So You Want A Job…

So You Want A Job… Joe Sexton, MD Lehigh Valley Hospital and Health Network

I do not want to do research I want at least $270,000 I want to do nights I’ll work 65 hours a week. I want to pay off my loans. I need to be near the water I don’t know where to start ! Finally I can get that BMW I need to travel I want to be just like Dr. Sexton I want to be a director someday What is an independent contractor? I don’t want to work any weekends Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job…. • Myths / Mistakes • Being a doctor will make you rich • Buying the huge house and car if you have loans • Buying a house before you work there (careful) • Working 70 hrs a week for three years to pay back your loans • Not having financial education Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Realities • You will probably work half the weekends the rest of your life • You will work half the holidays the rest of your life • Your schedule is usually very flexible • Niches are great, but also lock you in. • You can work anywhere you want in the US • You most likely will rarely be on call Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A job… • Realities • You will work with great docs • You will work slugs • Residents can save you or kill you • Get to know residents before you give them autonomy • Contracts are not always as negotiable as the books tell you • You won’t be able to take most deductions that the rest of the world gets for tax purposes Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… Mind searching Job searching Joe Sexton, MD Lehigh Valley Hospital and Health Network

Mind searching 1.What do you want in life 2.What do you need in life (Finances, etc) 3. Discuss the above with your significant other 4. What type of EM job do you want - short/long term Job searching 1.Prepare your CV 2.Job Searching Time 3. Interviewing 4. Contract reviewing So You Want A Job… Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… MIND SEARCHING Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Mind Searching • Priorities in life • Geographical area • Finances • Assets – Liabilities = Net Worth • Significant Other • What type of job do you want Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • MIND SEARCHING • Decide what type of ED job you want • Pace • Setting • Level of care/type of hospital • Academic job (usually hospital employee) • Teaching • Administration • Research • Clinical Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • MIND SEARCHING • Decide what type of ED job you want • Purely Clinical • Group member (or start your own group) • Hospital Employee • Independent Contractor • Open your own urgent Care Center Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… JOB SEARCHING 1. CV 2. Job Search 3. Interview 4. Contract Review Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Preparing your CV • Prepare your CV according to your job type • Yourself • Agency • Always Chronological with each section Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • What should be in a resident’s CV • GENERAL RULES • WHITE PAPER • Put degrees behind your name! • Font no smaller than 12 • Beginning and end dates (or present) for everything – no gaps from undergrad on • Put city and state for all institutions Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Sections – preferably in this order • Training and Education • Professional Experience • Additional Work Experience • Certification and Licensure • Research and Publications (can use Professional Activities if not enough) Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Sections in this order (cont) • Awards and Honors • Professional Memberships • Personal (Marital status,kids,spouse,hobbies, ties to the area). Most can be discussed in an interview. • No references-Put “References available upon request”. Have a separate piece of paper available with all contacts, their institutions, correct addresses and phone numbers Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Job searching • Sources to start • Your geographic area hospitals • Your residency hospital • Multiple ED magazines • Various ED organization publications • Recruiters • Online job search sites • Word of mouth Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Job Searching • ALWAYS keep in mind your priorities, ie, type of job, area, etc. from your MIND SEARCHING results • Will save you a LOT of time, money and stress Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Job Searching • Know what minimum salary you would accept ($150k-$400+) • TOTAL COMPENSATION “Package” • All salary, benefits, malpractice • MUST ask what is included in the package • Actual salary and bonuses • If it seems too good to be true, it might be true but it more than likely is not good Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… No blind CV mailings! You’re wasting your time. Look up the hospitals in your preferred area that you may think fit your priorities • Make a checklist and fill in all areas for each place • CALL the directors of the ED’s directly Joe Sexton, MD Lehigh Valley Hospital and Health Network

Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • What do you say when you call? • State who you are and where in your career you are – do you have a minute • Why you are calling-interested in the area, looking for possible employment if they have OR foresee any in the near future • Sometimes they will direct you to more appropriate hiring source, ie. human resources, recruiter Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Ask, if there are openings, would they mind if you sent them a CV and HOW they want you to send it. Ask if they use a recruiter (or does the hospital), or should you send it directly to them. • Use a brief cover letter separate from your CV. Remind them of your brief phone conversation, and your interest. Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • A word about RECRUITERS !! • Rule number one – finish all mind searching tasks before even calling them, or they will mind search for you. KNOW EXACTLY WHAT YOU WANT BEFORE YOU UTILIZE THEM • Their job should be to find a job that fits into what you want, not figure out what type of job you want • Can save you a lot of leg work in an unfamiliar area. • Some places have hired recruiters to find them docs, and they will defer you to them, so they get paid. That’s fine. Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • A word about recruiters • They get paid ONLY if you sign a contract • They will be pushy to get you an interview • Best advice - get ALL the information about the job BEFORE you accept the interview. Don’t waste your time interviewing places that don’t fit what you want. • Make sure the director reviews your CV before you get an interview Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • A word about recruiters • You should always speak to a director at some point before your interview • Recruiters RARELY tell you the negatives – or act like they don’t know about that particular issue • They are NOT to speak with your significant other on the phone • Each recruiter only covers a specific geographical area for their firm • They do NOT know specifics about benefits and are NOT at liberty to discuss salaries Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • A word about recruiters • If a hospital or group uses a recruiter, don’t try to circumvent them • Hospital recruiters are usually less pushy and more helpful / private recruiters are pushy and often not too patient • If a recruiter gets pushy, tell them you are not in hurry Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… THE INTERVIEW Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Be prepared for the interview-STRONGLY suggest bring significant other if a new area • Most have decided they want you – the interview is to 1) Confirm they want you, and 2) for you to get more information, and a feel for them-to see if YOU want the job Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Interview • Leave extra time to check out the area • Don’t be late • Make sure you are interested • Be relaxed – they don’t want anyone uptight • Bring questions – nothing wrong with bringing a piece of paper with questions Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • The Interview • Be open and frank about any concerns you have • If you don’t understand all the benefits, ask who you can talk to (human resources, etc) • Find out how long they have been there ie, the group, the director, why did they switch to the present group Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • The Interview • Ask if there any major problems they see with the 1) facility/space, 2) relationship with the hospital administration 3) relationship with medical staff 4) nursing staff/staffing 5) ancillary staff 6)on call response- AND how do they plan on fixing them • Let them know if you are interested in any specific non-clinical responsibilities / administration. But DON’T make a bunch of promises. Your first year will be tough. Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • The Interview • Get a broad overview on how they do scheduling-ask for a name who does the schedule to talk to • Leave salary to last - ask if this would be the appropriate time to inquire about compensation • Don’t sign anything at the interview • If they offer you a job, say “I think the interview has been positive up to now, but before I give you a final answer, I would like to go over the contract in detail.” Could they send you a contract to read over? When is the latest they need to hear back from you? Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… GETTING the OFFER and REVIEWING the CONTRACT Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • If you get a contract, you have been offered a job – it’s all in your hands now • Get a lawyer – They won’t know the ED specific stuff, but get them to go over legal jargon, esp. termination, waiver, restrictive covenant (noncompete), due process clauses and how accounts receivable are handled—careful with partnership jargon • Benefit specifics usually are NOT in the contract, only that the group will supply certain benefits – get the specifics from the benefits specialist Joe Sexton, MD Lehigh Valley Hospital and Health Network

Reviewing your contract terms Parties Obligations / Conditions Scheduling Compensation / Fee assignment Liability Insurance Termination Medical staff Privileges / Due Process Indemnification Miscellaneous So You Want A Job… Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Parties • Physician employment status • Employee – should be clearly stated • Partner -define • Independent contractor – careful! • Contract relationship • Physician with • Hospital • Private group • Contract management company (Megagroup) • Locum Tenens group Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Group vs hospital as the employer Groups will contract with hospital to supply a service with docs they hire, bill and collect for their own professional fees (profee), buy all benefits, insurance, retirement plans themselves. Hospital agrees to supply facility, nurse staff, ancillary services, often does their own credentialing. Have a final say fire/hire. A group has a president/chair, a hospital hires a director for the ED (often the same person) Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Group vs hospital as the employer • A hospital hires all the docs, bills and collects for all their professional services, supplies all benefits, insurance, retirement plans, keeps a certain amt for administrative fees, and hands out the rest to the docs as compensation. Hospitals are notoriously less efficient at billing and collecting than hired billing companies. Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • A physician as an independent contractor • Agrees on a contract with a group (small or mega) or hospital to perform his/her service. Hospital supplies all facilities, staff, ancillary services, and the doc bills and collects all his services himself-pays all his own expenses, you should buy your own malpractice. • Strict regulations reg. definition of independence-for tax deduction purposes Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • 20 Point Rule – IRS Guidelines – help them decide if you are functioning independently or as an employee Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Facts that provide evidence of the degree of control and independence fall into three categories: • Behavioral: Does the company control or have the right to control what the worker does and how the worker does his or her job? • Financial: Are the business aspects of the worker’s job controlled by the payer? (these include things like how worker is paid, whether expenses are reimbursed, who provides tools/supplies, etc.) • Type of Relationship: Are there written contracts or employee type benefits (i.e. pension plan, insurance, vacation pay, etc.)? Will the relationship continue and is the work performed a key aspect of the business? Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Explanation of rules for independent contractor status: • http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Independent-Contractor-Defined • Publication 15-A • http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Independent-Contractor-Self-Employed-or-Employee • http://www.irs.gov/taxtopics/tc762.html Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Independent contractor • Sometimes less risky if you incorporate yourself as a P.C. or private corporation • Your corporation then is contracting to work, not you – and you enter into an employee relationship with your new corporation • Protects you from audit, heavy back taxes and fines. Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Obligations / Duties / Conditions Precedent • Provide services during hrs scheduled • Any outside the ED • Med staff membership, Licenses, etc • ACLS,ATLS,PALS, or is ABEM/ABOEM cert enough • Teaching / research/administrative • Spec job descriptions • On call duties • ***Med Staff by-laws Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • Scheduling • Guaranteed min number of hours-week/month/year • Max hours required as well • ***Total hours required in the year • Total vacation ,CME time allowed-must add up - you are paid for what you work, not for vacation • On call hours affect total hours? What are docs allowed to call out for? • Vacation /weekend requirements often not in the contract • COVERAGE IS EVERYTHING – census means nothing Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job… • “Paid vacation” • LOOK AT TOTAL HOURS and TOTAL SALARY • Paid vacation monies are usually INCLUDED in your salary • Vacation time is usually INCLUDED in your total hours • SO ignore them for the time being • May want to ask how your hours will get shifted when you take vacation and how flexible they are with what months you take them in Joe Sexton, MD Lehigh Valley Hospital and Health Network

So You Want A Job…

So You Want A Job…

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