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Career Planning in

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Society for Academic Emergency Medicine. What would I ... Academic medical center. VA. Military. Society for Academic Emergency Medicine. Learning the market ... – PowerPoint PPT presentation

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Title: Career Planning in


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

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
CV dos donts
  • DO
  • Emphasize your accomplishments and special skills
  • Include your name on every page
  • Keep it simple and legible
  • Number each page
  • DONT
  • Include irrelevant information
  • Use dark paper that doesnt copy well
  • Make grammatical or spelling errors
  • Inflate your accomplishments

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 doesnt 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
  • Dont 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 dont 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
  • Dont skimp
  • anyone helpful or made time for you
  • Timely manner
  • even if you arent interested in the position
    or they did not seem interested in you

46
Contracts
  • Professional review
  • Reference manuals may help, but its 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
  • Dont resent how negotiations turn out

51
Time
  • Clinical duties most important
  • arrive early
  • work hard
  • finish your work
  • be pleasant to staff, patients families
  • no distractions!
  • Make yourself available for switching shifts (or
    extra duties if needed)
  • Study for boards

52
Time (cont.)
  • Exercise
  • Sleep is a priority
  • Take classes
  • Develop hobbies
  • Personal growth
  • Commit to family and friends

53
Medical licenses
  • Start early
  • Consider expense
  • Photos
  • Fingerprints
  • Diploma (translation)
  • Coursework

54
Things to avoid
  • Practice shifts
  • Arguing with nurses or consulting staff
  • Lack of interview preparation
  • Not ready for first shift (get a tour first)
  • You will be expected to provide expert care and
    compassion beginning with your first patient on
    your first shift!

55
Fear of leaving home
  • Comfort with whats familiar
  • No need to relocate
  • Know what youre getting
  • Already have reputation within hospital
  • No one would take advantage of me here...

56
Moonlighting vs. Staff
  • Advantages
  • check out various opportunities
  • no commitment
  • schedule flexibility
  • determine which ED is best fit
  • Disadvantages
  • why not hired?
  • clinical error or staff/patient complaint
  • not considered a member of the team
  • someone else hired instead
  • staffing needs change

57
Buying a house
  • Complicated process
  • Emotional experience
  • May be prohibitively expensive
  • Get to know the area first
  • Make sure you like the position
  • Make sure the position is stable

58
What can I do now?
  • Improve your clinical skills
  • Finish research project and manuscripts
  • Develop administrative skills
  • Learn coding, billing, documentation
  • Practice dictation
  • Improve language or computer skills
  • Read about hot political issues
  • Discuss your interests with faculty

59
Mentorship
  • Important throughout career
  • Personal and professional
  • Opportunities
  • research
  • academic
  • career advice
  • Consider more than one mentor
  • Mutual benefit

60
Life after residency
  • Enjoy the opportunity to provide care
  • Share your happiness
  • Give back to your program
  • Celebrate your hard work
  • Know when (and how) to take care of yourself!

61
Faculty development
  • EMF Teaching Fellowship
  • Navigating the Academic Waters
  • Research design, statistics, grants, etc.
  • Leadership
  • Patient satisfaction
  • Time management
  • Physician wellness

62
Avoiding physician burnout
  • Identify stressors
  • Learn to deal with them constructively
  • Dont internalize
  • Dont rely solely on family for support
  • Listen to those who have concerns
  • Seek professional help
  • Know when enough is enough

63
6 Cs of graduation
  • Confidence
  • Collaboration
  • Collegiality
  • Committees
  • Compassion
  • Community

64
7 Habits of highlysuccessful physicians
  • 1. Recognize your limitations
  • (learn from your mistakes)
  • 2. Dont speak ill of colleagues/staff
  • 3. Make yourself indispensable
  • 4. Lead by example
  • 5. Project a positive attitude
  • 6. A good team player is a good listener
  • 7. Dont conserve kindness

65
In the long run, outstanding interpersonal skills
are desired over clinical expertise.

66
Remember, you only haveone chance to make
afirst impression.
  • Good Luck!

67
Author Credit-Career PlanningGus Garmel MD
  • QUESTIONS?

68
Postresidency Tools of the Trade CD
  • 13) Negotiation Ramundo
  • 14) ABEM Certifications Cheng
  • 15) Patient Satisfaction Cheng
  • 16) Billing, Coding Documenting Cheng/Hall
  • 17) Financial Planning Hevia
  • 18) Time Management Promes
  • 19) Balancing Work Family Promes Datner
  • 20) Physician Wellness Burnout Conrad /Wadman
  • 21) Professionalism Fredrick
  • 22) Cases for professionalism ethics SAEM
  • 23) Medical Directorship Proctor
  • 24) Academic Career Guide Chapter 1-8
    Nottingham
  • 25) Academic career Guide Chapter 9-16 Noeller
  • 1) Career Planning Garmel
  • 2) Careers in Academic EM Sokolove
  • 3) Private Practice Career Options - Holliman
  • 4) Fellowship/EM Organizations Coates/Cheng
  • 5) CV Garmel
  • 6) Interviewing Garmel
  • 7) Contracts for Emergency Physicians Franks
  • 8) Salary Benefits Hevia
  • 9) Malpractice Derse/Cheng
  • 10) Clinical Teaching in the ED Wald
  • 11) Teaching Tips Ankel
  • 12) Mentoring - Ramundo
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