2013 june crossing the_finish_l_ine

Crossing the Finish LineCrossing the Finish LineWhat to expect and What to expect and

How to prepare for the job How to prepare for the job searchsearch

Mila Felder, MDMila Felder, MDCredits to multiple ACEP, SAEM presentations and Credits to multiple ACEP, SAEM presentations and

multiple Christ faculty membersmultiple Christ faculty members

Faculty DisclosureFaculty Disclosure

I do not have any relevant financial I do not have any relevant financial relationship(s) with any commercial relationship(s) with any commercial

interest(s).interest(s).

Goals and ObjectivesGoals and ObjectivesAfter this lecture, the resident should be able to:After this lecture, the resident should be able to:

• DiscussDiscuss– The timeline and necessary licensure/ The timeline and necessary licensure/

credentials/ costs involved (handout)credentials/ costs involved (handout)– Initial steps in the job searchInitial steps in the job search– CV overviewCV overview– Evaluating opportunities (and options)Evaluating opportunities (and options)

• Preview : FinancialPreview : Financial• Attending tips for the first years out of Attending tips for the first years out of

trainingtraining

What We Are Not Going to Talk What We Are Not Going to Talk About TodayAbout Today

– Interviewing well Interviewing well – Living through your first litigationLiving through your first litigation– Extensive Financial planning Extensive Financial planning – Initiating a successful business practiceInitiating a successful business practice– Wellness Wellness – Careers in Academic EMCareers in Academic EM

What do I do Now?What do I do Now?• Obtain extra copies of medical school Obtain extra copies of medical school

diplomas diplomas – 1-2 weeks : YESTERDAY… YOU MEAN YOU 1-2 weeks : YESTERDAY… YOU MEAN YOU

HAVEN‘T?HAVEN‘T?• Print out and fill out USMLE III application Print out and fill out USMLE III application

(or online)—combined with IL License (or online)—combined with IL License application in some states, including IL: application in some states, including IL: – 4-6 weeks to register/ schedule and 4-6 weeks 4-6 weeks to register/ schedule and 4-6 weeks

for results. Do not stress about the test. for results. Do not stress about the test.

And Later?And Later?• License processing fee to Springfield: 8 weeks License processing fee to Springfield: 8 weeks

and $700.00. and $700.00. – Locums will pay for states they send you toLocums will pay for states they send you to

• State Physician-controlled Substance License State Physician-controlled Substance License $5.00 and up to 8 weeks$5.00 and up to 8 weeks

• DEA application 6 weeks and $751.00DEA application 6 weeks and $751.00• Apply for NPI number (on line, a few minutes, Apply for NPI number (on line, a few minutes,

free)free)• Talk to your potential references, ask to Talk to your potential references, ask to

prepare letters in advanceprepare letters in advance

Send in a Picture you Identify Send in a Picture you Identify withwith

• Seniors: when your ABEM paperwork Seniors: when your ABEM paperwork arrives in April-May, send it in ASAParrives in April-May, send it in ASAP– Registration for Boards $355.00 (Apr-Jun30)Registration for Boards $355.00 (Apr-Jun30)– Written exam registr. $960.00 (June-Oct.)Written exam registr. $960.00 (June-Oct.)– Nov 11-17 Qualifying (written)exam Nov 11-17 Qualifying (written)exam – Oral Board Exam May $1225.00Oral Board Exam May $1225.00

• Staff privileges application $100.00 and Staff privileges application $100.00 and up; save IL State Healthcare Provider up; save IL State Healthcare Provider Application DataApplication Data

Totals?Totals?• $4000-5000, without the travel $4000-5000, without the travel

expensesexpenses• 4-7 months, depending on the state 4-7 months, depending on the state

applied forapplied for

I have a license, but no job. I have a license, but no job. Now what?Now what?

• Prepare CV and customize it Prepare CV and customize it • Find 1-2 geographically desirable Find 1-2 geographically desirable

recruitment firmsrecruitment firms• Window shop (and follow-up)Window shop (and follow-up)• Learn the market (network)Learn the market (network)• Go on “practice interviews”Go on “practice interviews”• Think of what you are bringing to Think of what you are bringing to

practicepractice

Where do I Start?Where do I Start?• Write out your dream: Write out your dream:

– cases, type of practice, lifestyle, group cases, type of practice, lifestyle, group size, patients per day, on call?size, patients per day, on call?

• Ideally, where do you want to be?Ideally, where do you want to be?– Geography/ weather/ family/ social goalsGeography/ weather/ family/ social goals

• Community with greater need Community with greater need (problems) with offer more money. (problems) with offer more money. – If that’s what you want, prepare to If that’s what you want, prepare to

sacrificesacrifice

What if I don’t love it?What if I don’t love it?• Remember ACEP, EMRA, SAEM, Remember ACEP, EMRA, SAEM,

recent graduates and networkingrecent graduates and networking• First job (or any job) does not have to First job (or any job) does not have to

be foreverbe forever– 43% of physicians that start a job are no 43% of physicians that start a job are no

longer there after 2 years.longer there after 2 years.– This may be a learning experience and This may be a learning experience and

is good as thatis good as that

Mechanics of a Job SearchMechanics of a Job Search• What are my goals?What are my goals?• How do I want to be compensated?How do I want to be compensated?• Do I want ownership?Do I want ownership?• Where will I be happy (geography)?Where will I be happy (geography)?

FORCEFORCE

•FFamily satisfaction with location/ lifestyleamily satisfaction with location/ lifestyle•OOpportunity to become a partner and earn pportunity to become a partner and earn

compensation based on individual effortcompensation based on individual effort•RReasonable working conditionseasonable working conditions•CCamaraderie with co-workersamaraderie with co-workers•EEquity from day one with shift assignment quity from day one with shift assignment

and incentivesand incentives

Goals for the DayGoals for the Day• Mechanics of a job searchMechanics of a job search• Preparing a CVPreparing a CV• Identifying your goalsIdentifying your goals• Evaluating a potential offerEvaluating a potential offer

Mechanics of a Job SearchMechanics of a Job Search• Most residents use one of the Most residents use one of the

following:following:– Residency search (who do I know here?)Residency search (who do I know here?)– Hometown search (who do I want near Hometown search (who do I want near

me?)me?)– ““Guess where I’ll live” Guess where I’ll live”

Mechanics of a Job SearchMechanics of a Job Search• 74% of all residents rate location as 74% of all residents rate location as

#1 priority#1 priority• 14% compensation14% compensation• 11% type of group11% type of group

Mechanics of a Job SearchMechanics of a Job Search• Over 50% change jobs after first yearOver 50% change jobs after first year• Most of these moves are PHYSICIAN’s Most of these moves are PHYSICIAN’s

CHOICECHOICE

Geography of a SearchGeography of a Search• CollegeCollege• Medical SchoolMedical School• ResidencyResidency• NOW, YOU CHOOSENOW, YOU CHOOSE

Mechanics of a Job SearchMechanics of a Job SearchIt’s NOT a job search…It’s NOT a job search…

It’s the beginning of yourIt’s the beginning of yourCAREER!CAREER!

Mechanics of a Career Mechanics of a Career SearchSearch

How do other professionals evaluate How do other professionals evaluate opportunities?opportunities?

• National recruiting and staffing firmsNational recruiting and staffing firms• Many different methods, depending Many different methods, depending

on a level of an employeeon a level of an employee• Choose a consistent process to Choose a consistent process to

increase chance of successincrease chance of success

ScorecardScorecard• IndustryIndustry• CompanyCompany• Claim to fameClaim to fame• Job descriptionJob description• TrainingTraining• Typical dayTypical day• CompensationCompensation• Growth opportunityGrowth opportunity

IndustryIndustry• AT&T Wireless:AT&T Wireless:

– $400 billion annually, quadrupled since ’98$400 billion annually, quadrupled since ’98– Projected ONE OF THE FASTEST growth Projected ONE OF THE FASTEST growth

industries over 10 yearsindustries over 10 years– Profitable, stable, very fast growingProfitable, stable, very fast growing– Dominated by a few providersDominated by a few providers– Dynamic present growth is predicted to Dynamic present growth is predicted to

continue for at least 2 decadescontinue for at least 2 decades

CompanyCompany• AT&T $150 billion market valueAT&T $150 billion market value• Merger with Cingular added up to $85 billionMerger with Cingular added up to $85 billion• New market leader with 29% share (Verizon 24, New market leader with 29% share (Verizon 24,

Sprint 10, T Mobile 9, Nextel 8)Sprint 10, T Mobile 9, Nextel 8)• Up from $5 billion in ’98Up from $5 billion in ’98• 3 main sales channels: stores, business to 3 main sales channels: stores, business to

business sales, national/ government salesbusiness sales, national/ government sales• Proactive competitive corporate cultureProactive competitive corporate culture

Claim to fameClaim to fame• Ranked #1 by JDPower for 5 conseq Ranked #1 by JDPower for 5 conseq

yearsyears• Outstanding brand name awarenessOutstanding brand name awareness• Excellent quality cell phonesExcellent quality cell phones• Excellent call coverage (doubled with Excellent call coverage (doubled with

Cingular)Cingular)• Competitive pricing, one stop shoppingCompetitive pricing, one stop shopping• Global organization, variety of servicesGlobal organization, variety of services

Opportunity ScorecardOpportunity Scorecard• IndustryIndustry• CompanyCompany• Claim to fameClaim to fame• Job DescriptionJob Description• TrainingTraining• Typical dayTypical day• CompensationCompensation• Growth opportunityGrowth opportunity

Scorecard: Scorecard: Location not a variableLocation not a variable• Sacrifice salary if location is more Sacrifice salary if location is more

importantimportant• Location is the primary concern for Location is the primary concern for

lower level occupationslower level occupations• Midlevel occupations use location as Midlevel occupations use location as

tie breakertie breaker• executive rarely consider itexecutive rarely consider it

Emergency Medicine Emergency Medicine OpportunityOpportunityScorecardScorecard• Industry: Emergency MedicineIndustry: Emergency Medicine• Company—history, structure, track Company—history, structure, track

recordrecord• Growth opportunity—directorship, Growth opportunity—directorship,

leadershipleadership• Training—orientation, mentorshipTraining—orientation, mentorship

Emergency Medicine Emergency Medicine Opportunity Opportunity Scorecard (continued)Scorecard (continued)• Compensation—salary, benefits, Compensation—salary, benefits,

retirement, equityretirement, equity• Typical Day-Shifts, scheduling, acuityTypical Day-Shifts, scheduling, acuity• Job description—position availableJob description—position available• Location—just one variable, not a key Location—just one variable, not a key

issueissue

Scorecard, continuedScorecard, continued• Industry-Emergency MedicineIndustry-Emergency Medicine• Typical day: shift work (how long? Typical day: shift work (how long?

Acuity?)Acuity?)• Job description—take care of sick or Job description—take care of sick or

not so sick, academic vs community not so sick, academic vs community practicepractice

Mechanics of a Career SearchMechanics of a Career SearchCompanyCompany• Hospital EmployeeHospital Employee• AcademicsAcademics• Single hospital groupSingle hospital group• Multi-hospital groupMulti-hospital group• Equity vs. No equityEquity vs. No equity

Site Specific IssuesSite Specific Issues• Ask to talk to other physiciansAsk to talk to other physicians• Talk to the last partnerTalk to the last partner• Talk to last non-partnerTalk to last non-partner• Talk to people who have left the Talk to people who have left the

companycompany• What is a partner?What is a partner?

Growth OpportunityGrowth Opportunity• How long can you do clinical How long can you do clinical

medicine?medicine?• Leadership opportunities?Leadership opportunities?• Is the company growing?Is the company growing?• Track others and ask for examples of Track others and ask for examples of

leadership advancementleadership advancement

Training: this is not my last job,Training: this is not my last job,what can I learn here?what can I learn here?• OrientationOrientation• Ongoing clinical educationOngoing clinical education• Coding/documentation feedbackCoding/documentation feedback• Mentors—Clinical? Administrative? Mentors—Clinical? Administrative?

Academic?Academic?

Mechanics of a Career searchMechanics of a Career searchClaim to FameClaim to Fame• Leader in the area (best residency? Leader in the area (best residency?

Best income? Most fair?)Best income? Most fair?)• Company reputation (history behind Company reputation (history behind

the name)the name)• Any awards or recognitionAny awards or recognition• Unmatched employee satisfaction? Unmatched employee satisfaction?

Retention?Retention?

Mechanics of a Career Mechanics of a Career SearchSearch

• Don’t fall for the upfront dollarsDon’t fall for the upfront dollars• Look at 10 years projections for Look at 10 years projections for

yourself and the companyyourself and the company• Compare apples to applesCompare apples to apples

LocationLocation• Pick a region of the countryPick a region of the country• Be flexible within the regionBe flexible within the region• Be willing to relocate for an Be willing to relocate for an

opportunityopportunity

How important is it?How important is it?• 17 shifts/ month17 shifts/ month• 13-14 days off13-14 days off• 60-120 min from prime locations60-120 min from prime locations

LocationLocation• Spouse’s opinionSpouse’s opinion• Spouse’s jobSpouse’s job• Social settingSocial setting• Children’s educationChildren’s education

LOCATION SHOULD BE A TIE LOCATION SHOULD BE A TIE BREAKER!!!BREAKER!!!

Emergency Medicine Emergency Medicine ScorecardScorecard• Industry: Emergency MedicineIndustry: Emergency Medicine• Company—history, structure, track recordCompany—history, structure, track record• Growth opportunity—directorship, leadershipGrowth opportunity—directorship, leadership• Training—orientation, mentorshipTraining—orientation, mentorship• compensation—salary, benefits, retirement, compensation—salary, benefits, retirement,

equityequity• Claim to fame—proud to wear logoClaim to fame—proud to wear logo• Job description—position availableJob description—position available• Location—just one variable, not a key issueLocation—just one variable, not a key issue

The DealThe Deal• Basics – CompensationBasics – Compensation• Production basedProduction based• Salary plus productionSalary plus production• Salary plus bonusSalary plus bonus• BenefitsBenefits• Malpractice coverage – claims made, Malpractice coverage – claims made,

occurrence and tail coverageoccurrence and tail coverage

Give it timeGive it time• Look at resources: ACEP, EMRA, AAEMLook at resources: ACEP, EMRA, AAEM• Like in marriage, both need to adjustLike in marriage, both need to adjust• Discuss with your mentor(s) and peersDiscuss with your mentor(s) and peers• Go prepared: things to do before 1Go prepared: things to do before 1stst shift shift• Maintain outside lifeMaintain outside life• Stay in touch!Stay in touch!

Frustrations of early Frustrations of early attending years, anonymousattending years, anonymous

Not being able to spend my new Not being able to spend my new wealth fast enough wealth fast enough Learning to suffer foolsLearning to suffer fools

What if it’s still not right?What if it’s still not right?• Emergency Emergency

Department DirectorDepartment Director• Physician working in Physician working in

freestanding urgent freestanding urgent care unit care unit

• Director, Multi-Director, Multi-hospital emergency hospital emergency medicine groupmedicine group

• Chief Researcher, Chief Researcher, University of University of Michigan, Division Michigan, Division of Emergency of Emergency Medical ServicesMedical Services

• Physician on a Physician on a cruise shipcruise ship

• Medical Director, Medical Director, EMS SystemEMS System

• Director, State Director, State Department of Department of Public HealthPublic Health

• President, President, American College American College of Emergency of Emergency PhysiciansPhysicians

• Injury control Injury control expert at NHTSAexpert at NHTSA

• Health Policy Health Policy Fellow, Robert Fellow, Robert Wood Johnson Wood Johnson FoundationFoundation

• Undersecretary for Undersecretary for Veteran's Health Veteran's Health AffairsAffairs

• Governor, State of Governor, State of OregonOregon

• Volunteer, Doctors Volunteer, Doctors without Borderswithout Borders

• Director of Medicare Director of Medicare Part B, Regional Part B, Regional Insurance CompanyInsurance Company

• Book author, ERBook author, ER• Executive Director, Executive Director,

Professional SocietyProfessional Society• TV Health AdvisorTV Health Advisor

• Director, QIO (Quality Director, QIO (Quality Improvement Improvement Organization), State of Organization), State of OhioOhio

• Venture Capital Venture Capital Specialist, HealthcareSpecialist, Healthcare

• Vice President for Vice President for Medical Information, Medical Information, WebMDWebMD

What Else is There?What Else is There?• Evaluating offer/contractEvaluating offer/contract

– Ask resources/mentor(s)Ask resources/mentor(s)– Extra documents availableExtra documents available

• Financial PlanningFinancial Planning– Saving/ investingSaving/ investing– Paying off loansPaying off loans– Starting practiceStarting practice– InsuranceInsurance

• BillingBilling

• Malpractice PrepMalpractice Prep• Other options?/Job Other options?/Job

Specific searchSpecific search• Careers within EM and Careers within EM and

FellowshipsFellowships• Starting and running a Starting and running a

businessbusiness• Wellness: tomorrow Wellness: tomorrow

and beyondand beyond

Key PointsKey Points• Simple CVSimple CV• Think about this as a career choice, Think about this as a career choice,

with 10 year projectionswith 10 year projections• Use leverage to maximize your tax Use leverage to maximize your tax

free savingsfree savings• Location should be one variable!Location should be one variable!

Getting startedGetting started• Sit down and identify your goalsSit down and identify your goals• Get out on the floor this weekGet out on the floor this week• Look at a minimum of 3-4 jobsLook at a minimum of 3-4 jobs• Try to get it right the first timeTry to get it right the first time

Remember,Remember,• Most residents will secure a job in the Most residents will secure a job in the

first quarter of the final yearfirst quarter of the final year• GOOD JOBS ARE ALWAYS AVAILABLE GOOD JOBS ARE ALWAYS AVAILABLE

FOR GOOD DOCTORS. ANYTIME OF FOR GOOD DOCTORS. ANYTIME OF THE YEAR. IT’S NEVER TOO LATE THE YEAR. IT’S NEVER TOO LATE AND NEVER TOO EARLYAND NEVER TOO EARLY

Questions?Questions?

YOU ARE IN THE DRIVER’S SEATYOU ARE IN THE DRIVER’S SEAT

GOOD LUCK!!!GOOD LUCK!!!