Finding the right hospitalist position can help make the transition from resident to attending enjoyable as you adjust to a new level of responsibility. But the wrong job can leave you feeling overwhelmed and unsupported. So what is a busy senior resident to do? Here we offer selected pearls and pitfalls to help you find a great position.
Initial Steps and Things to Consider
Start applying in the fall of your PGY-3 year. The process of interviewing applicants, finalizing contracts, arranging for hospital privileges, and enrolling a new hire in insurance plans can take many months. Many employers start looking early.
Meet with your residency program director and your hospitalist group director to discuss your plans. They can help you clarify your goals, serving as coaches throughout the process, and they may know people at the places you are interested in. Recruiters can be helpful, but remember—many are incentivized to find you a position. Advertisements in the back of journals and professional society publications are useful resources.
Obtain your medical license as early as possible. Getting licensed in the state you will be working in can be much faster if you already have a license from another state. Applicants have lost positions because they didn’t have their medical license in time.
Don’t shop for a job based on schedule and salary alone. There are reasons some jobs pay better than most, and they aren’t always good (home call, for example). A seven-on, seven-off schedule affords a lot of free time, but while you are on service, family life often takes a back seat. Conversely, working every Monday to Friday offers less free time for travel or moonlighting.
Think about the care model you prefer. Do you want to work with residents, physician assistants, nurse practitioners, or in a “direct care” model where it’s just you and the nurses caring for patients? Salaries often are inversely related to the number of providers between you and the patients. Positions without resident support might require procedural competence. Demonstrating academic productivity, especially in the area of quality improvement or patient safety, can help you secure a position working with residents. Some programs first place new hires on the non-teaching service to earn the chance to work with residents and medical students.
Think about what type of career you want. Do you only want to see patients, or do you want a career that includes a non-clinical role for which you will be paid? Some hospitalists find that becoming a patient safety officer or residency program director, trying out a medical student clerkship, or growing into another administrative role is a great complement to their clinical time and prevents burnout.
How to Stand Out
Start off by getting the basics right. Make sure your e-mail address sounds professional. A well-formatted CV, with no spelling errors or unexplained time gaps, is a must. A cover letter that succinctly describes the type of position you are looking for, highlights your strengths, and does not wax on about why you wanted to become a doctor—that was your personal statement for med school—is helpful. Don’t correspond with employers using your smartphone if you’re prone to autocorrect or spelling errors, or if you tend to write too casually from a mobile device. Before you shoot off that immediate e-mail response, make sure you’re addressing people properly and not mixing up employers.
Join SHM (they have trainee rates!), and attend an SHM conference or local chapter meeting if you can (www.hospitalmedicine.org/events). SHM membership reflects your commitment to the specialty. Membership in other professional societies is a plus as well.
Quality improvement (QI), patient safety, and patient satisfaction are central to hospital medicine. Medication reconciliation, infection control, handoff, transitions of care, listening carefully to patients, and explaining things to them are likely things you’ve done throughout residency. Communicate to employers your experience in and appreciation of these areas. Completing a QI or patient safety project and participating on a hospital committee will help make you a competitive applicant.
Interview Do’s and Don’ts
The advice most were given when applying to residency still holds. Be on time, dress professionally, research the program, and be prepared to speak about why you want to work at a particular place. Speak to hospitalists in the group, and be very courteous to everyone.
Don’t start off by asking about salary—if you move along in the process, compensation will be discussed. Get a clear picture of the schedule and how time off/non-clinical time occurs, but don’t come off as inflexible or too needy.
Ask why hospitalists have left a group. Frequent turnover without good reason could be a red flag. If the hospitalist director and/or department chair are new or will be leaving, you should ask how that might affect the group. If the current leadership has been stable, ask what growth has occurred for the group overall and among individuals during their tenure.
Find out whether hospitalists have been promoted academically and if there are career growth opportunities in areas you are interested in. Try to determine if the group has a “voice” with administration by asking for examples of how hospitalist concerns have been positively addressed.
Having a clear picture of how much nursing, social work, case management, subspecialist, and intensivist support is available is critical. Whether billing is done electronically or on paper is important, as is the degree of instruction and support for billing.
Take the opportunity to meet the current hospitalists—and note that their input often is solicited as to whether or not to hire a candidate—and ask them questions away from the ears of the program leadership; most hospitalists like to meet potential colleagues.
Closing the Deal
If you make it past the interview stage, be sure additional deliverables, such as letters of recommendation, are on time. Now is the time to ask about salary. Don’t be afraid to inquire about relocation or sign-on bonuses. At this point, the employer likes you and has invested time in recruiting you. You can gently leverage this in your negotiations. Consult your program director or other mentors at this point—they can provide guidance.
If you are uncertain about accepting an offer, be open about this with the employer. Your honesty in the process is essential, will be viewed positively, and can trigger additional dialogue that may help you decide. Juggling multiple offers dishonestly is not ethical and can backfire, as many hospitalist directors know each other.
Have an attorney familiar with physician contracts review yours. Look at whether “tail coverage,” which insures legal actions brought against you after you have left, is provided. Take note of “non-compete” clauses; they may limit your ability to practice in the area if you leave a practice. Find out if moonlighting is allowed and if the hospital requires you to give them a percentage of your outside earnings.
If you secure a position, whether as a career hospitalist or just for a year or two before fellowship, you should be excited. HM is a wonderful field with tremendous and varied opportunities. Dive in, enjoy, and explore everything it has to offer!
Dr. Bryson is medical director of teaching services, associate program director of internal medicine residency, and assistant professor at Tufts University, and a hospitalist at Baystate Medical Center in Springfield, Mass. Dr. Steinberg is residency program director in the Department of Medicine at Beth Israel Medical Center, and associate professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City. Both are members of SHM’s Physicians in Training Committee.