UO > Feature > The Job Quest

So you have about a year—maybe even 18 months or more—until your residency or fellowship training wraps up. It may seem like a long haul before you’re finished.

In terms of finding a job, it isn’t.

”My recommendation is to start your job search one-and-a-half years to one year before you finish,” says Ryan Mire, MD, an assistant clinical professor of internal medicine for Vanderbilt University in Nashville and the author of the book, Transitioning Into Private Practice: A Guide to Employment After Residency [published by Ryan Mire, MD, 2004; available through drmirejobsearch@yahoo.com]. “If you wait until your last semester, the opportunities will be picked over. The majority of practices know two years in advance that they’re going to need someone. They are ready to start looking at candidates.”

Even if you’ve put off your search (or didn’t realize that starting it six months out qualified as “putting it off”), there are steps you can take to ensure the best possible pool of opportunities.

Whether you’ll be working with a staff recruiter, looking on line, or using a search firm, you’ll need to approach your search in an organized manner.

“Physicians really aren’t given training in how to find a job,” says Julie Sherriff, the president of Sherriff and Associates, a search firm in Kansas City, Kansas. “I always say they should work through the process just as if they were diagnosing a patient.”

Sherriff recommends that you examine what you’re seeking in a practice. Consider practice size, type of patient base, call responsibility, and income.

Dana Butterfield, the executive director of the Association of Staff Physician Recruiters (ASPR), based in St. Paul, Minnesota, also recommends deciding on a location.

According to physicians who have been through the process, location is often a major consideration and can help focus your search right off the bat.

“I knew I wanted to get back to my wife’s hometown of Louisville [Kentucky] to practice,” says Rob Keifer, MD, a pediatrician-turned-anesthesiologist with Anesthesia Associates of Louisville. “I did my training at the University of Virginia, then contacted every employer in Louisville while I was on break two-and-a-half years before I finished. A little more than a year before I finished, I started pursuing those contacts in earnest. It was tough to find anesthesiology positions when I was looking [in the late 1990s], so I ended up taking a job for a year in Dayton, Ohio, until I got a call from Louisville. I don’t regret it [the time in Dayton], because it was still relatively close to Louisville.”

Joe Craft, MD, a cardiology fellow at Washington University/Barnes-Jewish Hospital in St. Louis and the chair of the resident/fellow section of the American Medical Association (AMA), will need a job in June 2006. He is looking at “a number of opportunities” in both teaching and

private practice, mostly in the midwest and southeast. He has already decided not to pursue any opportunities farther north than St. Louis.

“I think it’s important to consider geography during the job search,” Craft says. “You must be happy where you’re going to be. You will likely be bogged down with long work hours and call when you first start out, so you’re not going to have that much time for travel to visit family.”

Sherriff, however, thinks location is much less important. She says some job candidates dismiss an area of the country only because of preconceived notions about it. Many times, she says, she has turned around clients’ ideas that a city is “dull” or an area is “backwoods.”

“For one of my recent candidates, I found a job in Dayton, Ohio,” Sherriff says. “Her response was, ‘Dayton? I’m not going to Dayton!’ Her fiance was going to medical school and they wanted some options for him near her. She was also looking for cultural opportunities. I told her about the numerous medical programs in the area, as well as the fact that Dayton has a ballet company, an opera company, and plenty of other offerings. She decided it actually was a good choice for her to consider.”

On the other hand, excitement about location shouldn’t override your other job criteria.

Sheriff tells a story about a client who was deciding between coastal opportunities in Maine and the Southeast. “After seeing the southern location, he said, ‘This is gorgeous, let’s just go there.’ But I said that first, we must look at his criteria.”

His criteria included top-quality schools, a safe environment, and a practice opportunity that had an entrepreneurial bent with good prospects for a significant long-term increase in earnings. The southern opportunity, Sherriff says, fell short of the client’s goals.

“This city had one of the highest murder rates per capita in the country,” she says. “The public schools were poor. Three doctors had come and gone from the practice in the last year. It wasn’t a good bet for financial growth. So the client went to Maine. His wife’s family is somewhat close by, which was what the wife wanted. [See sidebar, “The Spouse Factor”, on next page] They’re now doing gangbusters and recently built a beautiful home.”

Once you’ve determined the characteristics of a job that are most important, you still have some big decisions. Not only can choosing a practice opportunity be a daunting prospect, you have to decide how you’re going to search. Where to turn? “Look at a number of resources,” says Marilyn Hill, the director of physician services for Beebe Medical Center in Lewes, Delaware. “When it comes to finding good physicians, we realize we must diversify. We use direct mailing, ads in Unique Opportunities, and direct e-mail, but we don’t use independent search firms. The hospital considers me their firm.”

Still, a search firm can be helpful in finding more obscure positions, says Rich Glehan, a principal for The HealthField Alliance recruiting firm in Danbury, Connecticut, and the chair of the ethics committee for the National Association of Physician Recruiters (NAPR),

“One big advantage to working with a recruiter is that you have the opportunity to hear about far more practices, especially those that are not well publicized,” he says. “But firms are not the be-all and end-all source for information.”

Craft says he is “not aggressively” working with a recruiter, but is relying on one for out-of-town opportunities. He has been able to research some positions himself and has heard of some through word-of-mouth, he says. “I have a pretty good idea of what’s out there.”

Often, the best leads just come from letting those around you know what you’re looking for.

A search firm may want you to sign a “right of representation” to be the exclusive representative in your search, Glehan says. “I don’t believe in this at all, although many of my colleagues don’t agree with me. Most doctors don’t adhere to rights of representation anyway. They’re going to work with whom they want and may want to keep their options open. A contract with a recruiter won’t get you better service. It doesn’t replace knowledge.”

If you’re considering a search firm, check www.napr.org to find out if the firm you’re considering is an NAPR member in good standing.

What to do about calls or e-mails from headhunters? Proceed with caution, says Glehan.

“These contacts can work out well, but you need to find out everything about the firm that the person is calling or e-mailing from,” he says.

And while it’s important to work with someone who is honest with you, it’s important for you to be completely honest with the recruiter, whether it’s a staff recruiter or a search firm. “Often, with international medical graduates, their culture may be to negotiate without being totally forthcoming,” says Sherriff. “This can be especially true about money issues. I’ve also had communication problems with Americans who are getting opinions from every family member remotely experienced in law or medicine. I hear these opinions second- and third-hand and have to sift through and figure out what my client is really concerned about.”

Several on-line search services are available geared specifically to physicians. Among them is HEALTHeCAREERS.com, which focuses only on health-care opportunities and is affiliated only with professional associations.

“We do the work for the associations,” says Carol Moore, the vice president of marketing and communications for HEALTHeCAREERS.com. “Candidates can get a very targeted search through the American Cardiology Association at our Web site, for example,” she says.

HEALTHeCAREERS.com’s services for physician job candidates include the ability to post a CV—anonymously, if you choose—and the opportunity to receive e-mail alerts, which give the candidate immediate notice about new positions that might be of interest.

“A single-specialty practice may not advertise anywhere else,” Moore says, “so you will find opportunities that are not advertised elsewhere.”

Keifer says he had colleagues who used GASNet.med.yale.edu for anesthesiology jobs, although he did not use Internet resources for his own search.

Moore also says that HEALTHeCAREERS.com offers support at various associations’ annual conferences.

“We often have computers set up in the convention halls for hands-on instruction from our people. A physician job candidate can flag his or her profile to say ‘I’m here at the conference’ and a potential employer can do the same thing,” Moore says. “We’ve been able to facilitate face-to-face interviews this way, without the added time and expense of travel and accommodations for the candidate. It works out great for everyone.”

Craft suggests that looking into professional societies—national, regional, and local—can be beneficial as well. The AMA Residents and Fellows Section offers written materials on transitioning to practice, licensure criteria, and contract negotiation.

State or county medical or professional societies also offer solid opportunities to network with established physicians locally. They’re also a good resource for trainees interested in settling in a new area. “These societies have a wealth of resources about local practice environments and what it is like to live and work there,” says Craft. These resources are often free or require a nominal membership fee, which always increases once residency or fellowship is over.