Crossing the Finish LineCrossing the Finish LineWhat to expect andWhat to expect andHow to prepare for the job searchHow to prepare for the job searchMila Felder, MDMila Felder, MDCredits to multiple ACEP, SAEM presentations and multipleCredits to multiple ACEP, SAEM presentations and multipleChrist faculty membersChrist faculty members
Faculty DisclosureFaculty DisclosureI do not have any relevant financialI do not have any relevant financialrelationship(s) with any commercialrelationship(s) with any commercialinterest(s).interest(s).
Goals and ObjectivesGoals and ObjectivesAfter this lecture, the resident should be able to:After this lecture, the resident should be able to:• DiscussDiscuss– The timeline and necessary licensure/The timeline and necessary licensure/credentials/ costs involved (handout)credentials/ costs involved (handout)– Initial steps in the job searchInitial steps in the job search– CV overviewCV overview– Evaluating opportunities (and options)Evaluating opportunities (and options)• Preview : FinancialPreview : Financial• Attending tips for the first years out ofAttending tips for the first years out oftrainingtraining
What We Are Not Going to TalkWhat We Are Not Going to TalkAbout TodayAbout Today– Interviewing wellInterviewing well– Living through your first litigationLiving through your first litigation– Extensive Financial planningExtensive Financial planning– Initiating a successful business practiceInitiating a successful business practice– WellnessWellness– Careers in Academic EMCareers in Academic EM
What do I do Now?What do I do Now?• Obtain extra copies of medical school diplomasObtain extra copies of medical school diplomas– 1-2 weeks : YESTERDAY… YOU MEAN YOU1-2 weeks : YESTERDAY… YOU MEAN YOUHAVEN‘T?HAVEN‘T?• Print out and fill out USMLE III application (orPrint out and fill out USMLE III application (oronline)—combined with IL License application inonline)—combined with IL License application insome states, including IL:some states, including IL:– 4-6 weeks to register/ schedule and 4-6 weeks for4-6 weeks to register/ schedule and 4-6 weeks forresults. Do not stress about the test.results. Do not stress about the test.
And Later?And Later?• License processing fee to Springfield: 8 weeks andLicense processing fee to Springfield: 8 weeks and$700.00.$700.00.– Locums will pay for states they send you toLocums will pay for states they send you to• State Physician-controlled Substance License $5.00State Physician-controlled Substance License $5.00and up to 8 weeksand up to 8 weeks• DEA application 6 weeks and $751.00DEA application 6 weeks and $751.00• Apply for NPI number (on line, a few minutes, free)Apply for NPI number (on line, a few minutes, free)• Talk to your potential references, ask to prepareTalk to your potential references, ask to prepareletters in advanceletters in advance
Send in a Picture you Identify withSend in a Picture you Identify with
• Seniors: when your ABEM paperworkSeniors: when your ABEM paperworkarrives in April-May, send it in ASAParrives in April-May, send it in ASAP– Registration for Boards $355.00 (Apr-Jun30)Registration for Boards $355.00 (Apr-Jun30)– Written exam registr. $960.00 (June-Oct.)Written exam registr. $960.00 (June-Oct.)– Nov 11-17 Qualifying (written)examNov 11-17 Qualifying (written)exam– Oral Board Exam May $1225.00Oral Board Exam May $1225.00• Staff privileges application $100.00 andStaff privileges application $100.00 andup; save IL State Healthcare Providerup; save IL State Healthcare ProviderApplication DataApplication Data
Totals?Totals?• $4000-5000, without the travel expenses$4000-5000, without the travel expenses• 4-7 months, depending on the state4-7 months, depending on the stateapplied forapplied for
I have a license, but no job.I have a license, but no job.Now what?Now what?• Prepare CV and customize itPrepare CV and customize it• Find 1-2 geographically desirableFind 1-2 geographically desirablerecruitment firmsrecruitment firms• Window shop (and follow-up)Window shop (and follow-up)• Learn the market (network)Learn the market (network)• Go on “practice interviews”Go on “practice interviews”• Think of what you are bringing to practiceThink of what you are bringing to practice
Where do I Start?Where do I Start?• Write out your dream:Write out your dream:– cases, type of practice, lifestyle, group size,cases, type of practice, lifestyle, group size,patients per day, on call?patients per day, on call?• Ideally, where do you want to be?Ideally, where do you want to be?– Geography/ weather/ family/ social goalsGeography/ weather/ family/ social goals• Community with greater need (problems)Community with greater need (problems)with offer more money.with offer more money.– If that’s what you want, prepare to sacrificeIf that’s what you want, prepare to sacrifice
What if I don’t love it?What if I don’t love it?• Remember ACEP, EMRA, SAEM, recentRemember ACEP, EMRA, SAEM, recentgraduates and networkinggraduates and networking• First job (or any job) does not have to beFirst job (or any job) does not have to beforeverforever– 43% of physicians that start a job are no43% of physicians that start a job are nolonger there after 2 years.longer there after 2 years.– This may be a learning experience and isThis may be a learning experience and isgood as thatgood as that
Mechanics of a Job SearchMechanics of a Job Search• What are my goals?What are my goals?• How do I want to be compensated?How do I want to be compensated?• Do I want ownership?Do I want ownership?• Where will I be happy (geography)?Where will I be happy (geography)?
FORCEFORCE• FFamily satisfaction with location/ lifestyleamily satisfaction with location/ lifestyle• OOpportunity to become a partner and earnpportunity to become a partner and earncompensation based on individual effortcompensation based on individual effort• RReasonable working conditionseasonable working conditions• CCamaraderie with co-workersamaraderie with co-workers• EEquity from day one with shift assignment andquity from day one with shift assignment andincentivesincentives
Goals for the DayGoals for the Day• Mechanics of a job searchMechanics of a job search• Preparing a CVPreparing a CV• Identifying your goalsIdentifying your goals• Evaluating a potential offerEvaluating a potential offer
Mechanics of a Job SearchMechanics of a Job Search• Most residents use one of the following:Most residents use one of the following:– Residency search (who do I know here?)Residency search (who do I know here?)– Hometown search (who do I want near me?)Hometown search (who do I want near me?)– ““Guess where I’ll live”Guess where I’ll live”
Mechanics of a Job SearchMechanics of a Job Search• 74% of all residents rate location as #174% of all residents rate location as #1prioritypriority• 14% compensation14% compensation• 11% type of group11% type of group
Mechanics of a Job SearchMechanics of a Job Search• Over 50% change jobs after first yearOver 50% change jobs after first year• Most of these moves are PHYSICIAN’sMost of these moves are PHYSICIAN’sCHOICECHOICE
Geography of a SearchGeography of a Search• CollegeCollege• Medical SchoolMedical School• ResidencyResidency• NOW, YOU CHOOSENOW, YOU CHOOSE
Mechanics of a Job SearchMechanics of a Job SearchIt’s NOT a job search…It’s NOT a job search…It’s the beginning of yourIt’s the beginning of yourCAREER!CAREER!
Mechanics of a Career SearchMechanics of a Career SearchHow do other professionals evaluateHow do other professionals evaluateopportunities?opportunities?• National recruiting and staffing firmsNational recruiting and staffing firms• Many different methods, depending on aMany different methods, depending on alevel of an employeelevel of an employee• Choose a consistent process to increaseChoose a consistent process to increasechance of successchance of success
ScorecardScorecard• IndustryIndustry• CompanyCompany• Claim to fameClaim to fame• Job descriptionJob description• TrainingTraining• Typical dayTypical day• CompensationCompensation• Growth opportunityGrowth opportunity
IndustryIndustry• AT&T Wireless:AT&T Wireless:– $400 billion annually, quadrupled since ’98$400 billion annually, quadrupled since ’98– Projected ONE OF THE FASTEST growthProjected ONE OF THE FASTEST growthindustries over 10 yearsindustries over 10 years– Profitable, stable, very fast growingProfitable, stable, very fast growing– Dominated by a few providersDominated by a few providers– Dynamic present growth is predicted toDynamic present growth is predicted tocontinue for at least 2 decadescontinue for at least 2 decades
CompanyCompany• AT&T $150 billion market valueAT&T $150 billion market value• Merger with Cingular added up to $85 billionMerger with Cingular added up to $85 billion• New market leader with 29% share (Verizon 24, SprintNew market leader with 29% share (Verizon 24, Sprint10, T Mobile 9, Nextel 8)10, T Mobile 9, Nextel 8)• Up from $5 billion in ’98Up from $5 billion in ’98• 3 main sales channels: stores, business to business3 main sales channels: stores, business to businesssales, national/ government salessales, national/ government sales• Proactive competitive corporate cultureProactive competitive corporate culture
Claim to fameClaim to fame• Ranked #1 by JDPower for 5 conseqRanked #1 by JDPower for 5 conseqyearsyears• Outstanding brand name awarenessOutstanding brand name awareness• Excellent quality cell phonesExcellent quality cell phones• Excellent call coverage (doubled withExcellent call coverage (doubled withCingular)Cingular)• Competitive pricing, one stop shoppingCompetitive pricing, one stop shopping• Global organization, variety of servicesGlobal organization, variety of services
Scorecard:Scorecard:Location not a variableLocation not a variable• Sacrifice salary if location is moreSacrifice salary if location is moreimportantimportant• Location is the primary concern for lowerLocation is the primary concern for lowerlevel occupationslevel occupations• Midlevel occupations use location as tieMidlevel occupations use location as tiebreakerbreaker• executive rarely consider itexecutive rarely consider it
Emergency Medicine OpportunityEmergency Medicine OpportunityScorecard (continued)Scorecard (continued)• Compensation—salary, benefits,Compensation—salary, benefits,retirement, equityretirement, equity• Typical Day-Shifts, scheduling, acuityTypical Day-Shifts, scheduling, acuity• Job description—position availableJob description—position available• Location—just one variable, not a keyLocation—just one variable, not a keyissueissue
Scorecard, continuedScorecard, continued• Industry-Emergency MedicineIndustry-Emergency Medicine• Typical day: shift work (how long? Acuity?)Typical day: shift work (how long? Acuity?)• Job description—take care of sick or notJob description—take care of sick or notso sick, academic vs community practiceso sick, academic vs community practice
Mechanics of a Career SearchMechanics of a Career SearchCompanyCompany• Hospital EmployeeHospital Employee• AcademicsAcademics• Single hospital groupSingle hospital group• Multi-hospital groupMulti-hospital group• Equity vs. No equityEquity vs. No equity
Site Specific IssuesSite Specific Issues• Ask to talk to other physiciansAsk to talk to other physicians• Talk to the last partnerTalk to the last partner• Talk to last non-partnerTalk to last non-partner• Talk to people who have left the companyTalk to people who have left the company• What is a partner?What is a partner?
Growth OpportunityGrowth Opportunity• How long can you do clinical medicine?How long can you do clinical medicine?• Leadership opportunities?Leadership opportunities?• Is the company growing?Is the company growing?• Track others and ask for examples ofTrack others and ask for examples ofleadership advancementleadership advancement
Training: this is not my last job,Training: this is not my last job,what can I learn here?what can I learn here?• OrientationOrientation• Ongoing clinical educationOngoing clinical education• Coding/documentation feedbackCoding/documentation feedback• Mentors—Clinical? Administrative?Mentors—Clinical? Administrative?Academic?Academic?
Mechanics of a Career searchMechanics of a Career searchClaim to FameClaim to Fame• Leader in the area (best residency? BestLeader in the area (best residency? Bestincome? Most fair?)income? Most fair?)• Company reputation (history behind theCompany reputation (history behind thename)name)• Any awards or recognitionAny awards or recognition• Unmatched employee satisfaction?Unmatched employee satisfaction?Retention?Retention?
Mechanics of a Career SearchMechanics of a Career Search• Don’t fall for the upfront dollarsDon’t fall for the upfront dollars• Look at 10 years projections for yourselfLook at 10 years projections for yourselfand the companyand the company• Compare apples to applesCompare apples to apples
LocationLocation• Pick a region of the countryPick a region of the country• Be flexible within the regionBe flexible within the region• Be willing to relocate for an opportunityBe willing to relocate for an opportunity
How important is it?How important is it?• 17 shifts/ month17 shifts/ month• 13-14 days off13-14 days off• 60-120 min from prime locations60-120 min from prime locations
LocationLocation• Spouse’s opinionSpouse’s opinion• Spouse’s jobSpouse’s job• Social settingSocial setting• Children’s educationChildren’s educationLOCATION SHOULD BE A TIELOCATION SHOULD BE A TIEBREAKER!!!BREAKER!!!
Emergency Medicine ScorecardEmergency Medicine Scorecard• Industry: Emergency MedicineIndustry: Emergency Medicine• Company—history, structure, track recordCompany—history, structure, track record• Growth opportunity—directorship, leadershipGrowth opportunity—directorship, leadership• Training—orientation, mentorshipTraining—orientation, mentorship• compensation—salary, benefits, retirement,compensation—salary, benefits, retirement,equityequity• Claim to fame—proud to wear logoClaim to fame—proud to wear logo• Job description—position availableJob description—position available• Location—just one variable, not a key issueLocation—just one variable, not a key issue
The DealThe Deal• Basics – CompensationBasics – Compensation• Production basedProduction based• Salary plus productionSalary plus production• Salary plus bonusSalary plus bonus• BenefitsBenefits• Malpractice coverage – claims made,Malpractice coverage – claims made,occurrence and tail coverageoccurrence and tail coverage
Give it timeGive it time• Look at resources: ACEP, EMRA, AAEMLook at resources: ACEP, EMRA, AAEM• Like in marriage, both need to adjustLike in marriage, both need to adjust• Discuss with your mentor(s) and peersDiscuss with your mentor(s) and peers• Go prepared: things to do before 1Go prepared: things to do before 1ststshiftshift• Maintain outside lifeMaintain outside life• Stay in touch!Stay in touch!
Frustrations of early attendingFrustrations of early attendingyears, anonymousyears, anonymousNot being able to spend my new wealthNot being able to spend my new wealthfast enoughfast enoughLearning to suffer foolsLearning to suffer fools
What if it’s still not right?What if it’s still not right?• EmergencyEmergencyDepartment DirectorDepartment Director• Physician working inPhysician working infreestanding urgentfreestanding urgentcare unitcare unit• Director, Multi-Director, Multi-hospital emergencyhospital emergencymedicine groupmedicine group• Chief Researcher,Chief Researcher,University ofUniversity ofMichigan, Division ofMichigan, Division ofEmergency MedicalEmergency MedicalServicesServices• Physician on a cruisePhysician on a cruiseshipship• Medical Director,Medical Director,EMS SystemEMS System
• Director, StateDirector, StateDepartment of PublicDepartment of PublicHealthHealth• President, AmericanPresident, AmericanCollege of EmergencyCollege of EmergencyPhysiciansPhysicians• Injury control expertInjury control expertat NHTSAat NHTSA• Health Policy Fellow,Health Policy Fellow,Robert WoodRobert WoodJohnson FoundationJohnson Foundation• Undersecretary forUndersecretary forVeterans HealthVeterans HealthAffairsAffairs• Governor, State ofGovernor, State ofOregonOregon
• Volunteer, DoctorsVolunteer, Doctorswithout Borderswithout Borders• Director of MedicareDirector of MedicarePart B, RegionalPart B, RegionalInsurance CompanyInsurance Company• Book author, ERBook author, ER• Executive Director,Executive Director,Professional SocietyProfessional Society• TV Health AdvisorTV Health Advisor• Director, QIODirector, QIO(Quality Improvement(Quality ImprovementOrganization), StateOrganization), Stateof Ohioof Ohio• Venture CapitalVenture CapitalSpecialist, HealthcareSpecialist, Healthcare• Vice President forVice President forMedical Information,Medical Information,WebMDWebMD
What Else is There?What Else is There?• Evaluating offer/contractEvaluating offer/contract– Ask resources/mentor(s)Ask resources/mentor(s)– Extra documents availableExtra documents available• Financial PlanningFinancial Planning– Saving/ investingSaving/ investing– Paying off loansPaying off loans– Starting practiceStarting practice– InsuranceInsurance• BillingBilling• Malpractice PrepMalpractice Prep• Other options?/JobOther options?/JobSpecific searchSpecific search• Careers within EM andCareers within EM andFellowshipsFellowships• Starting and running aStarting and running abusinessbusiness• Wellness: tomorrow andWellness: tomorrow andbeyondbeyond
Key PointsKey Points• Simple CVSimple CV• Think about this as a career choice, withThink about this as a career choice, with10 year projections10 year projections• Use leverage to maximize your tax freeUse leverage to maximize your tax freesavingssavings• Location should be one variable!Location should be one variable!
Getting startedGetting started• Sit down and identify your goalsSit down and identify your goals• Get out on the floor this weekGet out on the floor this week• Look at a minimum of 3-4 jobsLook at a minimum of 3-4 jobs• Try to get it right the first timeTry to get it right the first time
Remember,Remember,• Most residents will secure a job in the firstMost residents will secure a job in the firstquarter of the final yearquarter of the final year• GOOD JOBS ARE ALWAYS AVAILABLEGOOD JOBS ARE ALWAYS AVAILABLEFOR GOOD DOCTORS. ANYTIME OFFOR GOOD DOCTORS. ANYTIME OFTHE YEAR. IT’S NEVER TOO LATE ANDTHE YEAR. IT’S NEVER TOO LATE ANDNEVER TOO EARLYNEVER TOO EARLY