MARCHING INTO THE REAL WORLD, BEST FOOT FORWARD

Marianne Carim MDPGY3 Internal Medicine

George Washington University Hospital

OBJECTIVES

A. TimetableB. Goals and Objectives

ProfessionalEconomicPersonal

C. Finding Job OpportunitiesD. Preparing your CV/Cover letterE. Interviewing ProcessF. Contract Issues

Malpractice InsuranceDisability Insurance

G. Locum Tenens

TIMETABLE FOR SELECTING PRACTICE OPPORTUNITIES

12-18mos: define goals and objectives Prepare CV Research practice opportunities

7-10mos: Begin the interviewing process 6-9mos:

Conduct second interview Revisit new community Evaluate the opportunity

4-6mos: choose your practice

SETTING GOALS AND OBJECTIVES

Most important step: setting clear realistic goals

Define what your are looking for in professional and personal life

Design a plan

PROFESSIONAL ASSESSMENT

Strengths Greatest achievements and with what skills? What does patient care mean to me? Define your ideal patient population Importance of clinical interactions with

physician colleagues? Pen and paper!! Practice discussing them

IDEAL AND NIGHTMARE SCENARIOS Location Partnership track Type of common patient care activities Pace of office activity Extent of interaction with other MD’s Staff management responsibilities Total hours and on call hours required per week Technology Compensation Teaching and research opportunities Advancement opportunities Other non-patient care activities required Career/financial security Competition Reputation

PERSONAL ASSESSMENT

Special family needs Partner’s career aspirations Rural vs urban location Cost of living/house pricing Community support (religion, education,

healthcare) Recreation/culture/arts Climate and transportation (public, commute

patterns, airport access Crime rate

ECONOMIC ASSESSMENT

Define your financial position How does my economic situation influence the options Relocation expenses Know what benefits are important for me

Know your budget to know income requirements Know your loan policies. Call them often! When

do you start paying? Are you consolidated? Consider paying interest which may have accrued during residency

before it capitalizes. Are there benefits to direct debit or paying on time? Advantages to paying early?

Lowest salary figure to live comfortably Life/health/disability insurance and levels

needed

BOILS DOWN TO ….

Must Have Negotiable Unacceptable

TYPES OF PRACTICE SETTINGS Solo Practice Group practices

Established vs forming a new one Multispecialty vs single specialty Affiliated MD’s vs space-sharing arrangement only

Health Maintenance Organizations (HMO’s) Urgent Care Industrial/occupational medicine Health insurance company Administrator Federal/state/local government (VA, PHS, Military,

Licensures, disability determination) Medical research centers (universities, private centers,

government agencies) Hospital-based medicine Locum Tenens

PREPARING YOUR CV – SIMPLE GUIDELINES

DO NOT include: DOB, SS#, DEA#, pictures

Explain any time gaps

Use “active” words, be grammatically consistent Highlight achievements, explain what is not

obvious Highlight leadership roles as separate from

participation

Any lectures you’ve given (TR talks), papers you’ve written, poster presentations, or research assistance are fair game

PREPARING YOUR CV - OUTLINE Education Licensure and Certifications Professional Experience Professional Societies/Memberships Honors and Awards Second Language Skills Personal Interests Publications/Presentations• You can consider Hobbies/interests to make you

more interesting, but this is not typically done on medical CVs

PREPARING YOUR CV – LAST POINTS Consider more than one version if

applying for different types of jobs to highlight different things

Have someone you trust in and outside of medicine read it

Save it as a PDF file, not just on Microsoft. If you email it to folks in the future, always

send the PDF file (This eliminates layout problems)

COVER LETTER

Essential part of CV package Can set you apart One page Includes:

Name and address of prospective employer Date Include how you heard about the opportunity Brief paragraph End with call to action, ask them for more

information about the practice Sign your name and make sure to include your

address and information in case cover letter separated from CV

REFERENCE LETTERS

Crucial piece of application Usually get asked specifically for Chief

Resident, Program Director, Attending What they say and don’t say is very

important Be sure to ASK FOR PERMISSION and alert

your references of requests Be mindful:

Reference should be able to give specific examples about job performance and social skills

Employers are looking for physicians that are known for their great relationships with patients and staff

CREDENTIALING FILE Copy of vaccinations (tetanus, hep B and titres, MMR, varicella

illness or vaccine) Copy of last PPD within one yr (if positive, cxr) Copy of medical school diploma Copy of Residency diploma Copy of ABIM certificate Copy of DEA certificate Copy of all state licenses (even expired ones) and copy of

license application List of dates you were at all schools (undergrad, med, other)

and training programs, and phone # or address where you can get proof/transcripts

Copy of CV Professional references: 3 names and phone #s copy of USMLE scores NPI# Copy of CPR/ACLS certification cards Copy of all CME credits as you take them

FINDING PRACTICE OPPORTUNITIES Internet primary source Specialty journals, newsletters, direct mailings Job fairs and specialty conventions Networking with friends/colleagues from previous

years Search Firms In House Recruiters: permanent basis for

hospitals and medical groups **Know any docs in that city? Ask your attgs!!** Send CVs even if no openings: call and ask for

appropriate contact, can email, fax, mail

It is up to YOU to manage your career search!

INTERVIEWING STRATEGIES

First appearances ARE important Presentation:

Wear a suit. Wear nice shoes. Average doc looks like your dad (Wear something your dad would

like!)

Ask in advance who you will be interviewing with and Google them!

Google yourself! Bring copies of your CV and be prepared to talk about

EVERYTHING on it Have questions prepared

INTERVIEWING STRATEGIES

Ask the right questions of the right people: nuts and bolts questions probably answered by a chair or

person in charge of hiring day to day questions probably answered by other docs. Some docs will be put-off if you ask about salary/hours!

Consider writing notes: Jot down something you discussed with each person so you

can thank them and reference it! Get business cards/contact info from everyone you meet with

Send thank you letters/cards or emails to everyone you met with. Offer to give them professional references Ask what the next steps are and when you should expect to hear

from them!!

INTERVIEW LOGISTICS

Cover travel, lodging and even meal expenses at times

Significant other can accompany you to location

Long days - meeting most staff and most partners

Spend evening with partners and their spouses with your significant other if applicable

Few pointers: don’t drink alcohol even if offered!

INTERVIEWER’S CRITERIA Training program and skills 20% focus on technical skills 80% on social skills, goals and objectives and

behavioral characteristics Questions regarding career goals, conflict resolution

skills, ideal practice, medical philosophy, other practices, salary

Criteria to be evaluated: Communication skills Maturity Adaptability Motivation Work orientation Organization Judgment

Be true to yourself!!

EVALUATING THE OPPORTUNITY

Refer back to your goals and objectives

Guidelines developed by American Society of Internal Medicine (ASIM)

MALPRACTICE INSURANCE Claims-made Occurrence-made Tail coverage: necessary for claims-made

One time fee 1.5 – 2 x annual malpractice insurance premium 50% of practices provide it

Nose coverage Know your coverage and ensure that it is adequate

Pure loss vs ultimate net losses Lost wages Services provided

Premiums Exclusions: ex. Defense costs, deductible, third

party

DISABILITY INSURANCE Definition:

1. Own-occupation2. Modified own-occupation3. Any occupation

usually coverage to equal approximately 60% of earned income

Max monthly benefit $15,000 Premium rates Renewability Provision:

Guaranteed renewable Non-cancelable and guaranteed renewable

Residual Disability Rider: if greater than 20% loss of income

RESTRICTIVE COVENANTS

Also known as Non-Compete Clause Protect the practice that hires you Laws and norms vary state to state 2 main aspects:

Duration Restricted area

Termination and leaving practice Grace Period

UNDERSTANDING CONTRACT TERMS Salary Non-salary benefits Ownership/partnership Outside Activities Duties and Requirements Restrictive Covenant Non-solicitation clauses Term and Termination Gap/Tail insurance

http://www.acponline.org/running_practice/practice_management/human_resources/

NEGOTIATING THE CONTRACT

Gather information and be prepared Treat people with respect Negotiate from the perspective of mutual

benefit and fairness Set priorities Develop a strategy

Easy points first, hardest issue midway Know your practice to know the easy points Conclude with light ones

Goal to have a win-win solution!!

OTHER NEGOTIABLE ISSUES

Paid vacation CME Signing bonuses Moving expenses Yellow sheet items

A LAST LOOK AT THE CONTRACT Get a lawyer! Term:

1 to 2 yrs Cancellation partnership

Duties: Forbidden issues Moonlighting Teaching Call

Salary and Benefits Base salary, incentives, bonuses

Final issues

NOT SURE WHAT TO DO – NEED MORE TIME!

Consider: Locum tenensUrgent care

LOCUM TENENS Definition: Substitute physician or “one holding

the place” 4-15% of physicians worked LT Great way to experience “risk-free” the lifestyles

associated with various geographic locations 26 recruiting firms that provide placement

services National Association of Locum Tenens Malpractice insurance - priority task

30% basic claims-made malpractice insurance without tail coverage

Very competitive salary – but for a reason! No Health Insurance, no sick days, taxes are as an

independent contractor (tax 1099), no “vacation”

TURNING DOWN OTHER OFFERS

Don’t burn any bridges – you might want that job next time!

Be honest, tell them as soon as you know Best to do this by telephone

MARCHING BEST FOOT FORWARD!GOOD LUCK!!

THANK YOU!

Resident GME Committee Dr. Catalanotti Jeffrey Pecore, Esq James Doherty Jr, Esq Dr. Jim Fitzpatrick Maureen McCarthy, CPA

REFERENCES

JABFP Vol 16 No. 3 A Physician’s Guide to Working as a Locum Tenens

ACP website http://www.acponline.org/residents_fellows/

career_counseling/guidance.htm AMA website http://www.ama-assn.org/ama/pub/about-

ama/our-people/member-groups-sections/resident-fellow-section/succeeding-medical-school-practice.shtml