Career Planning in Emergency Medicine

1. Career Planning in Emergency Medicine

2. Objectives • Entering the job market • Tips for an effective search • The interview and follow-up • How to evaluate a position (and offer) • Successful negotiations • Strategies for rewarding careers in EM

3. Finding a position in EM • Realistic appraisal of your abilities • Discuss with family, friends, mentors • Research various possibilities • Consider more than one option • Gather information and verify it • Look to trusted advisors • Take into account personal needs, interests & talents

4. DEFINE: Personal/Family/Professional Goals • Most doctors choose to practice close to home, or within 100 miles of their training program • Many leave original practice within 2 years due to unmet expectations • Where you want to live and raise your family will ultimately determine where you stay long-term (“Recruit the spouse and you will recruit the doctor.”-- Recruiter Colloquialism)

5. DEFINE: Personal/Family/Professional Goals • Key – practice where you want to live • How much money do I need to make to meet my needs? • What will fulfill my professional needs? *What type of practice? *Is there a documented need for my services? *How many patients a day am I comfortable seeing?

6. Stages of the job search • Stage I - Preparation *type of position *type of employer *geographic location • Stage II - Investigation *look for possibilities *make contact *interview and tour ED • Stage III - Decision *negotiations may help

7. Career vs. Job • Distinction *Career: defines an individual *Job: pays the bills • Time frame *immediate *short-term *long-term

8. Where do I see myself ... • in the next year • in the next 5 years • in the next 10 - 15 years • Geographic region • Emergency setting • Hospital environment • Community

9. First year out ... • Learn a new system • Introduction to staff and consultants • Establish a reputation • Get to know the community • Study for boards

10. 5 years out ... • Career re-evaluation • Money somewhat less of a concern *school debts often repaid *growth in savings *partnership *vested in pension • Thoughts of retirement ...

11. 10 - 15 years out ... • “Make or break” time • Serious travel or time away • Rekindle your passion for EM • Thoughts of career re-direction *urgent care *occupational health *administration

12. What makes me happy? • Patient care • Teaching • Supervising • Research • Administration • Learning

13. What is important to me? • Power • Fame and notoriety • Personal time • Fancy vacations • Material goods • Money

14. What is really important? • Family and friends • Career satisfaction • Security *position *financial • Respect • Wellness

15. What do I enjoy when I am at work? • Nice patients • Supportive staff • Functional facilities • Challenging cases • Teaching • Camaraderie

16. Autonomy Physician autonomy is possible despite the advent of practice guidelines, managed care, and government agencies (although more difficult). • Test ordering • Decision-making • Best practices

17. What would I like to avoid? • Unmanageable patient volume • Delays affecting patient care • Difficulty getting patients admitted • Hassles with consultants • Non-supportive environment • Administrative headaches • Frustrations with ED/hospital design

18. Beyond graduation • Fellowships • Chief residency • Additional residency training • Positions *clinical *academic * “hybrid” • Travel

19. Clinical setting • Rural • Suburban • Urban • County • Academic medical center • VA • Military

20. Learning the market • AHA Guide to the Health Care Field • PDs & faculty (yours and ‘theirs’) • Recruiters (companies or ED groups) • Internet • Hospital operators • Family or friends • Phone book • EDs

21. Effective searching • Be focused • Be assertive • Be creative • Start early • Don’t take NO for an answer, it may become YES later

22. Job search vs NRMP • Search ends once candidate accepts *time and money *mutual decision • May be offered position at end of the interview, or within a short time • Make sure your PDs and references are available and know when, where, and why you are interviewing

23. Foot in the door • Telephone contact *not Monday AM or Friday PM *find out when someone will be available • Personal communication • Someone who knows the right person • Right place at the right time *introduce yourself at a meeting *stop by the ED

24. Preparation • Find out what is going on *hospital and ED *leadership *research *community • Why is the position open? How long? • Most recent hire? Departure? Why? • Turnover rate?

25. Faculty interests EM textbooks Medline / Pubmed Internet home pages Residency websites Conference faculty Your program’s faculty may know ... Job opportunities Journals/newsletters Job catalogs Postings (meetings, internet, bulletins) ‘Local’ program directors & residents Word of mouth Recruiters Resources

26. Professional recruiters • Use judgment before giving out CVs • Many have excellent skills / reputations • Firms vs. recruiters for contract group *who do they represent? *for whom do they work? answer to? *how do they get paid? when? by whom? • Weigh benefits vs. downsides • Not for everyone

27. Questions for recruiters • Years experience in EM? Exclusive? • Background? Previous employment? • Knowledge of EM? Geographic region? • Percentage of academic placements? • Willing to give reference(s)? • Success rate? Other ‘data’? • Financial arrangement? • Why them?

28. CV & Cover letter • Equally important with different roles • Curriculum vitae lists professional accomplishments, abilities, interests, and activities • Cover letter is a personalized attempt at convincing someone to offer you an interview • Both include name/address/phone

29. Curriculum vitae • Make it look like it “wants” to be read *professional style *use white space appropriately *good texture *easily read • It should copy well • Descending chronological order • Include special skills, esp. language

30. Important information • Include professional degree • Reliable phone number • Current contact address • Email address • Do not use pager, ED, or secretary #s • Keep contact information simple!

31. DO Emphasize your accomplishments and special skills Include your name on every page Keep it simple and legible Number each page DON’T Include irrelevant information Use dark paper that doesn’t copy well Make grammatical or spelling errors Inflate your accomplishments CV do’s & don’ts

32. Cover letter • Personalize - address it to someone • Send with your CV • Check spelling (esp. names) • Give a reason why you should be invited for an interview • Include personal information that doesn’t go on your CV

33. Interview • Dress professionally • Let them interview you • Interview them • Learn about the position, hospital, and community • Meet as many people as possible Find out as much as you can about as much as you can.

34. Interviews • Don’t waste their time or your own • Practice at your residency program • Be prepared *to present a case *to give a lecture *to share your CV / articles *to discuss your (and their) research

35. Bring to interview • Map with directions • Change for parking • Copies of CV and writing sample • Interview itinerary • Names of faculty and administrators • List of interview questions • Pen, paper, business cards, folder • Toothbrush and mscll. health care

36. Interview questions • Which questions? • Address questions to the right people • Ask same question to different people • Clarify answers to questions from earlier in the interview process Ask a question when asked if you have one (even if you don’t have any).

37. Their questions • Tell me about yourself? • What are your strengths? Weaknesses? • Tell me about a mistake you made and how you handled it? What did you learn? • What do you see yourself doing in ... ? • How/what/when will you contribute to our ED? • Why should I hire you?

38. Your questions • Why is this position open? • When was the last new physician hired? • How stable is the nursing staff? Hospital? Physician group? • May I speak with the most recent hire? Physician who most recently left? • ‘Credentials’ of MDs? Nurses? • How can I make myself more competitive?

39. Other questions • Anticipated changes in the ED *staffing (MD, RN, mid-level providers) *census (ED, hospital, community) *facility (expansion, observation unit, other) • Progressiveness and creative planning • Responsiveness of hospital administrators to the needs of the ED

40. Wish list • Nice practice environment • Stable hospital / growing ED census • Good community (growing) • Democratic group • Similar colleagues (‘family’) • Opportunity for social/family happiness • Fairness with respect to schedule, compensation, and future potential

41. Chief • Leadership • Innovation • Creativity • Respect (within group? hospital?) • Business sense/plan • Fairness

42. Democratic group • Competitive salary with reasonable administrative overhead • Open books • Equitable schedule with flexibility • Evenly distributed workload • Shared opportunity for advancement *professional *partnership (non-financial) *financial parity

43. Emergency department tour • Age • Layout and design • Size and space • Telephones • Computer access • Waiting room condition • Plans to remodel

44. Make sure you ... • meet as many physicians as possible • speak to nurses and paramedics • talk with consultants about the ED • meet administrators, if possible • talk to benefits office(r) • show an interest in the rest of the hospital and the community • make an effort with (quick) good-byes

45. Interview follow-up • Thank you *personalize (name and experience) *telephone, email, US mail *additional chance to express interest • Don’t skimp *anyone helpful or made time for you • Timely manner *even if you aren’t interested in the position or they did not seem interested in you

46. Contracts • Professional review • Reference manuals may help, but it’s like reading a foreign language • Read, understand, and amend what is important to you • Not everything can be changed • Employee manual is contract

47. Concerns with contracts • Termination clause • Restrictive covenants • Malpractice coverage *who provides? *type of coverage (claims-made or occurrences)? *tail (who pays?)

48. Employee vs. Independent contractor • Benefits • Financial (tax) implications • Recent pressure from IRS to redefine EM relationships as employee/employer rather than IC • Security ??????

49. Negotiations • Be prepared (find out what is negotiable before you begin negotiating) • Understand what the other side needs • Practice negotiations - getting to ‘yes’ • Keep your ego out of the deal • Be creative • Consider factors (skills, demand, need)

50. Negotiations (cont.) • Look to the future • Consider the risk vs. benefit ratio *ending up with nothing *getting what you want in the present *people remember frustrations *negotiate for a promising future • Don’t resent how negotiations turn out