Congratulations on your offer. What will you do next?

What we wish physicians would ask us when the offer is on the table.

By By Marci S. Jackson | Job Doctor | Winter 2011


Every physician, whether seeking their first job out of residency or fellowship, or seeking a new opportunity after having been in practice, needs to negotiate the terms of their new position—either employed or as a member of a practice.

A minimum of two parties are required for a negotiation, and that means two viewpoints will be represented, and two sets of requirements need to be fulfilled.

As in-house recruitment professionals, our job is to help our physician candidates be clearly informed about the organization, opportunity and community when they interview with us, and fully understand all of the information and options being presented to them by the prospective practice/employer, who we represent.

Today we will assume that you, the candidate, have already done preliminary homework, and have selected several opportunities for site visits.

Important questions to ask

Once serious discussion has begun regarding an opportunity and you are considering an offer, you need to make sure you understand the following for each opportunity, in order to appropriately negotiate the points that are important to you:

  • What is the timeline for post-visit contact and/or an offer?
  • What is covered/included in an offer?
  • What are the timelines for responding with questions or acceptance?
  • Once I’ve accepted the offer, what are the next steps?
  • Does the organization have additional interviews to conduct?
  • Have you given the organization your timeline for making a decision?
  • Do you need to provide the organization with any additional information so they can make a decision?
  • Do you need more information from the group in order to be able to make an informed decision?

Understanding the offer

Next, understand what may be included in an offer. Depending on the type of group you are joining, an offer outlines the following:

  • Compensation model and first year salary/draw amount
  • Benefits
  • Initial contract term (One year, two years or more? Renewable, limited or self-renewing?)
  • Any practice restrictions or restrictive covenants
  • Incentives
  • Expectations
  • Work schedule
  • Productivity, such as patient/procedure volumes
  • Call schedule
  • Outreach
  • Administrative duties
  • Teaching responsibilities
  • Research responsibilities
  • Professional liability (malpractice) insurance, including tail coverage
  • Termination of agreement (with and without cause)
  • Proprietary information
  • Items unique to the organization’s culture and hierarchy


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Surviving the Malpractice Storm

If you’re named in a malpractice suit, chances are you’ll go through every emotion, from denial to anger. But with these tips, you can get through it—with both your sanity and your career still intact.

By By Karen Childress | Feature Articles | Winter 2011


Peter Moskowitz

"Almost without exception, the physicians that I've watched go through this suffer terribly because of their own perfectionism." - Peter Moskowitz, M.D. is founder of the Center for Professional & Personal Renewal in Palo Alto, Calif.

Chicago ER physician George Hossfeld was notified that he’d been named in a malpractice suit more than two years after he’d stabilized an acutely ill elderly gentleman and admitted him to the ICU. Because his contact with the patient had been brief and he had provided appropriate care, Hossfeld assumed he’d be dropped from the case once the facts became clear to the plaintiff’s attorneys. “A good percentage of the time when a doctor is named in a case, he didn’t even see the patient, or was peripherally involved. You just wait to find out what’s going on.” In Hossfeld’s case, he waited five years to be dropped, only to find that ultimately he was on trial all alone, and that the plaintiffs were asking for damages beyond his malpractice coverage limits.

“It wasn’t fair, but fair has nothing to do with it,” he says. “It was very surprising to me, but right and wrong have little to do with it. Even more stunning, quality of care has little to do with it.”

“I went through stages like someone with a terminal diagnosis—disbelief, anger, rationalization (of course I’ll be dropped…), and then almost grieving. I was anxious and irritable. I felt like my home and my kids’ college might be on the line. I thought, well, if it’s been this unfair to this point, maybe I’ll be found guilty.”

“I like to think of myself as pretty tough ER doctor,” says Hossfeld. “After my six-day trial, I was just physically and emotionally limp. I was so drained, I felt ready to pass out.”

And Hossfeld—like the vast majority of doctors who end up on trial for medical malpractice—had won his case. more »


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What women want

Workplace flexibility may be key as women physicians choose their specialties.

By By PracticeLink Staff | Vital Stats | Winter 2011


It’s no secret that physicians these days are looking for jobs that will offer them the ability to balance work and life—such as the ability to raise a family and maintain a professional career.

That quest for balance may be attributable to the increased number of women physicians in the workforce. Or it could be that women in medicine gravitate to specialties that already accommodate flexibility, whether in daily schedules or amount of time in residency, or the ability to take a leave of absence and return without penalty. more »


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Back to school?!

What is motivating physicians to head back for more training and additional education?

By By Cindi Myers | Feature Articles | Winter 2011



For Paul Levy, MD, pursuing an MBA helps him understand the business side of medicine—and prepares him to handle a changing professional landscape.

When Dr. Paul Levy became a heart surgeon, he thought that was enough. He’d worked hard, making it through medical school and internship and fellowships. During the next 25 years, he rose to the top of his profession as one of the senior members of the New Mexico Heart Institute, named the number-one cardiac surgeon in Albuquerque in 2010 by Albuquerque The Magazine.

But by 2009, the world of medicine was changing rapidly. What had always been enough for Levy wasn’t anymore. “I’ve been in a patient’s chest for 20 to 25 years,” Levy says. “That’s where I’ve had my head. I know I can do this job, but I realized one day it was time for me to expand my horizons. I really need to know more about what’s going on.”

Levy signed up for the University of Tennessee’s Physician Executive MBA program, or PEMBA. In doing so, he joined a growing number of physicians who’ve decided to pursue an advanced degree, like an MBA or JD, in addition to their medical diploma.

Why another degree?

The reasons physicians pursue additional degrees vary. Many, like Levy, pursue degrees as a response to the current medical climate. “You’ve got to be aware of what’s going on in health care to stay in business these days,” Levy says. “There are a lot of doctors who are frustrated. There are a lot of doctors moving toward business degrees. They’re concerned about their profession.”

Some want to expand their career options. Dr. Mike Ward, who is currently completing a two-year operations research fellowship and pursuing a master’s in quantitative analysis through the University of Cincinnati, received his M.D. and his MBA from Emory University.

“The MBA brings diversity and opportunity,” he says. “It lets individuals know what you’re interested in and capable of doing.” Ward, one of the founders of the National Association of MD/MBA Students, thinks an MBA on a physician CV opens doors for more leadership roles in clinical medicine, as well as administrative and academic positions. more »


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Impact of the elections on health care reform

Reforms will impact physicians on many fronts, including insurance coverage for patients and possible changes in the malpractice system.

By By Jeff Atkinson | Reform Recap | Winter 2011


After the November 2 election, Senate Republican leader Mitch McConnell (R-Ky.) said, “We can—and should—propose and vote on straight repeal” of President Obama’s health care legislation. At the same time, Sen. McConnell acknowledged that a full repeal of the Patient Protection and Affordable Care Act (PPACA) was not likely. Although Republicans now have a majority in the House of Representatives, Democrats still have a majority in the Senate, and President Obama can veto legislation that reaches his desk.

The likely strategy of the Republicans is to seek to block implementation of portions of new laws they do not like by refusing to give full funding to certain programs. High on the list of health reforms disfavored by Republicans and some Democrats are the mandates on individuals and employers to purchase insurance and requiring states to expand Medicaid coverage.
The mandate on individuals to acquire health insurance also is the subject of challenges in the courts. On December 13, a federal trial court in Virginia held that the requirement that most Americans obtain health insurance was unconstitutional because it exceeded the power granted to Congress by the Commerce Clause. Two other federal trial courts, however, have upheld PPACA, including the individual mandate. Ultimately, the issue is likely to be decided by the Supreme Court. more »



Bestseller or Bust!

For physicians, seeing a nonfiction book through from idea to published masterpiece takes a wealth of patience. Take this advice to get started.

By By Jon VanZile | Feature Articles | Winter 2011


Dr. Christine Horner’s path to becoming an author was “a little unusual.” Before becoming an author, she was a plastic surgeon whose mother had breast cancer and went through conventional treatment, which seemed to work.


"The more I was learning, the more upset I got about how we practice medicine."

“Then, five years ago, she had a metastasis to her bone in her leg and gave up,” Horner says. “Nine months later, she was dead.”

As Horner dealt with this personal trauma, she saw the population of women coming in for reconstructive breast surgery after mastectomy get younger and younger, until she found herself working on breast cancer survivors in their 20’s.

Horner soon came to the conclusion that something wasn’t working in the way the medical community diagnosed and treated breast cancer. So she dove into the literature and was shocked at what she found.

“I found thousands of studies about things we weren’t doing in our culture to protect against breast cancer,” she says. “The more I was learning, the more upset I got about how we practice medicine.”

Horner wanted to spread what she was learning, and she was soon contributing regular segments to a local TV station while still working at her practice. But the workload quickly became overwhelming, and she knew it was time to take the next step.

“One day, I woke up and quit my practice and took some time off,” Horner says. “I thought I was going to write a book.”

The resulting book, Waking the Warrior Goddess, was published by Basic Health Publications in Laguna Beach, Calif. Norman Goldfind, her publisher, says the book has been a great success for his company, and they’ve returned to press several times.

The book has been good for Horner as well. She has been on multiple national TV programs, done hundreds of press interviews for major media, and has spoken before hundreds of audiences all around the country.

But as Horner learned along the way, publishing a book is a labor of love that requires skills doctors don’t naturally cultivate. And even with national media exposure and multiple print runs, it doesn’t necessarily pay the bills. more »


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Tucson, Ariz.—America’s favorite sun

The great celestial body is a magnet for many a Tucson newcomer, but the city’s unique ambience, informality, outdoor activities and job opportunities are equally enticing.

By By Eileen Lockwood | Live & Practice | Winter 2011



Eric Sipos, MD and family in Tucson, Ariz.

The following account is essentially true, according to the Arizona History Museum in Tucson. In 1880, when the railroad finally reached the boom city of 7,007 inhabitants, Mayor Bob Leatherwood was so proud that he sent a telegram to the pope in Rome, rejoicing that Tucson was now connected with the Christian world. Who would think that His Holiness, thousands of miles away, would respond? Thanks to a few of the mayor’s wise-guy friends, he did—sort of.

The telegram the friends concocted read, in part: “Congratulations…but where the hell is Tucson?”

Not a question that ever occurred to internist and pulmonologist David Engelsberg, M.D., but southern Arizona’s biggest city did seem far, far away to a born-and-bred New Yorker. “When I was a kid,” he says, “I thought this was a place where they had cowboys.”

Then, with a degree from the University of Kentucky College of Medicine, he signed on for training at the University of Arizona, arrived in town “and immediately hated the place.”

But things changed. “After I spent my first year in a pulmonary fellowship, I got to like the place, and after two years I didn’t want to leave. And I guess I still don’t want to leave.” In fact, “We don’t intend to move after I retire.”

He lists several reasons for staying. First, the obvious: The weather is “absolutely fantastic.” Because of the almost perpetual sun, Tucson is “a great place for doing outdoor sports. I hike, play tennis, fish and ski. We have all of that stuff in and immediately surrounding the city.”

Second: “Tucson is a real community and a unique community.”

Third: “I like the medical community. It’s collegial.”

Engelsberg currently cares for patients at St. Joseph’s Hospital, part of the Carondelet Health Network. more »


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Akash Sharma, M.D.

By PracticeLink Staff | Snapshot | Winter 2011


Akash Sharma, M.D., with his daughters

Assistant professor, Mallinckrodt Institute of Radiology, Washington University, St. Louis, Mo.

MEDICAL SCHOOL: Ross University School of Medicine, West Indies
RESIDENCY: Hartford Hospital, Hartford, Conn.
FELLOWSHIP: One-year fellowship in nuclear radiology after general radiology residency

Married with three daughters, including a set of twins. Hobbies include travel, photography, reading, being a tech junkie and studying. Sharma just finished an MBA program and plans to study finance and writing next. more »


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How to love your job

By exploring your answers to just a few questions, you can find a job and location you love.

By Andrew Harrison | Remarks | Winter 2011


For the past seven years, I have studied human motivation and careers. Part of those six years was spent traveling the country interviewing people who love their work. After 95,000 miles and 145 interviews, I have been able to learn from people of diverse backgrounds, ages and careers.

When I was asked to write this section, the first person that came to my mind was Dr. Hillary Beberman, a family medicine physician. Her journey to becoming a doctor was not a simple one. She left a well-established career as a financial journal writer to follow her passion in medicine. Although she enjoyed her writing job, something was missing. “The pay was great and I was exposed to some great things, but I wasn’t fulfilled. I asked, ‘Is this what I want to be doing for 50 years? Am I helping people?’ I wanted to make a difference. I didn’t know if being a financial journalist let me feel like I was doing that,” she told me.

The change hit her immediately. “In medical school I was very interested in the subject, and it was the goal I really wanted.”

Life did not stop during medical school and residency. Beberman lost her younger sister to cancer, got married between her second and third years, and had a baby during one residency. “Being a resident is brutal, and I didn’t know if this was for me,” she says. “There were times I was ready to quit. I couldn’t take it. I missed my newborn son. I said, ‘What am I doing, this is crazy.’”

But she pushed herself. “I almost quit, but this was my goal. I knew the pain was temporary, and in 20 years I’d look back and ask, ‘Why did I quit?’ Now I can say I’m so happy doing what I’m doing.”

There are many factors that go into loving your work. Yet you just don’t snap your fingers and have the job you love. The career equation is not that simple, but it can be solved. Here are two lessons from my book that have helped me, and others, on the career road.

Lesson 1: Find out who you are

In order to love your job, you need to understand yourself. That is easier said than done, but many times, we don’t put in the time and effort to know who we are. And that leads to us not being happy with the choices we make.

Rosemary Haefner, CareerBuilder’s VP of Human Resources, said, “Believe it or not, most people don’t take time to sit and think about what they want to do. We’re very much programmed to take a job to have a job. A paycheck to have a paycheck.”

The advice is to take the time and put in the effort to analyze who you are and how that ties in to your job goals.

Here are a few important questions to ask during your self-actualization process:

  • When it comes to work, what do I naturally enjoy doing?
  • What am I naturally good at?
  • What energizes me?
  • What stresses me?
  • What motivates me?
  • What annoys me?

Once you have the answers to those questions, the next step is to examine the big picture of your work environment. The answers to these questions will help shape your environmental choices:

  • Do I want to go solo, or be part of a small or big group?
  • Do I want a rural location, the suburbs or the city?
  • What type of patients do I want to work with: wealthy, middle class or those in financial need?
  • Do I want to see a high volume of patients in shorter bursts? Or work with a smaller number of patients for a longer duration?
  • What type of physician-patient culture do I want to be a part of?
  • What type of peer culture do I want to be a part of?

The more data points you can have, the better educated your decisions will be. Learn from the experiences of others. Find a physician more experienced than you. Buy him or her coffee or lunch, explain your goals, and ask for their career advice. Their stories and input will be of great benefit.


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The who, what, where, why and when of contracts

Before signing on to a new practice, ask these important questions.

By Bruce D. Armon | Legal Matters | Winter 2011


Before signing on to a new practice, ask these important questions.

There are five primary “W” questions that every physician should ask and understand before signing their employment contract.

1. Who is the employer?

It is critical to learn as much as you can about your prospective employer. If the employer is a private practice, what turnover (if any) has the employer had in its leadership? If the employer is a hospital, what is the relationship that it has with its employed physicians? Does the employer share your short- and long-term objectives? Does the employer have a good reputation in the medical community and the community at large? From a corporate standpoint, does the employer have affiliate entities? Will you ever have the opportunity to have an equity piece in any of the affiliates?

2. What does the employer expect?

After a few in-person meetings and e-mails, you may not have a good sense of the employer’s professional expectations. A properly drafted employment contract should delineate your and the employer’s rights and responsibilities. Don’t be surprised on your first day of work by the staff or equipment (or lack thereof) in the office. Understand the path to promotion. What are the benchmarks related to each step in advancement? Get as many as you can described in detail in the contract. The disappointment of not fulfilling expectations will be compounded by not knowing, in advance, what you were supposed to do.

3. Where will you be working?

Many employers have multiple practice locations. Depending upon the community where you live, you may have to travel great distances—even across state lines—to get from one office to the other.

There can be advantages and disadvantages to working in the main office versus a satellite office. The feel of the practice may be very different in one practice location versus another. This can be dictated by the physician(s) who regularly work in a practice location, the staff who are primarily based at a practice location, and even the patient population that frequents a particular location.

Will you be visiting more than one office in a single day? You should be particularly aware of this circumstance if your compensation is based upon productivity.

Because you will have down time while you are commuting from one office to the next, this will negatively impact your productivity compensation even though you are still making a meaningful contribution.

more »


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