2Objectives Entering the job market Tips for an effective search The interview and follow-upHow to evaluate a position (and offer)Successful negotiationsStrategies for rewarding careers in EM
3Finding a position in EM Realistic appraisal of your abilitiesDiscuss with family, friends, mentorsResearch various possibilitiesConsider more than one optionGather information and verify itLook to trusted advisorsTake into account personal needs, interests & talents
4DEFINE: Personal/Family/Professional Goals Most doctors choose to practice close to home, or within 100 miles of their training programMany leave original practice within 2 years due to unmet expectationsWhere 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)
5DEFINE: Personal/Family/Professional Goals Key – practice where you want to liveHow 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?
6Stages of the job search Stage I - Preparation*type of position*type of employer*geographic locationStage II - Investigation*look for possibilities*make contact*interview and tour EDStage III - Decision*negotiations may helpContact : 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.
7Career vs. Job *Career: defines an individual *immediate Distinction *Job: pays the billsTime frame*immediate*short-term*long-term
8Where do I see myself ... in the next year in the next 5 years Geographic regionEmergency settingHospital environmentCommunityGreg 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.
9First year out ... Learn a new system Introduction to staff and consultantsEstablish a reputationGet to know the communityStudy for boards
105 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 pensionThoughts of retirement ...
1110 - 15 years out ... *urgent care “Make or break” time Serious travel or time awayRekindle your passion for EMThoughts of career re-direction*urgent care*occupational health*administration
12What makes me happy? Patient care Teaching Supervising Research AdministrationLearning
13What is important to me? Power Fame and notoriety Personal time Fancy vacationsMaterial goodsMoney
14What is really important? Family and friendsCareer satisfactionSecurity*position*financialRespectWellnessWellness - 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.
15What do I enjoy when I am at work? Nice patientsSupportive staffFunctional facilitiesChallenging casesTeachingCamaraderieThis 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).
16AutonomyPhysician autonomy is possible despite the advent of practice guidelines, managed care, and government agencies (although more difficult).Test orderingDecision-makingBest practices
17What would I like to avoid? Unmanageable patient volumeDelays affecting patient careDifficulty getting patients admittedHassles with consultantsNon-supportive environmentAdministrative headachesFrustrations with ED/hospital designThis is the “short” list.Administrative headaches - MCOs and bullshit
19Clinical setting Rural Suburban Urban County Academic medical center VAMilitaryThis includes Urgent care, fast track opportunities, but most EM graduates aren’t looking for these type of opportunities.
20Learning the market AHA Guide to the Health Care Field PDs & faculty (yours and ‘theirs’)Recruiters (companies or ED groups)InternetHospital operatorsFamily or friendsPhone bookEDs
21Effective searching Be focused Be assertive Be creative Start early Don’t take NO for an answer, it may become YES later
22Job search vs NRMP Search ends once candidate accepts *time and money*mutual decisionMay be offered position at end of the interview, or within a short timeMake sure your PDs and references are available and know when, where, and why you are interviewingwhen, 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?”
23Foot in the door Telephone contact *not Monday AM or Friday PM *find out when someone will be availablePersonal communicationSomeone who knows the right personRight place at the right time*introduce yourself at a meeting*stop by the ED
24Preparation Find out what is going on *hospital and ED *leadership*research*communityWhy is the position open? How long?Most recent hire? Departure? Why?Turnover rate?
25Resources Faculty interests EM textbooks Medline / Pubmed Internet home pagesResidency websitesConference facultyYour program’s faculty may know ...Job opportunitiesJournals/newslettersJob catalogsPostings (meetings, internet, bulletins)‘Local’ program directors & residentsWord of mouthRecruiters
26Professional recruiters Use judgment before giving out CVsMany have excellent skills / reputationsFirms 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. downsidesNot for everyoneReputations - 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...)
27Questions 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)?
28CV & Cover letter Equally important with different roles Curriculum vitae lists professional accomplishments, abilities, interests, and activitiesCover letter is a personalized attempt at convincing someone to offer you an interviewBoth include name/address/phone
29Curriculum vitae Make it look like it “wants” to be read *professional style*use white space appropriately*good texture*easily readIt should copy wellDescending chronological orderInclude special skills, esp. language
30Important information Include professional degreeReliable phone numberCurrent contact addressaddressDo not use pager, ED, or secretary #sKeep contact information simple!
31CV do’s & don’ts DO DON’T Emphasize your accomplishments and special skillsInclude your name on every pageKeep it simple and legibleNumber each pageDON’TInclude irrelevant informationUse dark paper that doesn’t copy wellMake grammatical or spelling errorsInflate your accomplishments
32Cover letter Personalize - address it to someone Send with your CV Check spelling (esp. names)Give a reason why you should be invited for an interviewInclude personal information that doesn’t go on your CVInformation 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...
33Interview Dress professionally Let them interview you Interview them Learn about the position, hospital, and communityMeet as many people as possibleFind 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...”
34Interviews Don’t waste their time or your own Practice at your residency programBe prepared*to present a case*to give a lecture*to share your CV / articles*to discuss your (and their) research
35Bring to interview Map with directions Change for parking Copies of CV and writing sampleInterview itineraryNames of faculty and administratorsList of interview questionsPen, paper, business cards, folderToothbrush and mscll. health care
36Interview questions Which questions? Address questions to the right peopleAsk same question to different peopleClarify answers to questions from earlier in the interview processAsk a question when asked if you have one (even if you don’t have any).
37Their 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 - exampleHow / 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.
38Your 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?
39Other questions Anticipated changes in the ED *staffing (MD, RN, mid-level providers)*census (ED, hospital, community)*facility (expansion, observation unit, other)Progressiveness and creative planningResponsiveness of hospital administrators to the needs of the ED
40Wish list Nice practice environment Stable hospital / growing ED censusGood community (growing)Democratic groupSimilar colleagues (‘family’)Opportunity for social/family happinessFairness with respect to schedule, compensation, and future potential
42Democratic groupCompetitive salary with reasonable administrative overheadOpen booksEquitable schedule with flexibilityEvenly distributed workloadShared opportunity for advancement*professional*partnership (non-financial)*financial parity
43Emergency department tour AgeLayout and designSize and spaceTelephonesComputer accessWaiting room conditionPlans to remodel
44Make sure you ... meet as many physicians as possible speak to nurses and paramedicstalk with consultants about the EDmeet administrators, if possibletalk to benefits office(r)show an interest in the rest of the hospital and the communitymake an effort with (quick) good-byesParamedics - 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.”
45Interview follow-up Thank you *personalize (name and experience) *telephone, , US mail*additional chance to express interestDon’t skimp*anyone helpful or made time for youTimely manner*even if you aren’t interested in the position or they did not seem interested in you
46Contracts Professional review Reference manuals may help, but it’s like reading a foreign languageRead, understand, and amend what is important to youNot everything can be changedEmployee manual is contract
47Concerns with contracts Termination clauseRestrictive covenantsMalpractice coverage*who provides?*type of coverage (claims-made or occurrences)?*tail (who pays?)
48Employee vs. Independent contractor BenefitsFinancial (tax) implicationsRecent pressure from IRS to redefine EM relationships as employee/employer rather than ICSecurity ??????
49NegotiationsBe prepared (find out what is negotiable before you begin negotiating)Understand what the other side needsPractice negotiations - getting to ‘yes’Keep your ego out of the dealBe creativeConsider factors (skills, demand, need)
50Negotiations (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 futureDon’t resent how negotiations turn out
51Time 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 boardsDistractions - airline tickets, vacation plans, personal phone callsDon’t buy a house while you are starting - color carpets/cabinets, catastrophes, etc.
52Time (cont.) Exercise Sleep is a priority Take classes Develop hobbies Personal growthCommit to family and friends
53Medical licenses Start early Consider expense Photos Fingerprints Diploma (translation)Coursework
54Things to avoid Practice shifts Arguing with nurses or consulting staffLack of interview preparationNot 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)
55Fear of “leaving home” Comfort with what’s familiar No need to relocateKnow what you’re gettingAlready have reputation within hospital“No one would take advantage of me here...”
56Moonlighting vs. Staff Advantages check out various opportunities no commitmentschedule flexibilitydetermine which ED is best ‘fit’Disadvantageswhy not hired?clinical error or staff/patient complaintnot considered a member of the teamsomeone else hired insteadstaffing needs change
57Buying a house Complicated process Emotional experience May be prohibitively expensiveGet to know the area firstMake sure you like the positionMake sure the position is stable
58What can I do now? Improve your clinical skills Finish research project and manuscriptsDevelop administrative skillsLearn coding, billing, documentationPractice dictationImprove language or computer skillsRead about “hot” political issuesDiscuss your interests with facultyIMPROVE CLINICAL SKILLS - esp. EFFICIENCY and TIME ManagementAdministrative skills - CQI, QA, committees (patient flow, relationships with other depts.)
59Mentorship Important throughout career Personal and professional Opportunities*research*academic*career adviceConsider more than one mentorMutual benefitArticle in Annals EM August 99.Reference, mention, read it!Opportunities: projects, committees, book chapters, research assistance, etc.
60Life after residency Enjoy the opportunity to provide care Share your happinessGive back to your programCelebrate your hard workKnow when (and how) to take care of yourself!Look at CD ROM.Look at handout from my lecture (5 C’s and LIFE ....)
61Faculty development EMF Teaching Fellowship Navigating the Academic WatersResearch: design, statistics, grants, etc.LeadershipPatient satisfactionTime managementPhysician wellness
62Avoiding physician burnout Identify stressorsLearn to deal with them constructivelyDon’t internalizeDon’t rely solely on family for supportListen to those who have concernsSeek professional helpKnow when ‘enough is enough’Mention ACEP text.
636 C’s of graduation Confidence Collaboration Collegiality Committees CompassionCommunityGet 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.
647 Habits of highly successful physicians 1. Recognize your limitations(learn from your mistakes)2. Don’t speak ill of colleagues/staff3. Make yourself indispensable4. Lead by example5. Project a positive attitude6. A good team player is a good listener7. Don’t conserve kindnessWith 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 too7. Kindness - it takes nothing away (not a equal sum gain)
65In 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.
66Remember, you only have one chance to make a first impression. Good Luck!