Evidence-based apps take on gout, drug dependence and smoking

These three apps help physicians diagnosis gout, employ the SBIRT method and give patients the tools they need to quit smoking.

By Iltifat Husain, M.D. | Spring 2017 | Tech Notes


In this edition of Tech Notes, we’ll cover three great evidence-based apps: one for determining whether a patient is suffering from a gout flare or something more serious, one for screening for substance abuse, and one that may help your patients quit smoking. All three apps are free to download.

Gout Diagnosis

Gout Diagnosis

Price: Free iTunes: apple.co/2j69V9m Android: Not available

When a patient presents with joint pain, there is always the concern that an acute infection is the cause of the pain. Often a physician will perform a joint fluid analysis by doing an arthrocentesis of the joint—a procedure that can be very painful—even though he or she suspects gout is the etiology of the symptoms. The Gout Diagnosis medical app utilizes evidence-based algorithms that are straight from the literature to help physicians determine without a joint fluid analysis whether gouty arthritis is the source of a patient’s pain.

This medical app is based off research by Hein Janssens, M.D., and Jaap Fransen, Ph.D., et al. (Their original paper is called “A Diagnostic Rule for Acute Gouty Arthritis in the Primary Care Without Joint Fluid Analysis.”) With the permission of the authors of the original study, Joshua Steinberg, M.D., a prolific physician app developer, turned their decision algorithm (which has been validated in the literature and is widely used) into a point-of-care medical app.

The Gout Diagnosis medical app is very easy to use at a patient’s bedside. It offers you seven Yes or No fields, six of which can be answered just by talking to the patient. The decision algorithm then gives you a score along with recommendations about whether or not a joint aspiration may be necessary.

The app is free and easy to use. Unfortunately, it is not available for the Android platform right now. (In the past I’ve asked Steinberg and other medical app developers why they often don’t create analogous Android versions, and they’ve said they see tremendously fewer downloads on Android than iOS.)

Key ways to use this app. Use the app to determine if a gouty flare is causing joint pain or if an arthrocentesis should be performed. You can also use it to learn more about the original research by Janssens and colleagues and how it can be applied in clinical practice.



Price: Free iTunes: apple.co/2iFqU1G Android: Not available

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based method to help identify and reduce dependence on alcohol and illicit drugs. Given the current opioid crisis, this methodology has been gaining huge traction in the clinical arena.

Though specific SBIRT training is available, it would be difficult to learn the method simply through reading about it. The SBIRT app, however, provides a great means for learning how to use the method.

Created in partnership with the University of California San Francisco (UCSF) and the Substance Abuse and Mental Health Services Administration (SAMHSA), the app not only takes you through the steps of SBIRT but also provides the evidence behind the methodology and offers informative content (such as in the Epidemiology section) to foster an understanding of the opioid crisis and other substance abuse problems plaguing the general patient population.

One of the coolest features of the app is the video modules included. These video modules (found in the Key Resources section) show you examples of SBIRT evaluations and help you understand how to use the approach with your patients.

Because the app has screening sections built in, it can be used at the point of care with patients, so even if you don’t have extensive training with the SBIRT process, you can use the app at a patient’s bedside. It even gives you scripts to help you ask key questions of your patients.

The medical app also has questions at the end of the app that allow you to track your progress with SBIRT. You are able to denote your comfort level with the process and do self checks to see if you are mastering the technique.

Key ways to use this app. You can use this app to learn the SBIRT methodology, to go through the SBIRT process at a patient’s bedside and to learn more about substance abuse and how it’s affecting your patient population.



Price: Free iTunes: apple.co/2hTIRbo Android: bit.ly/2iJjZ7x

Apps to help patients quit smoking have been around since the launch of the smart phone. Not all are created equal, however, and not all use evidence-based techniques in their processes.

QuitGuide is a free smoking cessation app launched by the National Cancer Institute. It’s great to see a medical app from such a reputable source, and unlike several of the currently popular smoking cessation apps in the App Store, this one follows the practice recommendations for smoking cessation from the Tobacco Control Research Branch. Though the app has been around for a while, there have been many iterations over the years that continue to improve its overall functionality.

Some of the key highlights of QuitGuide are its ability to integrate social networks (such as Facebook) into the decision to quit smoking. Users can even post custom messages about why they want to quit smoking. The app also has a personal, customized touch to help patients with smoking cessation.

Key ways to use this app. This app is a great resource for educating patients on why they should quit smoking. If patients are ready to quit smoking, consider prescribing this app to them.



Sadia Ali, M.D.

Snapshot | Spring 2017


Sadia Ali, M.D.

Sadia Ali, M.D.

Specialty: Family medicine with obstetrics

Employer: Florida Hospital Family Medicine Residency Program in Orlando, Florida

Medical school: University of South Florida Health Morsani College of Medicine (2013)

Residency: Carolinas HealthCare System Northeast/Cabarrus Family Medicine (2016)


Florida Hospital Family Medicine Residency Program

Women’s Health/Obstetrics Junior Faculty/Fellowship (2017)

Ali is married with two kids. She enjoys running and trying new foods.

What surprised you about your first post-residency job search? The abundance of opportunities available to physicians. Often overwhelming, it took a lot of work and research to find out what I truly wanted in a practice.

What’s your advice for residents who are beginning their job search? Always stay true to your dreams and ask for what you really want. The worst possible outcome is getting no as a response, and the best case scenario is creating an opportunity to practice medicine the way you would like to.

Anything particularly unique about your job search? I saw the posting on PracticeLink and immediately emailed the recruiter. I heard within five days. I got a phone interview within two days and was scheduled for a site visit within two weeks.

How did PracticeLink help you in your job search? During my search, there were multiple messages in my email inbox and phone calls from different recruiters with opportunities that involved practices or locations that I wasn’t interested in. PracticeLink helped me narrow down the type of opportunities that I actually wanted to choose from.

Any other advice? Don’t get steered in a certain direction with your search because of trends in medicine. As I stated before, if you stay true to what you really want, you will be happy with your results and potential offers to choose from.



The health care policies of President Trump

Many parts of the Affordable Care Act may be eliminated during Donald Trump’s presidency, but some popular features, including prohibiting discrimination based on pre-existing conditions, are likely to continue.

By Jeff Atkinson | Reform Recap | Spring 2017


During his campaign for president, Donald Trump proclaimed, “On day one of the Trump administration, we will ask Congress to immediately deliver a full repeal of Obamacare.” Trump’s disdain for Obamacare under the Affordable Care Act was echoed on the 2016 Republican platform, which said the ACA “imposed a Euro-style bureaucracy to manage its unworkable, budget-busting, conflicting provisions.” Thus, it is expected that President Trump and the Republican-controlled House and Senate are likely to dismantle many provisions of the ACA.

Dismantling Obamacare

High on the list of provisions to dismantle will be the ACA’s mandates that employers provide health insurance and that people without insurance either acquire it or face tax penalties.

In addition, the current requirement that insurance plans offer minimum-benefit packages is likely to be abolished. Insurance companies will probably offer a wider variety of policies, some of which will have minimal benefits. There may also be more insurance companies offering policies in a given state if Trump follows through on his promise to enact laws to allow sales of insurance across state lines.

Trump favors increased use of health savings accounts and allowing full deductions of health insurance premiums on individual tax returns. Such steps would be helpful to middle- and high-income families but would have little benefit for families who are in low tax brackets or pay no taxes.

Medicaid Block Grants

Under Trump’s plan, which is supported by many Republicans, the federal government’s role in Medicaid will also be reduced. Traditionally, the federal government has provided states with funds for Medicaid and issued detailed regulations about how the funds could be spent (although states could be granted waivers).

Under the new approach, the number of federal regulations will be much lower, and Medicaid funds may be lumped into block grants, perhaps including welfare payments, leaving the states to allocate the funds as they see fit. The amount of federal money to fund Medicaid will likely also be reduced. The Trump-Pence policy statement says, “The state governments know their people best and can manage the administration of Medicaid far better without federal overhead.”

Parts of Obamacare that may Remain

Although Republicans are eager to get rid of Obamacare, some parts of it may remain, particularly provisions that are popular with both Republicans and Democrats. Those provisions could be retained in a scaled-back ACA or incorporated into a Republican bill that replaces it.

There is widespread support to have a law that prohibits insurance companies from discriminating on the basis of a person’s pre-existing conditions. Such a law would prevent insurance companies from denying coverage or sharply increasing rates simply because of a person’s health problems. Such protection, however, may be restricted to those who have had continuous insurance coverage, thereby discouraging people from foregoing insurance until the need for it arises.

Other Obamacare provisions that draw bipartisan support include allowing adult children to remain on their parents’ insurance policies until age 26 and using health care payment systems that promote cost-effective care.

Future of Medicare

Republicans vary in their opinions on what the future of Medicare should be.

Some Republicans, including House Speaker Paul Ryan, favor significant changes in Medicare, including converting Medicare into a voucher or premium-support system by which the government would pay a certain amount for retirees’ health insurance, which could be obtained through government or private insurance. If the cost of insurance exceeds the amount the government would pay (which is likely), retirees would have to pay the difference. Ryan would also raise the eligibility age for Medicare from 65 to 67.

Impact on Physicians

The full impact of “Trumpcare” on physicians remains to be seen. It is likely that payments to physicians and other providers from government-sponsored programs will be reduced. Unless Republicans develop a way for those who gained coverage through the Obamacare exchanges to retain their insurance, many currently insured people will return to being uninsured or will be significantly under-insured by policies with stripped-down benefits.

Payments under Medicaid—which are already low in most states—will be lower still if the federal government reduces funding for Medicaid and allows states to use block grants for purposes other than health care. If a state chooses to fund its Medicaid program generously, payments to providers may not be cut, but in an era of tight state budgets, added payments to Medicaid providers do not seem likely.

If Trump follows through on his general promise not to change Medicare significantly, Medicare reimbursement rates may not be adversely affected. Additionally, regulations are likely to be reduced in the Trump administration, which may result in lighter burdens of medical records and other paperwork.

Paths to Change

There are multiple paths to implementing Donald Trump’s health care reform. Some actions can be taken quickly by issuing executive orders—no action by Congress required. Reforms that President Obama implemented by executive orders can also be eliminated by President Trump’s executive orders.

If the Republicans seek to repeal the ACA outright and replace it with a Republican plan, Democrats may be able to slow the process with a filibuster. Republicans have a majority of seats in the Senate, but, under current rules, they do not have the 60 votes necessary to cut off a filibuster.

On the other hand, if reforms are made through a budget reconciliation process, only 51 votes in the Senate are necessary. Budget reconciliation bills are intended to focus on budgetary matters, and under Senate rules, debate can be limited to 20 hours. When the ACA was amended six years ago, the budget reconciliation process was used to make the amendments.

Jeff Atkinson teaches health care law at DePaul University College of Law in Chicago.



In-house recruiters and agency recruiters: What’s the difference?

During your job search, you’ll likely be contacted by both in-house recruiters and third parties (a.k.a. agencies, search firms or headhunters). Understand the differences with this helpful guide.

By Tammy Hager, PracticeLink.com | PracticeLink Tips | Spring 2017


In-house and agency physician recruiters

In my previous role as executive director of physician practices and recruitment for a large health care system, and in my current role as director of physician and client operations for PracticeLink.com, I’m often asked by physicians: “What is the difference between an in-house physician recruiter and an agency or search firm recruiter?”

Knowing the difference can help you make the best decisions when it comes to your job search.

Many job-seeking physicians know that tools like PracticeLink are helpful for identifying opportunities based on professional needs and geographic and lifestyle requirements. But you should also know who is on the other end of the job postings and how that person can help with your career needs.

One main difference between an in-house recruiter and an agency recruiter is that in-house recruiters are employed directly by the hospitals, clinics or other organizations they represent. It is their job to recruit physicians for positions within their own organizations and communities. The physicians that in-house recruiters hire will take care of those recruiters’ families and friends. Additionally, in-house recruiters can provide firsthand information about the organizations and communities. They usually live in the area where their opportunities are based. Because in-house recruiters are employed by the hiring organizations, they are already being paid a salary, so there is no placement fee when a physician is hired.

Long-term retention is key for in-house recruiters. They are concerned not only about each physician’s goals and career requirements, but also about their spouse and children. In-house recruiters want to learn about each candidate’s family needs and interests because they’re hoping to find a fit for the entire family.

Agency recruiters are contracted by hospitals or other organizations to find and place physician candidates. Placement fees are then paid to the agencies for each physician or candidate hired—sometimes in excess of $25,000. Although an agency recruiter may not be based in the community for which they’re hiring, they may be able to present you with multiple options in various locations.

Here at PracticeLink, we work with more than 5,000 health care facilities representing more than 25,000 job opportunities nationwide. Our network includes both in-house recruiters and agency recruiters. Both types are looking for physicians to fill jobs within the organizations they represent.

On PracticeLink.com you can choose to look at all open jobs, or you can narrow it to only those posted by in-house recruiters or agency recruiters. This allows you to choose the type of recruiter you’d prefer to work with. We want you to understand the differences between the types so you can decide which recruiter best suits your personal and family needs when you’re looking for a job.

We look forward to helping make your job search easier and putting you in control of your career.

Tammy Hager is PracticeLink’s director of physician and client operations. Reach her at (800) 776-8383 ext. 459.



How tight is the job market in your specialty? Spring 2017 issue

The PracticeLink Physician Recruitment Index can help you gauge the relative ease or difficulty of your job search.

PracticeLink Physician Recruitment Index | Spring 2017


What’s your competition like?

For job-seekers of all kinds, it can be hard to know. A simple PracticeLink.com search for opportunities in your specialty will give you an indication of the demand for physicians like you, but without knowing who else is vying for those jobs, it’s hard to get an accurate picture of supply.

How many other candidates in your specialty are actively looking for jobs at the same time? And how does that number correspond to the number of opportunities available?

That’s where the PracticeLink Physician Recruitment Index comes in. The Index is a relative indication of the ease or difficulty of job searches in various specialties based on supply and demand information gathered by the PracticeLink system quarterly. The larger the “Jobs per candidate” number for your specialty, the better your potential standing in the market.

The change in rank reflects the specialty’s movement since last quarter.

Screen Shot 2017-05-19 at 1.36.32 PM

The Most-Challenging-to-Recruit Specialties are those specialties with the highest demand-to-supply ratio in the PracticeLink system. The specialties on this list likely won’t come as a surprise to candidates; they’re often narrow fields.

The Most-In-Demand Specialties represent the specialties that have the most jobs overall posted on PracticeLink—specialties for which the demand for physicians is highest. For the Index, we then rank those in-demand specialties according to the supply. Those at the top represent specialties with the most jobs available and the fewest candidates per job.

After reading these Indexes, ask yourself: Do these Indexes match your experience of searching for a job in your specialty? Do you need to widen or narrow your job-search parameters as a result?

This PracticeLink Physician Recruitment Index was pulled January 1. Candidate ratios include physicians who have registered with PracticeLink.com within the past 24 months.



5 red flags to spot before you sign

Consider these potential red flags before you commit to a practice opportunity.

By Keith Herl, MHA, MBA and Matt Mingenback | Legal Matters | Spring 2017


The single most important factor for physicians in choosing whether or not to join a practice should be the quality of the practice—not its location, the compensation or any other factor. After all, most physicians will spend far more waking hours at work than at home. This is not a novel notion, but it does raise a key question: What makes a quality practice?

There is certainly no single correct answer to this question, and diverse personalities and skill sets will fit differently into a variety of practice cultures. There are, however, certain factors that indicate how well a practice is run (regardless of the market, size or specialty) and whether or not it may be a good fit for you. Spot any red flags upfront by considering these factors when evaluating a practice.

The reason the practice is hiring

There are typically two reasons a practice brings on a new physician: growth or the need to replace another provider. Either reason is certainly legitimate, but in the case of replacement, it’s key to get to the reason behind the vacancy. If the previous physician didn’t retire, the practice should be honest and specific about why he or she left. In many scenarios, it is reasonable for the practice to allow you to contact the physician who left. Additionally, it’s a good idea to find out whether the practice is replacing multiple providers in a short period of time, which may speak to a problem.

Though joining a growing practice is generally a good move, the practice should still be able to articulate their growth strategy and provide detailed projections about finances and patient volume that demonstrate that it is indeed smart growth. If it’s a new clinic in a new area, have they spent the time and money to conduct a formal market analysis? Have they set aside the capital needed to ramp up over the course of a two- to three-year period?

Patient volume expectations

By the time you complete residency or fellowship, you should have a pretty good idea of how patient volume translates into time (if not, speak to your attending and mentoring physicians). Though this does vary by specialty, the number of patients you see each day directly affects your ability to achieve the work-life balance you desire—and it relates to your risk of burnout.

This may seem like a simple, obvious fact, but two things may happen during the interview process that can cause you to lose sight of it. First, you may have an idea of the number of hours per week you would like to work but no idea of the number of patients or cases that translates to. Second, the practice, though well-intentioned, may try to sell you on taking a higher volume. Practices often promise that various efficiencies they have in place will help you see more patients in the same amount of time. In reality, this is rarely the case. Even a robust, well-trained support staff can’t make caring for 30 patients per day the same as caring for 22 patients per day.

The onboarding process (or lack thereof)

Whether a practice has an onboarding process in place can be an important predictor not only of how long you stay at the practice but also of your early career satisfaction. Onboarding processes will differ from practice to practice, but every practice should be able to explain what the process will be if you come onboard. You should never feel as though you’ll be thrown into the fire.

If a practice, for instance, would expect a new physician to see patients on his or her first day, it may be a sign of a chaotic work environment. Ideally, the onboarding process should include: shadowing one of the experienced physicians; learning practice workflows for scheduling, ordering supplies, billing, etc.; being trained on the EMR and any equipment; meetings with key staff members who head finance, operations and staffing; and general orientation (especially for large organizations).

In organizations with robust onboarding programs, it may be weeks before you see your first patient.

Staffing issues and turnover

An established practice without an established staff is certainly cause for concern. During your interview, ask how long the administrative and clinical staff have been with the practice—and how many staff have been with the practice for less than a year.

There are several other critical questions whose answers could also reveal staffing issues: Is there a nurse or medical assistant for every physician in the practice? How much of the work-up and charting are nurses and assistants allowed to do? Are credentialed support staff (registered nurses, medical assistants, nurse practitioners, etc.) practicing at the tops of their licenses—meaning are they carrying out tasks to the full extent that their education, training and certification allow?

The answers to these questions can reveal a lot about the efficiency of a practice and its ability to manage patient flow while taking as much busywork as possible off your plate.

You might also ask if there is a practice administrator on-site every day or most days. Is the administrator responsible for a number of other practices and therefore rarely seen? The only way to know a business is to be there. And in an increasingly complex practice environment, having someone to manage the day-to-day business operations is vital to improving the practice and the bottom line.

Transparency about frustrations

Health care is consistently rated as the highest-stress industry in the U.S., and it’s in a time of great transition. Every provider will have some frustration about their work. Asking about those frustrations starts an important conversation, and the practice should share those frustrations with you without hesitation. Whether a practice is willing to reveal its providers’ frustrations speaks to its transparency and culture. The frustrations you learn about may be a deal breaker or non-issue, but they’re something both parties should want you to know before you sign a contract.

No practice is perfect. Working to spot these five red flags can ease the path to finding the right fit. Choosing the right practice the first time can have a lasting impact on your career satisfaction and earnings.

Keith Herl, MHA, MBA and Matt Mingenback have more than 20 years of combined physician placement and retention consulting experience. They provide executive leadership for the career services team at Afferent Provider Solutions.



Live & Practice: Small Towns

By Liz Funk | Live & Practice | Spring 2017


Living in a small town or city has its advantages: a built-in sense of community, an easygoing lifestyle and shorter commutes. Physicians practicing in small towns and cities across America often develop especially strong relationships with their patients, and those relationships can afford extra insight into what’s going on with their patient population. This isn’t to say, however, that physicians looking to work there are limited to joining small practices. Many of these locations have large health systems that serve vast patient populations, including community members as well as those in outlying areas.

Eric Francis, M.D.

After undergrad in Chicago and residency in Colorado, Eric Francis, M.D., headed back home to Texas. His family enjoys the area’s water sports and German festivals. · Photo by Ashlee Newman

New Braunfels, Texas

This town of 70,000 people has no shortage of things to do. The city is known for its many seasonal traditions, including Wurstfest, the annual German food and drink festival going on its 56th year; Wassailfest, a holiday event where revelers stroll downtown and sample the spicy cider drink at stores or restaurants participating in the wassail competition; and the annual arrival of Santa Claus to New Braunfels.

“My grandparents came to New Braunfels about 25 years ago. They were looking around Texas, and they were looking for a place that they thought the kids and grandkids would all enjoy. They looked all across Texas and moved to New Braunfels,” says Eric Francis, M.D., a family medicine physician with Resolute Health Hospital in New Braunfels. “Over the past 20 to 25 years, all the grandkids have slowly migrated to this area. …It took 25 years, but now we’re all in the same town.”

Francis explains, “I grew up in El Paso, Texas, and I went to a small liberal arts school just west of Chicago called Wheaton College. I moved back to Austin for a year between undergrad and medical school, and that’s when I officially met my wife.”

Francis stayed local for medical school but took a risk for his residency. “I did medical school in Houston at Baylor College of Medicine. Then I put the map on the table and my wife and I said, ‘Hey, where would be a good place for me to do my residency?’”

Francis and his wife decided on the University of Colorado. Francis says, “I finished my residency and internship there, and I was working for Kaiser Permanente for about six years. For nine years, we lived up in Colorado, and our third child was on the way, and we thought, ‘It would be nice to be closer to family.’ Resolute Health Hospital just happened to be starting up at the same time. …I liked the vision they had. I pursued that opportunity and now I’m here.”

Today, Francis, his wife and their three children live in New Braunfels and enjoy the area’s wide variety of activities, including one of the largest water parks in the country, Schlitterbahn New Braunfels Water Park.

Danyl Butler, director of business development for Resolute Health Hospital, says the area’s diverse activities and attractions draw talent. “There’s something here for everyone—activities or events for families, festivals, beautiful German architecture, and access to water sports.” This variety is helpful for Resolute Health, as they are always recruiting. Says Butler, “There is a huge shortage of primary care providers in the market, so we are actively looking to bring primary care physicians and family physicians to New Braunfels. Although primary care is our primary focus, there are also opportunities for medical and surgical specialists.”

Resolute Health Hospital has 128 beds and was founded in 2014. Butler says, “Resolute Health Hospital has all of the latest amenities and technology. The culture at Resolute Health is also a plus. We have a very engaged workforce with high employee satisfaction scores. Our patient experience scores are consistently among the highest across Tenet Healthcare-owned hospitals. The hospital is built in one of the fastest-growing areas of Comal County.”

Resolute Health also operates a primary care clinic in the medical office building attached to Resolute Health Hospital. There is also an outpatient physical rehabilitation center on the campus. Resolute Health is affiliated with Tenet Healthcare-owned MedPost Urgent Care clinics in New Braunfels and nearby Seguin.

Francis says two main factors make New Braunfels so special: “It’s a combination of the water sports—the rivers and lakes—and just the uniqueness of an old German town. They’ve got festivals. There’s the Wurstfest. It’s fun to be able to celebrate sausage and German people in a big festival. There’s this uniqueness here that you don’t find anymore. Last month, the whole town shut down for the annual county fair. Kids can march in the parade to celebrate the fair. The schools are out for the parade.”

Says Francis, “New Braunfels, I would say, is the best place in Texas to live. It’s an old, unique town, but within 45 minutes you can get to two of the best cities in Texas: Austin and San Antonio.” And during the summer, New Braunfels is the place to stay cool. “Our neighborhood is connected to the river. In this part of the country during the summer, you tube in the river. You can get a lot more land down here. There’s a forest in our backyard. The kids really enjoy the outdoors,” says Francis. “It’s nice to be in a small town that has its own unique character. New Braunfels itself is pretty self-contained. Everything we need is here.”

David Baker, M.D.

A search for a positive quality of life helped David Baker, M.D., choose Carson City, Nevada, as home. The community offers all kinds of opportunities to be active outdoors—skiiing, hiking, camping and more. · Photo by Lemaire Photography

Carson City, Nevada

You can drive from one side of Carson City to the other in under 15 minutes, and the small town is also within driving distance of Lake Tahoe, San Francisco, Sacramento and beaches in California and Oregon. The city—the state capital—is nestled along the western border of Nevada, just to the east of the Sierra Nevada.

David Baker, M.D., has called several different regions of the United States home. He has lived in Davis, California; Omaha, Nebraska; Albuquerque, New Mexico; Portland, Oregon; and now Carson City, Nevada. He says he has enjoyed Carson City most of all these places.

“We love the area, period,” he says. “Some of it is the basics. The weather is phenomenal. It’s sunny 320 days a year, and there’s no humidity. The location is phenomenal. We are located on the backside of the Sierra mountains. We’re close to San Francisco, the Sierras, the California coast and the Oregon coast.”

One reason Baker has moved around so much is his medical training. He earned his undergraduate degree at the University of California-Davis and attended medical school at Creighton University in Omaha, Nebraska. He completed his residency at Oregon Health & Science University in Portland, Oregon, and a fellowship in cardiology at the University of New Mexico in Albuquerque. He made his way to Carson City, where he has been practicing cardiology for 10 years. For the past six years, he has worked for Carson Tahoe Health, the largest provider of medical care in Carson City.

Carson Tahoe Health has an 80-acre campus in Carson City with virtually all its services concentrated in one location, a 352,000-square-foot medical building. The facility has 144 acute care beds with 138 private rooms. The facility also has an open-heart surgery program with a private cardiovascular unit, a women and children’s center, a hybrid OR suite and vascular and catheterization labs.

Shay Dusek, practice administrator for Carson Tahoe Health, says, “Carson Tahoe Health is a private, not-for-profit health system with a beautiful modern hospital and offices. All decisions are made locally, and management is accessible to physicians, solicits physician input, and responds to physicians’ suggestions and recommendations.” Dusek is currently recruiting physicians in family medicine, internal medicine, oncology, general cardiology, psychiatry, pain management, and neurology.

“The lifestyle is good,” says Baker, on working for Carson Tahoe Health. “The hours are good. The people you work with are quite good. It’s nice having everything right on campus. You concentrate all your services in one location. For a small community, we have excellent care.”

Quality of life is what initially attracted Baker and his wife to Carson City. They thought it would be a good place to raise their two daughters. “Now they’re both grown and in college, but that was one of the things that brought us to Carson,” Baker says.

“We are a family community. This is a family kind of a town. This town is where Nevada began. We were once the seat of the Utah territory before we became the capital of Nevada. Lots of people think Vegas is the capital. It’s not. It’s Carson City,” says Ronni Hannaman, executive director of the Carson City Area Chamber of Commerce.

“We are a small community. We are a community in every sense of the word. People here are very, very friendly,” says Hannaman. Carson City has a population of 55,000, but 15,000 people commute there every day for work, for shopping and, of course, medical care.

Nevada’s economic benefits are especially attractive for job seekers. Baker explains, “There are no state income taxes, and the casinos pay a decent amount of taxes. The sales tax and property tax isn’t that bad. All of this keeps more money in your pocket.”

Of course, Nevada’s casinos are also a draw for many. Carson City is approximately a seven-hour drive to Las Vegas, but Hannaman says that the Carson City community tends to be more outdoorsy. “If someone is really into the outdoors, the living here is great,” Hannaman says, adding that hiking, bicycling and skiing are popular among locals.

Baker agrees, “It’s a very outdoorsy community. We’re nearby 20-odd ski mountains. I do a little bit of skiing. A lot of my colleagues will get in 70 or 80 days of skiing a year. I do a lot of hiking, backpacking and camping.”

“The great thing about working for Carson Tahoe Health or any of the many private practices, is you can live at Lake Tahoe, Reno or any of the towns and surrounding communities like Genoa or Virginia City,” says Dusek. “You get the benefit of smaller town living with no state taxes and with access to world-class ski resorts and next door to beautiful Lake Tahoe.”

Marlton, New Jersey

Just 30 minutes from Philadelphia, 90 minutes from New York City and 2 hours from Baltimore, Marlton is popular among people who want to be near family in one of these major geographic areas while enjoying a small-town lifestyle. Marlton has strong community spirit, with several annual festivals sponsored by local government and scores of free exercise facilities, family activities and classes such as yoga and karate for residents.

Small towns and rural areas sometimes present a challenge for health care providers. That was the case when a rural southern New Jersey community first contracted with CFG Health Network, which is based in Marlton.

The community asked CFG to cover its psychiatry needs. But a week before the contract was to begin, there was a new requirement: all physicians had to be able to get to the facility within an hour of getting a call.

None of CFG’s physicians lived within an hour of the facility, so a team from CFG traveled to Virginia to learn about what was then a new pilot program for telepsychiatry. And with that, a new CFG service line was born.

Back then, the telepsychiatry machine cost $25,000. CFG owned two: one at the hospital and one that traveled weekly between office locations.

Now, it’s a different story. Thanks to HIPPA-compliant technology for laptops and tablets, half of CFG’s physicians work outside New Jersey. One even practices from his sailboat in Florida.

In all, CFG employs about 1,200 people, including approximately 200 psychiatrists and 90 nurse practitioners. About 10 of those clinicians are based in Marlton. The network provides telepsychiatry services for a variety of settings, including hospitals, prisons, schools and treatment facilities. CFG also owns a residential treatment facility and outpatient clinics.

James Varrell, M.D., was part of the original team that traveled to Virginia to learn about telepsychiatry. He is now CFG’s medical director and president. He grew up in Marlton and enjoys its small-town feel. “My mother works at our office still,” he says.

Another Marlton medical employer is Virtua Health, a non-profit health system that operates three hospitals in the Marlton area. Virtua Memorial Hospital is a full-service hospital with 433 beds. Virtua Voorhees Hospital is a new facility with 388 beds, all of which are in single rooms. Virtua Marlton Hospital has 188 beds and offers advanced surgeries and spine, joint replacement and stroke specialists.

Virtua also operates 24 primary and more than 70 specialty practices. Says Courtney Kennedy, physician network director for Virtua: “We’ve been named ‘Best Place to Work’ by the Philadelphia Business Journal 11 years in a row.” She is currently recruiting for urgent care, family medicine, gastroenterology, surgery, neurosciences and hospitalists.

Marlton offers an easy drive to Philadelphia and New York, and it’s also close to the shore. “Marlton’s a very nice middle-class town,” Varrell says. “It also has a great school system.”

There are lots of activities for families in Marlton, according to Allison Bittner, special services & communications supervisor for Evesham Township Department of Recreation & Senior Services. Evesham Township includes Marlton, and its municipal offices are located in Marlton. “We offer quarterly recreation programs: winter, spring, summer and fall,” she says. “They range from arts and crafts to exercise classes, like swimming or karate. Yoga is extremely popular among adults.”

Bittner says the Evesham Memorial Sports Complex, free of charge for residents, is another popular destination for families. This indoor recreation facility has basketball courts, volleyball courts, tennis courts and a very large playground for kids.

“We do a lot of special events throughout the year that are open to the public,” says Bittner. “We do a lot of July 4th activities: we have a parade, we do a 5K run, we do fireworks at night. We put on a Harvest Fest in the fall, Winterfest in the winter, and Marlton Day in May, sponsored by the Marlton Business Association. It’s on Main Street, and it highlights the local Marlton businesses.”

“For anyone who wants to raise a family, it’s a great place,” Varrell says.

Pierre, South Dakota

In a way, South Dakota’s state capital is also the health care capital for half of the state. Pierre offers a tight-knit community where physicians can build meaningful relationships with patients. Its medical community serves a patient population spanning a 100-mile radius around Pierre. This presents unique and interesting challenges for providers. Physicians must tailor treatment for patients who drive long distances for medical care. Luckily, the natural beauty of South Dakota makes these drives scenic.

“I was born in this town. I did all my schooling here,” says Thomas Huber, M.D., a family physician with the Sanford Health Pierre Clinic. Huber was part of the first class to graduate from the University of South Dakota Sanford School of Medicine. Students who came before him had to transfer from Sanford’s two-year medical school to receive their degrees at a four-year school. But while Huber was a student, Sanford became a four-year degree-granting medical school.

“When I finished my schooling, and it came time to decide where I wanted to be, my choices were to go to the western part of the state or go to the river,” says Huber. “Pierre is on the river. The Missouri River comes right through the center of the state. I decided to practice in Pierre. There are lots of opportunities in this community. Pierre is the state capital. It has a low unemployment rate and a very high percentage of college-educated people who work here. It has an abundance of outdoor activities available either on the river or on the prairies, if you like to fish and hunt, which I do.”

Huber offers high praise for Pierre: “My wife is from here, and all of our families are still here. If I was faced with making that decision again, I would still end up here.” Huber has three adult children. His middle daughter lives in Pierre with her husband and two children, which Huber says, “worked out great for Grandma and Grandpa.”

Suzette Hohwieler, a physician recruiter for Avera Health in South Dakota, says, “South Dakota is a great place to live, work and raise a family. South Dakota has a strong economy, and many communities have been recognized nationally for their family-friendly atmosphere, excellent educational system and low crime rate.” Hohwieler is also quick to mention that South Dakota has no state income tax or corporate income tax.

Avera operates Avera St. Mary’s Hospital, a 60-bed hospital in Pierre. Avera Medical Group Pierre includes 52 physicians and advanced practice providers in 13 specialties. Sanford Health, which operates the Sanford Health Pierre Clinic where Huber practices, provides services including family medicine, cardiology, pediatric cardiology and 3D mammography.

Hohwieler says, “The market area provides the physicians and staff the opportunity to get to know their patients, as well as their families.” Huber adds, “The area we serve here is not limited at all by the town that we live in. We’re the center of the state, and we have a population of the two communities on the river. We’re the only medical community for a 100-mile radius, perhaps even more so. You get to have special relationships with all the people who live in the community. You learn how to make it work for the people.”

Pierre is excellent for those who love the outdoors. Says Laura Schoen Carbonneau, CEO of the Pierre Area Chamber of Commerce, “We are very, very heavy into outdoor recreation. People are very enthusiastic about fishing and hunting. Pheasant season is huge. It’s almost like a national holiday. We have lots of privately owned land and lodges, and pheasant hunters from all around the country come to Pierre and hunt.” Schoen Carbonneau says small-mouth bass, salmon and walleye are the most popular targets in the area.

Schoen Carbonneau also emphasizes the area’s central location, great for both local getaways and cross-country travel. “We have one of the nicest regional airports in the state, with 50-seat jet service to Denver,” Schoen Carbonneau says. “People can get away to Rapid City, to Sioux Falls or Bismarck. Because we are in the middle of the country, if you’re flying, it makes for very easy connections going east or west. Just because you come to Pierre doesn’t mean you can’t be connected on a larger scale as well.”

Still, the local connection is what keeps many residents in Pierre. Huber says, “If you grow up in a smaller community, I think your ties are stronger, and it’s been proven by the fact that when I came back here many years ago as a young physician. In the clinic I went into, there were lots of patients in that clinic who knew me as a little kid and watched me grow up.”

Huber calls this a “continuity of familiarity.” He says, “Some people in medicine might view it as not a good thing, but I view it differently. When you know your community and you know the people in the community, it makes it a little bit easier for you as a physician to understand how best to take care of the diversity of patients you see and the diversity of issues they may have. I don’t see that as a detriment; I see that as a very positive aspect of practicing medicine in a smaller community.”



From good to pitch perfect: Avoid common candidate communication errors

Don’t let poor communication blow a strong first impression.

By Therese Karsten | Job Doctor | Spring 2017


Your communication skills showcase your ability to organize, reason, handle technology and interact with staff. Employers know that the way you handle administrative tasks during recruitment is a harbinger of how you will handle administrative tasks in employment.

Plus, error-free communications keep you at the top of the candidate slate. In a competitive job market, missed communications give time for another equally qualified candidate to grab the employer’s attention while you’re trying to reschedule or reconnect.

Here are some practical tips for staying on top of your communication game.

Check your outbound voicemail message

Is your voicemail message professional but engaging? Is your name clearly enunciated? If not, the managing partner trying to call you may not know if she’s reached you. She may leave a message, she may not. She may be thinking, This can’t be the right number. A physician looking for a job would never leave a generic outgoing message on the phone number he gives to employers.

Check the email address on your CV

Is it one you actually check? If not, Murphy’s Law dictates that it will be the address that will actually be emailed. We’ve also had candidates miss emails because they used their training program email addresses to pose questions, but expect the answers in their personal email inboxes. For the duration of the job search, set your email application default to show “all incoming mail” so you don’t miss any crucial job search communications.

Check your telephone presentation

When you call a recruiter, don’t say “Hi, how are you today?” That’s how salespeople and outside search firms open a conversation. You, the physician, are our top priority, so your strongest open is “Hi, this is Dr. Smith.” Don’t say, “I’m calling about the internal medicine ad—is that job still available?” Recruiters are working on anywhere from 15 to 50 jobs at a time, and we need more information to answer you best.

Instead, say: “Hi, this is Jenny Smith, and I’m a third-year internal medicine resident at the University of St. Louis. I’m calling about your ad on PracticeLink for intensivists for Presbyterian/St. Luke’s in Denver.” The same goes for voicemails. A succinct, informative intro gets you what you need from us as quickly as possible.

Know when/how to use “reply all”

If an employer asks you a question via email and has other email addresses on the Cc line, use “reply all.” Cc is an abbreviation for “carbon copy.” It means the sender intended for a third party to see the email and implies that the sender also wants that recipient to see your response. If you ignore this, you are depending wholly on the initial sender not only to notice that you didn’t copy the other person but also to relay your response.

Make the most of the subject line of email

Recruiters receive up to 400 emails a day, and the only way to prioritize is by subject line. Use that line to convey urgency, and even use the urgent flag when warranted. “No location yet for Friday lunch” is going to get a recruiter or practice administrator’s attention immediately. An email with subject line “Update” is not—it doesn’t convey that an urgent reply is needed.

Identify yourself when texting

Texting is the best thing since sliced bread, but make sure you identify yourself in the initial text. “This is Dr. Jenny Smith checking to see if the group was able to move the dinner to Thursday. I have to give final dates to my program by EOB today.” We have wonderful applicant tracking systems that recognize names, email addresses and phone numbers in emails. But on a smart phone, all we see is a phone number if you are not stored as a known contact.

Leave a voicemail

We know, we know—many physicians under 35 simply don’t do voicemail. When the recipient sees a missed call, he should simply return the call, right? But recruiters and practices receive a lot of calls from vendors. We return messages, but we won’t redial every incoming call. Leave a message!

Know the steps to the conference call, WebEx or Skype interview dance

Verify the time zone. Try to click or dial in early to allow time to troubleshoot. If you can’t get in, or nobody is on the line after the scheduled time, email or text the organizer. If you are all alone on a conference call and someone is trying to call you, hit “hold and accept” to see if it’s the organizer. It’s not uncommon to have technical problems, and recruiters may be trying to reach everyone with a new number or to reschedule. Once on a call, don’t ever put the call on hold—just mute the call if you need to answer a page. (Hold means we all hear your hospital’s hold music and can’t talk among ourselves!) Also use the mute button if you need to sneeze, cough or hiss “Can’t you see I’m on the phone?!” at someone.

Don’t guess on reference contact information

Even if you are closely connected to a practice you are joining, the employer has to comply with HR protocol and document that they have checked references. Give us the right numbers and email addresses upfront!

Don’t copy/paste your thank you message

Employers forward your thank you note to others on the decision team. Of course there is going to be some commonality, but try to think of something relevant to that interviewer’s conversation with you. It’s painfully obvious when we all get exactly the same three sentences. Conversely, there are a lot of virtual oohs and ahs when we see thoughtful and original thank you messages.

Name documents thoughtfully

If an employer sends you a form to complete or asks for an updated copy of your CV, pause before hitting save. Every day we receive CVs with crazy names like “Ryan Resume—v 8 with research obj statement” or “St. Mary’s document.” The candidate who puts her first and last name and the title of the document in the file name is telling me that she is detail-oriented. She is thinking about what might be helpful to us in storing documents related to her prospective employment with us.

Inform the employers you decide not to join

Even if you’re not taking the job, close the loop with an email or phone call. I hear excuses like “They’ll just know when I stop responding” or “I didn’t want to respond because I hadn’t actually signed yet.” Once you have negotiated the key terms of your contract, it’s time to tell the unsuccessful suitors so they can move on to other candidates. Don’t end things on a sour note by going dark in a misguided attempt to preserve options. Wish the employer the best of luck with their search. It’s a small world, and you want to be remembered as a terrific candidate who acted with class and manners throughout the recruitment dance!

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



Budgeting for your job-search expenses

To make the job-search process easier on both you and your wallet, anticipate and budget for these potential expenses—and ask your employer what’s covered.

By Jeff Hinds, MHA | Financial Fitness | Spring 2017


As you embark on your job search, it is important to be aware of the potential personal expenses that may arise throughout the process. Though it is not uncommon for employers to cover some of these expenses, you should familiarize yourself with them at the onset of your search so that you know what to expect down the road.

Site Visits / Interviews

Ideally, any expenses associated with on-site interviews will be covered by the employer upfront or reimbursed later on. However, that is not always what happens. It is not unheard of for employers in highly competitive areas to expect out-of-town candidates to cover their own costs if the employer has other local options. Before you make a site visit or interview trip, make sure to confirm with potential employers who is responsible for the costs if it’s not made clear upfront. These may include airfare, gas, rental car, hotel and food costs, all of which could be rather expensive depending upon the location and travel distance.

Immigration Assistance

International Medical Graduates who have yet to obtain permanent resident status or citizenship may require the assistance of an immigration attorney both when exploring the potential restrictions associated with their job searches and when filing documentation after successfully securing a job. In many instances, the employer will have a pre-existing relationship with an immigration attorney for you to use and/or may agree to cover all associated immigration costs if you already have an immigration attorney. This, too, however, will vary by employer and is something that you should take into consideration and prepare for as you assess your potential job-search expenses.

Contract Review

A professional contract review should be considered a necessary expense for all physicians. Beyond the compensation package (which tends to get the most attention from physicians), there are many legal provisions within a contract that have a substantial impact on you both professionally and personally even beyond the terms of the agreement. Because of this, it is highly important that you have an attorney (one with significant experience in reviewing physician contracts) conduct a full legal review of your contract before you sign it.

In addition to the legal review, some groups will also conduct a compensation analysis and provide negotiation assistance to physicians. Consider your options, do due diligence in determining your needs, and confirm the total cost for the review—it will vary significantly depending on the scope.

State Medical Licensure

If you are taking a position in a state where you do not already possess a permanent medical license, this may be an additional expense to expect as part of your total job-search costs. Again, this may be an expense that your employer commits to cover in your contract; however, that is not a given for all employers. It is yet another item you need to take into consideration (and eventually confirm with your future employer) as you assess your expected expenses.

Relocation Expenses

The largest potential expenses of your job search are those associated with relocation. These may include the costs of selling your current house, purchasing or renting a new house and hiring a moving company.

This is an expense many employers are willing to assist with in the form of reimbursement up to a certain dollar amount, which should be outlined in your contract. Seek quotes from moving companies to confirm that the total cost will be reimbursed by your employer.

Jeff Hinds, MHA, is president of Premier Physician Agency, LLC, a national consulting firm specializing in physician job search and contracts.



Who are the most important people in your job search?

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

By Vicki Gerson | Feature Articles | Spring 2017


Allen Kamrava, M.D.

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

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

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

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

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

Mentors and colleagues from training

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

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

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

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

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

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

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

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

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

In-house recruiters

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

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

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

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

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

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

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

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

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

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

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

Ken Dunham, M.D.

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


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

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

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


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

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

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

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

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

Local physicians

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

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

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

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

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

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

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

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

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




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