Marching Into The Real World, Best Foot Forward

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Marching Into The Real World, Best Foot Forward

• Marianne Carim MD
• PGY3 Internal Medicine
• George Washington University Hospital

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Objectives

• A. Timetable
• B. Goals and Objectives
• Professional
• Economic
• Personal
• C. Finding Job Opportunities
• D. Preparing your CV/Cover letter
• E. Interviewing Process
• F. Contract Issues
• Malpractice Insurance
• Disability Insurance
• G. Locum Tenens

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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

4
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

5
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

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Ideal and Nightmare Scenarios

• Location
• Partnership track
• Type of common patient care activities
• Pace of office activity
• Extent of interaction with other MDs
• 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

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Personal Assessment

• Special family needs
• Partners 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

8
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

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Boils Down to .

• Must Have
• Negotiable
• Unacceptable

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Types of Practice Settings

• Solo Practice
• Group practices
• Established vs forming a new one
• Multispecialty vs single specialty
• Affiliated MDs vs space-sharing arrangement only
• Health Maintenance Organizations (HMOs)
• 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

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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 youve given (TR talks), papers
  youve written, poster presentations, or research
  assistance are fair game

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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

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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)

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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

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Reference Letters

• Crucial piece of application
• Usually get asked specifically for Chief
  Resident, Program Director, Attending
• What they say and dont 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

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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

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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!

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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

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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!!

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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 dont drink alcohol even if offered!

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Interviewers 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!!

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Evaluating the Opportunity

• Refer back to your goals and objectives
• Guidelines developed by American Society of
  Internal Medicine (ASIM)

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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

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Disability Insurance

• Definition
• Own-occupation
• Modified own-occupation
• 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

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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

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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/

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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!!

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Other Negotiable Issues

• Paid vacation
• CME
• Signing bonuses
• Moving expenses
• Yellow sheet items

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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

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Not sure what to do need more time!

• Consider
• Locum tenens
• Urgent care

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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

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Turning down other offers

• Dont 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

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Marching Best Foot Forward!Good Luck!!
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Thank You!

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

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References

• JABFP Vol 16 No. 3 A Physicians 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-peop
  le/member-groups-sections/resident-fellow-section/
  succeeding-medical-school-practice.shtml