Daniel Talamo, D.O.

Snapshot | Summer 2020

 

“Make a list of things that are important to you,” recommends Daniel Talamo, D.O. – Photo by Monica Stanley

Employer: Adelante Healthcare, Surprise, Arizona

Med school: NYCOM

In practice since: 2019

Talamo enjoys hiking, traveling, spending time with family, cooking, baking, playing sports and trying new foods.

What surprised you about your first post-residency job search? There are a lot of jobs out there because doctors are in high demand. What also surprised me was how long it takes to get licensed and credentialed to start working.

What’s your advice for residents who are beginning their job search? My best advice would be to start early. Start in your second year of residency toward the end. I know it’s hectic and busy, but doing your research on different jobs is key.

What was the most important factor in your search for a new job? My most important factor was being close to family. Being in medical school and residency is a full-time commitment, and you miss a lot of things. I focused on areas where I could be close to them.

Anything particularly unique about your job search? At first I applied everywhere to see the differences in jobs, EMRs and patient populations. Once I figured out what was important to me, I honed in my search.

How did PracticeLink help you in your job search? PracticeLink showed the job opening, and I applied through it.

Any other advice? Make a list of things that are important to you, i.e., family, location, patient population, census, EMR. There are plenty of openings for physicians out there and you can find what is best for you.

 

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Live & Practice: The Great Outdoors 2020

By Liz Funk | Live & Practice | Summer 2020

 

Residency in Greenville led to Adam Scher, M.D., and his family building their lives there. – Photo by Red Apple Tree Photography

Can you hear that? It’s the sound of peace and calm outside, underneath the wide sky. The noise and stimulation of the health care workplace—the beeping, the phones ringing, all the people—feels a world away. That’s why many physicians opt to live in areas where they have easy access to the great outdoors: for rest and relief. For others, the great outdoors presents an entirely different (and louder) slate of activities: outdoor sports to the enjoyment of both the athletes and the onlookers.

In Reno, Nevada, physicians enjoy the sunny, dry weather that is conducive to getting outside year-round. Chattanooga, Tennessee, was built around the Tennessee River where open swimming and a lively riverfront boardwalk provide year-round entertainment. Indianapolis, Indiana, is most known for car racing and, for a little less horsepower, cycling. In Greenville, South Carolina, golf is available practically year-round, and nature lovers can marvel at the beauty of the Blue Ridge Mountains.

Greenville, South Carolina

Located in the northwestern corner of South Carolina, Greenville is equidistant between Atlanta and Charlotte, North Carolina. This corner of the state—the greater Greenville-Spartanburg-Anderson area—is often referred to as “the Upstate” of South Carolina. Greenville is a lively small city with a vibrant downtown area, and total wilderness is just a short drive away.

When Adam Scher, M.D., first visited Greenville to interview for his residency, something just clicked. It was winter, and he ate downtown at a BBQ restaurant. He walked outside to the quaint street lit up with Christmas lights. “It was like a Hallmark movie,” Scher said. He called his then-girlfriend (now wife) back in New York City, raving about Greenville. “You are not going to believe this place,” he said. Scher grew up on Long Island and was in the mood for a change.

Says Scher’s wife, Taryn: “My thinking at the time was, ‘OK, worst case scenario, it’s a three-year commitment.’ Within a week, that was it. I was all in.”

Today, Taryn is so passionate about Greenville that she manages PR for Visit Greenville, one of her accounts at her public relations firm, TK PR. “My feeling on Greenville is, ‘You really can’t pack your bags fast enough,’” she says. “It’s a wonderful place to live and work. We came from a really big city, and we were nervous that we were going to miss out on the amenities. This did not turn out to be the case. Greenville is a small town, but we still have touring Broadway shows—Hamilton is coming through soon. We have James Beard-nominated restaurants. We have food festivals, art festivals, and it’s really affordable.”

In addition to a bustling health care community, both BMW and Michelin Tires have their headquarters nearby. The companies’ suppliers set up camp close to these headquarters, so there is industry humming away and steady job opportunity. Thus, there are often transplants moving to the area and getting acclimated to Greenville.

Taryn Scher says that community members like to volunteer and plan events, which makes it easier for new residents to become part of the community. There is also an entrepreneurial spirit fostered by local business owners who are collaborative and passionate.

Says Adam Scher: “If you walk around downtown Greenville, you probably wouldn’t feel like you were in a small southern town. You’d feel like you were in the ‘new south’ or metro south. But drive out 10, 20, 30 miles, and you’ll see farmland and forests.”

The Schers have built their lives in Greenville. Adam completed his three-year residency through Prisma Health-Upstate (at the time, the health system was called Greenville Health System) and then joined Prisma Health-Upstate’s outpatient internal medicine practice. Prisma Health-Upstate offers 19 residency programs. The University of South Carolina School of Medicine is located within Greenville Memorial Hospital (also owned by Prisma).

Scher’s group practice is called Cypress Internal Medicine. It’s located on the campus for Prisma Health Greer Memorial Hospital. Says Adam Scher, “Within our hospital system, the buildings and the structures are just beautiful. It looks like a hotel with a shopping mall. My practice is at the second biggest satellite campus in the area for Prisma.”

Says Hannah Sandberg, a physician recruiter for Prisma Health, “Across all eight campuses, Prisma Health Upstate employs 16,000 people, including over 1,200 physicians on staff.” The system is licensed for 1,627 beds across eight campuses.

Greenville Memorial Hospital, the health system’s flagship hospital in the area, is licensed for 814 beds. Greenville Memorial has the only comprehensive stroke center in the Upstate and also has a children’s emergency room. The maternity ward delivers 6,000 babies a year.

Sandberg is currently recruiting for “a little bit of everything: internal medicine, primary care, internal medicine specialties, emergency medicine, surgery, radiology and psychiatry.”

Adam Scher recommends that physicians in the mood for a change consider Greenville, not just for its quality of life, but also for the opportunity. “Our hospital system is really big, and then there are two other hospital systems in the Greenville-Spartanburg area,” he says. “There are tons of job opportunities. It’s an incredible medical community down here.”

When the Scher family has downtime, they tend to head to the great outdoors. “We love driving around the mountains or taking the kids to the golf course and putting them in the golf cart.”

Taryn Scher encourages those considering moving to Greenville to look at the Visit Greenville website and check out the events page to get a sense of how much is going on and what kinds of activities there are. Says Taryn: “It’s the best possible mix of everything in one. It’s a little hidden gem. I’m dumbfounded that more people aren’t here.”

Chattanooga, Tennessee

The Tennessee River runs through and around Chattanooga, a city of 180,000 in southeast Tennessee. Chattanooga is home to a large research university, the University of Tennessee at Chattanooga, as well as a health system that is investing in neurology research and state-of-the-art patient treatment. It is a scenically beautiful place for physicians to practice medicine and sharpen their skills.

“While practicing in Nashville, I spent some weekends in Chattanooga exploring the natural beauty of eastern Tennessee,” says neurologist James Fleming, M.D. Fleming heard the Erlanger Health System was doing innovative work in a dedicated neuroscience center, so he decided to interview. “I found a visionary program serving a population with unmet needs in a city I already enjoyed. There was no need to overthink it,” says Fleming. Fleming practices at the Erlanger Neuroscience Institute, the largest and most comprehensive neurology practice and research center in the southeastern region.

Fleming grew up in Owensboro, Kentucky. He was a first-generation college graduate when he finished his degree at Kentucky Wesleyan University and was accepted to the University of Kentucky College of Medicine. But first, he wanted to make time for a unique academic adventure.

Fleming says, “I asked for two years to pursue interests in bioethics and philosophy, leading me to Yale and then the London School of Economics where I completed a master’s degree. Then I returned to Kentucky, completed medical school, and headed off to Nashville to finish my internship and neurology residencies at Vanderbilt.”

He ended up at The Erlanger Neuroscience Institute, unique for its cutting-edge approach to neuroscience and its full range of patient care, particularly given that it is not located in a major metropolis.

Susanna Edmonson, a recruiter for Erlanger, says, “Erlanger is a health system that operates seven hospitals with a total of 950 acute care beds in Chattanooga.” She is actively recruiting for primary care, cardiology, pulmonary/critical care, OB/GYN, urology, endocrinology and neurology. Erlanger’s flagship hospital, Erlanger Baroness Hospital, is an academic teaching hospital located in downtown Chattanooga. It has a Level I trauma center and a Level IV NICU.

“Erlanger is also academically affiliated with the University of Tennessee College of Medicine Chattanooga,” says Edmonson. “Erlanger is the clinical practice site for around 190 residents and fellows each year. We also see around 240 medical students from the University of Tennessee Medical School (located in Memphis) rotate through our facilities.”

Edmonson says that Chattanooga is a great place to live and practice, whether you are just starting out or starting to eye retirement. “Chattanooga is a vibrant mid-size city with a friendly, southern culture that appeals to all backgrounds and ages,” she says.

Says Marissa Bell, the public relations manager for the Chattanooga Convention and Visitors Bureau: “We are a great outdoor city with a lot of options within a close distance. It makes a great quality of life. We have a walkable, livable downtown and a great culinary scene. All that’s going on makes people feel at home and feel like part of a community.” Taking in the great outdoors is also part of the local culture, says Bell. “Chattanooga centers around everything outdoors, which draws visitors from all over. Within Chattanooga and the surrounding area, you can find hiking trails, camping, fishing, golf, hang gliding, rock climbing and caving. Our temperate climate makes the outdoors accessible year-round.”

Chattanooga also draws an older group of transplants looking to retire somewhere with mild winters and beautiful scenery.

Fleming describes himself as “an avid mountain biker and outdoorsman.” Nature is integrated into Fleming’s day-to-day life, including his commute over the Tennessee River. “My commute lasts only minutes and takes me over a beautiful bridge built at the turn of the last century,” he says.

Says Fleming, “Erlanger provides services to a large and grateful population not otherwise available in the area, particularly comprehensive stroke care. As a stroke neurologist, I am privileged to care for these folks.”

In fact, Fleming describes his diverse patient population as “like a Sunday afternoon in the park.” Fleming continues his metaphor: “We care for a racially and ethnically diverse crowd, including movers and shakers on cell phones, young families picnicking, adolescents getting into trouble, homelessness, and elderly resting on the bench. Basically we care for everybody, and I prefer it that way.”

Indianapolis, Indiana

Indianapolis is experiencing a rebirth in its downtown. Hoosiers who want to get outdoors and get moving have great motivation: Indianapolis is considered one of the most bikeable cities in the country, and it’s an easy drive to nearby lakes and hiking paths.

When Kevin Gebke, M.D., was growing up on a farm in Illinois, he planned to become a veterinarian. “But I thought it would be better if my patients could tell me what was wrong,” he says. When he enrolled at Southern Illinois University, he was the first person in his family to go to college. Because he knew he wanted to be a physician, he didn’t have to do much soul-searching before enrolling in medical school in Chicago at the University of Illinois.

But things changed for this Illinois native when he went to Indianapolis. “I came to Indianapolis to Indiana University to do a one-year fellowship after my residency. My intention was to move back to Chicago. Twenty years later, I’m still in Indianapolis. There are great opportunities out here,” he says. Gebke is the vice president for community medicine at IU Health, as well as a family medicine academic department chair at the Indiana University School of Medicine.

IU Health also operates 50 advanced specialist practices and 50 outpatient clinics. IU Health’s flagship hospital is IU Health Methodist Hospital in Indianapolis, licensed for 625 beds. IU Health operates 17 hospitals across Indiana and employs nearly 30,000 people across the state.

Gebke praises IU Health’s administration for encouraging internal medicine physicians to explore their professional passions or pursue dual specialties. Says Gebke: “We have family physicians who do lots of obstetrics. We have people who are pediatrics and sports medicine. We encourage people to figure out what your area of passion is so you can have a defined niche. And that can range and evolve because you have that full spectrum of family medicine.”

Indianapolis is on the rise. It is a city of 1 million residents and is the United States’ 13th largest city. What’s unique is that people are moving to downtown Indy. Says Morgan Snyder with Visit Indy, “We have the highest downtown residential occupancy that we’ve seen in our city.” Snyder says that part of the city’s appeal is that it’s tight-knit, despite its size. “There’s always something—festivals or community events—going on, so people can get to know their neighbors,” she says.

“One of the coolest things is that while you’re in this vibrant city, you can reach lakes and hiking trails. It’s an extremely bike-friendly destination.”

Gebke is a “Hoosier” through and through. And “I have four Hoosiers of my own,” he says. “They are 17, 15, 13 and 10. Indianapolis is a really good place to raise a family. There are amazing opportunities and options for schools. There are public schools that offer great accelerated programs and AP classes.” Plus, for Gebke, his commute is a cakewalk compared to when he lived and worked in Chicago. Gebke says, “Indianapolis has the big city amenities without the traffic jams. Any commute from any corner of the city to another corner of the city doesn’t take more than 30 minutes.”

Says Snyder: “Overall, you won’t find another city as welcoming, affordable, or approachable as Indy. It’s a humble city with great momentum for the future.”

Reno, Nevada

Reno, Nevada, holds unique appeal: It’s close to the west coast, but it is not the west coast. It’s a unique region that appeals greatly to those who love to get outside in relatively temperate winters or sunny summers. In fact, Reno has an average of 300 days of sunshine a year. Physicians also tend to appreciate Reno’s close proximity to Lake Tahoe, a 22-mile-long scenic lake with sandy beaches on the California/Nevada border. Lake Tahoe is a beloved vacation destination for families and Los Angeles celebrities alike (think: glamping).

Matthew Gordon, M.D., is a PracticeLink success story. When he was looking for his next opportunity, he looked on PracticeLink.com and connected with Kim Crandell, the director of business development at Carson Tahoe Health, in Carson City, Nevada. Gordon would eventually see the beauty of the region and the modern atmosphere at Carson Tahoe Health facilities. But before his site visit, what piqued Gordon’s interest in this opportunity were the conversations he had with Crandell.

“His friendliness and his laid-back attitude truly made me want to visit. I liked Kim immediately because he was not pushy,” says Gordon. Sometimes during job-search conversations, Gordon says, there is some pressure put on the physician. Gordon was impressed that Crandell wanted to get to know him and wanted him to get to know Reno.

“Carson Tahoe Health has been welcoming from square one. And they did a great job being welcoming and inclusive of my wife, who visited with me,” says Gordon. Once Gordon met the physician leaders, it was a done deal. Today, Gordon practices at an outpatient internal medicine clinic in South Reno, operated by Carson Tahoe Heath.

Carson Tahoe Health is a local, not-for-profit health system. Crandell says this foments an especially pleasant work environment. Says Crandell, “Management is really flat. Our last CEO was here for almost 25 years. We don’t have a lot of turnover, and we have a lot of consistency.” Crandell is recruiting for internal medicine, family medicine, cardiology, general cardiology, neurology and pulmonology/critical care.

Carson Tahoe Health operates 20 sites across Carson City and Reno. Carson Tahoe Health operates a long-term acute care hospital, a psych hospital with an inpatient psych unit, as well as their flagship, Carson Tahoe Regional Medical Center. There is a surgical hospital on the Carson Tahoe Regional Medical Center campus; they are technically distinct facilities all under one license. A source of pride for Carson Tahoe Health is the visual beauty of their facilities. Says Crandell, “The buildings and patient rooms are well-maintained, and it creates a really great atmosphere. We work hard to keep them up.”

Carson Tahoe Health is especially hospitable to international physicians. Says Crandell, “In Nevada, in our system, a J-1 visa is for a physician who is not a U.S. citizen. If a physician does their residency or fellowship training here in the U.S. and they want to stay, they have to get a company to sponsor them. We never use all of our slots, so we can bring anyone in anytime of year.”

Gordon is from Toronto, Canada, and his wife is from Milwaukee. “We are extreme outdoor enthusiasts,” says Gordon. “We love whitewater kayaking, downhill skiing, mountain climbing. When we flew out here for an interview, we landed at night. I got up in the morning, and I couldn’t believe how mountainous it was.”

“People often think of Nevada and think that it’s all desert. But there are rivers and bodies of water that flow down from Lake Tahoe,” says Ben McDonald, senior communications manager for Visit Reno Tahoe.

In fact, Reno is a popular destination for kayaking enthusiasts, with a whitewater river that runs through the city.

Says McDonald, “In the warmer months, that’s one of the things that brings lots of people here to visit. It kicks off in May with the Reno River Festival. It’s a national kayaking competition right in the heart of downtown Reno.”

McDonald echoes that heading outdoors is a big part of life in Reno. “There is skiing, fishing, snowboarding, trail riding, mountain biking and rock climbing. Lake Tahoe has beautiful sandy beaches around the 72 miles of the lake.”

Another advantage to exploring opportunities in Reno is the substantial professional opportunity for physicians’ spouses. “We have a giant, behemoth technology park just a little bit outside of Reno,” says Crandell. “It’s the largest industrial park in the U.S.; both Tesla and Google have offices there. It’s hard to explain how big this place is. This campus employs a lot of people. We’re seeing a lot of growth in Reno mainly due to that, and that helps everything else grow.”

Indeed, Reno may be approaching its moment of sudden expansion, like Austin, Denver and Portland before it. Says Gordon, “Reno is having a real up-and-coming moment. It’s the best-kept secret. Sometimes I’m tempted to say, ‘Oh, don’t come to Reno, you wouldn’t like it.’” The high quality of life and affordable housing is a major perk. “There is lot of new development, especially new housing developments, and you can have beautiful views from the houses. My wife and I have a house we love, and I have a cabin in back with a wood-burning stove, so I can relax by fire,” says Gordon. That still counts as enjoying the great outdoors, right?

 

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Ready, set, visit

How to turn a site visit into the ultimate fact-finding mission.

By Debbie Swanson | Feature Articles | Summer 2020

 

“Don’t just focus on the organization wanting to hire you,” says Mark Anderson, M.D. “Be sure it’s a place you want to work.” – Photo by Michael Comulada

Just like touring colleges and universities, visiting employers is one of the best ways to evaluate your options. Of course, COVID-19 put some of those on hold; but in-person visits are sure to regain their importance. And when they do, plan for several days of interviews, meetings and extras, such as tours, meals or social gatherings. You’ll meet potential supervisors and coworkers, and you’ll have a chance to picture your future at a new place.

If things go well, you’ll finish each visit with a clearer idea of whether or not an employer is a good fit. That means you’ll be prepared to make a decision if and when you receive a letter of intent. But a successful visit depends on proper preparation. Follow these tips to make sure you get the most out of your time.

Phase one: Soak up information

The first step begins at home. Invest time researching the prospective employer, the region and the individuals you’ll be meeting. This will not only help you formulate your own opinion of the place, but also help you come across as a serious and committed applicant. The more you know about the employer, the more invested you’ll appear.

Study up on the employer

You probably have some preliminary knowledge about the organization you’re visiting, but now it’s time to learn even more. Go beyond basic facts about the practice and location. Instead, try to understand their mission, philosophy and outlook. After all, until you know what they stand for, you can’t really be sure you want to work there.

Some steps to take:

  • Review the organization’s website. Read staff bios (especially those of the people on your agenda), press releases, company history and philosophy, and anything else you find interesting.
  • Ask your recruiter for marketing material. While this information will all be framed in a positive light, it’s useful for understanding the image an organization wants to present.
  • Explore their social media presence to learn more about day-to-day affairs. See what’s being said about them.
  • Tap into your network to see if you know anyone with a connection who can tell you more via phone or email. Your professional associations or alumni organizations may be able to help.
  • “See [what] awards the organization may have been given, like best place to work or outstanding hospital or practice,” suggests J. Mark Anderson, M.D., founding partner at Executive Medicine of Texas. He adds that you should also pay attention to community ratings and reputation. “Is this place respected within a community? You can improve or devalue your future résumé by working there,” he says.
  • Take notes as you go. Everything you learn is valuable as you assess an employer. It’s also fodder for small talk during downtime on your visit.

Investigate the location

It’s likely you’ll be considering positions in a variety of locations, both familiar and unfamiliar. Local issues are often overlooked in the job search, but they can be a major factor in finding the right fit. For example, if you discover a great job in a bustling city, but the school system and crime rate aren’t ideal for raising your young kids, maybe that job isn’t so great after all.

Start by getting a clear idea of the factors that matter to you and your family, then rank the priority of each. Next, gather information about local demographics, crime rates, recreational opportunities, school systems, senior care, transportation/walkability, cost of living, etc. As you’re working, create a list of places worth visiting in person, such as places of worship, schools, recreational facilities and more.

If your spouse or significant other plans to accompany you, create a plan to make the most of the trip. Much of your time and energy will be occupied by meetings and interviews, so your companion can work through your list of places to explore or set up meetings with realtors, schools or job recruiters.

Remember to maintain an open mindset when it comes to regions, says Daniel Paull, M.D., founder and CEO of Easy Orthopedics in Colorado Springs, Colorado. Paull himself attended college in New York and medical school in Miami, so when he started looking at residencies, the Midwest wasn’t on his radar. However, he says, “When I interviewed for residency at the University of Toledo, I saw that all of the residents seemed happy.” On top of that, he discovered that Toledo had a low cost of living, very little traffic and friendly people. He never thought he’d end up there, but it turned out to be the perfect fit. That’s why he suggests: “Be flexible. Be ready to go anywhere.”

Confirm your arrangements

If you’re coming from a distance, discuss travel arrangements with your prospective employer ahead of time. Usually, your recruiter or contact person will arrange the flights, lodging and other transportation details, but don’t make assumptions. Some organizations expect you to take care of these things yourself.

Be sure to clarify:

  • Who is responsible for making your travel arrangements
  • What expenses are covered, such as flights, ground transportation or meals
  • Any monetary limits you should adhere to
  • What documentation you’ll need to provide for reimbursement and when to submit it
  • Whether you’ll have downtime in your agenda to explore the area or need to arrange that time on your own
  • Which events your travel companion (if you have one) is invited to, such as dinners or meetings with other spouses or families

It’s also wise to let your recruiter know as early as possible of any dietary needs or special requests. For example, if you want to meet with a realtor or your spouse wants to meet with a recruiter in his or her field, your contact person might be able to help.

As with any trip, you’ll need to make some arrangements on your own. Don’t forget to find a pet sitter, babysitter or anything else you need ahead of time so you won’t have any distractions while you are away.

Review your agenda

Your agenda should arrive well before your visit. Even if you’re busy with your residency program or other responsibilities, don’t wait to review it at the last minute. You might have questions you need to address with your recruiter ahead of time.

Make sure you know:

  • The location and length of any meetings on your schedule, as well as the name and contact info of the person you’re supposed to be meeting
  • The dress code for non-interview events
  • How to pronounce any difficult names listed on your schedule

The earlier you can get these details sorted out, the better. But as the date grows near, don’t forget to confirm that nothing has changed. Stay flexible if the times, locations or people on your agenda get switched around.

Daniel Paull, M.D., ended up in the Midwest for residency—a location he hadn’t expected. “Be flexible.
Be ready to go anywhere,” he says. – Photo by Brian Kwan

Get your answers ready

It’s impossible to anticipate exactly what you’ll be asked over the course of your interviews, but you can brush up on typical topics. If you don’t already have a list of common interview questions, reach out to your medical school’s career or alumni center. Remember to ask about any other information they have on best practices for interviews.

Some typical interview questions include:

  • Why did you choose this organization/region/specialty?
  • What motivates you as a physician?
  • Where do you hope to go with your career?
  • Do you have any specific jobs or experiences that shaped who you are today?
  • What special skills would you bring to this job? What do you hope to gain from it?

Spend some time formulating answers to these questions—and any others you think you might be asked. The more you practice, the more natural your responses will be. Try to bring in specific examples from your own experiences whenever possible. This creates a more memorable impression.

You should also be ready to discuss the items on your CV. Review it before the meeting to refresh your memory of all the dates, places, names and details you have listed.

Get your questions ready

You aren’t just evaluated on your answers. Interviewers also expect you to ask good questions. The more specific to the position and organization, the better. Avoid very general inquiries or any questions you could easily answer by checking their website. And save questions about benefits or compensation for later in the process.

A few great questions to ask include:

  • Who would I report to?
  • What goals would I be expected to achieve?
  • What is the organization’s plans for growth?
  • Besides clinical work, what other obligations will I be expected to meet?

“It’s also OK to ask how your performance will be assessed and what key performance indicators they usually use for physicians,” says Walter Gaman, M.D., a founder and chairman of the board at Healthcare Associates of Texas.

Phase two: It’s showtime

When the day arrives and your site visit begins, things tend to move quickly. Your planning and research will come in handy. Knowing where you need to be, who you’ll be meeting and how you’ll be getting around will raise your confidence and counteract interview jitters.

A good mindset to have is that you want to make a good impression on everyone you meet, from the person who meets you at the airport to the server at dinner and even other hotel guests. You never know who knows whom or who might report back on your behavior.

“Plan to stay in interview mode from the time you arrive until you return to the airport,” recommends Paull.

The nuts and bolts: Interviews

Interviews and meetings are the main reason for your visit, so you want to create a strong, positive impression. Plan to arrive to each appointment early. If you end up waiting, use the time to review your notes, do some valuable people watching or mentally prepare yourself. Greet everyone in the room with a firm handshake and steady eye contact, and split your time between listening and talking. Distribute your attention evenly among everyone involved. Be careful not to overlook anyone. And make sure to learn and note everyone’s names so you can follow up with questions and thank-you notes.

The important extras: Social events

A typical visit also includes informal activities. Expect to find a group meal, campus tour, local sightseeing or some other outing on your agenda. These events are an opportunity to meet and assess your potential colleagues, and they also help your interviewers evaluate how you might fit in with the group.

“There’s almost always a dinner, which is a good way to get a feel for things,” Paull says. “You can often bring your spouse or significant other, but if you aren’t sure, ask your organizer.” Even though these events are informal, you shouldn’t drop your professional demeanor. “I’ve seen situations where people drink too much, or [get carried away] dancing. That never goes well,” warns Paull.

And while a social event usually doesn’t warrant wearing a full suit, you should still lean toward a professional look. “If they say casual, make it more business casual,” explains Gaman, adding that if you have tattoos, it’s best to cover them up. When in doubt, err on the conservative side.

Remember that these events serve two purposes. You’re not just showing a prospective employer your personality; you’re also gaining valuable insights about their culture. Watch what goes on around you and trust your natural reactions. “People who are genuinely kind are kind to everyone. On the contrary, if the interviewee or interviewer is rude to the staff, that’s a potential red flag,” says Anderson. “Social gatherings are a great place for both parties to observe the other.”

And in your free time…

You’re likely to stay busy during your site visit, but don’t let that stop you from poking around on your own. For starters, talk to as many people as you can. Residents can be a good measure of an organization, according to Paull. “Would they do this program again?” he suggests asking. “They may not tell you directly, but you can probably get an idea by the way they answer you. Follow their cues. Probe a bit deeper. Make note of any strange or reluctant responses.”

You can also learn a lot from careful observation. “Pay attention to how the administration interacts with the staff and other physicians. If they smile at each other and greet each other warmly, that’s a good sign. It’s all about the body language. It will tell you what you can’t ask,” adds Gaman.

Finally, do as much exploring as you can. Take a brief walk between meetings, visit the cafeteria and gym, and accept any invitations that appeal to you. The more exposure you can get to people and places, the better you’ll understand the environment.

Phase three: Return and reflect

After a few packed days of meetings, you’ll need a breather to pause and digest the experience. While the experience is still fresh in your mind, review any materials you picked up, transcribe your notes and jot down pros and cons. If a companion traveled with you, review their notes and listen to their impressions. You may find it helpful to create a spreadsheet of relevant factors, especially if you are exploring multiple opportunities.

Get your final paperwork out of the way early. Send thank-you notes promptly, and follow up with the contacts you made. If you’ve got any outstanding questions, send them to the recruiter right away.

A site visit can be exhausting, but if you’ve planned it out, you’ll leave with the information you need to make a decision. Do your research before the visit, then make the most of the time you’re there. Give yourself time to process everything you saw, heard and felt. When it’s all over, you’ll have a better sense of whether or not you want to accept an offer.

And remember, every interview is a two-way street. It’s not just about securing a job offer. It’s about finding the right job for you.

Debbie Swanson is a frequent contributor to PracticeLink Magazine.

 

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What shapes your search?

Build enough time into your job hunt to fully evaluate the parts most important to you.

By Therese Karsten | Feature Articles | Summer 2020

 

Just like there’s no one way to interview, there’s also no one timeline that fits every physician’s job search. The search for a neurosurgeon physician couple looking nationally is completely different than that of a single family medicine resident wanting to stay in the community where she’s training. So let’s take a look at a few factors that can help you understand your own job-search timeline.

Know that different markets and specialties have different recruitment cycles

Finding a job depends on finding an employer who is looking for someone with your credentials to start at a time that meets your timeframe. Physician recruiters have both planned recruitment cycles —new positions posted due to the addition of a new site, growth at a current practice or backfilling a retiring physician—and unplanned to fill an immediate need from a physician leaving either voluntarily or otherwise.

Although the biggest interview visit surge for planned recruitment initiatives is in the winter to meet late summer/early fall start dates, know that subspecialists tend to start interviewing as much as 18 to 24 months before desired start date. The most desirable candidates are signing contracts a full year before their intended start date.

Get your CV ready

At least a year before you complete training, have your CV updated, critiqued and proofread by faculty and resources. Sara Lehman is the GME liaison for HCA Healthcare in West Florida. She is the career resource for more than 600 residents in nine programs and helps them with every phase of the job search.

She advises her residents to have their CVs done 12 to 14 months before they complete training, and to build in time for inevitable rotational struggles when there will be zero time to work on your job search.

Contact prospective employers early

Many times, residents delay their job search because they know physicians who didn’t start looking until spring and had no problem starting work a couple of months later.

“Residents who delay often do so because they don’t know there are logistical differences between their friend’s local hospitalist job and an outpatient job in another state,” Lehman says. “Licensure lead time, hospital credentialing and payer enrollment take several months, so the employer for that perfectly amazing job in Idaho started interviewing candidates in late fall and made an offer in January.”

The resident who waits until spring to start searching for a job misses that train entirely. “He or she is in my office, panicking because advertised jobs are moving forward with others who already interviewed,” she says. “Undoubtedly, there are more doors open to residents who start the job search early.”

At least a year before you complete training, contact the physician recruiters listed on some jobs that interest you. Ask them when you should start applying in that market, and for any tips to help you navigate that employer or region.

For example, recruiters in Denver and other in-demand cities like Austin, San Diego and Seattle advise candidates in highly competitive specialties not to wait for an interview invitation if they are 100 percent committed to the location.

They might suggest planning a trip at your own expense, and let practices know three to four weeks in advance that you will be in town. Usually, you will get at least a meeting, which may turn into a full-blown interview. Every year, we see candidates who present well in person “jump the line” and end up with job offers while a chief resident from a bigger-name program is still waiting for somebody to offer to pay for travel.

Beating the “why doesn’t she have a job yet?” perception

Employers suspect a resident or fellow is still on the job market in the spring because they are not receiving or closing job offers. Perhaps references are lukewarm or would-be employers backed away.

When you approach an employer in mid-spring, answer their unasked question in your cover letter or initial interview call.

If you were waiting to see where your significant other matched in fellowship, tell us. If every free weekend you traveled to the bedside of a terminally ill parent, tell us. If you just broke off an engagement and are now free to look in your dream location, explain that. Those are all reasonable explanations for being late. Some faculty advise withholding personal information on the basis that employers are only entitled to know that you are now available. That is true…but none of the possible explanations going through the employers’ minds are flattering to you. Transparency on your part can motivate a recruiter to advocate for you. Put a recruiter’s concerns to rest so they can make sure you are not overlooked.

Remember, some searches march to their own beat

Some large groups have very defined recruitment cycles designed to synch with their next year’s staffing projections, budgets and practice nuances.

One year I was helping a huge anesthesia group staff for the opening of a new hospital. We needed 13 hires to be ready to staff ORs and OB deck. Interviews started in September and ran through November. All of the other major groups in the market were on the same cycle, so it was no surprise to anesthesia residents and fellows to hear that regardless of interview date, offers would go out in December, once the partners had met all of the candidates. Offerees would have a two-week deadline to sign the letter of intent.

I remember the disbelief in the voice of a chief resident from a top-tier program who called me in February after his first-choice contract negotiations fell through. “I’m sorry,” I told him. “We have offers out for all of the positions and unless we have a turndown, the committee is electing not to conduct further interviews.” Was it shortsighted to not look at an exceptional candidate off-cycle? Maybe, but their process worked. It was not going to change unless they could no longer fill open spots with quality physicians.

The J-1 visa waiver cycle drives the recruitment timeline for Wesley Neurology Associates in Wichita, Kansas. Mohammed Hussain, M.D., a vascular and interventional neurologist, explains why his group starts interviewing neurohospitalist candidates 18 months before their anticipated start date.

“The state gives out J-1 visa waivers on a rolling basis starting the day the window opens on September 1,” he says. “In order to make sure that we get a J-1 waiver, our immigration attorney asks that her firm receive CVs and PDFs of the signed contracts by August so that she has time to prepare the waiver applications for submission the first week the window opens.”

Every year, the hospital has declined some highly qualified applicants because it is simply too late in the J-1 cycle to interview, offer and execute a contract in time to be sure of receiving the waiver.

Everything takes longer than you think

I see wide-eyed concern and occasionally deer-in-the-headlights panic when I tell a room full of last-year-of-training residents that they should have their first round of interviews by November.

Why so early? Every step prior to seeing your first patient in the new job takes longer than candidates expect. It can take days—even weeks—to get through initial email and telephone or Skype screening steps. Physicians, practice managers and administrators all have to agree that you are a likely fit with the position and the timing is right to bring you in for a visit.

Once we get to “yes” for the site visit, we have to find a date that works for everyone. Based on my Outlook e-chains, it can take anywhere from four to 32 emails to lock in a date for candidates to interview. Be patient and responsive.

To help move along site visit planning, check your schedule and have two or three possible dates in mind for a site visit. Think twice before you request a weekend or date adjacent to a holiday. And don’t offer a date you haven’t checked. Scheduling gaffes do tarnish your halo.

Before you take just one more interview…

Even the best-laid plans to be done with interviews by Christmas and under contract by St. Patrick’s Day can be derailed when Mother Nature shuts down airports with Snowmageddon. The one delay under your control is decision paralysis.

Once you have looked at several good job options and have a fair offer in a location where you and your family can thrive, resist the temptation to keep accepting interviews “just in case” the perfect job is out there. Too often, perfectionism backfires. A great offer might get rescinded because you can’t commit.

Contracting concerns

The first bumps and bruises in any new employer/employee relationship often happen after you have agreed on the major terms and before you execute the contract. You’ve agreed on salary, sign-on bonus and RVU rate…so what could go wrong?

If the practice hasn’t recruited in a few years, they may be waiting on their attorney to produce their draft. A hospital system may still need to obtain approvals if the position was not budgeted. A change in salary, an increased sign-on bonus, more PTO or CME or a new start date all have significant impact on the financial picture and must go through another round of approvals.

On your side of the table, your attorney could derail the ideal timeline. Line up your attorney in advance, and give them an estimated timeline for your contract review. Do your own research to know what your peers are seeing for RVU, PTO, CME. Read the contract thoroughly, and give your attorney a list of your questions and your thoughts. If you received instructions from your employer about negotiability, be sure to relay instructions to your attorney. Many corporate physician contracts are locked-down corporate templates, and nothing except what was filled in the blanks will change.

Once you and an employer agree to move forward to contract, a complex process kicks into gear. By the time you are ready to sign, there may have been as many as 20 professionals from recruitment, legal, operations, contract administration and finance certifying that there are no improper elements in the contract being offered to you. Anytime you have that many people involved in a process, there can be delays.

Licensing and credentialing

Obtaining a medical license takes on average three months, though it can take just six weeks for a graduating resident in many states. It can take up to seven months for physicians with practice histories or any hiccup in their records. Your licensure may be tabled with requests for more information if:

  • Your residency or fellowship was not accredited during part of your training
  • Your medical school was not accredited for any portion of your four years
  • Your residency training was outside the U.S.
  • Your residency or fellowship had any periods of probation or remedial repeat of rotations

The credentialing team can prepare for their 90 to 100-day sprint while your licensure is pending, but nothing can officially move forward until you have your state licensure. Similarly, payers will not move on the process of adding you as a provider for their health plan members until you are licensed.

Physician couples need to start earlier

As a rule, a physician couple should be at least a couple of months ahead of their classmates on the job search. This is especially true if one of you is either super-subspecialized, or in a highly competitive or highly saturated specialty for the cities in which you want to live.

Hal Anderson, M.D., contacted me about 18 months before he was scheduled to complete emergency medicine residency. His wife would be ready to start practicing family medicine the same month.

Anderson explained that his wife’s family medicine job search may look “easier” on the surface because of the number of options, but the couple will have to balance their commute times and make sure they could move to family neighborhoods in great school districts without career disruption.

“Bottom line,” he says, “we have to start early because we have to talk to more potential employers to find the two very best jobs that are geographically compatible, where we can grow professionally and start paying down our education debt.”

Physician specialists need the most time to carve out a two-physician relocation. Christina Wright, M.D., and James Wright, M.D., contacted practices a full two and half years before they will complete neurosurgery residency at Case Western Reserve and fellowships in complex spine surgery at the Cleveland Clinic.

“We know that few hospitals recruit two physicians in the same specialty, let alone the same subspecialty, in the same recruitment cycle—so we started early,” explains Christina Wright.

“Reaching out early allowed us to identify programs that might be interested,” says James Wright. “We were particularly looking for hospitals or systems with multi-year strategic plans for development in our specialty. Those facilities were very happy to talk to us this far in advance. …Several practices expressed that it might be possible to make adjustments in future hiring plans to accommodate us both.”

Don’t be late to the table

If you start late, hospitals and groups will flag your file for urgent or expedited handling, pay extra fees and generally move heaven and earth to get a good physician into a great job. The back flips stop, though, when it comes to negotiating for extras and flexibility that might have been on the table six months earlier.

“I had one candidate who kept asking for the stipend we offer to candidates who sign early in fellowship,” says one Florida physician recruiter. The surgeon was negotiating his contract when he had two days left in his fellowship. “It’s not happening” she told him. “That is something on the table for candidates who are willing to commit to us early and who allow us plenty of time.”

At the end of this process, you will have a good job! If you start early to allow for delays and setbacks, you will enjoy the process a lot more and show up relaxed and excited for that magical first day of your new job.

Therese Karsten is the division director for physician recruitment for the Continental Division of HCA Healthcare.

 

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Bore no more!

How to keep your interviewer engaged.

By Marcia Horn Noyes | Feature Articles | Summer 2020

 

Sending a written thank-you note is a great way to stand out after an interview, says Nicholas Jones, M.D. – Photo by Kris Janovitz

By the time you reach residency, you’ve done your fair share of interviews—first for colleges, then for med schools and once again for residency programs. As your job hunt begins, you may dread the prospect of enduring even more. After all, once you’ve done a few interviews, they all start to seem the same—especially if they happen virtually. Interviewers ask questions you’ve heard a million times before, and you find yourself giving the same answers over and over.

If it feels that way to you, imagine what it’s like on the other side of the table. Physician recruiters and other hiring managers have to sit through even more interviews than candidates do—season after season, year after year. So when they hear rehearsed answers from candidates, it’s only natural that their eyes glaze over and they tune out. If you want to make a good impression, it’s essential that you stand out with thoughtful, authentic answers.

So how do you avoid dull conversations and formulaic responses on the interview trail? Read on to hear tips from three seasoned physicians who know what it’s like not just as interviewees but also as interviewers.

Study up on interview skills

For most physicians, med school and residency involve virtually no training on the job search or the business side of medicine. That leaves a gaping hole in an otherwise exhaustive education, and it makes many physicians feel unprepared. From billing, human resources and marketing to salary negotiations and navigating interviews, there are all kinds of topics physicians entering today’s workforce have to figure out on their own.

That’s why Atlanta-based plastic surgeon Nicholas I. Jones, M.D., says doctors have to prepare for interviews outside of their residency training. “Physicians are so focused on learning how to operate and take care of patients that we don’t spend time doing anything but that,” says Jones. “If you do pick up those skills, it’s because you actually sought them out on your own.”

Travis Ulmer, M.D., an emergency medicine physician and the chief clinical recruiting officer for US Acute Care Solutions, agrees with this assessment. He says traditional medical training leaves little time to work on one’s overall career skills. As a result, he finds that most of the applicants he interviews are apprehensive about being themselves.

“They tend to stick to more robotic and canned answers,” says Ulmer. But he’s optimistic about bridging the skills gap, explaining, “Getting additional interviewing practice through the use of mock interviews or talking to residency training mentors—especially the ones that interview new doctors—can go a long way.”

In 2007, Ulmer completed his emergency medicine residency at Ohio State University Hospital, where he served as chief resident. He says he had to rely on natural instinct and wing it when he interviewed for his first position. He readily admits that he could have presented himself better than he did back then. “The internet and YouTube had not gotten to where [they are] today,” he says. “More resources exist now to help people with many aspects of interviewing.”

Top five interviewing questions

Every interview is different, as is every interviewer. But a standard set of questions is pretty common. No matter what kind of practice you’re looking at, what job you’re applying for or if the interview is virtual or in person, you can bet some of these questions will be asked:

  • Who are you? Tell me about yourself.
  • Why are you interested in this practice?
  • Where do you see yourself in five or 10 years?
  • What are your greatest strengths?
  • What are some of your weaknesses?

Now that he’s on the other side of the interview table, Jones says he views the standard questions with a grain of salt. “Those questions facilitate answers that are definitely rehearsed,” he says. “When I interview people, I like authenticity.” As a result, Jones doesn’t pay as much attention to cliché answers, but says the questions are still part of the interview ritual. And though a standard answer may not impress him, he does take note if he gets the sense that an applicant isn’t being genuine in his or her answers.

By preparing for these five questions, you’ll start out calm, confident and composed. That will help you even when the interview transitions to more difficult questions. And if you come prepared, you’ll be less likely to give lackluster responses that make your interviewer’s eyes glaze over.

“Getting additional interviewing practice through the use of mock interviews or talking to residency training mentors…can go a long way,” says Travis Ulmer, M.D. – Photo by Simon Yao

Avoiding cringe-worthy responses

You want to wow hiring managers with your wit, experience and charm. But that’s a lot more difficult if you consult the internet for the so-called right answers instead of using self-awareness to find an original response. Dig deep to find out what truly makes you shine, then base your answers around that. But as you’re doing so, be careful you don’t seem too candid—or worse, unprofessional.

For example, Ulmer says new physicians often make the mistake of thinking that everything will change after they leave residency. For example, some think they’ll no longer have to deal with certain types of presentations or populations. But Ulmer says difficult patients exist in every practice and in every environment.

“It’s a big red flag to hear an ER physician say they hate drug-seekers or taking care of patients who should be treated at lower levels, like urgent care,” he says. “This idea of a perfect patient population is unrealistic and stands out to me as something that is going to be a problem down the line.”

What are your strengths and weaknesses?

Ulmer says candidates open up about their strengths and interests, but they often shy away from discussing their weaknesses. Instead of speaking candidly, they try to answer the question as positively as they can. However, Ulmer warns, “There’s only so many ways to do so without drawing some type of attention to yourself.”

Giving a good response when an interviewer asks about your weaknesses requires self-awareness. It’s better to explain what you’re working on than to act as if you have no flaws. Ulmer explains, “We all know that we are not perfect clinicians. It’s a continuous journey toward that your whole career. I appreciate the younger clinicians that are aware of their weaknesses, aren’t afraid to admit them and show interest in getting better.” In his opinion, only physicians who acknowledge their shortcomings can start working on them.

Jones says he encounters the most cliché responses when he asks about weaknesses. The worst offenders include: “I don’t know how to tell people no,” and “I’m a perfectionist and work too hard.” Saying that you don’t have—or can’t think of—any weaknesses is also cringe-worthy. That type of response indicates a serious lack of personal insight.

Tell me about yourself

This icebreaker question from hiring managers can trip up interviewing newbies. Some applicants launch into long soliloquys about their life stories. If you spend too long answering this question, you’ll use up a good portion of the interview slot talking about your personal life instead of your qualifications.

The best response to this question is an elevator pitch. Craft a succinct, informative answer that describes you in a nutshell. If you need inspiration, look at the way entrepreneurs describe their startups. Think of it as a persuasive brief to pique an employer’s interest. Then move on to the rest of the interview, so you can highlight your medical skills and experience.

Why are you interested in this practice?

Employers almost always ask this question, so you should carefully consider your answer ahead of time. A good response not only requires extensive background research on the practice and its staff but also self-reflection. You should be able to articulate how the position aligns with your skillset and personality.

Jones recognizes that new physicians often have limited information about the practice before the interview. If that’s the case, he says honesty is the best policy. If you don’t have a specific response, it’s OK to say something like: “I just really wanted to come back home, and of all the practices that I researched, you had an opening. I went to your website, saw some of your pictures, talked to some of my colleagues, and it seems like a good fit for me for these reasons.”

Clive Fields, M.D., co-founder and chief medical officer of VillageMD, says he uses this question to make sure the doctors he hires have the same priorities as his organization. “I want to hear about a physician’s commitment to practice and live in the communities that we serve,” explains Fields. Since VillageMD emphasizes community building, he wants doctors who will get to know everyone from the cashiers at local grocery stores to the chiefs at local fire stations.

For example, if a candidate wants to live on the north side of town because it has good elementary schools, Fields says that’s a sign it’s not a good fit. The office is 40 miles away on the south side. “Doctors may say they won’t complain about the commute, but they will complain because it is the wrong place for them to be,” he says.

A compelling answer to this question can move you to the top of an employer’s list. But if you don’t have a good answer ready, it can be the kiss of death. After all, if you don’t know why you want to work somewhere, the employer doesn’t really have a good reason to hire you. Spend some time before each interview evaluating why it’s a good fit. That way, you’ll be ready to articulate a clear answer.

Where do you see yourself in five or 10 years?

Yes, this question has been done to death, but it’s essential for helping managers hire candidates who match what they’re looking for. An honest answer may not always land you the job, but it will almost certainly prevent years of unhappiness if you’re not a good fit.

Jones illustrates this exact point with two hypothetical scenarios: “Let’s say I work for a practice [that is] basically looking for low-paid interns for a hospital contract that pays the practice X amount of dollars to provide hospital coverage.” These types of practices, he says, don’t expect you to grow a patient panel or do any of the cases. They simply need physicians to fill some shoes and may not be as worried about retention. “If that’s the case, and someone says that in five years they want to have their own practice, then they may actually be a great fit,” he explains.

If, on the other hand, the practice wants to eliminate high turnover rates, someone who plans to settle down might be a better option. “If someone says that in five years they and their spouse want to settle down in the area and start a family, that sounds like a much better fit than the physician who says that in 10 years he wants to become this reality TV host doctor with his own show that earmarks him as the plastic surgeon of Atlanta,” Jones explains.

Curveball questions

In other industries, interviews sometimes involve oddball questions to test critical thinking skills, problem-solving and working style. Managers lob questions like “What’s your superpower?” and “If you were an animal, which would you be?” or ask employees to tackle puzzles and challenges. For the most part, medical interviewers steer clear of this rigmarole. Instead, they tend to gauge candidates’ clinical decision-making skills with scenario-based questions.

Still, physician candidates may encounter one or two off-the-wall questions along the way. Refrain from rolling your eyes or putting up a protest. Instead, play along as best you can. There are no right or wrong answers. These questions simply exist to give hiring managers information about how you approach difficult, unexpected or high-pressure situations.

Ending with a firm footing

At the end of almost every interview, you’ll be asked if you have any questions. You might want to ask about salary, vacation, 401(k) matching and insurance coverage, but you’re better off using this time to show you understand what the practice needs and how it fits into the broader health care industry. You can do just that by:

Confirming that your skillset is a good match for the organization. You can gain valuable information by addressing some of your limitations and seeing how an employer responds. For example, you might say something along the lines of: “I did my training in a private institution and didn’t get much experience in some of the procedures you do regularly here. I’m really interested in how you will help me fill that gap.”

Displaying your intellectual curiosity. Fields says he looks for candidates who ask real questions. He wants to know that a physician understands what big shifts in the medicine landscape mean on a day-to-day level at practices like his. He says well-read physicians want to learn about things like chronic care management programs, transitions of care and other coding support around clinical documentation and quality measures.

Exhibiting your commitment to the practice’s goals and mission. An interview isn’t just about your skillset. Your outlook and personal mission are also important. Show employers what you care about by asking questions like: “What kind of reputation are you trying to develop in the community?” and “How can I contribute to that effort?”

“We are looking for physicians that are asking those kinds of questions and when they do, it shows a certain amount of preparation for the organization for which they are interviewing,” explains Fields. “Culturally, the kind of intellectual curiosity that we would like to see from our young doctors shows us that ultimately they are on target for becoming our old doctors and will lead our practice in the future.”

How to deliver your answers

Saying the right things is only part of the equation. Your delivery and demeanor also matter. Jones, Ulmer and Fields all agree that once you have your responses down pat, it’s time to double check the five basics of physician interviews:

  1. Maintain eye contact
  2. Project appropriate body language
  3. Be articulate and specific
  4. Project confidence
  5. Dress appropriately

After the interview, Jones says there’s one more essential step. Send handwritten thank you notes to each and every person you spoke with. These should be written with pen and paper. “It goes way further than any email,” he says. “If you send me an email, I may not even read it. However, if you send me a handwritten note, I think, ‘This person really wants this job.’”

Marcia Horn Noyes is a frequent contributor to PracticeLink Magazine. She is a former television news reporter, newspaper and magazine journalist. She writes about health, fitness, career and frugality.

 

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Joe Biden’s health care policies

The former vice president has rolled out plans to eliminate copayments for primary care, expand Medicaid, end surprise billing and control drug prices.

By Jeff Atkinson | Reform Recap | Summer 2020

 

Former Vice President Joe Biden favors maintaining and expanding the Affordable Care Act (ACA). In his campaign for president, Biden invokes the image of him standing at Barack Obama’s side in 2010 when the ACA was signed into law. Biden promises to build on the ACA by giving Americans more choice and reducing health care costs.

No copayments for primary care

Under Biden’s plan, costs will drop for individuals and families by reducing copayments and increasing subsidies for insurance. There would be no copayments for primary care.

Tax subsidies for health insurance currently are available on a sliding scale for families earning up to 400 percent of the poverty level (about $51,000 for a single person and $105,000 for a family of four).

Under current law, the amount an eligible family has to pay for health insurance is limited to 9.86% of income. Biden would reduce that limit to 8.5% of income, and he would eliminate the eligibility criteria of 400% of poverty level. He estimates that under his plan, a family of four earning $110,000 per year would save $750 per month on health insurance. People with high income, such as above $250,000 per year, likely would not receive a tax credit for insurance because their insurance costs probably would not exceed 8.5% of income.

Expanding Medicaid and Medicare

The ACA allows states to increase the number of people covered by Medicaid, with most of the cost of expansion paid by the federal government. About three-quarters of the states took advantage of that incentive. Fourteen states, however, did not. Biden would modify federal law to expand Medicaid in those states, thus covering approximately 4.9 million adults who currently do not have insurance.

In addition, Biden would lower the age of Medicare eligibility to 60 and offer “a public health insurance option.” This proposal is similar to Pete Buttigieg’s plan of “Medicare for All Who Want It.” If a person was not satisfied with the insurance offered by his or her employer or other sources, the public option would be available.

Unlike senators Bernie Sanders and Elizabeth Warren, Biden does not favor a mandatory single payer system, such as Medicare for All.

Ending surprise billing

Surprise billing arises most often when a patient receives care from a provider who is out of network, such as in an emergency department or when a patient goes to an in-network hospital but is seen by a specialist there not in the patient’s insurance network.

A policy statement from Biden says his plan “will bar health care providers from charging patients out-of-network rates when the patient doesn’t have control over which provider the patient sees (for example, during a hospitalization).”

Controlling drug prices

Controlling drug prices is as an issue on which the Democratic candidates for president shared common approaches. All candidates, including Biden, favored allowing Medicare to negotiate prices with drug companies. Regarding the current provision in the law prohibiting the federal government from negotiating prices with drug companies, Biden says, “There’s no justification for this except the power of prescription drug lobbying.”

Biden also would allow consumers to buy prescription drugs from other countries, including Canada.

For pricing of new specialty drugs that do not have competition, Biden says he would establish “an independent review board to assess their value” and “recommend a reasonable price.”

Additional issues

Other health care issues Biden has addressed include:

Parity for mental health care. Increasing funding to promote access to mental health care and greater parity between physical and mental health care.

Reproductive rights. Codifying Roe v. Wade; eliminating many state laws that limit a woman’s right to have an abortion; and restoring federal funding to Planned Parenthood.

Opioid crisis and substance abuse. Spending $125 billion over 10 years for research, prevention, professional education and treatment, including ensuring that communities have sufficient supplies of Naloxone (also known as Narcan).

Rural areas and community health. Doubling spending for community health centers and care in rural areas.

Equity issues. Increasing research on diseases affecting minority populations with particular attention to lower life expectancies and maternal mortality rates of African Americans.

Antitrust enforcement. Increasing government regulation of health care mergers and acquisitions that concentrate market power and drive up prices.

Funding for new programs

Most of Vice President Biden’s proposals will increase the government costs for health care. The primary source of funding would be increased taxes on people with high incomes. The current top federal income tax rate of 37% would return to the pre-Trump tax rate of 39.6%.

Biden also would require those earning more than $1 million per year to pay the top tax rate on long-term capital gains rather than the current 20% long-term capital gains rate.

Drug companies would lose tax deductions for advertising expenses. Biden said that drug companies spent $6 billion on advertising in 2016—an increase of more than four-fold since 1997. “Taxpayers should not have to foot the bill for these ads,” he says.

Jeff Atkinson is a professor for the Illinois Judicial Conference and has taught health care law at DePaul University College of Law in Chicago.

 

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Preparing for your interview

An inDepth Interview with PracticeLink can help you stand out to in-house physician recruiters.

By Chris Scites | PracticeLink Tips | Summer 2020

 

The job search is stressful—and anyone who has ever looked for a job can relate. That’s especially true when it comes to the interview.

An interview is the culmination of sometimes months of contact with a potential employer via phone and email. No matter how good you appear on paper, an interview can make or break your chances of working somewhere. The good thing is that if you’ve made it to the interview stage, there’s a good chance the recruiter thinks you could be a good fit for the opportunity.

By the time of an interview, both parties have a lot invested in the job-search process. But that doesn’t mean you should rush anything. Though you’ll want to take the opportunity to sell your unique qualities, also take the time to ask questions of your own—and follow these steps before you go.

Review your CV

Review the CV you have shared with the potential employer. (Or start it at PhysicianCV.com.) Be prepared to discuss in detail and expand on any item. If you’ve done research, what drew you to the topic, and what did you find most interesting? Who was your favorite professor in medical school and why? What did you like about living in the area where you did your residency? Consider any examples of challenges you’ve overcome or problems you’ve solved creatively, and be prepared to share.

Identify a hook

Once you’ve reviewed your CV, it’s time to start thinking about what sets you apart. One way to stand out is through an inDepth Interview with PracticeLink.

After you create a free candidate profile on PracticeLink, our physician relations team will contact you for one of these brief interviews. We’ll ask you the who, what and why of your job search—the things that set you apart. After all, it’s fair to assume that all the other candidates that are being interviewed for the position have similar qualifications. So what is it about you that makes you the best fit? Your answer might include a back story about why you are so passionate about the field that you are practicing in, a familial tie to community, or a special interest in the employer. You’re looking to share anything that makes you uniquely perfect for the role.

With your permission, information from your inDepth Interview is shared with in-house physician recruiters who are looking to hire in the areas in which you’re interested. Your participation not only increases their understanding of your skills and interest in your profile, but it also gives you a chance to practice the interview process with questions we’ve honed over decades of working with both physicians and employers.

Research the organization

Make sure you do your research on the organization that you are interviewing with. This helps you avoid any awkward moments when they inevitably ask you what you know about them, and it will help guide your development of questions you’ll want to ask them. Remember that if you do get the position, you will likely be there for at least a couple of years. Of course you are going to want to ask about compensation structures, insurance, tail coverage, call and numerous things to do with the practice itself. But you will also be living in that community. If you have children, ask about the schools and extracurricular activities popular in the area. Do you have a spouse or significant other? Will they be able to find work? Don’t forget that, though your work life is important, it’s the total experience of living in the community that will have the biggest impact on your family’s quality of life.

The most important thing to remember about your interview is to be prepared. It is much easier to relax and project confidence when you are prepared. Study the materials you have submitted and the organization. Practice the interview and conduct an inDepth Interview —then nail the interview and achieve your dream practice.

Chris Scites is PracticeLink’s director of physician relations. Contact his team for free job-search help at (800) 776-8383.

 

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The do’s and don’ts of interview questions

What you should—and shouldn’t—talk about or ask when looking for a job.

By Bruce Armon & Ruth Rauls | Legal Matters | Summer 2020

 

Employers and employees are generally familiar with many of the basic interview do’s and don’ts. But in addition to federal protections, multiple states have statutes that must also be followed, in addition to state and local laws.

Before going on an interview, brush up on the sensitive topics of which both candidates and employers should be aware.

Background checks and prior convictions

Although background checks have become a normal part of hiring decisions, there are a myriad of state and federal laws that impact how and when these reports can be run, what information an employer can consider, and when a potential job candidate can be asked about their criminal record. Generally, the federal law that applies to the majority of background checks is the Fair Credit Reporting Act (FCRA). FCRA contains certain procedural requirements with respect to disclosure, authorization and notice to a job applicant.

However, based on the significant number of states that have passed “ban the box” laws, FCRA is not the end of this discussion—it is only the beginning.

Ban the box laws include a prohibition of including a box on employment applications regarding prior criminal history or convictions. These laws also generally prohibit employers from verbally asking job applicants about their criminal histories during the initial employment application process.

Generally, questions about criminal history or prior convictions should be avoided unless there is a connection between the conviction and the position, or if there is a specific statute or regulation permitting such questions based on the position. As a practical matter, a prospective employer can review the National Practitioner Data Bank, the records of the candidate’s state medical licensing board, a professional credentialing organization and other internet searches to gather as much publicly available information as possible.

Salary history

Multiple states now ban employers from inquiring about an applicant’s salary history. Some states have enacted these laws in an effort to eliminate at least one contributing factor to gender pay disparity. Thus, interview and screening practices need to be adjusted or revised to focus on skill set over salary.

In states with these laws, asking questions about an applicant’s desired salary is OK, but those asking about prior salary are not. To determine what can and cannot be asked about salary history in an interview, employers and candidates alike should understand their state’s laws.

Citizenship and national origin

Generally, there is an understanding that questions regarding an applicant’s citizenship or national origin are off limits in the interview process. However, there are questions that may appear innocuous that are in fact problematic for an employer.

Questions that run afoul of laws include those about an applicant’s birthplace, the birthplace of family members, and asking whether the applicant has the legal right to work in the U.S. with an emphasis on a green card or visa.

Instead, questions, if any, should be limited to “are you legally authorized to work in the United States.” If foreign language skills are relevant to the position, it would be permissible to inquire about the applicant’s ability to read, speak or write a foreign language. However, general inquiries regarding how a person learned to speak a foreign language could prove problematic.

Sexual orientation

Sexual orientation has been front and center in many employment-related litigations over the past several years. In order to avoid any issues on this topic, an interviewer should avoid direct questions on this topic as well as questions designed to detect a person’s sexual orientation or gender identity. Those kinds of questions include those about marital status, spouse’s name or inquiries about household members.

There is a difference between being friendly and trying to understand a candidate’s personal life and crossing the line into subjects or areas that have no relevance to a prospective employee’s ability to do a job.

Age

Most employers and employees understand that questions regarding a candidate’s age are off limits in the interview process. However, much like the discussion on citizenship and national origin, questions that try to get this information indirectly are still prohibited.

For example, asking during an interview what year an applicant graduated high school or when they first started working should be avoided.

The laws governing the interview process continue to change. Employers and candidates both need to stay apprised of what’s appropriate and what’s not throughout the interview process.

Bruce Armon is chair of Saul Ewing Arnstein and Lehr’s health care group. Ruth Rauls is a member of the Saul Ewing Arnstein and Lehr’s labor and employment practice.

 

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How tight is the job market in your specialty? Summer 2020 Issue

Summer 2020 | Vital Stats

 

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

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.

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 my experience of searching for a job in my specialty? Do I need to widen or narrow my job-search parameters as a result?

This PracticeLink Physician Recruitment Index was pulled April 1, 2020. Candidate ratios include physicians who have registered with PracticeLink.com within the past 24 months.

 

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Negotiating your next contract

5 questions to consider between interview and acceptance.

By Jeff Hinds, MHA | Financial Fitness | Summer 2020

 

Just the thought of negotiating an employment agreement can be quite intimidating for many physicians—particularly if it’s your first position coming out of residency or fellowship training. Fears of tension-filled, adversarial negotiations with a significantly more experienced physician or executive sitting across the table are prevalent, as are fears of overstepping one’s bounds and potentially losing the offer. These fears often lead to many physicians simply signing the contract as is, with no attempt at negotiating better terms.

The reality is that negotiations are rarely contentious, and you can inquire about improved terms with minimal risk of the offer being pulled. Entering negotiations with that mindset, along with possessing a basic understanding of the process, will have you more than prepared to tackle this not-so-daunting (yet very important) task.

1 When is the right time to negotiate?

Refrain from any negotiations until you have received the actual offer. Initiate this conversation too early, and you run the risk of coming across as being too aggressive or money motivated if negotiating compensation—traits that could deter an employer from seriously considering you. An employer is more invested in you after an offer is extended and potentially more likely to make concessions in order to “get the deal done.” Thus, your leverage and ability to negotiate are greater at that point than they were early in the interview process.

2 Should I use an attorney?

The answer to this question requires self-reflection. Will you be able to clearly articulate any desired changes and stand firm on requests if necessary without becoming too emotionally involved? If the answer is questionable, then it may be in your best interest to consider using an attorney for negotiation assistance.

You will find that most attorneys who offer contract review services also offer some form of negotiation assistance. Some will offer to speak with the prospective employer directly to negotiate on your behalf, while others may provide you with their suggested revisions and then it is up to you to communicate the requests on your own. Ask about these services in your initial attorney selection process. But in the end, do not be worried about inserting an attorney into the process. You’re reviewing a legal document that was written by an attorney to protect the employer’s interests. You should be doing the same.

3 What negotiable items are most important to me?

Knowledge of what contractual items are actually negotiable is paramount. Though most physician contracts are similar nationwide from a structural standpoint, there are some key provisions and terms that vary by organization and affect the overall quality of the offer.

Compensation is commonly at the forefront, as those are more easily recognizable items that tend to vary the most from organization to organization. However, do not overlook the many other variables that may also be negotiable. Those could include call expectations, paid time off (PTO) and research/administrative time. Lastly, are you protected should this position not work out for whatever reason? Is the termination and non-compete language fair and equitable? Will the provided malpractice insurance require you to purchase tail coverage upon departure, and is that something for which you’re prepared?

4 How aggressive should I be?

Your approach can dictate how receptive the employer will be during negotiations. If you’re concerned about losing an offer, you can be extremely soft in your negotiations and simply pose your requests as “would you consider…” type questions. That allows the employer the opportunity to simply say “no” without you being too aggressive and risking an offer being pulled—but at least you asked the question.

On the opposite end of the spectrum, there may be items that would lead you to turning down the offer if they are not changed. In that scenario, your ability to walk away from the offer allows you to be the most aggressive. Either way, it is important that you also learn as much as you can about the prospective employer’s process in order to adequately assess your leverage and ability to negotiate. For example, are you the only candidate they are interviewing, or do they have multiple candidates they are considering for this opening? As you can guess, you are taking more risk in being too aggressive in negotiations if they can easily move on to another candidate. Ensure your negotiations will make a long-term relationship a favorable prospect for all.

5 How can I be sure an offer is fair?

For compensation specifically, surveys from the Medical Management Group Association (MGMA), the American Medical Group Association (AMGA) and Sullivan Cotter can provide you with market data relevant to your specialty and practice location.

An attorney skilled in reviewing physician contracts can also help you determine if an offer is acceptable. In addition, there is great benefit in going on multiple interviews and collecting multiple offers. Doing so enables you to make an informed decision while comparing compensation, clauses and language throughout your ultimate negotiation.

Jeff Hinds, MHA, is president at Premier Physician Agency, LLC, a national consulting firm specializing in personalized physician job search and contract assistance.

 

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