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2013 01 03 beyond match 2013 01 03 beyond match Presentation Transcript

  • 3. After Residency Career Planning Visa issues Fellowship Types of Practice Job interviews US Geography
  • 3. After Residency Career Planning Visa issues Fellowship Types of Practice Job interviews US Geography
  • Planning your career July Personal assessment period (self- profiling of candidate, spouse, location, practice type, etc) Aug. Initiate search process based on multiple sources and criteria Sep. Narrow search based on criteria from self-profile View slide
  • Planning your career Oct – Dec Interviews Jan Start Federal/State credentialing process (may take up to 6 months to receive licensure and subsequently become a provider on insurance plans). Evaluate/compare/rank interview sites Feb Second-look interviews View slide
  • Planning your career Mar Review contracts/legal consultation. Follow up on credentialing process. Apr Decision process/sign contract May F/U on Federal/State credentialing process. June Hospital/insurance credentialing and privileges. Coordination of move
  • Job search Job recruiter Job fair Internet search  NEJM career center  JAMA career  Practice Link  Career MD  Indeed Personal information / contact
  • 3. After Residency Career Planning Visa issues Fellowship Types of Practice Job interviews US Geography
  • Visa & Entry Dept of State 국무부  A visa simply indicates that a U.S. consular officer has determined that you are eligible to apply for entry to the U.S. for a specific purpose Dept of Homeland Security 국토안보부  이민관이 미국 입국여부와 체류기간 결정  입국 / 출국 기록 카드 ( 흰색 혹은 초록색의 I- 94) 와 여권에 기재  Electronic System for Travel Authorization
  • Types of visas Immigrant visas  Permanent residence Nonimmigrant visas  H1B (hospital)  J1 (ECFMG)
  • Permanent Residence 영주권 , Green card 장점  입국 절차 간소화 , 비자 불필요  안정성  NIH grant  시민권 취득
  • 취업 이민
  • NIW (National Interest Waiver) 일반적으로 취업이민 2 순위를 통한 이민은 취업 이민 청원서 (I-140) 를 미 이민국에 제출하기위해 스폰서로부터의 취업제의 (Job Offer) 와 미 노동 국으로부터 노동허가서 (labor certification) 를 승 인 받아야만 함 이민을 신청하는 외국인이 미국에 국가적인 이득 이 있다고 판단할 때 위의 요구사항을 면제해주는 것을 국가이익에 준한 요구사항 면제 (National Interest Waiver) 라고 함
  • NIW 자격 조건  신청자의 전문성에 실제적으로 고유한 가치 (intrinsic merit) 가 있어야하며 ,  신청자의 전문성이 지역적이 아니라 미국가적 으로 (nationwide) 영향을 줄 수 있어야 하며  만약 노동허가서 (Labor Certification) 을 요구 할 경우 , 국가적 이익 (National Interest) 에 반할 것
  • 가족을 통한 초청이민 영주권 스폰서 자격  시민권자나 영주권자로서 , 본인의 가족 및 영 주권 신청자까지 지원할 수 있는 경제력 ( 빈곤 선 125% 이상 ) 이 있는 경우 초청가능 직계가족  시민권자 : 배우자 ; 21 세 미만 미혼 자녀 ; 21 세 이상 미혼 자녀 ; 기혼 자녀 ; 형제 , 자매 단 , 스폰서가 21 세 이상인 경우 ; 부모 , 단 스 폰서가 21 세 이상인 경우  영주권자 : 배우자 ; 미혼 자녀
  • Pathways J1 residency (  J1 fellowship)  J1 waiver & green card (  Fellowship ) H1 residency (  H1 fellowship)  H1 job & green card (  Fellowship) H1 residency / NIW (  Fellowship )
  • My two cents: Contact lawyer in the U.S.
  • 3. After Residency Career Planning Visa issues Fellowship Types of Practice Job interviews US Geography
  • Fellowship: to do or not to do? Do you have a deep love or fascination for the specialty area? Do you enjoy the role of consultant? Do you enjoy performing procedures? Are you fascinated by the hospital-related problems? Does deep mastery of a restricted content area appeal to you?
  • Fellowship: to do or not to do? Do you respect and admire the subspecialty faculty? Would a subspecialty career offer you important lifestyle or financial advantages? Are you entering subspecialty training because you disliked your general medicine hospital clinic experience?
  • Qualities and other factors important to fellowship PD (from the most important to the least important)1. Negative comments or hints of underlyingproblems in letter written by internalmedicine PD2. Personal comments by the internalmedicine PD3. The personal aspect of the interview4. Letter of recommendation (LOR) from acardiologist known by the fellowship director
  • Qualities and other factors important to fellowship PD (from the most important to the least important)5. Performance during an elective at thefellowship site6. Rank order in the residency class7. Genuine interest in research8. Being a graduate of a US medical school9. LOR from a nationally known cardiologist
  • Qualities and other factors important to fellowship PD (from the most important to the least important)10. Doing a residency program at aninstitution with a well known cardiologydivision11. Participation in research prior to thefellowship program12. Assessment of medical knowledgeduring the interview13. Publications prior to fellowship
  • Qualities and other factors important to fellowship PD (from the most important to the least important)14. Performance on the ABIM certifyingexamination if available15. US citizenship16. Performance on the USMLE
  • To do during residency Do well in the general medicine residency program. Interview well. Get a well-written LOR from the program director and your reference cardiologists. Whenever possible, arrange in advance an elective rotation at the institution that interests you the most.
  • To do during residency As a resident, find a mentor in your institution and get involved in research. Worry less about the factors that are ranked lowest in importance to fellowship directors, including performance on the USMLE, US citizenship, and completing a residency program with a well known division of cardiology
  • To do before, during or after residency Research Green card
  • Selection of subspecialty Academic interest Own history of training & research Compensation, QOL ACGME accredited fellowship ACGME non-accredited fellowship
  • IM subspecialities Cardio, GI Pulmo, Critical care, Hem, Onc Nephro, ID, Endo, Rheuma, Allergy Geriatrics Adolescent Medicine, Sleep medicine, sports medicine, palliative care Electrphysiology, Inverventional cardio, Transplantation Hepatology
  • Fellowship application & matching ERAS / NRMP SF match Individual applications
  • Timeline (IM July cycle) June ERAS Fellowships token request. Register at MyERAS. July  Fellowship applicants may begin applying. The ERAS PostOffice opens.    Aug – Oct Interviews Nov Rank Order List Closes Dec Match Day JUL  Fellowship training begins
  • Selection of programs Training Program structure / Compensation Research / Faculty potential Reputation / ranking Location
  • My two cents What is the best program for you?
  • My two cents What is the best program for you?  Probably you won’t know for years You don’t need to restrict your opportunity.
  • Differences from residency Application Mechanisms  ERAS Fellowships Documents Office (EFDO) Applicants: current trainees or not Interviews Research / green card Role
  • Fees $90 ERAS Token fee $70 USMLE Transcript fee $105 ERAS Processing fee (Up to 10)  $10 Each (11-20)  $15 Each (21-30)  $25 Each (31 or more) NRMP Application fee + 항공 , 숙식
  • Documents Upload Documents (ERAS)  Medical Student Performance Evaluation  Medical School Transcript 의대 성적표  Photograph Mail  Letters of recommendation On-line documents  CAF (Common application form)  자기 소개서 (Personal statement) www.ecfmg.org/eras
  • http://www.abim.org/about/examInfo/data-fellow/chart-05.aspx
  • FREIDA
  • Fellowship structure 2 year clinical fellow 1 year clinical fellow + 2-3 year research fellow
  • NIH Grants Most grants require green card or citizen ship to become eligible Series  Training grants are in the T-series  Individual Fellowships are in the F-series  Career development awards are in the K- series  Research Projects are in the R-series
  • Fellow rotations (Exemple: nephrology)  Dialysis  Consult  ICU  Transplantation  PD  Vacation Q4
  • Board certification Not mandatory Not license Need renewal  MOC (Maintenance of Certification) Multiple board certification
  • Licensure There is no ‘US medical license’ Every state board has its own requirement and licensure process FEDERATION CREDENTIALS VERIFICATION SERVICE (FCVS)
  • 3. After Residency Career Planning Visa issues Fellowship Types of Practice Job interviews US Geography
  • Types of practice Solo practitioner (starting your own practice) Joining a solo practitioner (single specialty) Single specialty, small group practice Single specialty, large group practice (often referred to as “mega” groups)
  • Types of practice Multispecialty group practice Managed care company employment Academic practice Locum tenens Government (Veterans Affairs, etc.)
  • Solo practice - Pros: Pride of being responsible for the growth and development of your own practice. Possible financial benefits from running an efficient and streamlined practice. Being your own boss. Avoidance of interphysician conflicts in running and managing the practice.
  • Solo practice – Cons: Added pressure of being singly responsible for the growth and devel- opment of your own practice. Maximum efficiency in terms of physician:staff ratio often not achieved in a solo practice—translation: higher costs of practice.
  • Solo practice – Cons: Responsibility for your own call coverage. Many often set up a loose association with other local practitioners (be aware of local politics and factions that may try to make it difficult for you to establish a practice). High start-up costs.
  • Solo practice – Cons: Financial aspects of setting up your own practice. You (and often, the bank) are responsible for setting up your own practice, which obviously entails a certain degree of financial risk. Potentially several months until revenue stream starts (insurance companies often have 90 days to process claims and make reimbursements).
  • JOINING A SOLO PRACTICE - Pros: Established patient and referral base (opportunity to become busy fast) Established office and staff (billing, collecting, nursing, etc.) Efficiencies of a small group practice (may translate to higher income) Help with call coverage Benefit of a colleague with whom to consult;Inherent camaraderie (hopefully)
  • JOINING A SOLO PRACTICE - Cons: Often the burden of the new recruit to conform to the norms and operation of the existing practitioner Potential personality conflicts Potential for preferential call schedule (new recruit may end up with a disproportionate number of weekends or holidays)
  • JOINING A SOLO PRACTICE - Cons: Potential for new recruit to be given a disproportionate number of insurance- poor or problem patients Preexisting office or staff politics (beware of family working in the office)
  • JOINING A SINGLE SPECIALTY, SMALL GROUP PRACTICE – Pros: Established reputation and referral patterns Established office (personnel, nursing) Potential for electronic record keeping and billing Resources in terms of advertising, capital investments into practice
  • JOINING A SINGLE SPECIALTY, SMALL GROUP PRACTICE – Pros: Likelihood of new physician becoming busy fast Better ability to negotiate insurance contracts Light call schedule Flexibility in establishing subspecialty within practice
  • JOINING A SINGLE SPECIALTY, SMALL GROUP PRACTICE – Cons: Possibility of conflicts concerning interphysician personality and professional issues
  • SINGLE SPECIALTY,LARGE GROUP PRACTICE – Pros: Large group size Camaraderie, ability to consult others Practice efficiency (variable) Group insurance reimbursement negotiating ability (variable) Established referral base Established office setup (billing, collecting, charting, etc.)
  • SINGLE SPECIALTY,LARGE GROUP PRACTICE – Cons: Bureaucratic decision-making process (variable) Physician compensation issues (variable)
  • JOINING AMULTISPECIALTY GROUP PRACTICE – Pros: Large group size Ability to consult within group Group insurance reimbursement negotiating ability Established referral base Established office setup (billing, collecting, charting, etc.)
  • JOINING AMULTISPECIALTY GROUP PRACTICE – Cons: Bureaucratic decision-making process Physician compensation issues Lack of participation in profit from ancillary services such as dialysis centers, radiology facilities, lithotripters, etc.
  • Academic – Pros: Student, resident interaction and teaching Decreased need to manage the financial aspect of medicine, compared to private practice Stable compensation Possibility of decreased call responsibilities
  • Academic – Pros: Potential better benefits such as retirement, health insurance, etc. Increased complexity and intellectual challenge of cases in academia Advanced learning opportunity with independence, balanced with an environment of guidance and support
  • Academic- Cons: Increasing need to meet revenue targets while maintaining research, teaching, and administrative duties Usually, no chance for partnership Often billing/collecting ratios are substandard in academia, compared to private practice Challenging road to tenure
  • Academic- Cons: Political structure and issues Restrictive covenants, if present, may be broad Possibility of decreased salary when compared to private sector
  • Locum tenens Latin for “one holding a place.”
  • Locum tenens – Pros: Freedom of work location and schedule Freedom from administrative, financial, and other headaches Liability, malpractice usually covered Housing, car, and other expenses often covered
  • Locum tenens – Cons: Need to be flexible in terms of different work environments Limited opportunity to develop long-term relationships with patients and colleagues Usually limited health and other long-term benefits May be difficult to arrange when considering spouse, children, and other needs
  • Government Job – Pros: Potential academic affiliation, providing for stimulating teaching duties Generous benefit packages • Stable salary Decreased need to hit production, financial targets • Sense of civic duty Stable hours and work schedule • Possibility of student loan/educational debt forgiveness
  • Government Jobs – Cons: Stable salary Possibility of decreased autonomy, and need to function according to strict protocols and guidelines Position may take on a certain monotony over time
  • Types of IM Practice Traditioinal Outpatient only Hospitalist
  • Hospitalist Physicians whose primary professional focus is hospital medicine Nocturnist  Hospitalists who are willing to work night shifts only  compensated higher than their day shift peers
  • Drivers of the US hospitalist movement Increased efficiency gained by dedicated inpatient physicians/providers (hospitalists) Reduced length of stay (LOS) and cost per case under hospitalist care Shortage of PCP to care for emergency department unassigned patients requiring hospitalization 
  •  Surgeons’ declining interest in general perioperative and nonoperative care Increasing acuity of patient illness in the hospital and outpatient settings Increasing challenges for physicians in mastering both inpatient and outpatient knowledge Payers’ demands for careful utilization of hospital resources  
  •  Primary physicians’ departure from the hospital because of lifestyle concerns Poor physician reimbursement for hospital care Reduction in resident work hours causing the growth of hospitalist-managed “uncovered” services in academic medical centers
  • My two cents: English
  • My two cents: English Don’t be creative: see others Context Culture
  •  “Never come out of a patient ’s room without asking about his profession and a local sports team. ”  JAMA 2012; 308(21): 2197-8
  • Case At the first day of your second year, you began to work with preliminary year intern who is AMG. You noticed that he called a patient, Robert Doe as Bob. What would you do?
  • My two cents: Alex: Alexander, Barb: Barbara, Deb:Deborah, Mike: Michael. Beth: Elizabeth, Fred: Alfred, Greta: Margareta, Lisa: Elisabeth. Bill: William, Bob: Robert, Peg: Margaret, Polly: Molly/Mary, Ted: Edward
  • 3. After Residency Career Planning Visa issues Fellowship Types of Practice Job interviews US Geography
  • Job interviews Application (cover letter & CV)  Email  Phone interview  Interview invitation  Interview  2nd interview  Offer & contract review  Acceptance Locations: Conference, Job fair, On site Travel and lodging paid by employer
  • Academic job interview Need to characterize the position  Research  Clinical K grant or not Job talk Intensive interviews
  • Tips for a Successful Interview When in doubt, always dress conservatively . Always provide complete references prior to the interview as it is a competitive market and references help your CV and you stand out above the rest! Plus many offers are not made until references are done, be ahead of the game. Bring a few professional copies of
  • Tips for a Successful Interview Get rest and do your research to communicate effectively . The best interviews are ones where people get engaged beyond the basics of a position. Ask questions, give feedback and communicate throughout. You are interviewing them as much as they are interviewing you.
  • Tips for a Successful Interview Do not bring up discussions about money, benefits, or compensation unless you are asked first. It will improve your negotiating position if an employer knows you are truly interested in the job first and foremost.
  • Tips for a Successful Interview Before you leave the interview, ask for the job . It is always easier to turn down a job offer than it is to ask for one “after the fact”. In other words, if you feel positive about the interview/opportunity, say so.
  • Tips for a Successful Interview Always send a personal thank you and f/u e-mail after the interview. Be prepared to make a decision on a position within two weeks of interviewing. This is the best time to engage in any areas of negotiation on a position, if needed.
  • 3. After Residency Career Planning Visa issues Fellowship Types of Practice Job interviews US Geography
  • Locations Residency / (Fellowship) Permanent job
  • Factors of Location Proximity to family Affordability Weather / climate Opportunities for spouse Quality of schools Entertainment and social opportunities Outdoor activities (ski, beach, hike, etc) Airport access Safety / crime Korean community
  • Cost of Living Salary.com’s Cost of Living Wizard at http://costoflivingwizard.salary.com. Compare your current location’s cost of living to your new location.
  • Crime Statistics http://www.relocationessentials.com/aff/w ww/tools/crime/crime.aspx Also contains useful information on schools, salary comparisons between cities.
  • Best places to live ?? CNN/Money: http://money.cnn.com/real_estate/best_pla ces/ Sperling’s Best Places: http://www.bestplaces.net/fybp/
  • My two cents: Only you can rank ‘best places to live’.
  • Direct flights to ICN East  JFK: KE, OZ; IAD: KE Midwest  ORD: KE, OZ; DET: DL South  DFW: KE, AA; ATL: KE West  LAX: KE, OZ, TG; SFO: KE, OZ, SQ, UA; LAS: KE; SEA: KE, OZ; SJC: KE
  • My two cents: Earn flight mileages: esp. ERAS Before residency  KE: All Sky team; OZ: All Star alliance  AA: One world  Priority Pass After residency  SPG: OZ, AA, DL, etc  Chase UR: KE, UA, etc www.milemoa.com
  • US geography New England: CT, MA, ME, NH, RI, VT Mid Atlantic: NY, NJ, PA South Atlantic: NC, SC, DC, DE, FL, GA, MD, VI, WV, KY, North Central: IL, MI, OH, WI, IN, MO, NE, IA, KS, MN, ND, SD South Central: TX, OK, LA, AR, AB, KY, MS, TN West: AZ, CA, HI, CO, ID, MT, NV, NM, UT, WY, AK, WA, OR
  • References Shaw, Koushik: The Ultimate Guide to Finding to Right Job after residency http:// www.acponline.org/residents_fellows/career_c www.practicelink.com