Heather A. Harris, MD, director of Eden Inpatient Services at Eden Medical Center in Castro Valley, Calif., has been a hospitalist for nearly four years and helped start her hospital medicine practice, which currently employs eight full-time day hospitalists and “a cadre of night folks.”
“I’ve been on both ends of looking for a job and hiring hospitalists,” she says. Below, she and other hospitalists share advice on how to choose your first position in hospital medicine.
The best job search begins before you graduate. “When you’re looking for a job, start as early as possible,” advises Sameer Badlani, MD, hospitalist and instructor at the University of Chicago. “Most people don’t realize how long it takes.”
To prepare for employment, take steps toward getting your medical license and put your paperwork in order. “If you know which state or states you want to be in, go ahead and start the state licensing as soon as possible,” says Dr. Badlani. “Each state has its own set of forms, and you can at least have the packet ready to send in.”
You can also prepare your certification materials so that they are ready to turn over to your future employer: “The FCVS [Federation Credentials Verification Service] is a repository for all your training certificates,” explains Dr. Badlani. “It costs $250 to get a copy of all your certificates, and an additional $30 every time you send it out to a [potential employer]. Some states will only accept certificates from FCVS, and I think that someday all states will require this.”
As a first step for the actual job search, Dr. Harris recommends trying to network through your university and your residency program. “Your program may keep a list of where residents have gone to work; you can at least talk to recent graduates that you know,” she says. “Call them up and see how they like what they’re doing.”
You can broaden your search by joining the industry association and exploring job postings. “I’d recommend that anyone become a member of SHM,” says Dr. Harris. “There are a variety of job postings available through their Web site. You can also simply “Google” ‘hospitalist jobs,’ and find all kinds of national services, headhunters, and companies.” To view job postings t through SHM’s online Career Center, visit www.hospitalmedicine.org and click “Career Center.”
Hospitalist Sanjiv Panwala, MD, a hospitalist at Providence Medical Center, Portland, Ore., has created www.mdgrad.com, a Web site that includes portals to hospital medicine job postings.
Narrow Your Search
When you take these first steps, you’ll discover just how many positions you have to choose from. How can you narrow your job search?
“Clearly, [you have] to distinguish the things that are important to you,” says Dr. Harris. “There’s quite a distinction between an academic and community-based position; you need to think this through before you begin your job search.”
Regardless of this first decision, there are universal factors to consider. “As in any job search, you start by thinking about the area of the country you want to be in, urban versus rural, and other factors,” explains Dr. Harris. “Then you think about the things that separate [hospital medicine] programs from one another.” You’ll find you have a lot of choices.
“There seem to be [hospital medicine] jobs everywhere,” says Dr. Panwala. “The money is in Texas or the Midwest, if that’s what’s important to you.”
Once you’ve decided on your general career path and where you’d like to live and work, consider what type of work you want to do. “One thing you should think about is whether you want to see patients in critical care arenas, or just those patients on the floors,” says Dr. Harris. “These are very different populations, and require different skill sets. You should also consider whether or not you want to work with residents. Residents work in some community settings, too.”
An Academic Job Search
If you decide you want to work in an academic setting, you don’t have to go far to start your search. “I’d think you could start by talking to the head of your department and ask if they can look around and put in a word for you,” says Dr. Harris.
Mark V. Williams, MD, FACP, director of Emory Healthcare’s Hospital Medicine Unit in Atlanta and editor of The Journal of Hospital Medicine, will become chief of the new Division of Hospital Medicine at Northwestern Memorial Hospital in Chicago later this year. He recommends scoping out how a potential employer’s hospital medicine group is perceived and treated within the institution.
“People coming out of residency should look at the amount of support provided by the department of medicine for the hospital medicine group,” he says. “Are the hospitalists active members of the department, with key faculty in leadership positions such as residency or associate residency program director, or are they being hired just to deliver clinical care? Ask if there is funded support for hospital medicine research faculty. If not, the job may be just like working in a community setting, only community settings historically pay better.”
Signs that an institution has a strong commitment to the field include the presence of a division of hospital medicine, and possibly even a hospital medicine fellowship.
Questions to Ask
Even if you’ve got your eye on a specific hospital medicine group, go though the interview process at several institutions so that you can see what the market offers. Important factors to consider include:
Who would I work for? Who owns the hospital medicine practice? “There are differences in who’s sponsoring the group,” says Dr. Harris. “It may be independent, employed by the hospital, or a national group that contracts with the hospital. The answer will give you insights into the job. You may not get the entire picture, but you’ll get a clue.” Consider whether the practice can offer opportunities for advancement—possibly even partnership—and the type of clinical or administrative work you prefer.
What type of schedule would I work? How is the schedule arranged? Consider the number of hours you’d spend on call, and the number of nights and weekends you’d be expected to cover.
“Residents don’t have a sustainable schedule, so anything that’s not ridiculous sounds good,” warns Dr. Harris. “But a seven-on, seven-off shift is very tiring and can lead to burnout over time. So consider whether a given schedule is realistic for the long-term.” Find out how many vacation days are included—or if there are none.
What is the workload? During the interviewing process, ask about the average number of encounters per day. Definitely ask those “nitty-gritty” questions about patient load, admissions, and so on, advises Dr. Harris.
Pay special attention to the number of encounters. “Seeing 18 to 20 patients a day is a lot; those are the turn-and-burn organizations that aren’t necessarily sustainable,” says Dr. Panwala. “The money offered for this may be appealing to younger hospitalists. But remember, if you’re getting paid more, nothing is free.”
Dr. Harris adds, “Ask if that includes admissions and—if there’s critical care work—ask how many of those encounters are in critical care, because those patients will take more time.”
Michael-Anthony Williams, MD, regional CMO of Sound Inpatient Physicians in Denver, advises job seekers to look at “what they have to do” for the salary offered. “Look at … the number of days worked, the length of those days, and the number of encounters per day. You have to ask questions about these things, because the information isn’t necessarily going to be laid out in front of you.”
What about compensation and benefits? Your first consideration of salary, benefits, and other compensation should be to ensure the figures are in line with what the market offers. You can find general information on what hospitalists make from SHM’s “Bi-Annual Survey on the State of the Hospital Medicine Movement,” available at www.hospitalmedicine.org. The Medical Group Management Association (MGMA) and the Association of American Medical Colleges (AAMC) provide salary scales, and salaries for positions at public institutions like university hospitals are public information.
Do your homework, and then simply ask each interviewer what the salary range is for hospitalists. “It doesn’t put me off to have these discussions [on compensation and benefits] early on,” says Dr. Harris.
You may be tempted to choose a job based on salary—but be careful: “Don’t always look at the amount of money as the deciding factor,” says Dr. Badlani. “If a job offers $5,000 or $10,000 more, what are they expecting for that extra salary? And consider how much of that additional money will go to taxes.”
As you gather information on these areas, you’ll need to keep it straight. Dr. Harris advises you to create a simple system that allows you to compare hospital medicine practices you’re considering. “Come up with a chart and list out everything,” she says. “It’s going to vary considerably” from practice to practice, and you’ll need a method to compare one job possibility with another.
How the Process Works
Here is how the interviewing process is likely to flow: “Generally, people send me their resumes, then I’ll have a phone interview with the best candidates,” says Dr. Harris. “If that works out, the next step is that they’ll come in for a tour of the hospital and meet some of the other folks in the group.”
Candidates are invited to call or e-mail physicians in the group with questions; the group will decide which candidate to hire.
That face-to-face meeting with members of the group is essential. “Spend time with other hospitalists,” advises Dr. Badlani. “See what their daily work looks like, including what kind of patients you’ll be seeing.”
You should ask those hospitalists some of the same questions you’ve asked your main interviewer, including questions about schedule, workload, and compensation. “Talk to as many people in the practice as possible,” says Dr. Michael-Anthony Williams. “They’ll give you an honest answer.”
If you like what you see and the group likes you, you’ll get a job offer followed by a contract to sign. “When we extend an offer, they have time to determine what they want,” says Dr. Harris, explaining that she realizes a candidate may be faced with several job options. “When they say yes, we’ll extend a contract and begin the credentialing process.”
The process is not over at this point; you may be months away from your first day on the job. “You need to become credentialed for each hospital you’ll work at, and for the group,” explains Dr. Harris. “At our hospital, that can take three to four months—other places take around two months. Just so you know that you shouldn’t be looking for a job in June and thinking you’ll work in July.”
You’ll have a part to play in the credentialing process. There will be paperwork to fill out, and you’ll need to provide your diploma and medical license and letters of support. “The credentialing committee at our hospital won’t proceed until [all of this] is 100% complete,” says Dr. Harris.
Find a Good Fit
The most important factor to consider in taking a job is simply, are you a good fit for the group? Finding a good match for the group’s values and mission is crucial to the success of the organization and the new hire.
When you meet with hospitalists in the group, “Ask what the mission or values are of the group,” says Dr. Michael-Anthony Williams. “Do they know what their mission is—and is it coherent? Coherence will lend stability over time.”
Dr. Panwala stresses finding a “like-minded” group. “You’ll work with them day in and day out. If you don’t mesh well, you’re going to be miserable,” he says. “You turn your patient over to another hospitalist at 8 p.m., and when you come in the next morning, you take over someone else’s patients. It’s very much a marriage.”
What Interviewers Look For
Because its essential to find a good personality fit for a group, allow decision-makers to get a sense of who you are during the interview phase.
“It’s important to be honest about your values and about who you are,” says Dr. Harris. She believes that most hospital medicine directors look for candidates who are “actively interested in being a hospitalist—preferably for a long time,” for physicians who are team players, and for traits that include flexibility and responsibility.
“I look for someone who’s outgoing,” adds Dr. Mark Williams. “ I want a nice person—someone who’s willing to bend over backward to help others. I appreciate people who’ve won humanitarian awards in residency.”
There are also more basic traits you should display. “General etiquette is important,” stresses Dr. Harris. “Be prompt in your responses when using phone and e-mail. If you’re interested in the position, be engaged in the process. After you come in to the hospital, send a brief letter or a quick e-mail thanking the person and expressing your interest—or your lack of interest. This doesn’t have to be very formal.”
When interviewing candidates for academic hospitalist positions, Dr. Mark Williams says, “I look for residents who have won awards, who have laudatory letters of recommendation from their program director. I love letters that say this resident was in the top of their class, or the best we’ve seen in five years. I look for those who have done research, and those who published case report abstracts, which shows they’re industrious.”
Dr. Mark Williams also asks questions of candidates early in the process and listens carefully to their responses. “I especially look for good communication skills, which are so critical for hospitalists,” he says. “If someone has poor communication skills, they’ll have a tough time on the job.”
To determine their skills, “I’ll ask about their goals, and ask what they see as their weakness,” he says. “It’s very positive to see someone articulate their weaknesses.”
Before You Sign
When you’re presented with a contract, it’s time to take a close look at what’s being offered. “Before you sign anything, you need to come to an agreement with the other party in the contract that this is exactly what we agreed to. Otherwise, it’s no deal,” says Fred A. McCurdy, MD, PhD, MBA, FAAP, FACPE, professor and regional chairman of pediatrics, Texas Tech University Health Sciences Center at Amarillo. “Everything needs to be really specific in the offer letter or the contract—their duties, expectations—all clarified up front.”
Examine the benefits, including retirement and insurance. Ideally, you want disability insurance—and malpractice insurance with tail coverage is essential. (Tail coverage, also called extended reporting coverage, covers you after you leave a group in case a patient files a lawsuit years after the fact.)
Make sure you understand what the contract says, and make sure your employer doesn’t hold too much power. “Check to see if you can be assigned to areas of work that would be a deal-breaker—if you can be sent to another city or state to work, for example,” says Dr. McCurdy.
As a new physician, you do have some leverage to negotiate for better compensation or schedule. Dr. McCurdy says of recent residents, “The two biggest benefits they bring to the table are their youth and the fact that they’re current and up to date on what’s going on in [internal medicine]. They have energy, and they’ll bring energy to the program; and they’ve spent three years in intense study and have the most up-to-date knowledge of anyone you can hire.”
Point out these advantages to the right interviewer, and you may be able to negotiate.
Dr. Badlani encourages new hires to negotiate their moving expenses, bonuses, and malpractice insurance.
But keep in mind that not all hospital medicine programs can or will negotiate. “It’s quite variable,” admits Dr. McCurdy.
Dr. Harris’ program is a prime example. “In my experience, we don’t have a tremendous amount of negotiating,” she says. “Basically, we say, ‘Here’s the deal.’ ”
Dr. McCurdy advises having someone else read the contract for you. “When you’re enthusiastic about a new job, you don’t see everything,” he explains. “And you need to have a lawyer read it to make sure it’s a correctly constructed legal document.”
Dr. Harris simply advises that you “read through the contract with a fine-tooth comb. Does it have a non-compete clause that prohibits you from practicing in the region after you leave? You can find a job [locally] without this clause.”
Dr. McCurdy has allowed new hires to strike these clauses from their contracts, but it’s a trade-off. “Non-compete clauses are hard to enforce,” he acknowledges. “Our boilerplate contract has one, because we want to send the message that we don’t want to spend two years training you and then have you leave and go to work for the competition. So if [a candidate] wants to strike that clause from the contract, I’ll say that’s fine, but on the basis of that I’ll make it a binding three-year contract.”
What if, after researching, interviewing, reviewing the contract, and taking every step possible to ensure you get the best job, you find you’ve made a mistake? “Remember, your contract is only for one year,” Dr. Badlani points out. “You can always change next year if you don’t like your [first choice].” TH