Transcript Growing Up!!

MARCHING INTO THE REAL WORLD,
BEST FOOT FORWARD
Marianne Carim MD
PGY3 Internal Medicine
George Washington University Hospital
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
TIMETABLE FOR SELECTING PRACTICE
OPPORTUNITIES
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12-18mos:
define goals and objectives
 Prepare CV
 Research practice opportunities
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7-10mos: Begin the interviewing process
 6-9mos:
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Conduct second interview
 Revisit new community
 Evaluate the opportunity
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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
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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
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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
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ECONOMIC ASSESSMENT
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Define your financial position
How does my economic situation influence the options
 Relocation expenses
 Know what benefits are important for me
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Know your budget to know income requirements
 Know your loan policies. Call them often! When
do you start paying? Are you consolidated?
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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?
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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
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Solo Practice
Group practices
Established vs forming a new one
 Multispecialty vs single specialty
 Affiliated MD’s vs space-sharing arrangement only
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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
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DO NOT include: DOB, SS#, DEA#, pictures
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Explain any time gaps
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Use “active” words, be grammatically consistent
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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
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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
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Have someone you trust in and outside of
medicine read it
Save it as a PDF file, not just on Microsoft.
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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:
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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 don’t say is very important
 Be sure to ASK FOR PERMISSION and alert
your references of requests
 Be mindful:
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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
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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
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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
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First appearances ARE important
Presentation:
Wear a suit. Wear nice shoes.
 Average doc looks like your dad (Wear something your dad would like!)
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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
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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!
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Consider writing notes:
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Get business cards/contact info from everyone you meet with
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Jot down something you discussed with each person so you can
thank them and reference it!
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!
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INTERVIEWER’S CRITERIA
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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
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Be true to yourself!!
EVALUATING THE OPPORTUNITY
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Refer back to your goals and objectives
Guidelines developed by American Society of
Internal Medicine (ASIM)
MALPRACTICE INSURANCE
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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
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Nose coverage
Know your coverage and ensure that it is adequate
Pure loss vs ultimate net losses
 Lost wages
 Services provided
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Premiums
Exclusions: ex. Defense costs, deductible, third party
DISABILITY INSURANCE
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Definition:
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2.
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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
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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:
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Duration
Restricted area
Termination and leaving practice
 Grace Period
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UNDERSTANDING CONTRACT TERMS
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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_ma
nagement/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
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Easy points first, hardest issue midway
 Know your practice to know the easy points
 Conclude with light ones
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Goal to have a win-win solution!!
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:
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1 to 2 yrs
 Cancellation
 partnership
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Duties:
Forbidden issues
 Moonlighting
 Teaching
 Call
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Salary and Benefits
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Base salary, incentives, bonuses
Final issues
NOT SURE WHAT TO DO – NEED MORE
TIME!
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Consider:
 Locum tenens
 Urgent 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
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30% basic claims-made malpractice insurance
without tail coverage
Very competitive salary – but for a reason!
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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
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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
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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/aboutama/our-people/member-groupssections/resident-fellow-section/succeedingmedical-school-practice.shtml
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