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they’re a husband/wife team and scheduling is more important than salary. I like to ask these things to make sure the position will be the right fit. The candidate’s leverage comes with negotiating extras. For example, he or she could ask whether [medical school] loan repayment might be included in the compensation package, especially if the salary offered seems on the low end. For someone with $250,000 in tuition loans, this can be the biggest issue. But the candidate should ask these kinds of questions last in the interview. You don’t want the immediate focus to be all about the money coming to you.”

Keifer recalls a candidate for a nurse anesthetist position at his practice whose first questions at the start of the interview were, “How much will I be paid?” “How much vacation will I get?” and “Will I be able to get this specific day off right after I start.”

Keifer says, “At that point, the president of the organization said, ‘Thank you, we’re done,’ and the candidate was very quickly shown the door. No one could believe she would ask those things right up front.”

Once salary is brought up by a potential employer, consider the long-term scenario carefully. Even if the starting salary is everything you’ve hoped for, focusing solely on short-term salary won’t do you any financial favors, says Vanderbilt’s Mire.

“Often, in the interview, residents or fellows focus on the first-year salary or guaranteed salary, which will be set for maybe two years,” Mire says. “Your salary beyond that may be based on productivity, meaning if you can’t see a certain number of patients in a day or week, you could end up taking a pay cut after the guarantee period is over. You must understand the productivity model or formula to determine how your future salary will be determined.”

Once you and an employer express mutual interest, follow-up is of key importance. One of the biggest mistakes a candidate can make during the interview process, says Mire, is not going back for the second interview.

“It happens,” he says. “Because they probably had to pay to travel to interviews for residency programs, residents may assume that their travel expenses for the second interview aren’t covered by the employer. At the same time, the employer may assume the resident knows that travel expenses will be paid for. So a resident may choose to go to only select second interviews—maybe even only one.” This can mean a great missed opportunity, or even burning a bridge for later in your career.

Other gaffes include not inquiring about the business aspects of a practice and focusing only on your call schedule and first-year salary or guaranteed salary.

“A good prospective employer would like to hear questions about the finances of the practice,” says Mire. “Any practice worth joining will have nothing to hide. But if they have three major malpractice suits pending, for example, they might not be on solid financial footing. It’s analogous to marriage: If you’re in love with a person in debt, you will acquire some of that debt yourself if you marry that person. Financial problems in a practice you join will become your financial problems as well.”

Keifer says that his practice’s business manager handles interviewees’ questions regarding finances.

“In our case, the business manager can best explain the business end of the practice and is happy to talk to candidates about it,” he says. “I’m most looking for questions about patient mix and load. I also welcome requests to be taught a few procedures. If there are one or two things a candidate has not yet been taught but is happy to learn, great!”

Keifer points to his own experience when he first started working in anesthesiology. “There were two guys from Duke who did blocks slightly differently and better than what I had learned, and I thought, ‘How great for me that I can learn from them.’ They were happy to show me what they knew.”

Keifer does caution that a job candidate should request only a few such learning experiences. “Obviously, if you seem not to know how to do much, your training will come into question and you’re not going to be hired,” he says.

For additional information, see “Acing the Interview,” from the July/August 2000 issue, at www.uoworks.com.

When you receive what seems to be a good offer, get it in writing, says Glehan.

“This is one of the biggest problems that could come up in a job search,” he warns. “You need to get a full employment agreement in writing. Many doctors get their compensation and benefits and call requirements in writing, but forget to ask for the terms and conditions of partnership.”

If the prospective employer wants an answer first and says, ‘Don’t worry, we’ll take care of the contract later,’ tell them, ‘No,’ Glehan says. “A verbal agreement and a handshake mean nothing.”

The other big mistake in accepting a job offer, according to Mire, is not getting a lawyer to review the contract.

“It is essential,” he says. “It is always worth the attorney’s fee.”

If a prospective employer does not allow you to take a contract to your lawyer for review, “Run, don’t walk, away from the job,” Glehan says.

If, on the other hand, the opportunity is in writing and you’re strongly interested, let the employer know, Mire says.

“If they make you a good offer, find out their deadline for your decision,” he says. “There is a fine line between being rushed and meeting a deadline, but you should know what their expectation is. If I have a candidate for a July start date, I would expect to do the interview in August and have the contract signed by December.” After contract negotiations, there are still the issues of licensing and hospital privileges. The entire process can take months to complete, and most employers like these steps finalized before the start date.

If you are trying to decide between two offers, Mire recommends visiting both places for a second or third time. Ask questions at the practice and in the community. Do some more exploring of neighborhoods. Even talk to a realtor about your situation and get some advice about what to expect in terms of housing availability and prices.

“Every potential employer expects that you’re looking at other possibilities,” Mire says. “So be honest if you want to explore other offers before making a decision. Just remember that no one appreciates being strung along in case ‘something better’ comes along.” g