Annul Your Job Choice

What do you do when your new job turns out to be the wrong one? Are you trapped by commitment? Scared of the professional fallout? Relax, you can start over and survive. Here's how.

By Susan Sarver | Feature Articles | Summer 2010


LIKE MOST PHYSICIANS FRESH OUT OF RESIDENCY, Karen Wicksmith, MD*, an internist, was excited about her first job. She had her eye on a position in a primary care clinic in the South owned by a not-for-profit hospital, a clinic that would soon be housed in a new, multimillion dollar facility. After being wined and dined, Wicksmith netted a nice offer complete with a tidy benefits package that included a 401(k). She was happy and hopeful. “I was going to get paid to make a difference.”

But within six months, things changed. The practice was sold to a for-profit corporation, and Wicksmith discovered that there was an urgent need to expand a practice that apparently had not been profitable. The new administration was counting on Wicksmith and her two colleagues, also new hires recently out of residency training, to do the entire job alone. “I was completely unaware of the business side of running a practice and making it profitable,” says Wicksmith. “I had suspected that you just hang out your shingle and people will just walk in the door.” Wicksmith found herself leaving her baby in daycare only to spend workdays sitting around with her colleagues figuring out how to get patients.

“It was then that the blinders were taken off, and I really saw things in a different light,” she says. Questions came to mind that she had never considered when interviewing.
The for-profit practice model was the polar opposite of the non-profit model she had signed on for. Within a year, it became clear to Wicksmith that she and her colleagues were going to have to bring in enough money to cover overhead costs, which were substantial on the new facility. Yet, there was no marketing program or other support to help them spread the word and build a patient base sufficient to establish a viable practice.

The three newcomers tried to stick it out, even attempting to lure some subspecialists into leasing part of the available space, but it quickly became apparent that,at this point in their careers, the young physicians were illequipped for business building. Wicksmith finally had to admit: “This is not going to work.”

An early departure wasn’t what Wicksmith had in mind when she had signed her three-year contract, and she was concerned about the financial and professional implications, but she knew she had to leave. After 18 months on the job, she secured another position and resigned; her two colleagues did the same.



Avoid Relocation Shock

Moving isn't easy for anyone - physician or family members - but there are steps you can take to make the transition smoother. A beat-the-blues guide that's required reading before you start packing.

By Marcia Travelstead | Feature Articles | Summer 2010


YOU’VE ACCEPTED THE POSITION and your family is excited about the move. Wouldn’t it be great if you could just snap your fingers and everything would magically fall into place? Unfortunately, it’s not quite that easy. However, there are things you can do to make your move a more seamless transition and minimize relocation shock.

If you’ve been working with a physician recruiter, search firm or real estate agent, chances are you’ve gotten answers to several questions prior to accepting the position, such as the best parts of town to live in for your family’s needs and where the best schools are.

Kathy Murray, the senior director of recruitment partnerships of Cejka Search Inc. in St. Louis, says that through the course of conversations between the physician and the recruiter, the recruiter should develop a summary of information about the physician candidate and the family’s needs so that the interview team can tailor the interview to meet some of those needs up front. An example might be school tours. Murray says, “If the new physician candidate’s child plays soccer, then the organization should set up a meeting with another family who has a child that plays soccer. Mutual interests are important. If those kinds of things happen over the course of the interview, things are pretty well set up when the physician arrives,” she says.

Scout it out

Hopefully, you’ve had that kind of support and the opportunity to visit the community during the interview process. Whether that was the case or not, now that you’ve accepted the position, one of the most important steps you and your family can take prior to moving is to spend some time in the area. There may be time constraints, but if there’s any possible way, it’s a great investment.

J.P. Saleeby, MD, a general practitioner, has a medical concierge service called Carolina Mobile MD. He relocated to Bennettsville, S.C., from Savannah, Ga., about three years ago. He is in the process of moving 70 miles to Conway, S.C., later this year, partly because of changing hospital staffing, payer mix issues, and a greater opportunity to build his practice. But he’s also attracted by a wider variety of entertainment and social offerings in the new city. “Before committing to a new contract, it is definitely worthwhile to work a few shifts, weeks, or even months at the new facility, hospital or clinic. There is nothing more frustrating for a physician than to start a new job with great expectations and find out it was a mistake and life is miserable,” Saleeby says.



New Name, Same Mission

By Mollie Vento Hudson | Editor's Note | Summer 2010


I AM HAPPY TO ANNOUNCE THAT WITH THIS ISSUE, Unique Opportunities – A Publication of PracticeLink, is now called simply PracticeLink. Renaming the magazine will more closely link the physician recruitment industry’s leading recruitment website with our publication. By marrying all of PracticeLink’s resources—including our online physician job bank and PracticeLink Magazine—we are even better able to help you navigate your job search.

For 20 years, our unique publication has had one editorial mission: to provide high-quality, practical information to young physicians to prepare you to launch and advance your careers. The name of the publication may be different, but the pages inside will be dedicated to the same mission. You’ll still find articles to help you identify your ideal job, land it, and make it the beginning of a great career.

Another name change you’ll be seeing is that of editor. It’s purely coincidental that the last issue “on my watch” is the first issue as PracticeLink, since the renaming of the publication has been in the works for months. As the founding editor, Unique Opportunities has been my “editorial baby” its entire life, and my feelings of turning in my red pen, so to speak, are somewhat akin to watching a child at college graduation or seeing a daughter walk down the aisle toward her new life with her husband. However, for 15 of my 20 years with the magazine, I have worn two hats, employed both as editor but also as an RN and then for the last 11 years as a family nurse practitioner in an inner-city clinic. As far back as high school, I struggled with whether to work in medicine or journalism and I have been thrilled with the career choices I made. However, the demands of trying to do justice to both have finally forced me to choose, so I am saying goodbye.

I have been blessed to work with a wonderful group of writers—creative, intelligent people I respect greatly and with whom I will miss working, as I will the rest of the PracticeLink staff. You will meet PracticeLink Magazine’s new editor, Laura Jeanne Hammond, in the next issue.

Our three writers this issue have put together a collection of diverse articles. Mark Terry catalogs employment options offered by Uncle Sam that may make you think twice. Marcia Travelstead shares step-by-step guidelines guaranteed to ease relocation shock for you and your family. Finally, Susan Sarver tells the stories of young physicians who realized not long after they’d started their new jobs that they’d made a fundamentally wrong choice. She details how you can annul your job choice and move on without causing career suicide.

It has been my pleasure and privilege to try to make your job search successful and your early career rewarding. Wherever your dreams and ambitions take you, I wish you great happiness and fulfillment.


Mollie Vento Hudson



Dr. Red, White and Blue

Practicing medicine within one of the federal government's agencies can mean great benefits, predictable hours, and travel opportunities. The pay is competitive and the hassle factor is close to zero.

By Mark Terry | Feature Articles | Summer 2010


THE UNITED STATES GOVERNMENT HIRES A WHOLE LOT OF PEOPLE. According to the Bureau of Labor Statistics, there are about 2 million civilian employees, excluding the U.S. Postal Service, and about 85 percent work outside the Washington, D.C.  metropolitan area. Generally, the pay is competitive and the benefits—especially healthcare and retirement—typically exceed those in the private sector.

The federal government is flush with jobs for physicians. Some of those jobs are fairly obvious, such as with the Veterans Affairs (VA) and the Department of Health and Human Services (HHS), which oversees divisions such as the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). Others, such as the State Department and the Federal Bureau of Prisons, might not be quite as obvious. Here are six federal agencies with opportunities for physicians seeking employment

Department of Veterans Affairs

Not surprisingly, the VA is a major employer of physicians, with approximately 18,500 doctors on its payroll. The agency operates 153 hospitals, but it has more than 1,000 points of care, such as community-based clinics, throughout the country. In addition, the VA is one of the largest trainers of physicians in the country. Joleen Clark, MBA, chief officer of workforce management and consulting for the VA says, “We have about 35,000 residents that rotate through annually and about 18,000 medical students.”

Clark says that they encourage those trainees to stay with the VA after residency, “but like any organization, you can only have so many new people. You want new people with your experienced people. It’s a mix. We look for all levels of experience within that scope,” she says.

Because of the numerous facility types, the VA has a need for all specialties, although the needs will vary from institution to institution. Clark says, “If it’s a large tertiary care facility, they’re going to have all the subspecialties there, so the complement of physicians and specialties is going to be very broad compared to one of our rural facilities.”

The size of the organization also benefits physicians’ career trajectory. “Because we are such a large organization there is plenty of room for advancement,” Clark says.

The pay for VA physicians is not as high as most physicians would get in private practice, but they fall under Title 38, which outlines veterans’ benefits. It’s market-based, competitive, and no malpractice insurance is required because of the VA tort claims system. Clark says, “We have a good benefit package and really regular hours. Even though they’re on call 24/7, it’s really an 8 to 4:30 shift.”

The VA currently hires about 3,000 physicians annually. Clark says, “Licenses are transferable; you just need to have a license in any state to practice anywhere in the country.”

Physicians interested in jobs with the VA should visit the official website at



Recession-proof your investments after healthcare reform

With proper diversification and alternative investments (think gold, oil and foreign currencies), a physician's portfolio can weather any storm.

By Jason M. O'Dell, CWM and Kim Renners, CPA, MBA | Financial Fitness | Summer 2010


UNDOUBTEDLY, MANY AMERICANS HAVE BEEN suffering through one of the worst economic crises in recent memory.

Though many economists claim that the recession is over, the most recent legislative changes (and those to come) are sure to impact most doctors in the form of  reduced reimbursements, increased employee benefit costs, and increased taxes on income and investments.

But although the economy may get better for most Americans while getting worse for most doctors, you can fight back by investing wisely. Doctors who take the time to understand today’s risks—and who are willing to address those risks—do not have to be afraid of investing.

Know the hurdles

In today’s market, there are no “free lunches” like there were with the dot-com and real estate markets of the mid-1990’s and early 2000’s.

You and your advisory team need to be prepared to navigate your way through the new tax minefields that have been laid for wealthy investors. Some tax increases have already been adopted, others will be phased in over time, and still more will be discussed this year and in years to come.

After all, healthcare reform is going to cost money, and the current administration has made no apologies for its plan to tax higher earners to pay for it.

Other hurdles include the United States’ dependence on foreign oil, debt service obligations from behemoth deficits, and a weak dollar—all fundamental threats to our nation’s fiscal health.

Savvy investors recognize that the marketplace will not change any time soon. They must focus their investment strategies on dealing with these challenges and mitigating the risks associated with these threats.

Diversify properly

Most investors understand that portfolio diversification is a key consideration to reducing some of the risk of loss in a portfolio. In historically volatile markets, mitigation of loss is not a luxury—it is a necessity.

Most investors who thought they were adequately diversified have looked at their statements at some point over the last two years and noticed very significant dips in their account values. That’s because they made the mistake of diversifying within the stock market. What these investors suffer from is called market risk. When economic factors cause a precipitous drop in the entire stock market, practically all stock investors suffer at some level.

What many experienced investors don’t understand is that diversification needs to go far beyond the diversification of securities like publicly traded stocks and bonds or bank deposits.

Proper diversification, especially in a highly volatile market like the one we are experiencing today, must also be across investment classes. A balance of domestic and foreignsecurities, real estate, small businesses, commodities, and other alternative investments, for instance, would prove less risky than holding the majority of your investments in real estate and securities.

Consider alternative investments

For doctors who can’t build or participate in surgery centers or other profitable healthcare investments that they can help make more successful, another popular investment strategy is to take advantage of different investment programs that are not publicly traded (i.e., not on the New York Stock Exchange or other exchange).

The term “alternative investment” covers a broad range of investment strategies that fall outside the realm of traditional asset classes:
• Gold and other precious metals
• Commodities, including but not limited to oil, natural gas,
wheat, corn and copper
• Foreign currencies
• Non-traded Real Estate Investment Trusts (REITs)
• Leasing funds
• Oil and gas drilling programs



iPads, Notebooks and Netbooks thrive in medicine

Physicians are on the move toward mobile computing.

By David Geer | Summer 2010 | Tech Notes


Several mobile computing devices have appeared on the landscape, offering physicians increased facility while on the go. The devices are steadily growing in popularity in many industries, but especially in health care. We’ve had the opportunity to review three tablet/notebook combinations and hear from physicians who actually use them in their day-to-day work environments:

The iPad

Physicians take advantage of the new Apple iPad, leveraging its efficiency, mobility and screen size. The device enables doctors to view Electronic Medical Records (EMRs), sign off on labs and prescriptions, and apply software once available only on the iPhone and iPod Touch. And the medical scenarios for iPad are expanding. For example, physicians can share the iPad’s 9.7-inch touch screen with patients as they review information about diagnoses and treatments important to the individual’s care.

The iPad has applications in medical education, as well. Charese Pelham, MD, an anesthesiologist in Moultrie, Ga., has at least two medical students assigned to her on a daily basis at the Spartanburg Regional Medical Center, a teaching hospital and trauma center. When a student who has not seen a regional anesthesia administered is preparing to join Pelham in the procedure, that student logs onto the iPad to view a video demonstration for additional training.

Pelham also teaches on the iPad using popular apps from the iPhone and iPod Touch that include the ACLS (Advanced Cardiovascular Life Support) Advisor and ACLS Simulator. The Advisor outputs the precise action that the doctor should take for a given set of symptoms. The Simulator enables doctors to simulate a medical emergency code procedure. With the larger screen, more students can watch a simulation at once from a single device.

Steve Updegraff, MD, in St. Petersburg, Fla., specializes in LASIK and cataract surgery. “We want to keep the patient experience on the cutting edge and remove bulky portable DVD players,” says Updegraff on his use of the iPad. Rather than handing patients the heavier portable DVD players, Updegraff hands patients the iPad for a close-up and more highly detailed viewing of short educational videos about the powerful technology involved in his procedures.

Updegraff’s patients also use the iPad to surf the Internet while they are waiting. The iPad offers a touch screen keyboard, available within the display, as well as a keyboard docking station.



Meet Your Medical Matchmaker

Physician recruiters are more than mere placement pros. Here's why they deserve your highest trust and respect.

By David Andrick | Remarks | Summer 2010


MARKET ANALYST. REAL ESTATE EXPERT. COMMUNITY HEALTH ADVOCATE. SALESPERSON. MEDICAL       ADMINISTRATOR. ACCOUNTANT. STAFF DEVELOPER. LIFE COACH. These are just a few of the hats worn by in-house hospital physician recruiters. Their broad knowledge base and confident personality puts their working relationships with physician candidates at the top of the totem pole.

Unlike independent recruiters, in-house physician recruiters aren’t motivated by commissions and meeting quotas; rather, they work within the healthcare delivery system to ensure that the healthcare needs of their communities are met with the proper mix of medical and surgical specialists. They are responsible for expanding the medical staff either through start-up practices or growing practices in the specialties identified through their medical staff development plan. So when they tap you for an interview, your role could be that much more meaningful and worthwhile.

A professionally trained quasi-clinician

Many in-house physician recruiters receive ongoing professional training from the American Academy of Medical Management (AAMM) or through the Association of Staff Physician Recruiters (ASPR). The AAMM provides intensive seminars for frontline in-house professionals who are responsible for contracting, compensating, managing and retaining medical professionals. The ASPR, comprised of more than 1,000 in-house physician recruiters, also offers education and training to its members.

The typical in-house physician recruiter has spent hours interacting with hospital administrators to help prepare and develop a medical staff development plan, approved by the board of directors, that maps out policies for sourcing candidates and identifying practice opportunities. In doing so, the recruiter gains a keen understanding of the key differences among clinical specialties. Grasping the distinction between an invasive and interventional cardiologist,  and what goes on in the cath lab versus the operating rooms, becomes second nature. This knowledge also comes in handy later on when the recruiter is required to explain the credentialing process with the hospital’s insurance carrier.

When a physician recruiter contacts you, it’s not some willy-nilly, seat-of-the-pants call; rest assured that you are being considered as the right fit within a strategic employment
plan. Of course, the recruiter is in the business of selling the benefits of a hospital, a community and a practice opportunity. Yet it behooves the recruiter to match the right practice setting to you as a qualified physician, so you’ll be an asset to the organization both now and for the long term.



Madison, Wis.—Idealism in Action

Wisconsin's capital, with a legacy of good government, exudes environmentalism, friendliness, and devotion to excellence. Its growing demand for medical care bodes well for physicians.

By Eileen Lockwood | Live & Practice | Summer 2010


Cities sometimes pop up in strange ways, but few municipal birthings could be more unusual than Madison, which was named the Wisconsin territorial capital before a single building stood on the land.

The credit goes to James Duane Doty, a suave transplant from upstate New York who has been described by one historian as “one of the slickest grafters and lobbyists in early Wisconsin politics.”

By the time the first territorial legislature met on October 25, 1836, then in another town, Doty had bought some 1,300 acres of forest and swampland on an isthmus between two large lakes—Mendota and Monona—in central Wisconsin, naming his non-existent town for America’s recently deceased fourth president.

Sixteen communities vied to be the capital of the newly established territory, but Doty had an edge on all of them: He offered free plots for voting in favor of his non-existent city. Then, as now, enticement worked well. The first structure in the new capital, a log cabin, went up in March of 1837. At their first assembly in November, legislators found a dubious welcome, as described by historian H. Russell Austin in his book, The Wisconsin Story, published by The Milwaukee Journal, 1964. Icy desks and seats, one fireplace, ink that froze and hogs in the basement was the setting of the new capitol. Delegates could see the hogs in the cellar below through holes between floorboards built with green wood that shrank as it aged. “When the legislators got sick of a long-winded speaker, one of them stirred up the hogs, which squealed down the speaker,” Austin reports.

Little did Doty know what a gold mine his land would become, the home not only of the state legislature but also the huge University of Wisconsin, a creditable number of major industries, and a center of superior medical care and research that includes three hospitals. UW Health is the hospital arm of the university, whose large related complex encompasses a medical school, research establishment, a network of clinics, a children’s hospital and a cancer center. Its transplant program is the third largest in the country.

Excellent facilities

Meriter Health Services represents a 1987 merger of the 1898 Madison General Hospital and the 1919 Wisconsin Methodist Hospital. Today Meriter, among its many services,
is remodeling its birthing center. In 1989 it was the first of its kind in the state and now boasts the second highest number of deliveries from 3,000 a month in 1989 to 3,800 today. The new “flex space,” says spokeswoman Mae Knowles, “allows for continuing growth and better accommodations for moms no matter how their babies are born.”

In a recent “exciting stage of renewal,” operating rooms are increasing from 14 to 18. The design, says Knowles, is “rather unique.” Each OR complex is shaped like a racetrack.The ORs themselves line the outer “lane” and have windows on the world. The inner part of the “track” is a supply corridor. Cabinets are custom built to ensure that specific supplies can be delivered to each OR, even during surgeries.

Hip resurfacing, an innovative procedure now being done by one of the practitioners at Meriter Health Services, is attracting patients from around the country. An attractive alternative for athletes, the surgery involves inserting new sockets while preserving the bone structure. This allows young sports heroes, for instance, to return to their athletic activities with fewer, if any, complications.