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 

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!!!

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.

 

Direct mail is a method used by business people and retailers to send unsolicited mail to potential customers. Marketing is not a random science. It is very systematic. If you send 10 resumes you will get 2 interviews. If you send out a 100, you will get 20 interviews. If you send out a thousand you will get 200 interviews !!! The ratio may be different for each specialty and each person but basics of marketing are the same.

So why not use this marketing method to find jobs. After all looking for a job is no less than marketing ourselves to the physician employer. So here is what you should do.

STEP 1: Find out a list of medical practices in your specialty in the location you are interested in. You can buy a list, you can search local yellow pages or you can look it up online.

STEP 2: Mail a resume and a cover letter to each of these practices or better still, each of the physicians in the area.

If a physician or physician group is planning to hire in the near future, just getting your resume will save them a lot of money, time and headaches. Others may be tempted to add another physician to their practice. Thank you Dr Muenzer for diggin out this advice.

A comment was left on this website by a physician recruiter in response to my post on ‘Physician Recruiters: Whose side are they on?’ and ‘Physician Recruiters: How to use them to your advantage‘. I think the points he mentioned are worth mentioning in a post. It is only fair for me to allow him to voice his opinion in this forum. Here is what Bob Eskeridge has to say in his own words.

I will admit, I did not know that even physician recruiters have to be board certified. I think I need to dig deeper into it and find out how are they certified and on what criteria. Like Bob mentioned, it does show their commitment to the field of physician recruiting. So we can be sure we are not dealing with fly by night recruiter.

I think his second point on providing a complete and accurate picture to  a physician recruiter is logically sound and important. Unless the recruiter knows what kind of physician job a candidate is most likely to accept, he may throw all kinds of stuff i.e. jobs at him. Still if you feel that you communicated your desires but the physician recruiter is not listening, then you need to break that relationship and change the physician recruiter.

May be Bob will agree for an interview for the benefit of our readers. I will shoot him an email. 

There are certain rules I used, when I had to deal with physician recruiters. It helped me avoid unnecessary interview trips, sidestep unwanted physician jobs and prevent pesky calls from them at work.

 Dont forget to read the physician recruiters vocabulary guide:)

Physician recruiters are salespeople. There job is to sell you a ‘physician job’ or a ‘physician job interview’ depending on how the recruiters get paid. There is big money to be made in physician recruiting(Sometimes double of the monthly salary offered for the physician job! ).

The physician recruiters contract with physician employers and may elect to get paid if they are able to send a physician candidate for interview. Or they may instead elect to get bigger payout only if a physician signs up for the job. For a recruiter, who is getting paid just to get candidates into the door for physician interviews, his main objective will be to get as many interviews set up as possible. An unethical recruiter will not care whether the physician job suits you or not. He will not care whether the physician employer may like that candidate or not. He would want you to just show up for the interview. So if you get kind of calls from recruiters, who are pushing you to go to a certain desolate place for interview, that’s what it is.

If the recruiter gets paid only if a physician candidate signs up for the doctor job, they have to be more careful about selecting physician applicants to recommend for interview. But again, they would like to send more candidates to increase the chances of filling the physician job.

Lets look at another scenario: The physician recruiter is agent for two physician jobs: Job opening A and Job opening B. Job Opening A is a lucrative physician job in Beverly Hills and Job opening B is in the middle of Sonoran Desert. If the recruiter is supposed to get double commission for filling up the Sonoran Desert physician job opening, then its obvious he will try to sell that position first. If he comes across a medical resident who sticks to his job criteria, and refuses to go to middle of no where, not even for an interview, then the recruiter will disclose the position in Beverly Hills.

Summary: Physician recruiters are salesmen. They will try to nudge you to go for physicians jobs which offer them more commission. They probably care the least about what physician candidate wants or what physician employer wants. Unless you bump into a good physician recruiter. Therefore keep your guards up.

We will discuss how to chose and handle physician recruiters in our next post…Happy Holidays!

1) Find out medical procedures which have better reimbursement from the insurance companies. Try to get credentialed in those so you won’t have to refer your patients to other places. It will also improve your employability. Don’t just focus on your specialty. Look into medical procedures of associated specialties. If  you can master those, that will make you different and desirable candidate for a physician job. For example Dermatology procedures for Internal Medicine residents.

2) By now you know almost everything about your medical specialty. Try rotating in associated medical specialties to widen your experience. Once you leave the medical residency, consider that opportunity gone.

3) Start studying for the boards. Do not count on taking few months off post residency to prepare for the boards. Better do it now. Ask your colleagues about good books and review courses for medical board exam.

4) DO NOT FORGET TO REGISTER FOR THE BOARDS ASAP. Most Medical Board Exam Deadlines are looming around this time of the year.

5) Get all your credentialing data to your medical residency program. So they have enough time to process the information prior to graduation.

6) Identify areas  of weakness and get an extra rotation to address them now.

7) Plan how you are going to pay back your medical loans.

Start reading books on personal finance so you would know how to handle the extra cash you will start earning post graduation. It is very important to understand savings, investments, stock market, bonds, retirement planning etc.

Hopefully now your six months will pass like a breeze!! Good Luck!

Understand the two parts of hospital privileges approval process: Credentialing and Privileges determination. Credentialing is that part of the application process in which it is  determined if the MD is qualified to get privileges.  The hospital medical staff office double checks on medical school, residency training, background check etc. The second step is giving privileges to do certain things in the hospital. For example the hospital may give broad privileges to do almost everything in your specialty including admitting patients, performing procedures pertaining to your specialty , consult and so on. Or the hospital may decide to give limited privileges, restricting the physicians to perform only certain medical procedures. or function. Certain hospitals may have exclusive association with a particular medical practice. And if you don’t belong to that exclusive medical practice, the hospital may allow you no privileges or some privileges. Yes! Welcome to the world of medical politics.

These are the steps to get hospital privileges:

STEP 1: Call the ‘medical staff office’ of the hospital and get a privilege application.

STEP 2: Fill and Submit it back to the medical staff office.

STEP 3: Follow up with your references to make sure they mailed the recommendations back to the hospital.

STEP 4: Make sure medical office has everything they need on your file, prior to the next credentialing committee meeting.

There are different types of hospital privileges. You may want to chose which is best suited for you:

Courtesy Privileges: Courtesy hospital privileges limit the physician to admitting only a nominal number of patients to the hospital. It still satisfies most medical insurance companies requirement for physicians to hold hospital privileges.  Physicians are usually exempt from attending medical staff meetings. Such privilege is used by physicians who do not expect to admit patients to the hospital or do procedures there.

Full Privileges: Under this category physicians are allowed to admit unlimited number of patients to the hospital. Physicians are usually given all the privileges needed to perform ‘core procedures’ of their medical specialty. Physicians are also required to attend a required number of medical staff meeting regularly.

The hospital privileges are renewed every few years. Currently it is done automatically, as long as physician’s morbidity or mortality rate is not too high as compared to their peers. But starting 2008, JCAHO is now requiring hospitals to develop criteria to renew hospital privileges every year based on measured criteria such as mortality rate, patient satisfaction score, complication rate, and, yes! believe it or not, even handwriting legibility. So holding on to the privileges will become quite a chore in the near future.