Culture check

How to determine an organization’s culture—and how you will or won’t fit in.

By Teresa Odle | Feature Articles | Summer 2015

 

Internist Rebecca S. Lee, M.D., medical director of North Shore Physicians Group in Danvers, Massachusetts, has practiced primary care in her hometown for eight years. “I am kind of born and raised where I practice, which I really love and which is part of our culture,” she says. This is not to say that every physician at North Shore Physician Group’s Danvers location also was born and raised in the area. “But it is more of a community feel,” she says.

Dr Lee

“We try to make decisions based on finances and hours and such, but I think you also need to go a little bit with your gut,” says internist Rebecca Lee, M.D., about finding a place where you’ll fit in.”

Reaching that community feel in Lee’s practice didn’t happen overnight or even organically. It took effort. Lee helped open the new practice near her home and had a say in everyone hired, from physicians to front-end staff.

Across the country, in northern Arizona, internist Derek Feuquay, M.D., also has worked hard with his group, Flagstaff Medical Center Hospitalists, and Flagstaff Medical Center administration to create an excellent culture in the group practice and hospital.

According to Feuquay: “We have created an employed practice where people just don’t show up and work together; they are friends, colleagues and teammates.” Feuquay and his wife both joined the group about six years ago, and he became the lead physician in 2011.

When successful teams are formed, it’s because the hiring parties were able to look beyond training, certifications and clinical skills and to something more ethereal: “fit.” So how does a physician seeking a new opportunity evaluate their fit? And just why is the organization’s culture so important?

What is culture?

Of course, culture has dual meanings in health care today. Cultural competence is all about understanding the body of knowledge and beliefs or the backgrounds with which patients identify because patients’ values and customs can influence their belief systems regarding health.

The same holds true for culture within a health system, hospital or group practice. Many of the beliefs and values are intangible—or at least difficult to pinpoint and measure. Louis Caligiuri, director of physician contracting and recruiting for North Shore Medical Center in Boston, which is affiliated with North Shore Physicians Group and the larger Partners Healthcare Network to which both belong, says that communication is a big part of the North Shore culture. “The lines of communication are open, and we try to be a physician-led organization.”

Much of that can’t be measured, but Lee points out that she receives notification whenever one of her patients is seen in a Partners facility. That’s something an incoming primary care physician might want to know.

Other examples of culture include the mission, vision and values of an organization. Some of these are formal and published, driving how everyone from the medical director to the billing staff conduct business.

“The culture of our organization is one that supports professionalism,” says Jonathon K. Foley, M.D., FACS, president of Cape Girardeau Surgical Clinic in Missouri. Foley, a general surgeon, says that the group focuses on “getting the right people, the most efficient processes, and the best technology to support the work of the organization.”

Not every practice or hospital has formalized their culture. Other times, the leadership believes they have a particular culture, but word may not have gotten to the rank and file physicians or staff. Those that are most successful at having and sticking with positive cultures have identified and are driven by core values.

For Cape Girardeau Surgical Clinic, getting to the point they now are at grew from intentional behavior and actions, says clinic administrator Sarah Holt, PhD, FACMPE. “Years ago, we discussed as a group the kind of practice we wanted to become.” Included in the group’s culture is a focus on applying formalized governance in “a fair and systematic manner,” says Holt, along with valuing individuals and the group as a whole. In addition, Holt says, “We hire the best people we can find.”

Kevin Bartow MD

Kevin Bartow, M.D., is the newest physician partner at Cape Girardeau Surgical Clinic. He suggests that candidates ask all their questions while they’re interviewing, including how work is distributed.

Why is culture important to job seekers?

Although physicians seeking new opportunities have much to consider and weigh, many recognize the significance of cultural fit when evaluating an organization. According to Caligiuri, some of the physicians he interviews mention that the organization’s culture is an important factor. “Some are explicit about it,” he says.

And although physicians often are prepared to evaluate compensation or benefit packages, they might not realize the effects an organization’s culture has on the bottom line or physician benefits. “Culture drives satisfaction or dissatisfaction with compensation, call, salary and benefits,” says Holt. She adds that culture also contributes to satisfaction with one’s colleagues—an important factor in a specialty such as surgery, where respect and collaboration are key. If not present in the culture, “problems develop, fester and finally erupt,” says Holt.

Foley agrees. “The work we do is too stressful to spend energy fighting the organization,” he says, adding that the organization “needs to support the work of the physicians and staff so that we can accomplish meaningful work.”

For those who vet, interview or hire new physicians, it’s crucial to make sure that the culture is a fit for both the new physician and for the organization. Caligiuri uses the hospitalist program in Partners as an example. There tends to be more turnover in hospitalist positions simply because some physicians work in the job for a few years and then move on to a fellowship or other position. If a new hire also is not a fit with the organization, then turnover increases more, which can add to costs for the organization and upset a carefully developed culture.

Feuquay says that when he first arrived in Flagstaff, rapid growth meant equally rapid hiring of hospitalists, and some of the hires were not good fits. Even though the group and hospital continue to expand, both have settled into a more steady and purposeful way of handling their growth and success.

“Nothing makes an employed hospitalist feel more comfortable than a stable organization that continues to support their group,” says Feuquay.

Megan Nordvedt, manager of medical affairs and physician recruitment for Flagstaff Medical Center, says cultural fit is everything when physicians join a new organization. “If a physician feels the culture is familiar and comfortable, warm, welcoming and professional, they are sure to perform better and stay with the hospital a long time.”

In turn, a culture that encourages happy physicians and staff and respect for those who care for patients ultimately results in better productivity and patient care. “We have had patient satisfaction scores above the 90th percentile for almost three years,” says Feuquay. “This is because when doctors come to work happy, they take good care of patients and people leave the hospital happy.”

How to evaluate culture

“We try to be very clear when recruiting about how our group members interact with each other,” says Cape Girardeau’s Foley. This includes expectations about how hard the group expects its surgeons to work, along with expectations regarding open communication and “camaraderie with other surgeons, and how we have developed a high-functioning team,” he says.

Kevin N. Bartow, M.D., the newest physician partner with Cape Girardeau Surgical Clinic, says that the group’s executive team meets every Monday morning to check out from the weekend and review patients’ statuses. Bartow had done a rotation with the surgical practice and was aware of its openness. He suggests that physician candidates ask plenty of questions when discussing opportunities with potential groups. “For example, do you have policies that outline benefits for all physicians? How is work distributed?” He also suggests inquiring about compensation for the next two to five years. Holt advises to also ask about details regarding how compensation is distributed and whether any component of compensation is based on production.

It may help to ask how physicians in a group practice assign new patients to physicians, along with how new physicians contribute to strategies and decision-making in a practice or hospital. Other considerations include consistency of policies and procedures and how they’re applied. Often, talking with the practice administrator as part of the process provides clues to communication, governance and decision-making.

Lee recommends that a potential hire come back after the initial interview and shadow the physicians for a day to see what the practice is like. “But even if you can spend an afternoon with someone” she says, it is helpful to get a feel for the culture.

At the very least, candidates should be sure to speak to as many physician peers as possible. “For hospitalists, make sure you meet other hospitalists and ask them questions,” Feuquay says. “Meet other subspecialists and ask them questions.” He says the hospital tour often gives potential hires a chance to see how others perceive the hospitalist group, which can be a selling point for applicants.

Throughout your interview, tour and site visit, observe communication and interactions. “Pay attention to the way the physicians interact with one another, with nurses, specialists and managers,” says Nordvedt. “How is everyone working together, and how do others achieve the work/life balance outside the hospital?”

Sometimes it is tough to identify signs of low morale, physicians who anger easily or hidden hierarchies, but the more people you talk with and the more time you can spend touring and visiting hospital or practice locations, the more likely you can spot signs of cultural fit. How employees treat patients, vendors or one another may provide clues to how organized, hectic or stressful the culture is on a typical day, and whether everyone buys into the mission and vision of the organization.

Owen J. Dahl, MBA, FACHE, of Owen Dahl Consulting in The Woodlands, Texas, says he advises asking for meeting minutes if possible, or at least to review a meeting agenda from group practices or medical staffs. “Notice if the agenda focuses solely on finances.” He says there may be nothing wrong with that, but if the first agenda item focuses on patient quality of care, that sends an altogether different message than if every agenda for the quarter focuses on finances. It’s up to the candidate to decide which type of message or value fits with his or her beliefs, styles and vision for this new opportunity.

Jonathon Foley MD

Finding candidates who support the group’s culture is key for Jonathon Foley, M.D., president of Missouri’s Cape Girardeau Surgical Clinic. “The work we do is too stressful to spend energy fighting the organization,” he says.

Feuquay recommends asking for a tour of the hospital and town. All candidates who visit his group have a tour of the Flagstaff area with a group member’s spouse, who is a real estate agent. Finally, remember to be observant not only throughout the planned activities, but during your entire site visit. So many clues to the potential employer’s culture are better ascertained through observation. As soon as you arrive, observe the feel of the waiting room and check-in or admissions area. Dahl suggests noting details such as whether notes and signs that inform patients about payment and policies are professional in appearance. If your tour takes you into clinical areas, observe nuances such as lighting, cleanliness and organization. Even the employee break room atmosphere might give a clue about the culture.

One of the best ways to assess cultural fit is to evaluate the intangible feelings you have when making the recruitment visit. Lee encourages physicians to go with their guts. “We try to make decisions based on finances and hours and such, but I think you also need to go a little bit with your gut and where you think you will have the best time,” Lee says. “You are going to be spending a lot of time at work, and you need to genuinely enjoy the folks you are working with.”

Teresa Odle is a frequent contributor to PracticeLink Magazine.

 

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Playing nice: how to handle your first negotiation (with grace)

Yes, you can negotiate your first contract. Follow these tips to make your experience a positive one.

By Teresa Odle | Fall 2015 | Feature Articles

 

Mario Espindola, M.D.

Mario Espindola, M.D., knew he wanted to practice at a federally qualified health center. Through professional conversations and gentle negotiations, both he and his employer found happy outcomes.

As Mario Espindola, M.D., neared the end of his residency in the University of California, San Francisco Fresno Family and Community Medicine program this spring, he began looking for his first practice opportunity. He knew where he and his wife wanted to live and that he preferred a federally qualified health center.

Espindola found just that at Hillside Health Center in Ukiah, California, but his work wasn’t over after he landed the job. He still had to negotiate his offer.

Kelly Kesey, the recruiter and training coordinator for Mendocino Community Health Clinic, Mendocino Coast Clinics and Long Valley Health Center in northern California, recruits health providers and executives for Hillside Health Center and a number of other locations. She says Espindola handled his negotiations exceptionally well.

“He knew that the practice wanted someone who was bilingual,” says Kesey. “So when it came to negotiations, he said, ‘I’m wondering if the agency strongly values that I’m bilingual and if that has a place in these negotiations.’” Espindola wasn’t pushy, but he paid attention and balanced his interests with the needs of the employer.

Espindola’s example shows physician contract negotiations don’t have to be a battle. Both he and Hillside Health Center ended up with happy outcomes. And that’s what negotiation is all about: making sure everyone comes out ahead.

Don’t fear negotiation

Amber Brake, chief executive officer of Physicians’ Negotiators LLC, says new physicians need to know how to negotiate. She believes the first contract builds a foundation for a physician’s career and that it’s important to begin on good terms. “About 60 percent take terms that are unfavorable,” says Brake. “And about 50 percent of physicians change jobs in the first two years.”

Some physicians hesitate to negotiate because they don’t want to come across as difficult, according to Ryan D. Mire, M.D., FACP, who practices at Heritage Medical Associates and serves as associate chief of medicine at Saint Thomas West Hospital in Nashville.

“There is a natural intimidation factor that exists with an early career physician who feels like they need the job and doesn’t want to get into a contentious relationship or conflict from the beginning of the relationship with the practice,” he explains. But Mire and other seasoned physicians know that negotiating terms is just part of the process.

Physician recruiters know this, too. As the regional director of physician recruiting for LifePoint Hospitals in Colorado, Utah and Nevada, Bruce M. Guyant, DASPR, has seen good and bad examples of negotiations in his 18 years of recruiting. He says that although some negotiations have wrinkles, LifePoint Health always wants physicians to feel good about the outcomes.

“I speak not only for myself, but all of my esteemed colleagues in the industry, when I say that I truly want a physician to be happy, contented and comfortable with the agreement that they sign with us,” says Guyant.

Another reason new physicians don’t negotiate is that their first salaries seem large compared to what they made as residents. Espindola, who served as chief resident at UCSF Fresno before joining Hillside Health Center, points out that new physicians are often making more money than they’ve ever made before. He says that when they talk to practices, they think: “‘I’m going to be working five days a week and getting paid two to three times more than in residency, and I’m getting great benefits. Why would I negotiate more?’”

But physicians who don’t negotiate may later find out they could have been earning more. Although most employment agreements must keep physicians within a set range, there can be wiggle room. Additionally, compensation varies from region to region and even practice to practice, says Espindola. He emphasizes that physicians have to find out what’s out there. The only way to negotiate is to know your own worth and the going rates.

Preparation is key

Rebecca Miller, M.D.

When negotiating, it’s helpful to look past the short term and consider what you want your work life to be several years in the future, recommends Rebecca Miller, M.D.

The easiest way to find out your worth is by thorough preparation. “It’s important for a physician to know what his or her fair market value is,” says Rebecca Blythe, DASPR, MBA, physician recruiting specialist for St. Vincent’s Health System in Birmingham, Alabama. She says a tool such as the Medical Group Management Association’s regional salary guide is a good resource. “A physician can also talk to other physicians in their specialty and to new hires,” Blythe adds. Consultants such as Brake can also help. Brake says, “We come in, take all of the different salary surveys and distill them down to what’s applicable and say, ‘Here’s what we think you’re worth.’”

In addition, it’s important for physicians to understand how a potential employer or practice determines compensation. Some base pay on productivity, while others use experience or specific skills to determine salary.

Knowing what matters most to an employer helps physicians gather the right data to estimate a fair starting point. “People respond to objective data,” says Brake. In fact, if another party doesn’t respect the data you present, it could be a red flag about future dealings.

Asking questions also eases you into the salary discussion. Rebecca W. Miller, M.D., who specializes in internal medicine and pediatrics for St. Vincent’s Family Care in Hoover, Alabama, says she was not comfortable negotiating her contract. “When you come to negotiations as a resident physician, you may not feel empowered,” she explains. Miller says questions help you start the conversation, establish a relationship and gather information. “I would recommend to ask a lot of questions and consider what you will want out of life not just one year, but many years into the future,” says Miller.

Know what you want

Salary is not the only item on the table. A financial package might include a sign-on or retention bonus, moving expenses and other perks. Physicians may be able to negotiate these amounts or adjust their payment schedule. For example, Espindola worked with the group to negotiate slight changes in his signing and retention bonuses.

Lifestyle factors are also important to many physicians today, says Miller. Schedules and vacation time might be negotiable depending on the practice. “This was not the case when I entered the workforce,” she says. Physicians who want additional family time should find out whether those terms are even on the table before negotiations go too far. And if an employer is willing to budge on lifestyle factors, a candidate might need to be more flexible about other terms.

Before negotiating, physicians should determine their priorities. Guyant recommends ranking contract terms from most to least important. “Successfully negotiating requires some preparation ahead of time,” says Guyant. “If you go into discussions and shoot from the hip, so to speak, then you will likely not have a favorable outcome.”

Guyant adds that physicians should try to understand an employer’s perspective. When a practice denies a request, it may be less about winning the negotiation and more about ensuring the practice’s viability. To stay in business, practices have to maintain a certain budget while providing a high level of care.

Fully understand your contract

Mire hired an attorney to help with contract interpretation. He advises new physicians to do the same, but to negotiate without an intermediary. “I would hire an employment agreement attorney for the legal understanding of the contract, but handle negotiations on your own,” he says. He believes this is more personal and less adversarial.

Blythe agrees. “A physician is his or her best representative,” she says. Attorneys help by reviewing contracts and making recommendations, but candidates shouldn’t assume their attorneys have the final word. Blythe has seen candidates propose long lists of contract changes from their attorneys even when “there may be just a few things that are negotiable.” Many established practices have standard phrasing and clauses that aren’t up for debate.

Similarly, Guyant cautions, “You are not obligated to make legal counsel’s gripe yours.” He says he’s found that “minor parts can become huge sticking points, and all of a sudden, you have a deal-breaker because the physician feels that there is a big issue, when it really is not big to them.”

It’s important to understand a contract and ask questions, not just nitpick about potentially unfair terms. Often, recruiters and mentors can help explain contract terms so candidates can make their own decisions. As Guyant says, “The contract is for you, and you must be happy with it.”

Once you’ve agreed on terms, nail down the details in your written contract. Play nice

After research comes negotiation. The same rules of professional courtesy apply here as with all other communication. Honesty and openness are important. And although candidates and employers should consider offers carefully, it doesn’t help either party to play waiting games. “Hillside Health Center took the time to review every counteroffer that I presented to them and get back to me in a timely manner,” Espindola says. “Kelly and Dr. (Thomas) Bertolli were very good about communicating,” he adds. Other practices made him wait longer and did not communicate as well.

Poor communication during a negotiation can be a warning sign. As Kesey points out, practices should want providers to feel valued and vice versa. An open, friendly negotiation process creates “an established relationship of trust and of hearing each other, like how to say ‘no.’” This sets the stage for open discussions in the future.

Blythe echoes this sentiment. “Be honest and aboveboard with everyone, and try to make it a win-win for all involved. Being comfortable with your relationship with your new employer is as important as anything you will negotiate in a contract,” she says.

Choose your battles

Negotiation always involves compromise, and sometimes a practice can’t meet a physician’s request. For example, some physicians try to negotiate paid time off with Mendocino Community Health Clinic, but Kesey says, “That’s just not negotiable with our agency.” However, she’s willing to work with candidates. She explains the practice’s policies to them, saying, “Here’s what we can and can’t negotiate. How can we make this work for you?”

According to Mire, some physicians are under the false impression that candidates can’t negotiate. “While there are times that there is a standard contract for a group, there is always a possibility that you negotiate some aspect of a contract, especially if the group has a high interest in you as a potential candidate,” Mire says. “I advise all physicians to ask for what they want. …But understand that it’s a negotiation. Pick your battles for those aspects that are most important to you, and realize that you have to compromise on some aspects.”

Each party should show respect for the other and be willing to address issues. “It’s important to approach it from a respectful point of view,” says Brake. “So neither party is negotiating from a zero-sum game. They aren’t trying to negotiate everything to their advantage and have the other party walk away with nothing.”

According to Guyant, conceding a little leaves both parties feeling good after the physician signs. “Often, to get a few things that you need or want from your practice arrangement, you need to be willing to give some concessions to the hospital or clinic for whom you are going to work,” he explains. Mire agrees. “I advise all physicians to ask for what they want but understand that it’s a negotiation and they may not get everything they ask for,” he says.

Espindola certainly didn’t get everything he asked for from Hillside Health Center, but he was welcomed and respected. Now he knows that it never hurts to ask. He says, “You want to make sure that you’re being adequately compensated and left with no doubt that you didn’t explore all your options.”

Teresa Odle is a frequent contributor to PracticeLink Magazine.

 

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How to comb through your contract like a lawyer

Legal jargon and complicated clauses make contracts hard to decipher. Take a fine-toothed comb to your contract to understand what exactly the opportunity entails.

By Marcia Layton Turner | Fall 2015 | Feature Articles

 

Bhuwan Lal Kayastha, M.D.

“An expert can provide information and guidance around subjects that we physicians are often unaware of,” says internist Bhuwan Lal Kayastha, M.D.

Yes! You got the job. The hard work is done, right? Not exactly. Now it’s time to nail down the specifics of your employment agreement. You’re probably most interested in negotiating your salary, but you shouldn’t overlook other contract terms. Fine-print details can make the difference between a dream job and daily drudgery.

Forty-six percent of physicians leave their first jobs once their contracts end, says Jon Appino, principal and founder of Contract Diagnostics just outside Kansas City, Missouri. This suggests that nearly half of new doctors aren’t satisfied with their first arrangement. After starting, they may find their contract terms aren’t all they hoped for.

Appino’s firm reviews physicians’ contracts to make sure they understand the details. “Our job is to educate physicians around what the contract says,” he explains.

Because specialists know the ins and outs of the industry, they can recognize missing clauses. And what’s left out usually causes more harm than what’s included.

Nothing can replace a lawyer’s advice, but here are a few ways to approach your contract from a legal perspective.

Salary is just a starting point

Salary or total compensation is often a physician’s biggest concern in contract negotiations, but it’s usually the least flexible term. Employers typically base salaries on annual compensation surveys, which report national, regional and state salary data. The Medical Group Management Association (MGMA) report is perhaps the most frequently cited, although several other surveys are available. Few hospitals or practices will pay a base salary above the MGMA median, and most initial offers are below that figure, says Jeff Hinds, MHA, president of Premier Physician Agency in Columbia, Missouri. His agency helps doctors find jobs, understand contracts and handle negotiations.

To assess a job offer, you need to compare your salary to the norm. Use MGMA data for your specialty and region to see how the offer stacks up. But don’t get salary tunnel vision. Other contract terms may be more negotiable and may affect your quality of life more. According to Hinds, you should pay attention to these key details:

Productivity compensation

Productivity bonuses probably won’t apply in your first year, says Hinds, but they may make a difference later on. Some contracts offer a base salary for two years and then use productivity thresholds to determine pay. Before you sign a contract, be sure you understand what factors determine your salary and bonuses.

Termination language

Hinds advises physicians to examine termination language carefully to make sure it’s fair and equal. Find out what circumstances can result in termination and what kind of warnings you’ll receive before you’re let go. You should also check state laws. Some states permit termination without cause—meaning an employer can let you go without stating a reason.

Notice and cure period

In addition to fair termination language, make sure your contract includes a notice and cure period clause. This clause requires your employer to notify you in writing of behavior you need to address and then give you time (usually 30 or 60 days) to correct it.

Restrictive covenant

Most health systems and private practices include non-compete clauses in their employment agreements. These determine how soon you can work for a competitor (defined by geographic proximity) after leaving your current employer. Some states do not enforce these clauses, but if your state does, be aware of highly restrictive non-compete terms.

“The time and distance needs to be reasonable,” says Hinds. Keep the time window of the non-compete clause as short as possible (one year is better than three), and understand where the clause applies. The radius is typically smaller in a major metro area than in a rural community, and it should be measured relative to your actual location. For example, if you practice in San Francisco and your health system also has offices in Fresno, the clause shouldn’t restrict you from working near the Fresno offices.

Malpractice coverage

Will your employer pay for your malpractice insurance? And if so, which kind? Two types of malpractice insurance exist, and the difference is important.

A claims-made policy only covers claims filed while that policy is in effect. An occurrence-based policy covers claims that occurred in your coverage period, even if they are filed while the policy is no longer active. Most practices opt for claims-made policies because they are cheaper. If your contract includes a claims-made policy, you need to purchase or negotiate a tail policy to cover claims filed after you leave, says Hinds.

Your contract probably includes many other sections, but don’t neglect these key clauses. Consider hiring an attorney or contract expert to review your agreement, and remember your ultimate goal: an arrangement that provides the lifestyle you want for yourself and your family.

Linette Rosario-Tejada, M.D.,

Linette Rosario-Tejada, M.D., felt successful in her negotiations because she was clear from the start about her priorities. “Know what you want and what you don’t want,” she says.

Creative ways to earn more

“Everyone gets so caught up by the big numbers [the salary], but I’ve found you can get more by nibbling on the fringes,” says Mark Livecchi, M.D., clinical chief of rehabilitation services at Erie County Medical Center in Buffalo, New York. “You can often get what you want in a way you didn’t think of.” If you can’t increase your paycheck, look for ways to reduce your expenses. For example, you might ask your employer to cover these costs:

  • Continuing medical education and travel expenses
  • Cell phone subsidy
  • Health and dental insurance
  • Disability insurance
  • Relocation expenses
  • Contributions to student loans after a certain number of years on the job

When your employer covers these expenses, you increase your take-home pay without increasing your salary. It’s best to ask for these provisions before your contract is finalized. After you sign with an employer, these perks are much harder to get.

Enlist a professional

An advisor can help you avoid contract pitfalls. Bhuwan Lal Kayastha, M.D., a hospitalist with Benefis Health System in Great Falls, Montana, says his advisor’s contract review and feedback was invaluable. “An expert can provide information and guidance around subjects that we physicians are often unaware of,” he says. “They help you understand key terms in your contract and help in reading between the lines.” Their insight can protect you from taking on unreasonable obligations.

Kayastha believes his advisor helped him get a better deal. He was unable to negotiate a higher base salary, but he did increase his signing bonus, and his employer paid 50 percent of his relocation expenses. And salary was only one of his priorities. Work hours, patient load, visa sponsorship and vacation also mattered to him. Negotiating those allowed him to achieve the lifestyle he wanted, not just earn more money.

Looking back, Kayastha believes an expert could also have helped with his contract negotiation. “During my first job, I was unsuccessful with negotiations, and all I could achieve was an increase in the signing bonus—the reason being I did not have access to compensation data that an expert could have provided me.”

Know your nonnegotiables

Linette Rosario-Tejada, M.D., a family medicine physician at St. Vincent’s MultiSpecialty Group in Bridgeport, Connecticut, did her own negotiating. She says she ended up with a happy outcome because she was clear from the get-go about her priorities. She advises physicians to “know what you want and what you don’t want.”

Since Rosario-Tejada is a citizen of the Dominican Republic, she needed visa sponsorship to stay in the U.S. She also wanted to stay in the New York tri-state area. The former was a requirement, the latter a preference. During her search, Rosario-Tejada says she was fortunate enough to find two hospitals that “gave me everything I wanted.” Since one was a couple hours south of the New York metro area, she declined that offer after finalizing the one she really wanted.

With the help of a contract advisor, she negotiated a few changes to her agreement, including more favorable visa language. She was also able to adjust the termination clause because the original language allowed for termination without cause. Her employer also paid her professional fees, medical licensing and board certification.

If you don’t ask, the answer’s always no

You have less leverage once you sign a contract, so now is the time to ask for whatever you want. Asking doesn’t guarantee you’ll get it, but not asking guarantees you won’t. Even so, many physicians hesitate to speak up. “A lot of physicians are generally not comfortable doing their own negotiation,” explains Appino. As a result, they “sometimes choose not to ask.”

Negotiate confidently

Based on his own experience, Kayastha offers this advice to fellow physicians:

1 Prioritize

Rank your personal and professional priorities before beginning negotiations. Choose your battles, and don’t blow small details out of proportion. Kayastha’s immigration status topped his list, but workload or vacation time may be more important to you.

2 Review, review, review

“Invest time in reviewing your contract, and have your contract reviewed by a professional,” he recommends. After signing, you can’t revise it, so make sure you understand the agreement before putting pen to paper.

3 Take your time

“Do not accept or decline an offer instantaneously,” he suggests. After you receive a formal offer, ask for time to review and consider it. Pausing allows you to fully understand your obligations.

4 Always ask

Don’t be shy about your wishes. “Those who ask are often successful in negotiations,” Kayastha says.

Make it a win-win

Appino reminds physicians that contract negotiation “is not a win/lose or an us/them. It’s a discussion, a conversation between two interested parties.” Both sides have the same goal: creating a positive employment relationship. The recruiter or human resource representative isn’t your enemy.

Throughout his career, Livecchi has been on both sides of the negotiating table. He reminds fellow physicians, “You can’t always be taking. You also have to give.” To get what you most want, you may need to concede on some other point. “Don’t be unreasonable,” he advises.

Since compensation is at the heart of most contracts, it can become a sticking point. If you insist on a base salary outside the MGMA range for your city or specialty, you may end up without a job. “You could price yourself out of the market by asking too much,” warns Livecchi.

About 5 to 7 percent of the time, physicians and employers don’t come to agreement, reports Appino, and physicians are more often the party to back out.

Walking away is much easier when you have a second offer you can accept if you turn down the first. It’s tougher if you’ve already turned down all of your other offers.

Ultimately, an employment contract is an agreement that you’ll provide physician services under certain terms for certain compensation. As you push for the maximum compensation, make sure you’re able to meet all of your employer’s needs as well.

Marcia Layton Turner is a frequent contributor to PracticeLink Magazine.

 

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The when, what and who of your site visit

When an employer is interested, chances are they’ll bring you in to interview in person. We help you navigate that visit like a pro

By Chris Hinz | Feature Articles | Summer 2015

 

Allan Sison, M.D., knew exactly what he wanted from his 2014 site visit to Texas Children’s Hospital and Baylor College of Medicine. As a pediatric hematologist/oncologist, he had already honed his leukemia research bona fides at Johns Hopkins University. So it was important to discover if Houston was a good fit for his flourishing bench scientist and clinician skills.

Although administrators had their own interview agenda—even asking him to do a “job talk” to evaluate his research achievements—Sison wanted assurances that Baylor would support his contributions and ambitions long-term.

“Since I was coming from a place that was very highly focused on laboratory and clinical research, I was interested in finding out how these institutions value their faculty,” he says. “Were the lab researchers as important as the clinical researchers, and were the researchers as important as the clinicians? That’s what I wanted to know.”

Whether you’re interviewing for your first or next opportunity, making the most of a site visit is critical. A face-to-face meeting allows you to assess the situation by what you see, hear and intuitively feel. Meeting decision-makers is your chance to nail the parameters and potential of the job while getting a feel for future co-workers too. Although the schedule will be tailored to your circumstances, knowing a few basics, what questions to ask and what concrete steps to take to learn about the community will help you find the right job in the right place.

As Sharee Selah, director of physician recruitment services for the University of Maryland Medical System, notes: “It’s like anything else you do. You have to be willing to put time and effort into it. You shouldn’t approach this any differently than you did in learning to practice medicine. That means putting in energy and resources before the visit to get results from it.”

When, What and Who

Although there’s no one-size-fits-all model for site visits, familiarizing yourself with three basic “W’s”—when, what and who—will help you prepare.

When does a visit take place?

Site visits occur either when administrators have an immediate position to fill or they’re intrigued enough with a candidate’s CV to meet and keep the person on their radar. Sometimes a face-to-face is the first time the two sides talk, but for the most part, a site visit follows a prescreening telephone or even Skype interview concerning the job and the person’s qualifications for and interest in it.

If you make the cut, you may participate in a follow-up phone interview with someone higher in the administrative or medical food chain. For instance, since Baylor’s position involved a three-year National Institutes of Health grant, Sison had to apply for funding. That meant several phone conversations with the division chief in addition to the screening interview prior to his visit.

What does the visit include?

A site visit is designed to integrate many different tasks in a relatively short, albeit intense, daylong or overnight stay. During that time, you’ll not only be navigating various interviews, but also exploring the medical facility, touring the community and attending a social event. Even though site visits follow a somewhat standard format, they’re still tailored to each candidate, depending on the specialty, job opening and even type and size of the organization. Meeting with stakeholders who may be key to your understanding of the practice—or your success working in it—are a crucial part of your day.

In addition to meeting a cross section of people who make the practice work, you may have to participate in other activities germane to the job. Because Sison’s potential position was 75 to 80 percent research, he had to deliver a talk during his two-day visit on progress in determining if blocking a molecule—called CXCR4—on the surface of leukemia cells from interacting with healthy bone marrow cells can make the malignant cells more sensitive to therapy.

Who should join you?

You’re the star of your site visit, but your spouse and/or children have important roles, too. Some recruiters prefer that candidates come alone so they have no distractions. But since family members are often the major reason physicians reject offers, it’s helpful to include your partner for his or her real-time impressions. It’s not universally the case with children, however. Although some organizations are amenable to everyone being present initially, administrators often prefer that you wait until there’s an offer at hand before including your whole family. As much as you love them, your children can create logistical challenges. That’s not to say that recruiters won’t adjust, however. For instance, when a recent candidate for a job at Chattanooga, Tennessee-based Erlanger Health System asked if he and his wife could bring their youngest child along, Lee Moran, director of physician recruitment, happily obliged. She resolved the only strategic issue—dinner with the partners—by scheduling it at a restaurant within walking distance of the hotel so his wife could leave if it got too long for their little girl. “Luckily for us it was a pediatric group,” says Moran. “It was probably a better situation to work around than if he were meeting with cardiologists or surgeons.”

Who foots the bill?

A potential employer should pick up the entire tab for your site visit. That usually includes airfare, hotel, meals and other incidentals such as a rental car, airport parking and even baggage fees. It doesn’t cover personal expenses, such as toiletries, sightseeing trips or the mini-bar. Even though most groups do the booking for their candidates, in some cases you have to pay upfront with reimbursement later. Whatever the plan, get it in writing.

Also, although your partner’s travel expenses should be included, make sure you understand the situation with children. Not all practices underwrite the entire family unless a candidate accepts the job and/or returns for a suggested second visit. But they all should be willing to pay whether or not an offer is extended or accepted.

Finally, keep in mind that this is a professional visit, so only submit reasonable, related expenses. You don’t want to shoot yourself in the foot like the candidate who tried to charge an employer for a six-pack of beer purchased in the middle of the night before his big interview—a move that brought into question the soundness of his decision-making abilities.

Getting answers

Formal face time with senior partners, administrators and others is a site visit’s main event. During your initial phone conversations, you likely answered screening questions to see if you had the training, skills and interest in the job. After returning home, you’ll probably have additional conversations to tie up loose ends. But this is your opportunity to dig deeply. Because there’s a lot at stake clinically, financially and emotionally, it’s important to steer the discussion toward topics that could make or break your success. The reassuring news is that anything important to you is fair game.

Selah suggests that your goal should be to fill three information-gathering buckets before the visit ends. The first includes questions related to any aspect of the job that affects your daily ability to see patients. The second focuses on inquiries about the culture or potential fit with other physicians, support staff and the greater medical community. The third concerns geography. Will the area meet your family’s social needs? “You need to come away with more than just information about the nuts and bolts of the job,” says Selah. “You want to see if it’s the right culture, the right team, the right infrastructure and the right place. Everything should align with your professional and personal priorities.”

So what should you explore? Although there are many plum areas, the following subjects are ripe for the picking:

Position

Why is there an opening and how long has the organization been recruiting? Given today’s physician demographics, it’s easy to assume that you’re filling a retiring colleague’s shoes when there may be other things afoot. You want to know if you’re part of a succession/expansion plan—or simply walking through a revolving door.

Dr. Mona Amini

Personal thank-you notes helped psychiatrist Mona Amini, M.D., MBA, stand out in an interview.  “If the opportunity is something that you really want, it shows that you took the time and effort because you really care,” she says.

Kelvin Shaw, M.D., learned from a spate of interviews how important it is to keep digging until you hear the full story. He nixed one small opportunity after getting the physician-owner to finally admit that she’d retain 51 percent control; he’d never be a full and equal partner. His persistence eventually landed more conducive buy-in arrangements in Dallas and then Houston, where he’s now part of Allergy & Asthma Associates, a 40-member allergist and ENT team. “You have to know structure upfront,” says Shaw. “It doesn’t do any good to work for several years and then realize, ‘Oh, I’m never going to be a full partner.’ Then you have to leave and start over again—or stay and be bitter.”

Clinical expectations

What will be required of you, and does it match your expectations? Be sure to get an accurate picture of day-to-day life. How many patients will you be seeing? How much time can you allot for each one? And what’s the competition? Knowing who’s out there is especially important if you’ll need referrals to build volume and stay busy.

Osteopathic family physician Julia McDonald, D.O., MPH, knew what she wanted her practice to look like. So when administrators at Maine Dartmouth Family Medicine Residency in Augusta invited her for a site visit, she targeted questions that would clarify whether or not the physician-faculty opening mirrored her requirements. By the time McDonald finished, she believed that she’d be a good faculty preceptor fit. Moreover, the private practice and clinical patient care roles were to her liking. “They didn’t provide 100 percent of what I was looking for, but since I’m new to medicine, I’m certainly open to different ways of doing things,” she says. “The fact that they were even considering things I was considering made me excited to work here.”

Practice dynamics

How collegial is the group? Since surveys repeatedly show that a poor cultural fit is the major reason people leave their jobs, focusing on the work environment should be front and center. Who makes decisions? How are disagreements handled? Who are potential mentors? Even though you can gauge dynamics by watching and listening, asking will fill in the blanks.

When Vanessa Wear, M.D., was interviewing for a diagnostic radiology position in 2010, it was important to her to know the parameters of the job, including the daily workload, call schedule and weekend coverage. So when interviewing at Chicago-based Wellington Radiology, a private-academic practice servicing two Advocate Health Care Center hospitals, she zeroed in on questions that would give her the best idea of what would be expected of her. Also, since culture was key, Wear was very interested in how happy her potential colleagues seemed in their jobs and how well everyone got along in the office. For instance, although many factors entered into her decision about Wellington as a great place to use her breast imaging expertise, it registered over lunch with co-workers that they seemed to enjoy one another and were genuinely interested in each other’s lives. “I think it’s very obvious if people are happy or not in their jobs,” Wear says. “Yes, everyone can fake it for a little bit, but people’s true feelings come out…whether it’s a frustrated eye roll during the interview or everyone having a great time at lunch.”

Structural support

Can you deliver quality care with the nurses, ancillary services and systems in place? It’s appropriate to ask about anything that could impact a flourishing practice. Do you have to share nurses? Does the group encourage advance practice providers? What bureaucratic hoops exist to alter equipment? You want evidence that the organization has both infrastructure and flexibility.

Wear says she didn’t ask too many questions about the radiology equipment during her interview. She just assumed any successful practice would have quality scanners necessary to diagnose patients and navigate their breast biopsies. But in retrospect, she’d be more pointed in her equipment inquiries, especially about the ability to make modifications. Fortunately, Wear had flexibility in changing some technology. Besides bringing new expertise to the practice, she benefited from the relatively small size of the group (20 physicians), which made it easier to accomplish her goals than it may be in a larger organization. “I was fortunate that everyone was OK with the changes that we made,” she says. “There was some hesitation, but they understood that I had specialized in breast imaging and knew what I was doing.”

Compensation

What will your package include? It’s important to learn how your salary and buy-in will be structured. What are bonuses based on? What’s the mix of payers? Be thorough in your inquiries, but don’t make financials your lead-in. “We all work for money,” says Craig Fowler, vice president of recruiting at Atlanta-based Pinnacle Health Group and president of the National Association of Physician Recruiters. “But you need to ask about compensation in the right way at the right time. You don’t want to be the person who obsesses about it. That sends the wrong message.”

Kegley Davis

Kisha Davis, M.D., interviewed for her first post-residency practice while nearing her due date. She recommends that young physicians ask clearly about any policies at a potential employer that could impact their personal choices, parenting or family life

Shaw entered the interview fray in 2003 eager to find an ideal allergy position either in Chicago, where he had completed fellowship training, or in Texas, his home turf. Since he needed to know that he’d have a patient base to support his practice, he asked how full his potential colleagues’ schedules were and how far into the future they were booked. Confident enough in the answers to accept a position in Dallas, Shaw used similar inquiries two years ago when relocating for a faster growing Houston opportunity. “If you’re fighting over the same pool of patients with 10 other physicians, you need to know that the pool will be big enough,” says Shaw. “Some people can come into a crowded situation and make something of it, but for others it may not be acceptable to grow slowly. So you have to figure out, ‘Is this is really a good situation?’”

Future and family

No one can predict the future, particularly with an ever-evolving health care system. Yet having a feel for the organization’s challenges and plans might help you minimize surprises. Also, because your personal and professional lives are bound to intersect, getting a handle on work/life balance is critical. What’s the call schedule really like? Will you be home for dinner? Is there time for a healthy family life? Check with the practice’s younger doctors to gauge their experience.

During her first job search in 2007, Kisha Davis, M.D., had an obvious reason to address a topic often tricky to navigate during a site visit. Because she was in the late stages of pregnancy, talking frankly about family for this family medicine graduate was very pertinent. She needed to know that the Maryland-based community health center’s administrators were open to a delayed start date. Delighted by the answer, Davis took the job, even though she eventually moved on to a White House fellowship before her current position as medical director of Gaithersburg, Maryland-based Casey Health Institute. She now urges young physicians to inquire about any policy that could impact their personal choices, parenting or family life. “When it gets to the point that you’re strongly considering a practice and a practice is strongly considering you,” she says, “it’s better for both sides if you ask, ‘How can you accommodate me?’”

The final lap

Once the heavy lifting is done, you’ll likely close off your visit with dinner. Even though social events are usually for decompressing, you can still learn about the company you’ll be keeping. One Connecticut gastroenterologist, for instance, was impressed when eight of 10 physicians in the practice he eventually joined showed up for a Monday evening meal. “It really spoke volumes about how much they prioritized bringing someone new into the practice.”

No matter how well everything goes, however, it’s unlikely that you’ll leave your site visit with an offer. You may have every indication that the group wants to pursue talks further, yet administrators rarely put an agreement on the table before the close of business that day. They’ll likely want to assemble input from all relevant parties first. “Our philosophy is that if we’re going to ask people to be involved in interviewing,” says Mike Krier, senior physician integration specialist for Milwaukee-based Aurora Health Care, “we better get their thoughts and feelings about a candidate to make a determination. That’s unlikely to occur before the candidate leaves.”

Because you also want to evaluate the opportunity, it’s to your advantage that other steps must occur. In fact, you may want a second visit to confirm your initial findings. Whether or not you anticipate another face-to-face, make sure you understand what happens next. You may be fortunate in that someone is assigned to walk you through the process. If not, don’t be afraid to get specific about timelines and variables that might affect your search. Also, if you perceive a great possibility, stay in touch.

McDonald didn’t have to wait long to know that her Augusta, Maine, primary care practice wanted her. During the site visit, administrators signaled their interest, even mentioning the pay structure. Within a week, she had an offer. Even though the scale was largely set in stone, the practice sweetened the pot by agreeing to loan repayment and a sign-on bonus. It was just enough to close the deal with a group that had been on McDonald’s radar since before training. “The culture just struck me as my tribe of people,” she says. “I really admire the physicians and staff. I love the way medicine is practiced and want to be a part of it. I can imagine being here for the rest of my career.”

As for Sison, he wasn’t anxious that he didn’t receive an immediate offer after either his first or second site visit since he was interviewing at two other institutions and assumed Baylor administrators were talking to other candidates too. He just kept in contact until the division chief made an official offer to join the institution’s academic hematology community. Sison accepted, confident that this position would offer the promotion potential that had eluded him in his prior job because of senior colleagues on the same career path. At Baylor he met physicians who arrived as fellows or young faculty and stayed long enough to be promoted. Sison’s takeaway? Leaders there valued promising researchers and made their progress a priority. “It proved to me that my development as a junior faculty member was important and that I would have a long-term future here.”

Chris Hinz is a frequent contributor to PracticeLink Magazine.

 

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Closing the gap

Physicians share how they’re handling home buying, family starting and retirement planning along with the reality of student loan debt.

By Marcia Horn Noyes | Feature Articles | Winter 2015

 

Seth Eisdorfer, M.D.

Seth Eisdorfer, M.D., an anesthesia fellow at Children’s Hospital Colorado, purchased a home by using a physician-loan program that his wife discovered.

As if life decisions aren’t difficult enough, it’s no secret that indebted graduates find that the added weight of student loans can make their choices about what comes next in their lives all the more arduous.

That holds even more true for new physicians—especially those who delayed decisions about home purchases, retirement planning, marriage and starting families in favor of finishing training first.

The growing student debt obligation, which now stands at $1.2 trillion, has been painted in some media as “America’s coming student loan apocalypse.” Some graduates not only play “kick the can” down the road on loans, but also on crucial life milestones. For new physicians, the crushing debt load may even alter long-term decisions about practicing medicine.

But hope is on the way.

Several companies have discovered the need for products and solutions that ease the monetary burdens faced by new physicians.

By creating innovative solutions around the issues of debt, physicians are better able to close the gap between their dreams and reality. Knowing what’s available can help you more easily move into your first job, start a family, begin saving for the future, and participate in the economy while putting your full focus on your patients.

It also helps to know you’re not alone. Read on for how other young physicians are planning to make their futures bright.

Making the house call

One thing unique to physicians is the length of their continued education even after they graduate medical school. This length of training time extends the Income-Based Repayment (IBR) option for recent medical school graduates. According to the American Association of Medical Colleges (AAMC), on average, a medical student making a little over $50,000 as a resident now pays just over $400 a month with IBR, regardless of their student loan debt. That’s no more than a car loan, so where’s the catch when qualifying as a new borrower for a home loan?

A traditional home mortgage must take into account the full student loan debt and thus assume a full monthly payment, which can often exceed $1,000 per month.

Most student borrowers rarely qualify for a mortgage through those traditional channels, and renting becomes the default option.

One company working to provide a way for doctors to get into a home of their own is PhysicianLoans (physicianloans.com).

Tal Frank, president of PhysicianLoans, the specialty division of Tower Mortgage Corporation, says their family business started in 1993 when three disparate things happened near the same time. His mother, then president of the company, closed a loan for a physician client using a precursor to a true physician loan. At the same time, Frank’s younger brother was in medical school while Frank attended Ohio State and also worked for the mortgage company.

“One day, my marketing professor said something that just clicked with me: ‘Above all else, you must understand the power of serving a niche,’” says Frank. “Once we saw how this particular loan went, we then actively pursued special mortgage financing that accepted the IBR student loan financing.” The loans started out at five percent of their business and gradually grew. Frank says that physician loans now account for more than 95 percent of total revenue.

“A true physician loan is a portfolio loan, and there’s no secondary market for those—meaning they are not sold back and forth like other mortgages,” explains Frank. “Many banks want to get into this space, but they can’t do a large volume of portfolio business, because it must sit on their books.”

Frank says those who use PhysicianLoans fall into two categories: those who are graduating medical school or residency, and those who have finished residency and are now practicing.

Physicians within these two groups typically need special financing because they don’t have cash for down payments and have much more student loan debt than those in other professions.

Seth Eisdorfer, M.D., a fellow at University of Colorado Department of Anesthesiology working at Children’s Hospital Colorado, is one such doctor. Even though he graduated from Colorado College without undergraduate loans, his debt after graduating from the University of Miami Miller School of Medicine totaled about $260,000. At the time of the interview, Eisdorfer had not begun repaying that loan.

“My government loans are still in forbearance, but if I were to estimate, I’d say the monthly payment would be around $2,200 per month,” he says. Once he became an attending physician, Eisdorfer purchased a home, saying it was less of a nail-biting experience than he thought. “I wasn’t sure I’d be able to afford a home, but I found out about PhysicianLoans through my wife, who had more time to research what options were available to us.”

Years ago, a graduate student or resident had only a few options for buying a home: a subprime loan with no money down and higher interest rates; a parent as a cosigner; or a parent bought the home and the physician repaid the parent.

“Very few options were available because a newly practicing doctor rarely had the down payment stipulated in the Fannie Mae and Freddie Mac guidelines,” Frank says, and explains that though special financing did exist long ago, he says it was not widely used.

Another physician who has benefited from specialized physician home loans is Aaron King, M.D., a family medicine physician with BHS Physicians Network in San Antonio. He worked through a local bank to buy a starter home right out of medical school. “We got 100 percent financing with zero down; otherwise we couldn’t have purchased it, because we had no savings,” King says.

Raphiel Heard, M.D.

Raphiel Heard, M.D., purchased a home during medical school with help from family–and now rents it out to students while he completes residency in a different state.

Virginia Commonwealth University resident Raphiel Heard, M.D., purchased a house with the help of family while still in medical school at LSU Health Science Center in Shreveport, Louisiana.

“From medical school, I only carried forward roughly $165,000 to $175,000 in debt—definitely lower than the national average, but that’s probably due to the lower tuition rates where I went to medical school,” he says.

Now, while in residency, Heard rents an apartment in Virginia and has turned his Shreveport home purchase into a business venture where he acts as a landlord for other medical students who rent his house. Though Heard held some uncertainty about purchasing the home, he says that concern was put to rest by the knowledge that better salaries would be available a few years down the road.

In fact, Frank says statistics prove that for physicians with very good credit, their likelihood of defaulting on a mortgage is slim to none. “The same can’t be said for other occupations,” he says.

Frank says other factors contribute to the case for providing physicians with special home mortgage financing, even though those same physicians may be saddled with huge student loan debt:

  • Physicians won’t typically find themselves unemployed at any point in their careers.
  • If physicians maintain good credit undergraduate through medical school, that trend tends to continue.
  • Physicians who have good credit show a higher level of responsibility.
  • Physicians tend to take a job and remain a part of the community for a long time.

Says Frank: “The Association of American Medical Colleges tracks the repayment rate of their students, and medical schools have the highest level of repayment compared to other occupations.”

Saving for the future

Two-time world heavyweight boxing champion George Foreman once said: “The question isn’t at what age I want to retire; it’s at what income.”

According to John Collins, managing director for Waltham, Massachusetts-based GL Advisor, a company that provides student debt advice to professional graduates, a lot of young physicians think they can’t participate in retirement plans until they make a dent in their student debt. “However, we can assess which programs are the best options for helping them relieve their debt burden while saving for retirement. It’s definitely part of the equation,” says Collins.

GL Advisor got its beginning at Harvard Business School when the company’s founder took a class that covered debt markets and how investors are paid. The GL Advisor founder raised a dissenting view that student loans are handled differently than typical debt and therefore should be treated in a different way. The company now advises clients on various consolidation tactics and repayment programs, and company leaders are in hot demand as speakers at medical schools.

Caleb McCall, M.D., is an Internal Medicine resident with Jefferson University Hospitals. “While doctors’ earnings eventually make up for their relatively much lower salaries in residency, many residents are focused on just starting to pay loan debts as soon as they can instead of using their income to buy a house, a car or thinking about saving for retirement along with their non-physician contemporaries,” McCall says.

McCall’s medical school roommate agrees. “Just as I haven’t paid off loans, I’ve also not saved for retirement,” says Heard. “I don’t have a lot of experience in investing, and I wonder how steep that learning curve will be.”

Heard says that other engineering-type friends have been saving for retirement for the past seven or eight years, so “I’ll have to aggressively pursue the same while simultaneously paying off debt.”

“I suspect that most physicians don’t start saving for retirement until after the age of 40,” Dr. Aaron King says.

Tal Frank says physicians are pretty much at a high negative net worth at least until their early 30s to mid-30s. “The difference with them is that the doctors who manage their financing can dig themselves out pretty quickly,” explains Frank. “Even at the low end of the pay scale, a doctor can make $120,000 to $180,000 right out of residency.”

Eisdorfer says that day is right around the corner for him, but when compared to his friends that went the engineering or legal route, he’s way behind the eight ball. “I’m 35 years of age and I’ve only been saving for retirement for 10 months,” he says. “I’ve seen the numbers. As I start saving for retirement now, I know that friends who have been putting $1,000 a month away from the age of 25 will have more money than I will at retirement age.”

With this ring, I thee wait

In a 2013 American Student Assistance (ASA) survey, 29 percent of respondents said they had put off marriage as the result of student loans, while 43 percent indicated that student debt had delayed their decision to start a family.

“Debt may likely play a factor in delaying any decision I might make about marriage in the future,” says Heard.

The economic insecurity prompted by student loans extends far beyond marriage into decisions about children.

Anesthesiology resident Eisdorfer had his first child during residency, while King and his wife, who is also a physician, have decided to postpone having children until her medical school debt has been repaid.

The current ASA survey shows that about 41 percent say they can’t afford to have kids and pay off student loan debt at the same time.

Overcoming the debt burden

McCall says that loan debt can be quite crippling on physicians.

“I know quite a few people that stay in medicine after residency for only one reason—they are saddled with debt. Some doctors would explore other careers if they had the chance,” McCall says.

“Some doctors finish residency and immediately begin buying a few things and start having fun after years of doing without. In a few years, they may have more toys, but are in no better shape financially,” says Tal Frank. “With each year, life gets more expensive. But if physicians adhere to a budget from the beginning, they can be completely debt free by the time they are 40.”

Marcia Noyes is a frequent contributor to PracticeLink Magazine.

 

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A sense of place

Giving thought to the size and type of community you enjoy the most helps shape your job search and improve your chances of success.

By Marcia Layton Turner | Feature Articles | Winter 2015

 

Dr. Dominguez

Marcela Dominguez, M.D., first looked for a job that would help learn from established physicians—then one that would allow her to work and raise a family within five minutes of the beach.

Physicians practicing in Manhattan, Kansas, have a different set of day-to-day experiences than those practicing in Manhattan, New York—but each environment is perfectly suited for different types of people.

As you begin evaluating your next career move, what type of community will be your best fit?

Do you need a major metropolitan area for your specialty? Would seeing a wider variety of cases in small-town America be your best move? Or is a suburban practice your perfect fit?

There is no one-size-fits-all answer for everyone. Depending on your own experiences, career goals, outside interests, personal connections and employment offers, you can zero in on the type and size of place that will make you happiest. Because isn’t that what life after residency is all about—finding a place to call home?

For many residents, the search for a place to live and work often starts back where they grew up, whether that was a small town of 500 people, suburbia or a bustling metropolis.

“Where physicians grew up often drives where residents want to practice,” observes Linda Gommesen, faspr, a physician recruiter with Metro Health Hospital in Wyoming, Mich. Those raised in a big city often want to end up close to a big city, she has found, while residents who grew up in the suburbs or smaller towns may want a similar upbringing for their own children.

But not always.

Big city choice: Be open to new experiences

John Martin, Jr., M.D., grew up in a small town in the Berkshires of Massachusetts and attended Williams College—also in a small community—for undergrad. Med school at Harvard kept him in New England but introduced him to the pace and atmosphere of a larger city. He loved it.

After four years in Boston, Martin headed to Philadelphia for residency and then applied for a very competitive fellowship in oculoplastic surgery. Only about 20 programs were available at the time, and Miami and Los Angeles were Martin’s top picks.

He accepted the position in Miami and headed south for a 15-month fellowship—but he didn’t expect to stay. At the time, his attitude was, “I can do a year anywhere,” and Miami sounded pretty nice for a short assignment. “The availability of outdoor activities anytime was particularly appealing,” he says.

Though he enjoyed Miami, he considered a number of opportunities for oculoplastic surgery positions after completing his fellowship. He landed back in New England in Westport, Connecticut, a suburb of New York City. He was close to home and close to a major city, which he thought would yield plenty of plastic surgery patients.

In fact, being so close to New York actually hampered the growth of his practice. “People went in to New York City for surgeries; more plastic surgeries were done there,” he found, than in Connecticut, which made attracting clients more challenging. After two years, an opportunity surfaced to return to Miami and Martin accepted. “Westport wasn’t urban living, and I decided I wanted that,” he says.

Having experiences in different types of working environments helped Martin recognize the type of place that would make him happy. He needed a larger city where plastic surgery was accepted, even expected, and where he could also enjoy outdoor activities year-round. Miami turned out to be the perfect locale.

Suburban happiness: Start with your career goals

Marcela Dominguez, M.D., would have been comfortable in a big city or suburb but knew that a small town wasn’t in her future. Not that a smaller community wasn’t appealing, but Dominguez recognized that she hadn’t had the broad surgical training needed to serve the needs of a smaller community. “People in other programs get training in removing gallbladders,” for example, which she hadn’t had as a family practice resident. For that reason, she wanted to join a practice that specialized in serving moms and healthy babies, which she thought she would be much more likely to find in an urban or suburban setting.

Dominguez grew up in the suburbs of southern California and knew from an early age that she wanted to be a physician. She went to high school in San Diego and did her undergraduate work at UCLA in kinesiology. She then intentionally took a year off after college to do something she knew she wouldn’t have the opportunity to do once she proceeded with her medical training and taught fourth grade at an underserved bilingual elementary school.

Med school at the University of California at San Diego came next, followed by residency at Long Beach Memorial. Knowing that she wanted to perform obstetrical care in private practice, she pursued further OB training during residency and became the chief OB resident at Long Beach, taking advanced OB electives at several busy urban hospitals.

During the early years of her medical career, Dominguez began heading to a more holistic approach in treating her patients, moving away from a complete reliance on conventional medicine. During her senior year in residency, she visited several private practices that were available for sale and realized it would be best if she joined a group practice first before going into private practice.

So, after residency, she joined a group practice and stayed there for seven years. She called the move “a confidence-builder.” “I wanted to join an established practice first, to confirm that my medical skills were sufficient, before I transitioned into opening my own private practice.” Working within an established practice gave Dominguez access to experienced doctors who shared “practical pearls” that continue to help her. “I recommend joining a group practice first, for experience,” she says.

Confidence built, in 2006 she went into private practice in the suburb of Mission Viejo, California, forming Complete Care Family Medicine.

In 2013, Dominguez switched to a hybrid concierge practice as a solution to a fast-growing practice. She gets regular referrals and is able to provide more personalized care to a more manageable number of patients. “[Patients] get better accessibility” to their physician, she explains.

Dominguez’s decision process included looking for a position that would first give her experience and then later allow her to work and raise a family within five minutes of the beach. Her practice is in a large enough suburb to keep her busy, and it’s not far from the beach and her family’s home.

Small-town setup: Making quality of life a priority

Dr. Prakash

Medical oncologist Sucharu “Chris” Prakash, M.D., and his wife were both used to big cities. But when it came time to join a practice after residency, they chose Paris—the Texas version, population 25,000. “It’s a better quality of life,” he says.

Dominguez grew up in the suburbs, trained in a larger city, then settled in a community similar to the size she experienced as a child. But Sucharu “Chris” Prakash, M.D., a medical oncologist with Texas Oncology, PA, in Paris, Texas—population 25,000—followed a different path.

Prakash grew up in a big city in India, went to medical school in India, and then did his residency and a fellowship at Wayne State University in Detroit. He married a Texan who was a big-city girl, but the couple decided a smaller community was more their speed, even though they had never lived in one. Prakash’s wife wanted to be closer to family in Texas, so they moved to Paris after his fellowship. He now says, “We wouldn’t consider moving.”

It’s all about finding the right combination of factors that are important to you. For Prakash and his family, small-town life offered many advantages. On the personal side, outdoor activities dominate and traffic is minimal. “It’s a better quality of life,” he says.

On the professional side, smaller towns like Paris are good for generalists, he says. “You see a wider range of patients—a broader spectrum of diseases here” than in larger city hospitals and practices where care is “super-specialized.” The medical community is very close-knit, and there is more interaction among doctors; “everyone knows everyone.” The close proximity builds a bond within the community that is good for doctors. “There is a sense of brotherhood,” he says, which would be less likely to occur within a major metropolitan area with millions of residents.

Overall, Prakash says Paris is “slower paced” than Detroit, and that’s a good thing. He sees 20 to 25 patients a day (fairly typical for oncology, he says), and that pace allows him to give each patient more personal attention. Because of the small-town atmosphere and geography, physicians and their patients frequently run into each other outside the office, and those casual connections help build a personal bond.

Evaluating your options

But life for an oncologist in Paris, Texas, is different than life in Chicago or Dallas.

Each type of community has its own pluses and minuses, depending on what you’re after.

The main differences Prakash sees between large cities, suburbs and smaller towns are the level of specialization and the time available for outside interests.

The larger the community, the more medical specialization there is because the larger population requires it. The pace of life and practice also tends to be faster in general at larger practices and hospitals, which can affect the time you have available for personal interests and pursuits.

Small towns are best for generalists interested in a slower pace, observes Prakash. Patients in need of a specialist are more likely to travel to a major city for specialized care because there simply isn’t enough demand in a town of a few thousand people. That means that patients in need of a generalist receive more personal attention from a physician who knows them personally.

What will make you happiest?

Deciding where to move after residency is about much more than simply choosing a place to live and work—it’s about figuring out what drives your happiness, says Metro Health Hospital’s Gommesen. Deciding what is most important to you up front will lead you to a community that makes you happy to be there.

Some of the questions to ask yourself as you evaluate all the places you could live include:

  • Is there enough work here for my specialty?
  • How much competition for my specialty exists here? Is there enough demand to support another practice?
  • Am I willing to pay more to live in a larger city?
  • What preference does my partner or spouse have for where we live?
  • What kind of cultural and athletic opportunities exist to take advantage of here?
  • Do I want to live close to family and friends?
  • Do I want to be near a place where I can pursue my hobbies on a regular basis, such as skiing or golf?
  • What kind of climate is important to my happiness?
  • What type of environment makes me happiest, such as near water or mountains?
  • Is the quality of the local school district important to me?
  • Do most children attend local public schools, or is private school more typical? Am I comfortable budgeting for that added cost?

Asking these questions of yourself, says Gommesen, will help you zero in on job opportunities that are a good fit for you. Recruiters will provide information about the job and the community at-large, but “we rely on you to know what you want in a location,” explains Gommesen. And before you accept a position, ask yourself if you can see yourself there, she says. Even if a particular situation meets all your criteria on paper, if you can’t imagine living and working there, don’t take the job.

Most new physicians stay in their first job two to five years, says Gommesen. “They see it as a stepping stone, but it doesn’t have to be that way,” she says. If you ask yourself the above questions before beginning the interview process, you’ll save yourself time and will be more likely to land in a location where you’ll be happy long-term, she says.

Listening to what other physicians tell you is important input, but it shouldn’t be the deciding factor. If you’ve made up your mind where you want to live, your challenge is simply finding an open position.

And don’t rule out the possibility of opening your own practice in the near future, even in a smaller market. “Everyone always says the market is oversaturated,” says Martin, no matter which town or city you may be headed to. “But there’s always room for one more. It may be slow going at first but you’ll survive…Stick with it if it’s where you really want to be,” he says. Because being where you’ll be happy is the most important consideration of all.

 

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Forget the Joneses

Embracing frugality and dismissing the “doctor lifestyle” will help guarantee your financial and professional freedom.

By James M. Dahle | Feature Articles | Winter 2015

 

Physicians are among the most studious, learned, industrious, sober, temperate and virtuous people with whom I have ever had the pleasure to interact. However, for some reason, the virtue of frugality seems to escape physicians entirely too often.

In fact, doctors are nearly universally regarded by financial professionals as exceptionally poor at managing money compared to other professions.

Frugality is, in essence, the opposite of “keeping up with the Joneses,” the mythical family that lives next door who always seems to have the larger kitchen, the newer boat and the flashier car. Our society at large struggles with frugality, and often even derides it. Thrifty people who spend their money carefully on the things they most value are described as “cheap,” “miserly” or “stingy.” Scrooges. The truth, however, is that frugality is a core principle in not only acquiring wealth, but in acquiring happiness.

As Matthew Cassell, M.D., an oncologist in Marion, Mississippi, puts it: “Having healthy kids, a loving spouse, vehicles that run, a roof over our head, and a stable job is about as good as life can get. The size of my house and the symbol on the front of my vehicle have no influence on my happiness. It’s a matter of contentment.”

Seven reasons why frugality is key for physicians

You have expensive loans.

The first and most urgent reason to embrace frugality is something you’ve already encountered: the ever-expanding cost of a medical education. The cost of acquiring an M.D. or D.O. degree has ballooned over the last 20 years, with tuition alone increasing from as little as $6,000 to as much as $82,000 per year.

It is no longer unusual for physicians to finish residency owing more than $450,000 in student loan debt at interest rates of 6 to 8 percent. Even those who obtain significant forgiveness will still end up paying hundreds of thousands of dollars.

Rakesh Chaudhari, M.D., a neuroradiologist in Woodridge, Illinois, advises: “It should be a priority to pay those off rapidly. That loan needs to go away in five years if possible, 10 at the most.”

An uncertain future for income.

The second reason physician frugality is important is that physician incomes in many specialties are trending downward due to the ever-increasing costs of compliance, the move to an employee model, and the downward pressure on reimbursements from public payers and private insurance companies.

The trend toward using high-deductible health plans has made the consumer more cost conscious, and also placed much of the burden of payment on the patient, who sometimes cannot or will not pay.

In short, many mid- and late-career physicians have found that they are making less money now, on an inflation-adjusted basis, than they did earlier in their career. Most physicians expect this trend to continue.

Physicians are 30 years old—and sometimes 35 or even 40—before finishing their training. The portion of their career where they are actually earning a full salary is much shorter than it is for many other professionals.

You have to consider insurance costs.

Disability and life insurance can be very expensive. The less money you and your family need to live on, the less disability and life insurance you need to carry. The sooner you reach financial independence, the sooner you can drop expensive policies.

You’ve got taxes to consider.

A physician may assume that an income of $200,000 per year—four times the median household income in the United States—would entitle him to a lifestyle that is four times as decadent as the average family.

However, once you incorporate the need for the additional tax due (along with the savings already mentioned), a doctor may find that four times the income is really only equivalent to twice the lifestyle. Underestimating the progressive nature of the income tax code, especially right out of residency, has led to the financial ruin of many physicians.

Society doesn’t expect you to be frugal.

Matthew Cassell, M.D.

Frugality is a core principle in not only acquiring wealth, but also in acquiring happiness. “The size of my house and the symbol on the front of my vehicle have no influence on my happiness,” says oncologist Matthew Cassell, M.D. “It’s a matter of contentment.”

One reason physicians should be frugal is the very reason that so many of them are not: family, friends, and even the doctors themselves have an expectation that a doctor is rich and should spend like it.

Eric Raasch, M.D., a nephrologist in Cary, North Carolina, mentioned that his mother frequently utters the phrase “when you get your doctor house.”

He has also noticed that the physicians’ parking lot at his hospital is filled with “Porsches, Maseratis, and the like.” He says the hardest thing for him was “going to a dinner party at a neuroradiologist’s house and realizing that I didn’t even know what I was missing!”

Matt Cassell and family

Matt Cassell and family

I once traveled by boat across Lake Atitlan in Guatemala. There were no posted prices, but it quickly became very clear that there were two prices for passage across the lake: the local price and the vastly inflated tourist price.

There is also an inflated “doctor price” for many goods and services in our society.

But you should not feel that your status or income prevents you from negotiating, mandates you to live in a certain neighborhood or drive a certain type of automobile, or requires you to pay in a situation where others might not. Fear of looking “cheap” might just make you have to be cheap in retirement.

Physicians also often feel that money is their most easily renewable resource. However, that income stream may not last nearly as long as you hope. I assure you it is just as easy (perhaps easier) to overspend your income as a physician as it is with any other career.

Your goals include professional, personal and financial freedom.

When you are living on the edge (or worse, over the edge) of your income, every drop in reimbursement, personal or family illness preventing you from working or contract scare becomes a financial emergency. Work is a lot more fun when you do not desperately need your paycheck.

Financially secure physicians can determine how much they wish to work, when they wish to do so, and how they will practice. They essentially buy immunity from financial threats to their practice style.

Prudent money management and weight maintenance are remarkably similar. Both are simple, but not easy. Success in either area is the result of thousands of tiny decisions made over decades.

If you wish to be thin, you had best do what thin people do. If you wish to be financially secure, comfortable, wealthy—or even rich—then do what rich people do.

In their classic treatise The Millionaire Next Door, Thomas Stanley and William Danko enlightened America on what millionaires really look like. It turns out they drive Ford F-150s, hate caviar, wear inexpensive watches and suits, and are more concerned with being financially free than living an ostentatious lifestyle. Income matters, of course, but it turns out that “out-go” matters far more.

The physician’s guide to frugality

Want to embrace frugality and financial freedom? There are five principles to follow.

Principle 1: Realize that money does not and cannot buy happiness.

That statement, of course, is not entirely true. It turns out that money does buy happiness, up to a certain point. Academic studies suggest that point is about $75,000 per year, far less than almost all physicians make.

Many physicians can, within reason, buy anything—but not everything—they want. The art of frugality consists of using your money to purchase those things that will bring you the most happiness. Experiences, especially experiences shared with those we care about, are generally much more likely to bring happiness than actual things.

As such, a physician may be faced with the choice of purchasing a $60,000 sedan or taking his family to Europe six times. When faced with similar decisions, choose the one that will make you happiest.

Principle 2: Avoid growing into your income all at once.

This is incredibly important that first year out of residency when your income jumps from $50,000 a year to perhaps $250,000 per year.

It is much easier to never increase your spending than it is to cut it back. Graduating residents will still “feel” a huge raise by spending $75,000 (a 50 percent raise), and can use the additional income to save up for down payments, pay off student loans, and catch up to their college roommates by stuffing their retirement accounts full.

Adrienne Collier, M.D.

New car? New house? Not in your first one to two years after residency, advises pediatrician Adrienne Collier, M.D.

Adrienne Collier, M.D., a pediatrician in Bowie, Maryland, recommends, “Do not buy a new house or a new car within one to two years of completing residency.”

Chaudhari says he could have used that advice. “My first year as an attending I fooled myself into thinking that I wasn’t keeping up with the Joneses; I was just doing what all 35-year-olds who are married with children do. I closed on a house in my last month of fellowship and bought a car in my second month out and started filling my house with expensive furniture and audio/visual equipment. It took two years of seeing my hard-earned money going out so quickly to energize my resolve to start changing my ways.”

Principle 3: Remember that it is the big things that matter most.

Personal finance books love to talk about “the latté factor,” which is the fact that small expenses, paid daily, quickly add up into huge sums. You may have heard things like, “that $5 latté costs you $1,500 a year.”

However, the real money is not found by cutting out your daily latté. The real money comes from the money you spend on big items—especially your housing and taxes.

A recent study from Redfin showed that a typical physician in San Francisco could only afford to purchase 23 percent of the houses in the city. That number was over 96 percent in the vast majority of the country.

Physician incomes tend to be very similar in both high and low cost of living areas, and in states with high income taxes, low income taxes and no income taxes.

Aim to spend less than 20 percent of your gross income on all of your housing-related expenses, and try not to carry a mortgage higher than two times your gross income. Also consider carefully where you choose to practice. Though Northern California may initially seem more attractive to you than Texas, Indiana, Georgia or Arizona, once you factor in that you will have a house one-quarter of the size, will only be able to go on half the vacations, and will have to work five years longer to retire, practicing in an expensive city may no longer be quite so attractive!

Principle 4: Believe that you are not what you drive, wear or live in.

A physician recently commented to me that it was impossible to live on $50,000 per year. It is a good thing that half the people in his city weren’t aware of that, as they are doing just that.

Ask yourself if you really want to be around people who actually care about what you drive to work each day or what brand of clothes you wear. If you don’t care, why do you assume that others care what you drive?

The least frugal way to drive cars is to upgrade them every two or three years. It is reasonable to purchase used, inexpensive cars. It is also reasonable to purchase a new car, so long as you hold on to it for a decade or more.

Many physicians will be surprised to learn that their frugal colleagues have never actually had a car payment because they purchase all of their cars with cash and “drive them into the ground.”

David Spilker, M.D., a retired emergency physician in Pebble Beach, California, drives a 41-year-old Mercedes he bought new in 1973. “Money made during internship was big money to me. My father was raised on a farm and instilled in us a good work ethic. I have never lived the ‘rich’ lifestyle,” he says.

Principle 5: Limit your fixed expenses.

Large mortgage payments, property taxes, student loan payments, vacation homes, expensive cell phone contracts, car payments and private school tuition are all difficult to cut back on when money becomes tight, which it eventually will for one reason or another. Variable expenses like vacations, one-time purchases, retirement savings, food and entertainment costs are far easier to decrease when income is low. Try to minimize the percentage of your income that is already spoken for each month.

Frugality is a virtue for physicians and non-physicians alike. Those who learn practical money management skills as early as possible in their careers will benefit from lower stress, more freedom to live and practice as they choose and more happiness.

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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Have you started yet?

In-house recruiters and the physicians they’ve helped to hire share their timelines for new practice success.

By Karen Childress | Feature Articles | Spring 2015

 

If you had the time to sit down for leisurely conversations with a group of experienced recruiters and physicians who had recently found new practice opportunities, you’d get an earful about how to conduct an efficient and effective job search.

But we know you’re busy, so we went out to have those discussions for you.

Here you’ll find advice and ideas from four savvy recruiters who use PracticeLink along with physicians they helped hire. Each one offers sage advice on how to find your dream practice. Read, enjoy, learn and prepare for your own successful search.

Western Maryland Health System – Cumberland, Maryland

Dosty Malone, manager of physician recruitment at Western Maryland Health System (WMHS) in Cumberland, Maryland, has been with her organization for more than three decades. She says physicians who conduct efficient and successful job searches are the ones who have thought carefully about what they want. “They think about their desired location and what they want in their practice and lifestyle. These two things go hand in hand,” says Malone. “Know where you want to work and what you want to be doing when you’re not working. Salary and the call schedule are secondary.”

Malone says geography is the number-one criteria for most physicians when they are looking for a job. Western Maryland Regional Medical Center is in a relatively rural area, so attracting candidates who want that lifestyle is important to Malone. “We’re obviously looking for doctors with good training and credentials, but their desire to be in this location is important. I like finding someone who has a connection to the community,” she says. This might include having grown up in the region, having family nearby, or having a passion for recreational activities that a specific area offers.

If a location is not a match, physicians shouldn’t try to “make it work.” “We interviewed a good candidate recently and he liked the opportunity, but his wife wanted to be closer to a city,” says Malone. She advises physicians not to downplay lifestyle factors such as this when deciding where to apply for jobs. Doing otherwise can backfire. “It’s like knowing something is going to upset your stomach and then eating or drinking it anyway,” says Malone. “If you know for certain that something is a deal breaker, don’t waste your time interviewing. It just confuses the situation.”

Take the time to tailor your CV to the organization you are applying to work with. “We’re not an academic institution. I don’t need to see 17 pages of publications on a CV,” says Malone. “But I do appreciate seeing work experience—even what someone did before medical school—as well as volunteer activities, personal interests and evidence of leadership. That tells you a lot about a person.”

Be prepared to provide several personal and professional references. “Our final offers are based on checking references, and our chief medical officer is very intuitive. We only ask what we’re allowed to within legal limits of course,” says Malone. Some recruiters will ask for six to seven references because people can be hard to get in touch with. When time is of the essence, this ensures that the individual doing the research will be able to speak with enough references to get a clear picture of the candidate.

Getting back to recruiters promptly when you know you’re going to turn down a position is the courteous and professional thing to do. “I find that some physicians are hesitant to say ‘no thanks’ when they’re not interested,” says Malone. This leaves the recruiting facility in limbo and may even keep another qualified candidate from landing the position.

Malone recently recruited Emme Chapman-Jackson, M.D., to Western Maryland Regional Medical Center. Chapman-Jackson knew early on in her training that she wanted to be a plastic surgeon. “I had a mentor in medical school who encouraged me,” she says. “I planned to join him in practice, but he passed away while I was in residency.” Chapman-Jackson talked to her mentor’s partner, but the two were not close and ultimately she decided that was not the right position for her.

“So now I was sort of behind the eight ball,” says Chapman-Jackson. Time was short, but fortunately she was clear on the type of opportunity she was looking for. “I wanted a rural area where I could do reconstructive as well as cosmetic surgery and take care of everyone, not just the wealthy.” In addition to reconstructive surgery, Chapman-Jackson has a special interest in breast reconstruction and cosmetic breast surgery.

Chapman-Jackson also wanted to be within a day’s drive of where her parents were living, so she began her search by looking for opportunities within a 400-mile radius of their home. “You only have so much time to interview, so you have to be selective,” says Chapman-Jackson. She spoke with several organizations by phone before making contact with Malone. “They weren’t completely set up for my type of practice, but they gave me the impression that I could trust them, and that’s turned out to be true,” says Chapman-Jackson. “They wanted me to come here, and I thought highly of the program from the beginning. The people made the difference.”

Chapman-Jackson hired a consultant to review her contract before signing but says that in retrospect, doing so raised unnecessary questions. “He picked the contract apart, but I realized that this was an agreement to get me here, not some sort of trap,” she says. Chapman-Jackson, along with her husband and their 4-year-old son, settled in Maryland in September, 2014.

“I was busy from the start. They had 14 patients scheduled for me on the first day,” says Chapman-Jackson. “This area needed someone to do hand care, and before I came, a lot of facial trauma was being transferred out,” she says. “I’m providing a service that’s needed.”

Asked what advice she would offer physicians about to begin a job search, Chapman-Jackson had two words: start early. “It takes a long time to get licensed and credentialed,” she says.

Rush University Medical Center – Chicago

BJ Krech, faculty recruiter at Rush University Medical Center in Chicago, advises physicians beginning a job search to start having conversations eight to 12 months in advance of their ideal start date. “Start exploring early and set aside time for interviews,” he says. Most of the physicians and scientists he recruits sign agreements sometime between February and April. “This allows time for licensing, credentialing and planning to relocate,” says Krech.

Krech appreciates seeing a CV that is clear and makes it quickly obvious where the candidate is currently practicing or in training. “Often times with academic positions there is a lot on a CV, but I want to know what the candidate is doing right now,” says Krech. “A quick description that highlights what they do within their specialty is helpful. If you’re an endocrinologist and have a lot of experience in neuro-endo, put that near the top of the CV,” he advises.

What might seem like small things can trip up a candidate during the job search and interview process. “On a CV, that might be grammatical or spelling errors. In an email it would be abruptness. If I receive a CV by email and all the note says is the candidate’s name and specialty, that doesn’t prompt me to even open the CV,” says Krech. A candidate who asks about salary during an initial phone contact is also making a mistake with Krech.

During an interview, Krech looks for appropriate body language, good eye contact and an ability to engage socially. Dress is also important. “First impressions are everything. If you’re not dressed professionally, I question how interested you are in the position,” says Krech. And as old-fashioned as it may seem, a hand-written thank you note after an interview makes a candidate stand out from the crowd. “Set yourself apart. Small things like that are easy to do,” says Krech.

Don’t assume your spouse or partner will be invited to the initial onsite interview. Krech says a physician should definitely involve their spouse or partner in the job search, but in a behind-the-scenes way. “Never bring your spouse to any part of an interview unless they are specifically invited,” he says. “We’re very interested in meeting the spouse and making them a part of the decision, but not until we are ready to make an offer.” This varies by location, however. In smaller communities, it may be routine for an organization to encourage and pay for a spouse or partner to accompany on the first interview. Ask about the protocol for spouse/partner involvement before each on-site interview.

When asked what might cause an interview or negotiation to go off the rails, Krech offered several examples including unrealistic counter-offers on salary, requesting a part-time work schedule for a full-time salary, and asking for expensive equipment that’s in the “nice to have” but not truly necessary category. “If you’re going to negotiate, make sure that your requests are reasonable and that you have a good reason for them,” says Krech.

Dr. Sohrevardi

“I think when you graduate from fellowship, you should move to a new place,” says Mahtab Sohrevardi, M.D., an endocrinologist at Chicago’s Rush University Medical Center. “Get experience that is outside of the facility where you trained.”

Krech recently recruited endocrinologist Mahtab Sohrevardi, M.D., for a position at Rush. This is Sohrevardi’s second job post-training and, for her, both searches were relatively straightforward. During the final year of her fellowship at the University of Utah Hospital, she was approached about taking a position at Intermountain Healthcare. “I was planning to stay in Utah because my son was in school there,” says Sohrevardi. Six years later, Sohrevardi decided she wanted a position that was purely academic in nature and began her second job search. Again, being near her son—now a pre-med student in Minnesota—was a priority.

Sohrevardi found positions that were posted online and began applying. One was at Rush University Medical Center where, after considering several offers, she began working as an assistant professor in 2013. “There is an adjustment period with any new job,” she says. During her first year, there were staffing and schedule changes in her division but she has taken those in stride. “We’re moving forward,” she says. Sohrevardi is happy with her position and also likes Chicago, notwithstanding the fact that her first winter there turned out to be the harshest the city had seen in 40 years.

One positive aspect of Sohrevardi’s position at Rush is that she did not train there. “I think that when you graduate from fellowship, you should move to a new place,” she says. “Get experience that is outside of the facility where you trained. You don’t want to be a PGY 6, 7 and 8 where you’re always viewed as a fellow. If you stay in the same place, you’ll battle that.”

MemorialCare Medical Foundation – Orange County, California

Lori Vickers is a physician recruiter for MemorialCare Medical Foundation in Orange County, California. She suggests that physicians begin their search with a relatively narrow scope and then expand it if necessary. “This seems counterintuitive. A lot of physicians do broad searches with the idea that they’ll interview anywhere,” says Vickers. “Be specific and aim for what you want, and broaden the search later if you need to. When I ask a candidate what they are looking for in a position and their only response is, ‘I’m open to anything,’ it’s a hard place for me to start. I would prefer a more defined response such as, ‘My family is from Southern California, so I’d like to find a position in that area. In addition, I would prefer an outpatient only position with a call time of 1:4 or better. Also, I’d like to be on a partnership track.’ Most recruiters appreciate when a physician knows what they want.”

One problem with casting too wide a net is that it’s easy to lose track of where you’ve sent your CV. “Sometimes I’ll get in touch with a physician to set up a phone interview, and they don’t know who I am or where I’m calling from,” says Vickers. Vickers says that spouses of candidates can be helpful with making initial inquires, keeping the search organized, and even arranging the logistics of an on-site visit, but ultimately it’s the physician being considered for the job who has to make the right impression.

Even though Vickers is in what many consider a somewhat laid back area of the country—Southern California—she is impressed by candidates who take the job search process seriously and who are professional in their communications. “Because of social media, we’ve become more relaxed. I sometimes get emails that are written like text messages,” says Vickers. She advises physicians to take the time to write using complete sentences and use proper punctuation. “Maintaining a level of formality through the process makes a candidate stand out,” says Vickers.

When it comes to interviews, Vickers says the best candidates are prepared with questions of their own. “It helps us understand how people think,” she says. Examples of good questions include: What do you value in your physicians? How would I fit in as part of the team here? In what ways could I contribute to the organization? “In the early stages you’re selling yourself,” says Vickers. “Don’t lead with questions about the holiday pay policy. Get an offer first, then talk salary. Don’t negotiate yourself out of a job.”

Maryam Yazdanshenas

Maryam Yazdanshenas, M.D., met in-house recruiter Lori Vickers at a job fair. “MemorialCare didn’t have an opening, but I didn’t lose contact with Lori,” says Yazdanshenas. “I knew that opportunities can come up, and I still had time before graduation.” 

Family physician Maryam Yazdanshenas, M.D., started her job search in October of her final residency year. She targeted Southern California because she wanted to live close to her family. “I looked from south of Los Angeles to San Diego, but when I realized how many opportunities there were, I decided to look only in southern Orange County where my family is,” says Yazdanshenas. She went on six interviews and received a job offer after each one.

Yazdanshenas was also clear on what kind of practice she was looking for. “I didn’t want inpatient work,” she says. “I’d been working 80 to 100 hours a week in residency. I wanted an 8-to-5 job.” She also wanted to be part of a group that had opportunities for leadership, growth and future partnership.

It was at a job fair that Yazdanshenas met recruiter Lori Vickers. “MemorialCare didn’t have an opening, but I didn’t lose contact with Lori. I knew that opportunities can come up, and I still had time before graduation,” says Yazdanshenas. Patience paid off. Vickers contacted Yazdanshenas a couple of months later about several different positions that had become available.

“At MemorialCare I found everything I was looking for. I started in August and I absolutely love taking care of entire families and never knowing who’s going to walk into the office,” says Yazdanshenas. She advises physicians who are about to start a job search to be clear about what they want and then don’t give up. “Jobs are continuously opening up,” she says.

Cayuga Medical Center – Ithaca, New York

Ginny Olsen, RN and physician recruiter at Cayuga Medical Center in Ithaca, New York, and president of the Upstate New York Physician Recruiter Network (UNYPR, nyphysiciancareers.org) suggests that physicians should consider themselves to be interviewing for a job from the moment they email a CV or pick up the phone to make an inquiry. “Try to have a pleasant phone voice, and if you’re sending a CV, include a cover letter if you really want the job,” says Olsen. “It can be brief but it should be specific to the organization. Explain why you want to be there and why you’re a good match.” Olsen also says taking the extra time to direct a CV to a specific person rather than just “Recruiter” or “Medical Director” makes a positive impression.

For the on-site interview, Olsen advises physicians to show up on time, dress appropriately, have questions that they want to ask written down, do some basic research on the people they’ll be interviewing with, and be flexible. “Even with a schedule for the day, sometimes things come up and we have to adjust,” she says.

Olsen says physicians who have anything in their background such as sanctions or malpractice suits should disclose that right up front. “We check licenses and do Google searches, and our credentialing people can probably find out what you had for breakfast,” she says. “It doesn’t bode well if something comes up late in the process.”

As far as spouses being involved in the interview process, Olsen encourages it. “We like to have the family engaged and know that they are interested in coming to the area,” she says. “We don’t require it, but we pay for spouses to come to the first interview. I’m more excited when they want to come because I know the candidate is serious.”

Olsen is careful not to get too personal with physicians during the interview process, but if a physician happens to mention certain interests or hobbies, she makes an effort to introduce them to other members of the medical staff who have things in common. “We recruit with an eye toward retention,” says Olsen.

Interventional radiologist Roman Politi, M.D., was slated to complete fellowship in 2013 and found himself facing a very tight job market. “I and my five co-fellows at Massachusetts General Hospital were all feeling a little anxious,” says Politi. “Due to cuts in reimbursement, groups weren’t hiring as robustly as they had been.” His attendings told him not to worry, but with a wife, a newborn son and significant student loan debt, that was easier said than done.

Politi went on five interviews and eventually took a position in Pennsylvania. “I wanted a job that was mostly interventional radiology and that would also allow me to maintain my diagnostic radiology skills,” he says. Though his first job fit the bill in that regard, it only lasted a year. “I was committed to putting in a full year because I didn’t think it would look good on my CV to do otherwise,” says Politi. As the year mark drew near he began his second job search and was pleased to find an open position at Cayuga Medical Center in Ithaca. “It’s a beautiful college town with hiking trails and friendly, down-to-earth people.” It was important to Politi and his wife, Monica, who is a physician assistant, to settle near where she grew up in northeastern Pennsylvania.

Politi says he clicked with everyone in his new group almost immediately. “You don’t have to be best friends with everyone, but you will spend a significant amount of time with your colleagues so it’s important to get along with them socially,” he says. He appreciates that Cayuga Medical Center is able to offer high-end imaging services. “The patient population here is educated and well-informed. I’ve had patients who have done their research on me ahead of their procedure and ask me questions about my training,” says Politi.

Asked about advice for other physicians who might be in the market for a new job, Politi offered: “Find a group that is collegial and treats you with respect. Make sure you’ll have interesting, satisfying work. Look for work/life balance, particularly if you have a family. When interviewing, ask about turnover rates and try to meet with as many of your potential colleagues as possible. And don’t focus too much on money.”

Karen Childress is a frequent contributor to PracticeLink Magazine.

 

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Job search (times two)

How physician couples are navigating their dual job search.

By Karen Edwards | Feature Articles | Spring 2015

 

Dr. Leslie Cavazos and her husband

When Leslie Cavazos, M.D., begins her post-training job search, she’s hoping for an opportunity near her husband, Like He, M.D., a family practice physician in Gladstone, Missouri.

For Leslie Cavazos, M.D., finding a job seems a little like playing a game of musical chairs. She hopes when the music stops and her residency as a physical medicine and rehabilitation specialist at the University of Kansas Medical Center comes to an end, she’ll be able to find a job.

But Cavazos doesn’t want just any job. She wants a position in her specialty and one that will put her in close proximity to Gladstone, Missouri, where her husband, Like He, M.D., a family practice physician, is working.

“His job is here, so I would prefer to find something here as well,” she says.

There are no guarantees, of course, and therein lies a problem for physician couples. Though the job market is still a favorable one for physicians, finding jobs for two physicians—especially if one is in a hard-to-place specialty—can be more challenging.

Rise in physician couples

More and more physicians today are facing this problem. Maybe that’s because physicians seem to be the marrying kind. A recent Medscape Physician Lifestyle Report found that more than 85 percent of male physicians who responded to the survey and 71 percent of female physicians are married—a number that exceeds the 51 percent of all Americans who are married.

But that’s not all. An increasing number of physicians are marrying other physicians. The annual 2013 Cejka Resident and Fellows Survey showed that physician-couple marriages were up 5 percent from 2012.

Dr. Allen and Dr. Simmons

Scott Allen, M.D., and Emma Simmons, M.D., have been able to find work throughout their careers as a couple. “It’s like looking for a house,” says Simmons. “List your priorities and what you want, ideally. …Know what your deal-breakers are.”

“It’s not surprising,” says Scott Allen, M.D., an internist and associate dean of Academic Affairs at the University of California Riverside who is married to Emma Simmons, M.D. “Women make up nearly half of the workforce these days, and more are entering medicine.” And think about it, he says. Medical trainees spend much of their time circulating with other physicians, so who else would you expect them to see socially?

“In general, physicians who marry physicians meet the criteria for successful marriages,” says Monica Lypson, M.D., who is married to Andrew D. Campbell, M.D. “Physicians are typically older when they marry, so they’re likely to be more mature, and usually they’re financially secure. That means their marriages may last longer.”

Lypson, an assistant dean at the University of Michigan, was one of several authors of a recent study of medical marriages. One key factor, the study found, is a reliance on each other for mutual support. “Physicians, especially those still pursuing training, can often find themselves located far from family and friends,” Lypson says. That’s why, when a job search arises, it’s important for couples to support each other through the process, she adds.

It may not be easy, though. After all, job hunts can put a strain on any searcher. But throw in factors that are unique stressors for physician couples, and you may have the perfect storm for relationship issues.

Unique stressors

One such stress is finding work that’s located in the same geographic area as the spouse.

Suzanne Anderson, associate director of medical staff recruitment at Duke Medicine, recalls one physician she had recruited. He and his wife were both physicians, and Duke had positions for both. “We were excited about recruiting them,” she says. Unfortunately, although one spouse was happy with the position, facility and area, the other spouse apparently was not. “We lost them both,” she says.

Geographic distance can be an issue for some physician couples as early as resident match. During training, for example, Lypson found a job she knew was perfect for her and she quickly accepted—even though it meant living and working miles away from her husband. “We had discussed this possibility during the couples match, so we were prepared and could have an open and honest discussion of the pros and cons,” she says. Lypson made the move to Michigan. A short time later, her husband found a position nearby.

Another physician-couple stress factor can be family. Although starting and raising a family can be an issue for any couple looking for work, the physician couple with children (and double the medical debt) can be under tremendous pressure to find work quickly.

Abby Mozes, M.D., is an emergency physician who, for the past few years, has followed her husband, Josh Mozes, M.D., as he trains for his specialty in cardiac electrophysiology.

They have moved together from New York to New Mexico to Indiana, and now the two have landed in Boise, Idaho, where he works as an attending physician. Abby, however, is currently unemployed—a choice the pair made together. “I was in my ninth month of pregnancy with my third child when we moved to Boise,” she says.

Financially, the Mozeses are in a position where it’s feasible for Abby to stay home with their two sons and new daughter, and she’s likely to do so for a while. But previously, she worked during all the moves made for Josh’s training.

“With family,” she says, “there is pressure to work. Even if it was in a part-time capacity, I worked,” she says. And, she adds, “I didn’t want to waste what I learned after years of training.”

Physician couples may face other unique challenges.

“Some facilities have nepotism policies,” says Diane Safner, a senior search consultant for Cejka Search. John Heydt, M.D., who recruits physicians as CEO of the University of California Riverside Medical Group, says one of the university’s policy regulations prohibits employees from taking positions where one spouse reports to another. “It’s an issue we’ve dealt with as well,” says Laura Blake, director of physician recruitment for WVU (West Virginia University) Healthcare. “We worked it out, but it’s something we watch now when we hire physician couples.”

There are also some employers who may be wary of physician couples because they may want the same time off for vacations and holidays. “If the couple joins a large group or is in different groups at a hospital, it’s not so much an issue,” says Blake. But small group practices may not be as flexible.

“Many physicians deal with sudden absences,” says Anderson, “but small group practices may have a more difficult time with that than a larger practice.” Adds Heydt: “The larger the practice, the less it becomes a problem.”

Another challenge that couples must navigate is if one physician is in an unusual specialty or sub-specialty. “Due to the size of their market, equipment needed, demand for services, etc., they may not have that specialty position available” if the search area is narrow, says Blake.

Don’t rule out a location before having a conversation, however. “We worked with a gynecologist who was married to a psychiatrist,” says Maureen Jamieson, a senior search consultant with Cejka. “The rural hospital wanted the gynecologist, so they created a psychiatry position for his wife.”

Whose job is priority?

That type of scenario can happen, but most experts agree that isn’t something you’ll want to count on. And that leads to perhaps one of the greatest stressors for physician couples looking for work: If both physicians are looking for work at the same time, whose job search should take priority? Which physician should take the lead?

There are two schools of thought here.

Emma Simmons, M.D., says the most marketable physician should take the lead. “As a strategy, it makes sense for the physician who can find work easily to lead. That way, the physician can bring in income while the spouse looks for work.”

Others, including Mozes, say it’s best to let the physician with the more difficult-to-place specialty take the lead. “I let Josh take the lead because there aren’t many job openings in his sub-specialty,” she says. And although she’s not currently working as an emergency physician, she says she usually finds work when she looks.

Blake is also inclined to let the physician with the hard-to-place specialty lead the search. “Even if the primary care physician finds work, there may not be a job for the sub-specialist, so they may have to leave the area anyway,” she says.

“Figure out whose job is primary, whichever physician that may be, and start there,” suggests Heydt.

And if you can’t find work immediately, there are options, says Cavazos. You can work locums or moonlight until the right job opens up, she says.

Your own practice

Or, you could open your own practice.

Opening an independent practice is harder now than it used to be, says Cavazos. “It’s scary but feasible if you’re in the right specialty.”

Psychiatry is one of those feasible specialties, says Hy Gia Park, M.D., who, along with her husband, Charles, work together in their practice, Arahant Health Services in Denver, which offers help for addictive, behavioral and other psychiatric disorders. Unlike a primary care practice, she says, the initial capital to open a psychiatry practice isn’t as large.

But why open a practice at all when so many physicians are opting for employment?

Charles Park, M.D., explains that, following a variety of clinical experiences, he felt compelled to give voice to a holistic philosophy that was shaping his practice goals. “We picked the name Arahant for our clinic because it means ‘one who is worthy’ in Sanskrit. We felt our patients needed to be reminded that they are worthy human beings because the label of ‘addict’ caused them to forget this,” he says.

“Charlie opened the practice in 2006, right after his fellowship,” says Hy Gia Park. She joined his practice after leaving her own fellowship in 2013. “I looked for work, but my husband said he needed me in the practice.”

Before considering opening a practice of your own, Hy Gia offers some advice: “Assess your family situation first,” she advises. “In residency, you have steady pay and great health care coverage. You don’t have that initially with a practice, so make sure there is a stable income coming from somewhere before making the leap.” Hy Gia says her family has always owned businesses, so she knew what to expect when she joined her husband’s practice. If you do decide this is the route for you, she also suggests you learn to love the business side. “You have to be involved with the business side. There’s no getting around that.”

Still, it can be rewarding, says Charles Park. “If I have any advice for people coming out of residency and fellowship, it would be to embrace the freedom that is given to us by our field, and try on every role in their chosen specialty. See how their professional identities are shaped by these varied experiences, and see if any one organization can truly contain their growing voice.”

If not, you may want to open your own practice, with or without your spouse.

In-house recruiters can help along the way

Of course, if it’s employment you’re seeking, there are plenty of things you can do to help the job search along—whether the search is for you, your spouse or for both of you.

Your potential employer’s physician recruitment department can help.

Shelley Tudor, vice president of research with the Association of Staff Physician Recruiters (ASPR) and an in-house recruiter for a managed-care system, says she’s happy to work with physician couples. “When an organization has multiple positions available, working with two physicians is a welcomed benefit,” she says.

Anderson also says she’s happy to work with couples. “It can be an advantage for us if we have two positions open, so physician couples can be an asset,” she says.

However, Heydt says physicians who want to make a job decision based on whether or not their spouse can also find work is something they’ll want to factor into their negotiations. “We’re a large employer, so we’re likely to find a job for the spouse, but if we don’t have anything available in that specialty, we’ll work with our partners to see if others in the area might have a position open at their facility,” he says.

Still, there are a few things you’ll want to do on your end before showing up for an interview.

First, sit down with your significant other and talk, says Lypson. “Be really honest with each other. Put everything on the table.” Heydt agrees: “As a couple, you each need to decide what your needs are and what you want professionally.”

Blake suggests that the couple brainstorm on their own, listing the areas that are deal-breakers and areas where they may be willing to compromise. “Then get together to discuss them,” she says.

“It’s like looking for a house,” says Simmons. “List your priorities and what you want, ideally. Talk about how much distance would be comfortable if you were to take jobs in different locations. Discuss different scenarios that might come up. Know what your deal-breakers are.”

Allen and Simmons have been fortunate throughout their careers to find work as a couple. Allen says if an employer didn’t offer them both jobs or find work for his spouse, that would be a deal-breaker. But they were both upfront about that and let potential employers know that was the deal. “You have to know what your values are, what you will and won’t accept,” says Allen. If you and your partner have different priorities, or disagree on deal-breakers, it’s better to discuss that before either of you start reaching out to recruiters—or appear before a potential employer for your first interview.

Once your priorities have been set, deal-breakers discussed and target locations determined, it’s time to start the search. Plan to be honest and open about what you want. And the sooner in the process you state your wants and needs, the better.

“If you’re looking for a job for your spouse, give us that information at the initial phone screening,” says Tudor. Don’t bring it up when you’re ready to commit to a contract.

Overall, however, recruiters are happy to get your call. “I don’t see any disadvantages to physician couples,” says Heydt. And most recruiters will work with you to meet as many of your needs as possible. “We don’t want to give good people a reason to look elsewhere,” says Heydt. Adds Anderson: “Two for one is an advantage for us, and we’re willing to work with both of them. We realize that if one is unhappy, then two are unhappy, and that can lead to two vacancies.” So as long as your expectations are reasonable, you can count on recruiters to do what they can to bring you on board—and keep you.

Karen Edwards is a frequent contributor to PracticeLink Magazine.

 

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5 ways to stand out

You want the job, but how will the employer know it? Use these five steps to put the wow into your job search and emerge at the top.

By Marcia Layton Turner | Feature Articles | Spring 2015

 

You’ve probably received all sorts of guidance from colleagues, recruiters and department chairs about how to approach your job search. Figure out what kind of medicine you want to practice, decide where you want to live, head online to start your search, and beef up your CV are all probably on that list of must-dos. That is good advice, certainly, when it comes to landing a job. But what do you need to do to get the job that was meant for you? How can you land at your dream practice?

The physicians and recruiters we spoke with emphasized preparation—going beyond the medical training that is required for your specialty and focusing inward on what you really want your life to be like. What kind of people do you want to work with on a daily basis? What kind of patients do you want to treat? Where do you want to be in five years? In 10?

As you ponder these big-picture questions, also pay attention to the little things. Details can make a big difference. Here are five ways you can stand out and rise above fellow job applicants.

1. They matter: Pay attention to the little things

Amy Bird, director of executive and physician recruitment at Christiana Care Health System in Newark, Delaware, fills as many as 40 positions a year, so she sees a lot of CVs and meets a lot of candidates. What do the stand-outs look like? They do their homework, they ask thoughtful questions, and they demonstrate that they’ve thought about their career and how their unique qualifications relate to potential employers, she observes. More specifically, they go beyond what is generally expected during the job search.

On the first pass when reviewing CVs, Bird looks to see if a cover letter is included. If a candidate has taken the time to write a cover letter, which only “about 50 percent do,” she says, it shows that they did some research, helped connect their experience to Christiana Care, and were willing to invest a little time. Not having a cover letter won’t immediately disqualify a candidate, but the ones who provide a well-written letter stand out in a positive way, she says.

At a site visit, she looks for physicians who arrive on time, are dressed professionally, and provide thoughtful answers to questions about their background and experience and the kind of role they might play at Christiana Care. This requires preparation and shows that “they’ve thought about their qualifications and accomplishments,” she says. Those who, conversely, arrive late, dress too casually and struggle with answers—failing to connect their background with the job they are applying for—leave Bird wondering, “Are they sincerely interested in building a career here?”

After the visit, send a thank you note, she advises. “Only 25 to 30 percent of all applicants send an email thank you” after a site visit, she says, and the handwritten cards are even fewer and far between, so they stand out even more. A mailed card “isn’t necessary,” she says, “but it will help you stand out.”

In the thank you note, refer back to something you discussed with the person you are thanking, she suggests. “That shows you are interested and that you were paying attention.” It also helps jog the memory of the recipient.

By themselves, these little efforts likely won’t win you the job, but they will certainly present a positive impression that can only help get you on the short list of possible new hires.

2. Get personal: Go beyond the facts on your CV

Before you even get on-site to interview, there is work you can do to prepare for your first or next job, starting with setting some goals. Ideally, you should be doing this regularly: asking yourself if you love what you are doing, if you can see yourself doing it in 20 years, and thinking about what you can do to position yourself for a fulfilling career in medicine. “Make sure you’re honest about what you want in your job,” says Scott Kaiser, M.D., pediatric orthopedist at Children’s Hospital Oakland in Oakland, Calif. “Don’t pursue something that is not a good fit because you’re worried about getting [any] job.”

Kaiser actually started out in business, taking his undergraduate degree from Georgetown University back to San Francisco to work at Gap Inc. corporate, managing the accessories business. However, he came to realize that working in a cubicle was not what he wanted to be doing, so he began researching medical careers. He found a post-doctorate pre-med program that would only take 15 months to complete, so he registered, and then went on to complete medical school at Washington University in St. Louis. After residency at the University of California at San Francisco, he recognized that he wanted a career in academia, so he took a fellowship at the Hospital for Sick Children in Toronto before beginning his job search back in San Francisco, where he wanted to practice.

The good news was that Kaiser had developed a vision early on for where he wanted to be at the end of his medical training and had taken every opportunity during residency to prepare himself for his career goal. He knew he wanted to treat children, which severely limited his career options. “There are few general orthopedists who want to treat children,” he says, and even fewer who specialize in deformity correction, as he does.

“Getting back to San Francisco was a feat,” he says, given that only one or two jobs are available in his niche each year.

Knowing upfront that he faced a challenge, Kaiser did everything possible to make sure he was well-positioned for any job that would come up, starting with revising his CV. He asked colleagues and friends outside of medicine to share their CVs and the CVs of candidates they hired. He wanted examples of CVs of candidates who got the job so he could pick and choose elements that he liked to use on his own CV.

He asked his colleagues what stood out in a good way on the CVs they shared. “What made you want to meet them?” he asked. He edited his own CV accordingly, leaving in details of his education, training and research and adding more about his life outside the hospital.

One of the biggest changes was adding an “interests” section. “I didn’t want to put an interests section on my CV, but those around me said that interests make you look well-rounded,” says Kaiser. It provides information about what you’re like outside of the hospital—“the character piece”—and helps interviewers to connect with you. “It shows that you’re more than a doctor and a researcher,” he says. It also provided a starting point for conversations, especially when there was a common interest besides medicine.

With his CV polished, Kaiser began contacting recruiters who had pediatric orthopedic openings, even in other parts of the country. He found that recruiters were sometimes aware of job openings not yet posted in the region he wanted to be in. He also networked religiously, attending local and regional professional meetings, to mix and mingle with fellow physicians. “The conversation at these meetings always goes to talking about what you’re doing, where you want to be, and the job you’re after,” he says. So there is no need to be worried about how you’ll shift the conversation your way—it will go there naturally.

His preparation paid off.

3. Start sharing: Be assertive in your network

Dr. Lisa Chui

Because location was the most important factor in her job search, Lisa Chui, M.D., began networking with physicians in the area during residency. Being assertive worked—she landed a job at Kaiser Permanente San Francisco.

Another physician who wanted to remain in the San Francisco area was Lisa Chui, M.D., an internal medicine physician at Kaiser Permanente San Francisco. A native San Franciscan, Chui and her husband wanted to be near family in the area after attending medical school at the University of Vermont. Because location was the most important factor for her, aside from being in primary care, Chui took every opportunity to network with local physicians, starting as early as her second year of residency at California Pacific Medical Center.

As a second-year resident, Chui routinely placed courtesy calls to the patients’ primary care doctors to keep the physicians up to date on their care. Impressed with her communication and care skills, many conversations often transitioned to Chui’s background and future career path and planning. Although at first she didn’t share much detail, thinking the other physicians were only trying to be polite, she realized that she was missing out on a great opportunity to tell them about herself. So when asked, she would tell them, “I’m graduating next year and looking to stay in San Francisco.”

That proactive response served her well. By the middle of her third year, she had three formal offers in hand and several other open-ended opportunities.

Sharing information wasn’t the only step Chui took to stand out. Having heard good things about Kaiser Permanente, Chui wanted to attend a local recruitment dinner but had a schedule conflict; she was expected to work the overnight ICU shift that evening. When a colleague urged her to do whatever was necessary to be there, she swapped schedules to give herself a small window of time to attend. Unfortunately, when she arrived, she was seated at the family medicine table instead of internal medicine. However, the seating snafu gave her a reason to introduce herself to the internal medicine department chair before having to leave and articulate her interest. To her surprise, he had already heard her name through one of his colleagues, who had encouraged him to recruit her to Kaiser. She received a formal interview invitation the next morning.

4. Set your goal: Separate needs and wants

Robbyn Upham, M.D., MSEd, an attending physician in family medicine at the University of Rochester in Rochester, New York, found that being honest about her interests, her situation and her career goals served her well during her search and led her to a job that was created just for her. “Being yourself can make you stand out,” she says. “Be who you are.” Only then can you be assured that the jobs you are offered are a good fit for your personality, priorities and lifestyle.

Upham knew early on that she was interested in medicine and public health, going so far as to study in Israel at Ben-Gurion University of the Negev to obtain a different perspective. Back in the States, she studied family medicine and then spent an additional year at the University of Rochester Medical Center as chief resident in family medicine.

After deciding that she wanted to remain in Rochester in private practice, Upham applied to the local primary care network to see what opportunities might exist in family medicine. She included plenty of details about herself, her training and her career goals to ensure she would be found by recruiters with appropriate positions. It was important for her to find a job that was the right fit—not just any job. “There is such a shortage of primary care docs that I receive 10 to 20 offers a day from recruiters,” she says. But by limiting herself to Rochester, most of those jobs were not of interest.

While interviewing, Upham made sure to be honest about who she was and what she was after. “I didn’t hide the fact that I have three kids,” she says, and, in fact, that may have helped her develop rapport with her interviewers, who liked the fact that she had a family of her own. “People want to get to know you, to make sure you’re a good fit.” While revealing details of her family life was a personal decision and a good move within her specialty, she says that family medicine is generally supportive of this.

Discussions that resulted from her applying to the local primary care network involved exploring what she was looking for and what was available. “It was never a matter of if, it was a matter of where” she might fit, says Upham. The “where” turned out to be a new clinic location opening during the fall of 2014, which Upham had a hand in planning. “Honesty goes so far,” she says, and helped her attract a job that is the perfect fit.

5. Give them a call: Pick up the phone!

Where some physicians have their pick of positions thanks to urgent demand for their specialty, their location or other factors, others have to apply at every hospital, introduce themselves to dozens of recruiters, and network, network, network in order to find a spot.

Dr. Alex Betech

When you’re in full-on job-search mode, don’t hesitate to pick up the phone. Alex Betech, M.D., found that calling instead of passively emailing about opportunities helped set him apart.

Because Alex Betech, M.D., attended medical school in Mexico City, rather than the U.S., he found himself in the latter category, spending months reaching out to nearly every person he knew to find an “in” to a position in orthopedics at a U.S. hospital. His is a story of persistence that all job-seeking physicians can learn from.

Betech was born and raised in Mexico but always wanted to live and work in the U.S. That meant finding a residency that accepted international medical training. He decided to do a first-year general surgery residency, called a “preliminary internship,” and was successful in being matched with the Mayo Clinic in Rochester, Minn. He then went on to do a research fellowship at the University of Texas in Houston. Next, through networking, he found out about a clinical fellow position in limb lengthening and reconstruction at Sinai Hospital in Baltimore, which he took.

He then returned to Mexico City to complete his residency with a goal of ultimately returning to live and work in the U.S. To that end, during residency he applied to fellowships in America, successfully finding one at Baylor College of Medicine in pediatric orthopedics, followed by a second fellowship in joint replacement at the University of Chicago with a pioneering surgeon. While there he started looking for a job.

Betech’s process involved using Google to find websites linking doctors with physician recruiters, including PracticeLink, then following up by phone. “I called everybody,” he says.

Where emailing with questions is reactive—you send it out and wait to see if you receive a response—phone calls are proactive. You dial and either speak with the person you were trying to reach, or you leave a message requesting the information you’re after.

Betech’s final challenge was finding a way to qualify for board certification. To work in the U.S., he had essentially two options. He could work in a remote hospital that did not require board certification, or he could take the more challenging route of finding an academic hospital that would hire him. After working five years in an academic hospital, he would become board eligible. Despite being more difficult, it was Betech’s preference, so that he could eventually qualify for board certification. This search led him to Louisiana State University at Baton Rouge, where he will soon begin work.

The trick to getting that job involved picking up the phone.

“Most people didn’t respond to emails or phone calls,” he says, but if you could catch someone on the phone for even a minute, they could direct you to the right person. In many cases, that is how Betech tracked down the person he needed to speak with about an opening. Betech was not content to send out an email and not receive a response. If he did not receive a response, he would follow up with a phone call until he got the information he needed.

Other physicians said much the same thing: Too few have time to read all their emails at the end of the day, but if you can catch someone for 30 seconds by phone, you can get the information you need.

Finding ways to stand out during your job search comes down to doing more than everyone else is doing—taking that extra step. Be proactive in seeking job opportunities, such as by calling instead of emailing; network to make contact with those making hiring decisions; be willing to step out of your comfort zone to introduce yourself; be honest about what you do and don’t want in a job; and remember to say thank you whenever possible. If you do all of these things, you will certainly stand out in the best way possible.

Marcia Layton Turner is a frequent contributor to PracticeLink Magazine.

 

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