.D., an attending family physician in St. Paul, Minnesota, didn’t like that the program seemed so politically uncertain—not to mention the fact that no person has yet received forgiveness through the program. (The program requires 120 monthly payments after 2007, and there have not yet been 120 months since 2007.) The idea of dragging out payments on the $162,000 she graduated medical school with was very unappealing. “I was psychologically uneasy with making payments that didn’t even cover the unsubsidized interest, and I felt that, since I borrowed the money and had the means to pay it back, I should.” By living frugally, she paid off a car, avoided credit card debt, funded a Roth IRA and paid off $64,000 of her student loans while in residency.

Another alternative for those concerned about the political viability of the program (aside from avoiding it altogether as Weinmann did) is to save up the equivalent of the debt on the side in an investing account. If the program disappears or becomes severely limited, the funds in the side account can be applied to the debt. If forgiveness materializes as expected, the side account will provide a boost to your retirement nest egg.

Owen Vincent, D.O., a family physician practicing in Prairie du Chien, Wisconsin, uses this approach. He works for a 501(c)3 and is going for PSLF for his $315,000 in student loans. He states, however, “I’m also saving as much as I pay each month in taxable accounts [above and beyond my retirement savings]; so if [PSLF] doesn’t work out, I’ll throw a lot of money at those loans quickly and get rid of them, and if it does work out, I’m that much closer to financial independence eight years from now.”

Employer loan assistance

In interviewing physicians for this article, I was surprised by just how many of them had received loan assistance from their employers. This is an increasing trend among physicians and non-physicians alike. The classic example is the military with its various programs including the Health Professions Scholarship Program, which pays for tuition, books, fees and a stipend for medical students, and the Financial Assistance Program, which pays an annual grant (currently $45,000) plus a monthly stipend to residents in exchange for a service obligation.

The National Health Service Corps (NHSC) offers similar programs. The NHSC loan repayment program offers up to $50,000 toward your student loans in exchange for a two-year commitment to an NHSC-approved site. The NHSC also offers a scholarship program similar to the military HPSP program in that the student receives tuition, fees, other educational costs and a living stipend in exchange for a commitment to serve in an NHSC-approved job. Each year of support in medical school requires a one-year commitment, with a minimum of two years. The scholarship is generally considered the better deal, but the loan repayment program has its advantages as well. This program, however, is generally available only for primary care providers, mental health providers and dentists.

Vincent, who expects Public Service Loan Forgiveness, found that he also qualified for a state-specific, rural provider, tax-exempt loan repayment of $50,000. Kononchuk, too, was surprised to discover that he qualified for a New York loan repayment program designed for physicians treating underserved patients. He says, “I see way too many people not even consider such programs, as they assume that if they don’t live in a rural area, they won’t qualify. Guess what? I work in NYC and I still met criteria!” If he stays in the same job for five years, the program will have paid his entire $150,000 student loan burden.

The bottom line is that more and more employers, states and communities are offering student loan repayment programs and the qualifications are highly variable. You may be surprised what you can find. Vincent says: “My locale may not be for everyone—as some would never dream of living more than an hour from a Target—but I’ve found the slower pace allows for more meaningful time with family, friends, patients and hobbies. Plus, the much lower cost of living has done wonders for my financial situation.” If you, like Vincent, are willing to work in a geographic locale where few physicians are interested in working, you may find you have significant negotiating power. Even if you cannot get a higher salary, consider asking for assistance with student loan repayment.

Whatever your strategy for your student loans, the keys are lifestyle control and educating yourself about proper loan management. As Weinmann says, “It’s literally worth tens of thousands of dollars to spend a little time educating yourself about loan options. If you compare that to your hourly rate as a resident, you’ll find this to be a great use of your limited free time.”

James M. Dahle, M.D., FACEP is the author of The White Coat Investor: A Doctor’s Guide to Personal Finance and Investing and blogs at whitecoatinvestor.com. He is not a licensed financial adviser, accountant or attorney and recommends you consult with your own advisers prior to acting on any information you read here.

 

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Apples and oranges: how to compare job offers

Compensation is important, but comparing your offers when making a job change means more than just looking at the bottom line. Are you evaluating every facet of the opportunities?

By Bruce Armon | Fall 2016 | Feature Articles

 

During the course of your career, you will make many changes: finishing training and taking that first job, advancing within an organization, switching jobs, moving to a different town or, eventually, retiring.

You may initiate many of these changes. Family situations may cause some. Your employer may precipitate others. Still others may result from mergers, acquisitions, affiliations or consolidation as health care continues to evolve. Regardless of the cause of a change, when it is about to occur, you will need to evaluate and compare multiple opportunities.

Comparing opportunities by weighing the costs and benefits of various options is critically important. And crucial to a proper cost/benefit analysis is the understanding of what is most important and viable to you in both the short- and long-term. Which job will protect your future and provide you the flexibility you need for the next opportunity you’ll pursue down the road?

Weigh it: Familiarity

The road through residency and fellowship can be long and winding with an uncertain future. After finishing training, you might weigh the option of staying at the same academic medical center.

There are benefits to staying in the same environment: continuity, familiarity, and the opportunity to teach junior residents whose strengths and weaknesses are known. There are also potential costs to staying at the institution where you trained. You may struggle to be seen as a peer rather than a trainee. You may find upward advancement difficult in a crowded division or department. And you may be more accepting of less compensation in exchange for the comfort of staying at a familiar institution.

To help you evaluate

If you’re considering whether to stay in your current program or not, ask yourself:

  • What is my relationship like with my mentors here? How long will they practice here?
  • What are the growth opportunities?
  • Will I always be viewed as a resident or fellow, or will I be able to be viewed as a colleague?
  • Would I be better off in a different environment that would broaden my professional experiences?
Caren Kirschner, M.D.

Geographic location, quality of life and benefits were most important to Caren Kirschner, M.D., as she evaluated opportunities. · Photo by Colin Lenton

Caren Kirschner, M.D., had three primary considerations when comparing opportunities after completing residency at St. Christopher’s Hospital for Children in Philadelphia: geographic location, quality of life and benefits. Each was of equal priority, and more important to her than other criteria such as starting salary or advancement opportunities.

Kirschner chose to join a private practice, but familiarity still played a role. “I grew up in the Philadelphia area and went to medical school and completed my residency in Philadelphia. I knew I wanted to stay in the immediate Philadelphia area, and I really wanted to avoid an unpleasant commute,” she says.

Weigh it: Geography

As in Kirschner’s case, geographic location is a top consideration for many physicians comparing job options. Geographic preferences are mostly personal, but there are also practical and legal issues regarding the area in which you choose to work.

Professional liability insurance costs vary among regions largely because of each region’s reputation of being provider-friendly in legal matters and because of its history of suits, judgments and settlements. If the cost of professional liability insurance is significantly more in one community than another, that may affect the salary that can be offered by an employer—and your choice to practice there.

Noncompete clauses prohibit physicians from practicing within a certain distance from their previous employer for a certain amount of time after they leave that employer. A clause’s scope may vary depending upon your specialty, employment setting and the competition in an area. If you know you want to be in a specific community for a long time, a noncompete stipulation may be the most important section of your contract. In states that prohibit noncompetes, you may find that employers include a liquidated damages clause to ensure that physician employees pay damages if they practice within a certain radius during a certain time frame after their employment ends.

Cost of living is another consideration tied to geography. How much of your salary will go toward housing, property taxes, groceries and transportation? Will you need to budget for private school tuition in one practice location and not another?

To help you evaluate

Plan to talk with realtors, local school district officials, leaders in the local hospital and others who will provide objective information. Ask about anything that’s particularly important to you: cost of housing, school options, athletics and other recreational activities, and turnover of other physicians.

Knowing the standard of living that your base salary would provide in a community is also important, particularly when you are considering relocating to an area with which you have limited familiarity. Get a clearer picture of the areas you’re considering with help from these websites:

  • CNN Money (cnnmon.ie/28PPyEd): A straightforward online calculator.
  • Sperling’s Best Places (bit.ly/1wO6KTN): A calculator that factors in food, housing, utilities, transportation and health costs.
  • Bankrate (bit.ly/1gTzoZ0): Detailed cost comparisons for a few dozen common cost-of-living items, from ibuprofen to tennis balls.
  • The U.S. Department of State (1.usa.gov/1RrNOPI): A list of helpful resources regarding salaries, cost of living and relocation, including links to various chambers of commerce as well as realtor and retirement information.

Weigh it: Compensation

Two jobs that both pay $150,000 annually may result in very different standards of living depending on where each is located. But there are also other factors to consider as you compare compensation. The salary in the contract is just the beginning.

A fundamental premise that you must understand as you compare compensation offers is that your total pay (base salary, bonus, benefits) will be based upon some variation of return on investment—the return you provide on the investment employers make in you. Employers will pay you less than what you generate in revenue because the resulting margin will help fund their other operations, which may include less profitable practices. Your responsibilities—whether clinical, administrative, research or a mix—also affect your compensation.

Employers typically pay physicians based on one of three models: straight salary (with or without bonus opportunities), productivity, or profit-centered.

Straight salary. The straight salary model guarantees you a specific amount of pay for a defined period of time. No matter how hard you work, how many patients you see or how many procedures you perform, your salary remains the same.

Productivity. Under this model, you are paid according to your personal productivity. This may be measured as cash in the door, work relative value units (wRVUs), patient encounters, number of call shifts, overnight shifts or another standard. This model often includes a lower base salary or draw, but the more productive you are, the more money you can make.

The wRVU measurement eliminates bias based on the payer mix of a physician’s patients. For instance, a physician who treats only uninsured patients likely generates far less cash in the door than a physician who treats only privately insured patients. But if they work the same number of hours and see the same number of patients, they should have the same number of wRVUs.

Profit-Centered. A profit-centered model bases your salary on both your productivity and your expenses. Your compensation depends on both the opportunities you have to generate revenue and your ability to keep expenses to a minimum.

If you’re considering an opportunity with this payment model, it is important to understand the approximate revenue you can generate and how expenses are calculated. Are expenses determined pro-rata (for example, if there are five physicians in the profit center, they are each responsible for 20 percent of the expenses), or are they based on some other formula?

For some employers, the compensation model may be negotiable. If you’re more comfortable with one model over another, it’s worth asking your potential employer if their model is flexible. The response will likely depend on the size of the practice and how developed its infrastructure is. Other employers may start you with a straight salary that shifts to a productivity model at some pre-determined point in time.

To help you evaluate
Diane Godorov, D.O.

When evaluating offers, “having an objective, unbiased resource to help you set compensation expectations is very important,” advises pediatrician Diane Godorov, D.O. · Photo by Kelly Giarrocco

Diane Godorov, D.O., is a pediatrician who has worked in several different settings including private practice and urgent care. “It is important to know what you are supposed to earn and how realistic it is that you can attain proposed bonuses,” she says. “Having an objective, unbiased resource to help you set compensation expectations is very important.”

One source of objective data is the Medical Group Management Association (MGMA), which publishes several reports compiling annual compensation data for physicians. MGMA data shows how salaries are affected by factors such as specialty, years of experience, size of practice and geographic location and can help you understand the physician marketplace.

For physicians pursuing academic medicine, the Association of American Medical Colleges (AAMC) publishes physician compensation data. AAMC reports include detailed information about how compensation is affected by faculty level, departments and specialties, and the mix of clinical work, teaching and research.

Many employers use national surveys such as the above to set salary and bonus caps at the median or 75th percentile. By creating this cap, an employer can ensure that compensation is based on fair market value and balanced among peers. Ensuring there is a salary floor, too, can ease your anxiety of switching from a job with a guaranteed salary to one that may be variable and based on factors outside your control.

Another compensation factor to be aware of is that, if your practice includes clinical or academic research, your employer may expect you to secure grant dollars to cover part of your own compensation. If the grant dollars are eliminated or reduced, your compensation may be adjusted accordingly. In many instances, receiving additional grants may not increase your compensation, but it can allow additional research to be performed by hiring additional staff.

Weigh it: Benefits

Benefits are an often-overlooked piece of the compensation package, but they can make a significant difference both in dollars and in quality of life.

For Kirschner, “maternity leave was an important consideration of any job offer.” As a pediatrician and a hopeful mother, she prioritized this benefit as part of her job search.

It’s important to understand how the benefits you’re offered compare both monetarily and toward your quality of life. What is the value of the health insurance and vacation time offered, or the funds available for CME? How about the value of the retirement program or the professional insurance coverage offered?

An opportunity with a lower base salary but excellent benefits may actually be better than one with a higher base salary and few or no benefits.

Weigh it: Family Fit

Stuart Ort, M.D., was a successful otolaryngologist in California for eight years. He practiced with one other physician and had no employment-based reason to switch jobs. But as he weighed his happy job situation with a desire to be closer to family in the New York City area, family took the higher priority.

In his search for a new practice, Ort says his “major consideration was finding a non-academic institution or group where I would be able to focus the vast majority of my time and energy on clinical work.”

Ort reached out to friends in the New York City area and ultimately identified a large single-specialty ear, nose and throat practice. Even though it is a much larger practice than his former employer, Ort reports that he is “very happy with how transparent the practice is and the fact that no one feels like they are missing out or are getting unfairly treated.” Despite moving cross-country to a very different practice environment, Ort says his new practice is a “great fit.”

To help you evaluate

To help ensure your new practice and community meet you and your family’s needs, ask these questions:

  • What is the real estate market and school district like?
  • Does the community offer access to my and my family’s religious, educational and extracurricular needs?
  • How close would I be to family and friends?
  • How is the climate and environment?
  • What community do most physicians live in? What is the commute like?
  • What do physicians in the area do when they’re not working?
  • What do other physicians and their families like best about living and working there?

Comparing your options

Some physicians compare the job-search process to a dating game: you meet a lot of different people interested in getting to know you better, and they all want to see if you are compatible with them. Once you are interested, the employer prepares a contract to make the relationship official.

Mike Srulevich, D.O., who recently changed jobs, was philosophical as he considered a new opportunity. A change in jobs “can be transformative on several levels,” he says. “You may have been doing the job for years, but all of a sudden it’s a new culture, a new schedule and a lot of different personalities.”

Taking a new job, he says, is “like buying a new house: Finding it might be the easiest part.” Once you sign the employment contract, you must “navigate the paperwork, coordinate schedules and unpack life as it formerly was [in order to] start a new and different professional life.”

Just as in house-hunting or dating, physicians who are comparing options must understand and prioritize their own short-term and long-term goals. Choosing among multiple options is never easy. As you weigh the costs and benefits of opportunities, make sure you have carefully defined your own objectives. Additionally, make sure that the language of your final contract is consistent with these objectives and matches your impression of the opportunity. Identifying what matters most to you will help you make the choice that is most professionally and personally gratifying.

Bruce Armon is chair of the health care practice group at Saul Ewing LLP and frequently speaks to physician audiences and other health care audiences. He has helped hundreds of physicians and practices over the years with contractual, compliance, reimbursement and regulatory issues.

 

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