Physician’s job hunting timeline 

Getting your job application ready 

Writing a good cover letter 

 What do physician employers want?

How to handle the telephone interview

Anatomy of a physician job interview 

In the restaurant with physician employers

Do’s and Don’ts in a doctor job interview 

Interview Dress Code for Doctors

Evaluating a physician job opportunity 

Physician Employment Benefits

Using an attorney to review your physician employment contract 

Understanding physician employment contract 

Physician Contract Negotiations 

How to negotiate physician employment contract 

Getting ready for your first physician job 

No doctor has time to read all of these papers. They all rummage through it and sign wherever the signature needs to go. After all there are atleast 100 or more signatures to be done everyday for which there is no compensation.

Among these papers are those sent by some shady vendors and companies. Here are few examples of those:

1) Diabetic Supplies:Diabetic Supply is a big business. That is why you hear those ads about free diabetic supply delivered to your door. Automatically! It is not that automatic. Once the patient requests diabetic supply from the company, they will send a form to the physician to sign. This form has the diagnosis codes and frequency of use, which is usually already filled out by the company salesmen. What they won’t tell you is that they documented the patient needs to check his or her sugar 5 times a day. Even when they are not on insulin. If you sign this form without correcting it, they will send the patient enough supply so they can check their sugars five time a day. This is called Upselling – Selling more than what someone needs. If Medicare comes after them, they have a good defence – “the doctor told us to do that!”

The doctor did not even have the time to read the form thoroughly and gets dinged for overutilization of medicare resources!!

2) Motorized Wheelchair and Scooters: You get these prefilled forms that patient needs a scooter. He may not need it. He probably will do fine with a manual wheel chair. But those sell cheap. So these wheelchair dealers will try to get you to sign a motorized wheel chair for the patient. If Medicare audits, then your neck is on the line.

3) Change Meds to Generic and save $$$: But they won’t tell who saves the dollars. The company or the patient. The patient many a times still pays the same. But if you sign it thinking patient would not mind saving this money, you will be in for a surprise. The Pharmacy will turn around and tell the patient that the doctor asked us to change it. The patients will be angry that they were not consulted before doing so.

4) Refill these prescriptions: Patients who have not followed up with you in a year may go to the pharmacy to see if they can get their meds. The pharmacist will send you a fax. Sign it for refills for next few months will increase your liability as you are now responsible for the side effects of the meds if not monitored. If such a request comes in just give out enough pills to give the patient time to et to your office. Definitely NO REFILLS!

Moral of the story: No one can read everything. But know what to check for each document before you sign it.

But with great benefits cones even greater demands. We all will have to stop writing. No more of the sloppy handwriting we are used to. In fact handwriting will soon disappear from the face of the earth. By now, I am sure, you know what I am getting to.

Every Doctor should learn typing. Once in practice you will need to see as many patient as possible in a day. Whether you own your practice or if you are an employed physician, you will be forced to see more patients as Medicare institutes more cuts in reimbursement. These cuts will have ripple effects and will reduce reimbursements in private insurance payments too.

Once we instituted EMR (Electronic Medical Record) in our medical practice, it was a wake up call for me. I started using my two index fingers and struggled to finish my chart. It also slowed me down. Then one of my friends Edward taught my how to use all of my fingers on the keyboard. Over next six months I noticed a dramatic change. I was typing as fast as patients were speaking. By the time the patient left the room the chart was already complete. It was a miracle. It was better than dictating or writing on the chart.

So for all those who are entering residency or into practice, hone your skills in typing. It will serve you well and make your more efficient. Two finger typing is not enough. You should be able to type without looking at the keyboard.

Since Childhood, everybody has chased the dream of having the workload lighten up once the education part of life is over. Same goes with medicine. Once into Medical School, we realize the amount of work we have to put in it. Every day Medical Students slog through various rotations, schedules, USMLE, reports etc. This list goes on. 

Once the medical school is over, getting into internship is a shocker. If you thought medical school was tough, then you have no idea what an internship would be like. Once the internship is over, the pressure does ease off in the later years of residency but not significantly. There is always more to do and learn.

So for those who wonder if being an attending physician is easier than residency or not, then the answer is NOT. The workload of an attending physician is similar to or worse than that of medical interns. But there are some good differences:

1) The scutwork and running around is reduced.

2) Number of patients the attending physicians take care of  are higher, but then their schedule is not interrupted by conferences and classrooms.

3) With experience, the medical decision making becomes easier and attending physicians do not have to refer to clinical data and research too often.

4) Compensation improves and takes the brunt away from hard work. 

So there is more mental work than physical work after becoming an attending physician, which is a blessing. But it is still hard work and for most of us. There is more responsibility, more rewards. How hard did you expect to work after medical residency?

It is almost July and most of the residents should have landed a physician job. If not, but you are mulling over several physician job offers — then you are still good to go. But if you have not done a single interview yet or worse if you have not started applying yet, then you are really getting late. But do not despair, as there are plenty of physician jobs available.  Those who have visa issues need to be extra careful about the deadlines for applying for one.

There are several strategies to catch up for your Doctor job search. These techniques can be used by the early birds too as they are very effective in getting the contract in hand.

1) Networking: Talk to your attending physicians in the hospital and program. Many if them will be looking for a partner in the near future. May be you can fit into that role. Even if they are not looking, they may know someone , who is looking for physician employees.

2) Medical Staff Office: Talk to the Medical Staff Office in your training hospital. They are usually aware of MDs looking for potential partners/ employees. 

3) Pick up the phone!: Yes! pick up the phone and call up all the places you have put your resume to. Ask them for the physician responsible for making hiring decision. Talk to the hiring MD and ask him if you can set up an  interview to discuss the opportunity further. Many a times, a reverse interview offer like this does work.

4) Physician recruiters: Call the physician recruiters in your specialty and they will be do glad to have you signed up somewhere. Why? Because that’s how they make the big bucks.

5) Friends and Seniors: Do not forget friends and seniors who are already employed or own their own medical practice. They can also hook you up with a physician job.

What if the worst fear comes true. What if you graduate and there is no physician job in sight for you. Well that is a rare thing and should not happen if you have read the ‘Secrets of physician job hunt’.  But even if it does, then you still have option of locum tenens and moonlighting. This option is not for you if you need a visa for employment. The biggest drawback of having a  gap between residency and employment — you will have  to explain it on all  your applications  in the future. I hope this sets you on fire to get started!!!

Let us talk about taking a break after a medical residency program. Once we are through with the hard labor of medical residency program, the long hours, and the stress, which has haunted as for at least last three years, there is a natural tendency to take a break, To rest, to rejuvenate.

Lets consider the question of financial implications of taking a break after residency. Since you have not the started a Physician job, it is quiet clear that you will not be paid for this vacation time. Other thing to note is that your salary would almost quadruple after graduation. And so taking a break will cost you more than $10K for each month you do not work assuming your starting salary is $120K. This does not includes the money you will spend to enjoy that vacation. That makes it a very very expensive break!

You should rather start working at the physician job and then take a vacation maybe three to four months later which would be paid vacation at that time. So by delaying gratification by four months, you actually earned more than 15K. If you have a higher starting salary then 150K, then the stakes are even high.

The other issue to be discussed is the timing of your board examinations. Should you give board examination right after residency, or may be two or three years down the road?

The likely reason medical residents try to take a break is because of all the stress of examinations. But remember this stress is something that you have been used to already. So why not go through the stressful medical board exams, while you’re used to taking huge amounts of stress. Almost all hospitals require board certification for approving your privileges to the hospital. If you do not have privileges to the hospital, you cannot enter the hospital to work there.

The problem with delaying the boards is that the longer you are away from the residency graduation, the harder preparation you will need for the boards. It is the easiest to pass the medical board’s or specialty medical boards right after residency. Why? Right after residency the knowledge is fresh in your mind. That reduces the amount of readings you may have to do. Also it is the latest knowledge, which is most relevant for the medical board exams. Not to mention your recent practice in preparing for multiple in-house examinations does keep your efficiency at the highest.

So make sure you avoid these two big mistakes often graduating from the residency program. Number one, do not take a break right after residency whether to relax or to prepare for the board exams. It is not worth it. Number two, take your board exams right away.

We all went through the medical residency programs and did just fine. But there is always more that we could have learnt or done in the medical residency years. Medical residency is a great place to learn medical skills, as there is plenty of time to learn and lots of physicians willing to teach. This all changes rapidly after graduation. After graduation from a medical residency program, there is almost no time to learn anything radically new. Also there are very few willing individuals to learn from, as no one wants competition.

Here are the biggest  mistakes medical residents make during their residency. Hopefully if your are one, you will avoid them. 

1) Not taking rotations in different specialty in the elective: Experiment and take chances. Rotate through an entirely different clinical specialty. You may learn new procedures you can use later and boost your bottom line. You may gain perspective and experience which will differentiate you and make you a better physician.

2) Becoming Chief Resident and spending extra year in residency: Yes! That is a shocker. There are only two reasons you may want to become a Chief Resident. One, you want to go into academic medicine. Second, you want to get into a certain fellowship program you could not get into after graduating. If you are gearing towards private practice, the extra chief residency year will not come in  handy. Not to mention the hefty pay cut you inadvertently took.

3) Taking outpatient clinics too easy or completely ignoring them: During medical residency, there is a lot of focus on inpatient treatment. However the most time you will spend as a practicing physician is outpatient clinic. Ever got that feeling that you may not be ready for practice as yet? Half of it stems from not doing enough outpatient clinic.

4) Not asking someone to teach medical billing: No one talks about the business of medicine in medical residency. But medical residents need to find someone who can teach them medical billing.

5) Ignoring medical students: If your medical residency program has medical students, take some time out to teach them some clinical skills. Their persistent questioning will give tremendous boost to your learning ability.

6) Not taking advantage of retirement plan and matching program offered by the medical residency program: If your medical residency offers you a retirement plan, more than likely they match the contributions you make to it. If you do not contribute, you lose that match. That is lost money. So call the human resources or the education office, find out what retirement plan they have, and contribute into it.

7) Not starting job search early enough: To get the best job, the physician job search should be started at least within the first three months of the final year. Good jobs don’t last till the end. Also early birds get more interview. Follow the timeline.

Ignoring your family or friends: Medical residency is a busy time. The notion that it is temporary, makes many physicians ignore their family and friends. As a physician, we are doomed to be busy for life. But keep your family and friends for life an be efficient enough to take care of them. And I mean to include your parents, brothers and sisters also.

To make the point clear let me use some examples:

SCENARIO A: Imagine you are in a medical practice, practicing medicine and your yearly earning reports looks as follow.

Gross Revenue: $200,000 per year.

Overhead: $150,000 / year  [Overhead is the cost of doing business eg. expenses including rent, nurse salary, equipment and supplies cost etc.]

 In the above scenario, a physician is better off being an employee than a partner in the medical practice. Why? Because a physician employee salary is guaranteed. Even though there is $200,000 in gross revenue, the net profit is only $50,000 and would be the take home income of a medical practice partner.

Lets look at another aspect:

SCENARIO B: Few years later, your  earning reports look like this:

Gross Earnings: $500,000 / year

Overhead: $ 200,000 / year 

 As you see, the increase in gross earning does increase the overheads, but not proportionately. The increase in overheads is because of increased volume of patients resulting in increased use of supplies and increase in the number of support employees. The disproportion is because of fixed costs such as rent and malpractice insurance. But here the Net Income is $300,000 and would be the take home income for a partner in the medical practice. If, as an employee, a physician is being paid significantly less than this amount as salary, then it makes more sense for him to buy in and become a partner in the medical practice.

If the salary is only few thousand dollars less than the above amount, the only reason for becoming a partner is for job security and sense of ownership. Because, with partnership in the medical practice, also comes the never ending responsibility of managing the business aspect of it.

Before a physician even raises the issue of becoming a partner a look at the current year earnings’ and projected earnings in the next few years, is vital. Nobody wants their income to go down. Especially if you have to pay money to buy into the business. If the numbers don’t look right, it is probably better to wait an year or two before reconsidering the medical partnership.

This is the biggest problem with those jobs which offer mandatory partnership in one year. The problem is that the physician has no clue what his earning will look like at the end of the year. So for accepting a physician job with an opportunity for partnership, make sure becoming a partner is not manadatory in the contract, to continue practicing in the same medical practice. 

1) Physicians are intelligent and independent creatures. They became physicians in the first place to call the shots.

2) Physicians have high sense of self esteem and this fuels their stubbornness and inability to follow orders. They rather command than follow.

3) Over time physicians develop a relationship with their patients – a sense of owning them aka being responsible for their well being. This creates a conflict about who owns the patients – the medical practice or the physician. (My take on it? It is the patient who owns the physician or medical practice!)

4) Becoming the owner or partner appears lucrative – both financially and spiritually.

What are the ways you can own a medical practice ? There are only three:

1) Start your own medical practice

2) Buy a medical practice

3) Become a partner in already existing medical practice ( i.e. buy a share of the medical practice) 

Pros of becoming a partner in a  medical practice:

1) You do not have to start a medical practice from scratch

2) Already operating infrastructure available to you in the medical practice.

3) Business risk is shared in a medical partnership.

4) Easier to get business loans once a business is deemed established. Usually two years of operation is considered adequate by the banks.

5) More flexibility in scheduling vacations.

6) Already existing networks and word of mouth reputation established. (Hopefully good reputation!)

7) Ability to get higher reimbursement rates from the insurance companies.

You do get business related tax breaks. 

Cons of partnering with a medical practice:

1) Income levels not guaranteed. They may vary based on overhead for that year.

2) You still are not the ultimate boss you dreamt of. The most senior partner usually retains the ability to call the shots.

3) You still cannot do whatever you want. You have to go through a partner voting system.

4) Medical partnership usually retain a restrictive covenant in the contracts.

5) Getting out of partnership is akin to a messy divorce.