1. Career Planning in Emergency Medicine

2. Objectives Entering the job market Tips for an effective search
The interview and follow-up
How to evaluate a position (and offer)
Successful negotiations
Strategies for rewarding careers in EM

3. Finding a position in EM
Realistic appraisal of your abilities
Discuss with family, friends, mentors
Research various possibilities
Consider more than one option
Gather information and verify it
Look to trusted advisors
Take into account personal needs, interests & talents

4. DEFINE: Personal/Family/Professional Goals
Most doctors choose to practice close to home, or within 100 miles of their training program
Many leave original practice within 2 years due to unmet expectations
Where you want to live and raise your family will ultimately determine where you stay long-term (“Recruit the spouse and you will recruit the doctor.”-- Recruiter Colloquialism)

5. DEFINE: Personal/Family/Professional Goals
Key – practice where you want to live
How much money do I need to make to meet my needs?
What will fulfill my professional needs?
*What type of practice?
*Is there a documented need for my services?
*How many patients a day am I comfortable seeing?

6. Stages of the job search
Stage I - Preparation
*type of position
*type of employer
*geographic location
Stage II - Investigation
*look for possibilities
*make contact
*interview and tour ED
Stage III - Decision
*negotiations may help
Contact : first by phone, then with CV and CL (and mention the phone conversation).
Negotiations MAY help, implies that the job must be something you want, negotiations are not going to make a bad job a great job.

7. Career vs. Job *Career: defines an individual *immediate Distinction
*Job: pays the bills
Time frame
*immediate
*short-term
*long-term

8. Where do I see myself ... in the next year in the next 5 years
Geographic region
Emergency setting
Hospital environment
Community
Greg Henry, MD once mentioned at a conference we both presented at on Career Planning that some people spend more time planning their next vacation than they spend planning their careers.
Let’s face it - region is important to most of you.

9. First year out ... Learn a new system
Introduction to staff and consultants
Establish a reputation
Get to know the community
Study for boards

10. 5 years out ... *school debts often repaid Career re-evaluation
Money somewhat less of a concern
*school debts often repaid
*growth in savings
*partnership
*vested in pension
Thoughts of retirement ...

11. 10 - 15 years out ... *urgent care “Make or break” time
Serious travel or time away
Rekindle your passion for EM
Thoughts of career re-direction
*urgent care
*occupational health
*administration

12. What makes me happy? Patient care Teaching Supervising Research
Administration
Learning

13. What is important to me? Power Fame and notoriety Personal time
Fancy vacations
Material goods
Money

14. What is really important?
Family and friends
Career satisfaction
Security
*position
*financial
Respect
Wellness
Wellness - means health, well-being, and peace of mind. This is a philosophical notion. It may be hard to imagine right now, since everyone in this room is probably working harder and getting paid less than they would like. Well, get used to getting paid less than you would like, and working harder than you would like too! That’s why number of hours/week isn’t really on this list.

15. What do I enjoy when I am at work?
Nice patients
Supportive staff
Functional facilities
Challenging cases
Teaching
Camaraderie
This list will differ for everyone in this room, even those at the same program or hospital.
Comaraderie - this may mean “double-coverage” to converse with another person (not to have them review xrays or help you).

16. Autonomy
Physician autonomy is possible despite the advent of practice guidelines, managed care, and government agencies (although more difficult).
Test ordering
Decision-making
Best practices

17. What would I like to avoid?
Unmanageable patient volume
Delays affecting patient care
Difficulty getting patients admitted
Hassles with consultants
Non-supportive environment
Administrative headaches
Frustrations with ED/hospital design
This is the “short” list.
Administrative headaches - MCOs and bullshit

18. Beyond graduation Fellowships Chief residency
Additional residency training
Positions
*clinical
*academic
* “hybrid”
Travel

19. Clinical setting Rural Suburban Urban County Academic medical centerVA
Military
This includes Urgent care, fast track opportunities, but most EM graduates aren’t looking for these type of opportunities.

20. Learning the market AHA Guide to the Health Care Field
PDs & faculty (yours and ‘theirs’)
Recruiters (companies or ED groups)
Internet
Hospital operators
Family or friends
Phone book
EDs

21. Effective searching Be focused Be assertive Be creative Start early
Don’t take NO for an answer, it may become YES later

22. Job search vs NRMP Search ends once candidate accepts
*time and money
*mutual decision
May be offered position at end of the interview, or within a short time
Make sure your PDs and references are available and know when, where, and why you are interviewing
when, where, and why -
“Oh yes, they told me they were interested in your position because of XYZ” instead of “I didn’t know he was looking in Buffalo?”

23. Foot in the door Telephone contact *not Monday AM or Friday PM
*find out when someone will be available
Personal communication
Someone who knows the right person
Right place at the right time
*introduce yourself at a meeting
*stop by the ED

24. Preparation Find out what is going on *hospital and ED
*leadership
*research
*community
Why is the position open? How long?
Most recent hire? Departure? Why?
Turnover rate?

25. Resources Faculty interests EM textbooks Medline / Pubmed
Internet home pages
Residency websites
Conference faculty
Your program’s faculty may know ...
Job opportunities
Journals/newsletters
Job catalogs
Postings (meetings, internet, bulletins)
‘Local’ program directors & residents
Word of mouth
Recruiters

26. Professional recruiters
Use judgment before giving out CVs
Many have excellent skills / reputations
Firms vs. recruiters for contract group
*who do they represent?
*for whom do they work? answer to?
*how do they get paid? when? by whom?
Weigh benefits vs. downsides
Not for everyone
Reputations - you may work with them in the future, you may recommend (or not recommend) that firm or individual to a friend, etc. etc.
However, if you know you want to work in Grand Rapids, and there are only 2 EDs, then you really don’t need a recruiter (and you might be at a disadvantage...)

27. Questions for recruiters
Years experience in EM? Exclusive?
Background? Previous employment?
Knowledge of EM? Geographic region?
Percentage of academic placements?
Willing to give reference(s)?
Success rate? Other ‘data’?
Financial arrangement?
Why them?
Have they seen the ED?
Do they “know” the players?
Have they placed anyone at that ED? Group? Area? Hospital?
Numbers of people last year? Presently?
Background - paramedic? Patient?
What resources they recommend (this gets at their ability to help)?

28. CV & Cover letter Equally important with different roles
Curriculum vitae lists professional accomplishments, abilities, interests, and activities
Cover letter is a personalized attempt at convincing someone to offer you an interview
Both include name/address/phone

29. Curriculum vitae Make it look like it “wants” to be read
*professional style
*use white space appropriately
*good texture
*easily read
It should copy well
Descending chronological order
Include special skills, esp. language

30. Important information
Include professional degree
Reliable phone number
Current contact address
address
Do not use pager, ED, or secretary #s
Keep contact information simple!

31. CV do’s & don’ts DO DON’T
Emphasize your accomplishments and special skills
Include your name on every page
Keep it simple and legible
Number each page
DON’T
Include irrelevant information
Use dark paper that doesn’t copy well
Make grammatical or spelling errors
Inflate your accomplishments

32. Cover letter Personalize - address it to someone Send with your CV
Check spelling (esp. names)
Give a reason why you should be invited for an interview
Include personal information that doesn’t go on your CV
Information that doesn’t go...
We met at conference/whatever.
Dr. Y recommended that I contact you.
I have family in the area - I was born in that hospital - I volunteered at that hospital.
One of your staff trained at my program...

33. Interview Dress professionally Let them interview you Interview them
Learn about the position, hospital, and community
Meet as many people as possible
Find out as much as you can about as much as you can.
Better to overdress than underdress. No scrubs!
Let them say to you “you didn’t need to dress up for this” which you can reply “but it is important to me that I represent myself in the best possible light since this is an important opportunity...” rather than not say “ you are a slob, and therefore I won’t introduce you to...”

34. Interviews Don’t waste their time or your own
Practice at your residency program
Be prepared
*to present a case
*to give a lecture
*to share your CV / articles
*to discuss your (and their) research

35. Bring to interview Map with directions Change for parking
Copies of CV and writing sample
Interview itinerary
Names of faculty and administrators
List of interview questions
Pen, paper, business cards, folder
Toothbrush and mscll. health care

36. Interview questions Which questions?
Address questions to the right people
Ask same question to different people
Clarify answers to questions from earlier in the interview process
Ask a question when asked if you have one (even if you don’t have any).

37. Their questions Tell me about yourself?
What are your strengths? Weaknesses?
Tell me about a mistake you made and how you handled it? What did you learn?
What do you see yourself doing in ... ?
How/what/when will you contribute to our ED?
Why should I hire you?
Special projects - example
How / What / When = how soon?
My favorite - “why should I hire you?” opens the door to impress them, tell them whatever you want.
Instead of fearing this question, you should all HOPE that you get asked this question.

38. Your questions Why is this position open?
When was the last new physician hired?
How stable is the nursing staff? Hospital? Physician group?
May I speak with the most recent hire? Physician who most recently left?
‘Credentials’ of MDs? Nurses?
How can I make myself more competitive?
What are you looking for in a candidate?

39. Other questions Anticipated changes in the ED
*staffing (MD, RN, mid-level providers)
*census (ED, hospital, community)
*facility (expansion, observation unit, other)
Progressiveness and creative planning
Responsiveness of hospital administrators to the needs of the ED

40. Wish list Nice practice environment
Stable hospital / growing ED census
Good community (growing)
Democratic group
Similar colleagues (‘family’)
Opportunity for social/family happiness
Fairness with respect to schedule, compensation, and future potential

41. Chief Leadership Innovation Creativity
Respect (within group? hospital?)
Business sense/plan
Fairness

42. Democratic group
Competitive salary with reasonable administrative overhead
Open books
Equitable schedule with flexibility
Evenly distributed workload
Shared opportunity for advancement
*professional
*partnership (non-financial)
*financial parity

43. Emergency department tour
Age
Layout and design
Size and space
Telephones
Computer access
Waiting room condition
Plans to remodel

44. Make sure you ... meet as many physicians as possible
speak to nurses and paramedics
talk with consultants about the ED
meet administrators, if possible
talk to benefits office(r)
show an interest in the rest of the hospital and the community
make an effort with (quick) good-byes
Paramedics - they know that ED and other EDs much better than you would think. Also, they are more than happy to share their opinions, and often have plenty of time to “chat.”

45. Interview follow-up Thank you *personalize (name and experience)
*telephone, , US mail
*additional chance to express interest
Don’t skimp
*anyone helpful or made time for you
Timely manner
*even if you aren’t interested in the position or they did not seem interested in you

46. Contracts Professional review
Reference manuals may help, but it’s like reading a foreign language
Read, understand, and amend what is important to you
Not everything can be changed
Employee manual is contract

47. Concerns with contracts
Termination clause
Restrictive covenants
Malpractice coverage
*who provides?
*type of coverage (claims-made or occurrences)?
*tail (who pays?)

48. Employee vs. Independent contractor
Benefits
Financial (tax) implications
Recent pressure from IRS to redefine EM relationships as employee/employer rather than IC
Security ??????

49. Negotiations
Be prepared (find out what is negotiable before you begin negotiating)
Understand what the other side needs
Practice negotiations - getting to ‘yes’
Keep your ego out of the deal
Be creative
Consider factors (skills, demand, need)

50. Negotiations (cont.) Look to the future
Consider the risk vs. benefit ratio
*ending up with nothing
*getting what you want in the present
*people remember frustrations
*negotiate for a promising future
Don’t resent how negotiations turn out

51. Time Clinical duties most important *arrive early
*work hard
*finish your work
*be pleasant to staff, patients & families
*no distractions!
Make yourself available for switching shifts (or extra duties if needed)
Study for boards
Distractions - airline tickets, vacation plans, personal phone calls
Don’t buy a house while you are starting - color carpets/cabinets, catastrophes, etc.

52. Time (cont.) Exercise Sleep is a priority Take classes Develop hobbies
Personal growth
Commit to family and friends

53. Medical licenses Start early Consider expense Photos Fingerprints
Diploma (translation)
Coursework

54. Things to avoid Practice shifts
Arguing with nurses or consulting staff
Lack of interview preparation
Not ready for first shift (get a ‘tour’ first)
You will be expected to provide expert care and compassion beginning with your first patient on your first shift!
Practice shifts (shadow instead)

55. Fear of “leaving home” Comfort with what’s familiar
No need to relocate
Know what you’re getting
Already have reputation within hospital
“No one would take advantage of me here...”

56. Moonlighting vs. Staff Advantages check out various opportunities
no commitment
schedule flexibility
determine which ED is best ‘fit’
Disadvantages
why not hired?
clinical error or staff/patient complaint
not considered a member of the team
someone else hired instead
staffing needs change

57. Buying a house Complicated process Emotional experience
May be prohibitively expensive
Get to know the area first
Make sure you like the position
Make sure the position is stable

58. What can I do now? Improve your clinical skills
Finish research project and manuscripts
Develop administrative skills
Learn coding, billing, documentation
Practice dictation
Improve language or computer skills
Read about “hot” political issues
Discuss your interests with faculty
IMPROVE CLINICAL SKILLS - esp. EFFICIENCY and TIME Management
Administrative skills - CQI, QA, committees (patient flow, relationships with other depts.)

59. Mentorship Important throughout career Personal and professional
Opportunities
*research
*academic
*career advice
Consider more than one mentor
Mutual benefit
Article in Annals EM August 99.
Reference, mention, read it!
Opportunities: projects, committees, book chapters, research assistance, etc.

60. Life after residency Enjoy the opportunity to provide care
Share your happiness
Give back to your program
Celebrate your hard work
Know when (and how) to take care of yourself!
Look at CD ROM.
Look at handout from my lecture (5 C’s and LIFE ....)

61. Faculty development EMF Teaching Fellowship
Navigating the Academic Waters
Research: design, statistics, grants, etc.
Leadership
Patient satisfaction
Time management
Physician wellness

62. Avoiding physician burnout
Identify stressors
Learn to deal with them constructively
Don’t internalize
Don’t rely solely on family for support
Listen to those who have concerns
Seek professional help
Know when ‘enough is enough’
Mention ACEP text.

63. 6 C’s of graduation Confidence Collaboration Collegiality Committees
Compassion
Community
Get yourself on some committees, which is a great way to meet people and to make yourself indispensable (in other words, important to the hospital and to the group). Don’t let it interfere with your clinical duties, however.

64. 7 Habits of highly successful physicians
1. Recognize your limitations
(learn from your mistakes)
2. Don’t speak ill of colleagues/staff
3. Make yourself indispensable
4. Lead by example
5. Project a positive attitude
6. A good team player is a good listener
7. Don’t conserve kindness
With apologies to Stephen Covey.
1. You will make mistakes.
3. Indispensable = committees, etc.
4. Lead by example - work as hard as you would like those around you to work. They will rise to the “challenge.”
5. Positive attitude - don’t complain.
6. Good listener - patients too
7. Kindness - it takes nothing away (not a equal sum gain)

65. In the long run, outstanding interpersonal skills are desired over clinical expertise.
Medical -legal literature supports this (numbers of lawsuits are greater if physician is not “liked”).
You will be expected to know that a pregnant female with lower abdominal pain is an ectopic pregnancy until proven otherwise.

66. Remember, you only have one chance to make a first impression.
Good Luck!

67. Author Credit-Career Planning: Gus Garmel MD
QUESTIONS?

68. Postresidency Tools of the Trade CD
13) Negotiation – Ramundo
14) ABEM Certifications – Cheng
15) Patient Satisfaction – Cheng
16) Billing, Coding & Documenting – Cheng/Hall
17) Financial Planning – Hevia
18) Time Management – Promes
19) Balancing Work & Family – Promes & Datner
20) Physician Wellness & Burnout – Conrad /Wadman
21) Professionalism – Fredrick
22) Cases for professionalism & ethics – SAEM
23) Medical Directorship – Proctor
24) Academic Career Guide Chapter 1-8 – Nottingham
25) Academic career Guide Chapter 9-16 – Noeller
1) Career Planning – Garmel
2) Careers in Academic EM – Sokolove
3) Private Practice Career Options - Holliman
4) Fellowship/EM Organizations – Coates/Cheng
5) CV – Garmel
6) Interviewing – Garmel
7) Contracts for Emergency Physicians – Franks
8) Salary & Benefits – Hevia
9) Malpractice – Derse/Cheng
10) Clinical Teaching in the ED – Wald
11) Teaching Tips – Ankel
12) Mentoring - Ramundo