The best strategy for landing that first job is to start your search early, says Cheryl DeVita, senior search consultant at Cejka Search, Inc., in St. Louis, Mo.
“Many hospital organizations planning to add to their staff are willing to consider candidates six or 12 months out,” DeVita explains. Required licensing and credentialing “don’t happen fast,” she adds, and you will not be the only applicant. To preserve your range of choices, explore options early, preferably in the fall before your residency concludes.
Tom Baudendistel, MD, FACP, program director of internal medicine residency at Kaiser Permanente in Oakland, Calif., encourages his senior residents to “at least interview at new settings, and test the waters a bit.
“Too often, I see residents trying to find the absolute perfect position for the next 30 years of their career,” he says, “when in reality they are likely to change jobs in a few years for a variety of reasons, from personal to geographic to the job itself. Even if they decide to remain with Kaiser—as many do—they’ll have some perspective on what other systems are up to, which they can file away for future reference.”
At Stake? More than Money
Salary and benefits are important, but they aren’t the only factors to evaluate during a job search. Dr. Baudendistel offers a few “don’ts” to help guide the job search journey:
- Don’t forget to consider how you will stay up to date: “Residents sometimes take for granted the amount of didactic learning going on every day in the academic environment of residency, only to become disenchanted to take a job at a hospital where there may only be one grand rounds a week [if that], and the group meetings center primarily on business items, such as contracts, coding, and RVUs.”
- Don’t be lured by the money: Debt-ridden residents may be drawn to the quick fix of a nice salary, but this can cloud the fact that the salary might not increase much over the next five to 10 years, that the benefits/retirement/home loan packages are thin, or that there is very little growth potential within the group. To assess the potential for professional growth—a better predictor of job satisfaction—ask the attendings who have been with the group for five to 10 years: “How has your job evolved since you first started?” Be wary if the answer is, “I’ve been doing the same full-time clinical job since I started.”
- Don’t forget to look critically at group happiness. What is the turnover of the group? How is leadership viewed by the rank-and-file attendings? What is the relationship between the HM group and the hospital administration and nurses? A good question to ask is, “Does the group go to lunch?”
- Don’t forget to consider who your mentors will be. Who will help you grow and thrive in your job? Is there a formal mentoring program? If not, how does the group leader mentor the attendings?
The Nuts and Bolts
Once you’ve been offered a contract, it’s not just a simple matter of whether you will be salaried with benefits or a contract employee and have to purchase your own benefits. Legal counsel might be appropriate, DeVita says, to ensure you understand the ramifications of malpractice insurance.
Importantly, find out who pays for “tail insurance” for when you leave a job. This is vital, because physicians remain liable for malpractice acts performed when they were a part of the previous medical group.
You’re In, Now What?
Dr. Baudendistel and DeVita agree that honing your clinical skills will be “job one” once you start to work.
“If you’re averaging 12 patients and your peers are averaging 17, you will be in a position of jeopardy,” DeVita cautions.
For that reason, Baudendistel advises young hospitalists not to overcommit to nonclinical duties.
“There is a temptation to say ‘yes’ to every opportunity that arises in your first job. There will be plenty of time over the years to get involved in committee work, QI [quality improvement], and the like. Sometimes saying ‘no’ is the right approach in your early years,” he says.
Once you’re maintaining the same productivity level as your peers, DeVita points out, then it may be appropriate to participate in committee work—and there may be bonus components for citizenship work.
Gretchen Henkel is a freelance writer in California.