1. 3. After Residency
 Career Planning
 Visa issues
 Fellowship
 Types of Practice
 Job interviews
 US Geography

2. 3. After Residency
 Career Planning
 Visa issues
 Fellowship
 Types of Practice
 Job interviews
 US Geography

3. 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

4. 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

5. 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

6. Job search
 Job recruiter
 Job fair
 Internet search
 NEJM career center
 JAMA career
 Practice Link
 Career MD
 Indeed
 Personal information / contact

7. 3. After Residency
 Career Planning
 Visa issues
 Fellowship
 Types of Practice
 Job interviews
 US Geography

8. 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

9. Types of visas
 Immigrant visas
 Permanent residence
 Nonimmigrant visas
 H1B (hospital)
 J1 (ECFMG)

10. Permanent Residence
 영주권 , Green card
 장점
 입국 절차 간소화 , 비자 불필요
 안정성
 NIH grant
 시민권 취득

11. 취업 이민

12. 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

13. 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

14. 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

15. Pathways
 J1 residency (  J1 fellowship)  J1
waiver & green card (  Fellowship )
 H1 residency (  H1 fellowship)  H1 job
& green card (  Fellowship)
 H1 residency / NIW (  Fellowship )

16. My two cents:
 Contact lawyer in the U.S.

17. 3. After Residency
 Career Planning
 Visa issues
 Fellowship
 Types of Practice
 Job interviews
 US Geography

18. 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?

19. 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?

20. Qualities and other factors important
to fellowship PD (from the most
important to the least important)
1. Negative comments or hints of underlying
problems in letter written by internal
medicine PD
2. Personal comments by the internal
medicine PD
3. The personal aspect of the interview
4. Letter of recommendation (LOR) from a
cardiologist known by the fellowship director

21. Qualities and other factors important to fellowship
PD (from the most important to the least important)
5. Performance during an elective at the
fellowship site
6. Rank order in the residency class
7. Genuine interest in research
8. Being a graduate of a US medical school
9. LOR from a nationally known cardiologist

22. Qualities and other factors important to fellowship
PD (from the most important to the least important)
10. Doing a residency program at an
institution with a well known cardiology
division
11. Participation in research prior to the
fellowship program
12. Assessment of medical knowledge
during the interview
13. Publications prior to fellowship

23. Qualities and other factors important to fellowship
PD (from the most important to the least important)
14. Performance on the ABIM certifying
examination if available
15. US citizenship
16. Performance on the USMLE

24. 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.

25. 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

26. To do before, during or
after residency
 Research
 Green card

28. Selection of subspecialty
 Academic interest
 Own history of training & research
 Compensation, QOL
 ACGME accredited fellowship
 ACGME non-accredited fellowship

29. 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

30. Fellowship application &
matching
 ERAS / NRMP
 SF match
 Individual applications

31. 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

33. Selection of programs
 Training
 Program structure / Compensation
 Research / Faculty potential
 Reputation / ranking
 Location

34. My two cents
 What is the best program for you?

36. 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.

38. Differences from residency
 Application Mechanisms
 ERAS Fellowships Documents Office (EFDO)
 Applicants: current trainees or not
 Interviews
 Research / green card
 Role

39. 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

40. 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

41. http://www.abim.org/about/examInfo/data-fellow/chart-05.aspx

42. FREIDA

43. Fellowship structure
 2 year clinical fellow
 1 year clinical fellow + 2-3 year research
fellow

45. 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

46. Fellow rotations
 (Exemple: nephrology)
 Dialysis
 Consult
 ICU
 Transplantation
 PD
 Vacation
 Q4

47. Board certification
 Not mandatory
 Not license
 Need renewal
 MOC (Maintenance of Certification)
 Multiple board certification

48. Licensure
 There is no ‘US medical license’
 Every state board has its own requirement
and licensure process
 FEDERATION CREDENTIALS
VERIFICATION SERVICE (FCVS)

50. 3. After Residency
 Career Planning
 Visa issues
 Fellowship
 Types of Practice
 Job interviews
 US Geography

51. 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)

52. Types of practice
 Multispecialty group practice
 Managed care company employment
 Academic practice
 Locum tenens
 Government (Veterans Affairs, etc.)

53. 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.

54. 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.

55. 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.

56. 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).

57. 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)

58. 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)

59. 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)

60. 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

61. 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

62. JOINING A SINGLE SPECIALTY,
SMALL GROUP PRACTICE –
Cons:
 Possibility of conflicts concerning
interphysician personality and professional
issues

63. 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.)

64. SINGLE SPECIALTY,
LARGE GROUP PRACTICE
– Cons:
 Bureaucratic decision-making process
(variable)
 Physician compensation issues (variable)

65. JOINING A
MULTISPECIALTY 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.)

66. JOINING A
MULTISPECIALTY 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.

69. 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

70. 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

71. 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

72. Academic- Cons:
 Political structure and issues
 Restrictive covenants, if present, may be
broad
 Possibility of decreased salary when
compared to private sector

74. Locum tenens
 Latin for “one holding a place.”

75. 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

76. 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

79. 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

80. 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

82. Types of IM Practice
 Traditioinal
 Outpatient only
 Hospitalist

84. 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

87. 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

88.  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

89.  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

91. My two cents: English

93. My two cents: English
 Don’t be creative: see others
 Context
 Culture

94.  “Never come out of a patient ’s room
without asking about his profession
and a local sports team. ”
 JAMA 2012; 308(21): 2197-8

95. 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?

96. 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

97. 3. After Residency
 Career Planning
 Visa issues
 Fellowship
 Types of Practice
 Job interviews
 US Geography

98. 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

99. Academic job interview
 Need to characterize the position
 Research
 Clinical
 K grant or not
 Job talk
 Intensive interviews

100. 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

101. 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.

102. 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.

103. 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.

104. 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.

105. 3. After Residency
 Career Planning
 Visa issues
 Fellowship
 Types of Practice
 Job interviews
 US Geography

106. Locations
 Residency / (Fellowship)
 Permanent job

107. 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

108. 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.

109. Crime Statistics
 http://www.relocationessentials.com/aff/w
ww/tools/crime/crime.aspx
 Also contains useful information on
schools, salary comparisons between
cities.

115. Best places to live ??
 CNN/Money:
http://money.cnn.com/real_estate/best_pla
ces/
 Sperling’s Best Places:
http://www.bestplaces.net/fybp/

116. My two cents:
 Only you can rank ‘best places to live’.

117. 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

120. 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

121. 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

126. References
 Shaw, Koushik: The Ultimate Guide to
Finding to Right Job after residency
 http://
www.acponline.org/residents_fellows/career_c
 www.practicelink.com