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First steps for applying to post-training positions?

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  • Avatar Doc Spouse 
    Moderator
    Status: Small Business Owner, Spouse
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    Joined: 10/20/2017

    Hello all,

    My spouse recently started her final year of cards fellowship, and we’re getting deluged with wildly contradictory advice from her attendings and peers on how to start looking for her first job out of training.

    Aside from a few blogs and posts on SDN, we haven’t found much actionable advice for first steps. Considering the members of this forum have mostly been through this before, I’d like to throw out a few questions in the Lounge and see if anyone has input. Our thanks, in advance, for any advice you can give.

    1) How soon should we be sending out applications for posted positions?

    Some of her peers are saying she should start sending them out now, others are saying it’s too early and that nobody hires a year out. Have you noticed an accepted sweet spot, or is it just position/employer dependent?

    2) What information are employers actually looking for, and what should we be including on her CV?

    Her CV has remained pretty static since she applied to residency, only being updated with publications, research and, of course, training that she’s completed.  What else should we include or take off, if anything?  For example, do employers care about STEP scores? How about board eligibility/COCATS, number of examinations/procedures, etc? Is that something that should be front and center on the CV?  Some of the sample physician resumes I’ve seen out there are pretty bad. What’s worked for you?

    3) What’s worked best for you when it comes to finding open positions?

    One of the main issues is that we’re not planning on living where we are now, or where she did prior training; so our networking through current and former co-workers is limited. We’ve been looking on the NEJM and ACC job boards, but I can’t help feeling like we’re leaving a lot potential openings on the table. We’re not above cold-calling practices and medical groups in our desired areas. Has that worked for you in the past (either as employee/employer) and what’s been the best way you’ve found to approach it? Any other job resources beyond Indeed and those listed above that you’d recommend? Thoughts on external recruiters?

    I’m sure there will be more questions as we get closer to accepting a position, but much of those (interviews, contracts, benefits, salary) have been covered before. It’s these initial questions we’re having a hard time getting straight answers for.

    Thanks again.

    #228371 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 3052
    Joined: 01/03/2017
    1) How soon should we be sending out applications for posted positions?

    Click to expand…

    I think about a year is perfectly fine. Many practices with have a good idea about their staffing needs in a year.

    2) What information are employers actually looking for, and what should we be including on her CV?

    Click to expand…

    I think this will be dependent on what kind of job she wants. For private practice EM, we couldn’t care less about research. Academic places care much more. General stuff about college, medical school, residency, research, volunteer work, and interests outside of medicine are a good start. Nobody cares (or should care) about STEP scores at this point. Number of procedures should be fairly irrelevant since she’s in an accredited fellowship. I mainly look at a resume to see if I think they’ll possibly stay in the area long term or want to go somewhere else in the near future.

    3) What’s worked best for you when it comes to finding open positions?

    Click to expand…

    Word of mouth is usually how you find the best positions. If you’re not from the area or have contacts in the area, I would do research about the hospitals that are well respected in her field and then start finding out what groups staff those hospitals and start contacting them.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #228388 Reply
    Liked by Tim, Doc Spouse
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2640
    Joined: 05/07/2017

    It’s a physician friendly market.   If private practice is the plan, you have to determine list of priorities.  Most people have some type of geographic preference-  no smaller than x, near ocean, near mountain, or even LCOL.  They have some list of priority clinical practice items-not going to do x, want to do y.  They have some idea of how much call they want to take.  They have some idea of how much money they want to take.  What to be in private practice (very small number left in cardiology) or want to be employed (typically higher starting salaries but more structured)

    Don’t need scores of exams, just list pass dates.  Would include level 2 or level 3 certifications.  Will read nuclear, CT or whatever.

    Time to get looking is all over the place.  It depends on how OCD you are and some of the answers above.  It depends on how hard it is for spouse to find job in area.  Figure when you want to start working.  Figure 4 months for licensing and credentialing (less if already licensed in state).  Figure two months for interviewing and second visits.  That’s the minimum timeline to start when you want to start.  Some like more certainty, others like to wait and see what becomes available.  It’s easier if you know what geographical market you specifically want.    It’s more like buying a used car than a new car.  There is no similar structure to residency/fellowship where everyone starts at the same time and finishes at the same time.  If someone else takes the only job in the town you want, then you have to change the other parameters.  If no job available in the town you want, and you sign somewhere else, if something becomes available, you might have some regrets for committing too early.

    good luck!

     

    #228391 Reply
    Liked by Doc Spouse
    ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 3571
    Joined: 01/14/2017

    Hello all,

    My spouse recently started her final year of cards fellowship, and we’re getting deluged with wildly contradictory advice from her attendings and peers on how to start looking for her first job out of training.

    Aside from a few blogs and posts on SDN, we haven’t found much actionable advice for first steps. Considering the members of this forum have mostly been through this before, I’d like to throw out a few questions in the Lounge and see if anyone has input. Our thanks, in advance, for any advice you can give.

    1) How soon should we be sending out applications for posted positions?

    Some of her peers are saying she should start sending them out now, others are saying it’s too early and that nobody hires a year out. Have you noticed an accepted sweet spot, or is it just position/employer dependent?

    2) What information are employers actually looking for, and what should we be including on her CV?

    Her CV has remained pretty static since she applied to residency, only being updated with publications, research and, of course, training that she’s completed.  What else should we include or take off, if anything?  For example, do employers care about STEP scores? How about board eligibility/COCATS, number of examinations/procedures, etc? Is that something that should be front and center on the CV?  Some of the sample physician resumes I’ve seen out there are pretty bad. What’s worked for you?

    3) What’s worked best for you when it comes to finding open positions?

    One of the main issues is that we’re not planning on living where we are now, or where she did prior training; so our networking through current and former co-workers is limited. We’ve been looking on the NEJM and ACC job boards, but I can’t help feeling like we’re leaving a lot potential openings on the table. We’re not above cold-calling practices and medical groups in our desired areas. Has that worked for you in the past (either as employee/employer) and what’s been the best way you’ve found to approach it? Any other job resources beyond Indeed and those listed above that you’d recommend? Thoughts on external recruiters?

    I’m sure there will be more questions as we get closer to accepting a position, but much of those (interviews, contracts, benefits, salary) have been covered before. It’s these initial questions we’re having a hard time getting straight answers for.

    Thanks again.

    Click to expand…

    I’ll try to make this as step-wise as I can, but she should absolutely get started with this process immediately.  Before getting to the steps, here’s why she should start right away:

    1.  Everything takes more time than you think.  Prepping the CV, writing cover letters, waiting for people to get back to you, etc.
    2.  Some places are assuredly looking already, and more will come on line over the next 1/2 year.  So if she reaches out prematurely, who do you think the practice who hasn’t advertised yet is going to reach out to first?  Plus, she’ll have alternatives lined up – key to negotiation.  Early bird catches the worm.
    3.  Credentialing takes time.  She’ll have to possibly get a license in another state, which is a prerequisite for malpractice insurance, hospital credentialing, and then getting on the payer’s networks.  This all doesn’t happen quickly and takes months.  And that’s all AFTER she finds a place she likes, goes back and forth with the contract/lawyer review, and signs.

    So the steps:

    1.  Prep the CV.  This shouldn’t take much time but she shouldn’t make it more than 3-4 pages.  It should be broken up into categories (name/contact info at the top), education, credentialing/certifications, work history, research/presentations, awards, hobbies.  Definitely include hobbies.  That will tend to generate more convo on job interviews than some random research she did in med school.  Don’t include things like Step scores and undergrad GPA.  If she graduated Summa Cum Laude then put that under awards.  No one cares what she got on step 1.  Also, don’t include the number of procedures.  Her recommendations will vouch for that, and this will be teased out in interviews.  If there is anything highly specialized I’d probably include that (but this would probably be under certifications).
    1b.  Get references lined up – 3 from the like specialty – who can drop a note on a moment’s notice.  I’d even have them formally start writing something ahead of time, but she’ll need to give them a heads up as to what she’s seeking in #2.

    2.  She needs to investigate her philosophy.  Does she want academics, hospital employed, private?  Why?  The CV is a logistical step that’s necessary, but this step will chart her course from #3 on.  It will help draft cover letters appropriately.  It will help hone in her efforts to particular job postings, locations, etc.  If she already knows, awesome.  But this is a very important and introspective step where she needs to be fully honest with HERSELF, not do what will satisfy the academics and mentors around her.

    3.  Discuss as a couple places that you’d consider living.  This is one of the easiest ways to make sure you’ll be happy with the situation and to narrow the job search.  Research places thoroughly, and consider family, cost of living, your job prospects, etc.

    4.  Start searching job postings in the bulletins and journals that are pertinent to her specialty.  Consider the NEJM job search and others.  But look to what fits #2 and 3 and narrow in on those ones that are clearly looking first.  Then, research the practice types she wants in your ranked areas and start making a list.  For example, if she wants to be part of a large, private group in the St Louis area, go online and start searching out practices and make a list of them.  LEAN ON CONTACTS and other people who can help her out.  This is vital.

    5. Start calling the practices that weren’t listed but that she researched in #4.  Have the CV polished, and have a basic cover letter drafted that would include specifics of their practice.  When she calls she should be ready to talk to someone – likely the practice administrator – immediately, so have time to spare, and be ready and rehearsed with a basic intro and elevator pitch.  If there’s a possibility of a job opening they’ll give you their email, and BAM you immediately send the prepared CV and cover letter.  Be sure to mention ties to the area if relevant.  Also, ask if they would like a list of references (see 1b).

    6.  From your more robust list she’ll start to whittle things down as people don’t get back to her and as known job openings manifest.  Save the ones where a job might be opening in X months that still fits her timeline.  Typically a phone interview will happen if it hasn’t already.  Be prepared.  Strengths, weaknesses, know the CV backwards and forwards, HAVE QUESTIONS for the practice that reflect the fact that you’ve done research on them and/or the market.  Prepare, prepare.  Look for fit first and ask questions pertinent for fit.  Financial stuff will come later in the interview. If they don’t bring it up it’s reasonable to bring it up, but only after you get to know them better and if she really wants to be there.

    Two books that are OK for all this stuff are Life After Residency and The Ultimate Guide to Finding the Right Job After Residency.  I have my critiques of the books, but you’ll find some good tid-bits as well as good interview questions.

    7.  Schedule in-person interviews.  Have known availability when doing the phone interview.  Make sure the program isn’t going to screw her in this regard.  When she goes on them this is all going to be for fit and getting to know the practice and people.  But she’ll want to delve into the financial aspects where relevant if/when it comes up.  This is more important for the private side, but it might be relevant for other models in terms of contract terms for revenue as well as costing.

    8.  Leave each interview with actionable next steps.  Who is going to contact who and when?

    9.  Write them a note, even if it’s not a place she wants to be.  Word of mouth is still important here.

    10.  If legitimately interested ask for detailed financial information or other relevant information prior to signing any contract.  Look over the contract if offered a job and have it reviewed by a healthcare attorney in that state (preferably).

    11.  Negotiate aspects of the contract she doesn’t like, even doing this on multiple contracts in order to seek the best outcome for you both.  Reach back out to other jobs along this process to see if others pop up.  Keep in mind when you’re in the contract/job offer time period time is of the essence.  Usually you’ll have a few weeks to a month to respond and hash things out.

    12.  Sign.

    13.  Now starts the licensing, credentialing, etc. which takes MONTHS.

    Best of luck to you both.

    #228480 Reply
    ACN ACN 
    Moderator
    Status: Physician
    Posts: 669
    Joined: 01/08/2016

    Lots of good info above. Remember you get to choose two of three: location, type of job, money.

    If you're ever having a bad day, just remember in 1976 Ronald Wayne sold his 10% stake in Apple for $2,300.

    #228488 Reply
    Liked by Doc Spouse
    Avatar Doc Spouse 
    Moderator
    Status: Small Business Owner, Spouse
    Posts: 236
    Joined: 10/20/2017

    Incredibly informative responses here.  You’ve given us much to think about and, even better, much to work on. It’s greatly appreciated.

    #228492 Reply
    ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 3571
    Joined: 01/14/2017

    Lots of good info above. Remember you get to choose two of three: location, type of job, money.

    Click to expand…

    I would disagree with this as a general rule.  But it may be true in some circumstances.

    #228499 Reply
    Avatar treesrock 
    Participant
    Status: Physician
    Posts: 350
    Joined: 08/14/2017

    What kind of positions are you looking for? Small private practice? Big employed group? Academics?

    I agree with the advice above, and starting your search now is good timing. But if you want an academic job there is a lot more to think about.

    #228504 Reply
    Liked by Doc Spouse
    Avatar Doc Spouse 
    Moderator
    Status: Small Business Owner, Spouse
    Posts: 236
    Joined: 10/20/2017

    What kind of positions are you looking for? Small private practice? Big employed group? Academics?

    I agree with the advice above, and starting your search now is good timing. But if you want an academic job there is a lot more to think about.

    Click to expand…

    We’ve talked about this extensively, and she’s leaning more towards a larger group/academics rather than small private practice.  That’s partially for the back office support that comes with a larger group or hospital, and also because we just had our first child and there are QoL concerns.

    One issue she has with an academic job is that, at least where we were before, it comes with a significant hit in potential salary.  Salary isn’t her highest concern, but she wants to feel adequately compensated for the work load.  Based on what some of her co-workers were making in an academic setting, that wouldn’t be the case. Some of them were getting financially abused.  Of course, that could have just been the area we were in before (East Coast), but she’s a bit leery of them, now.  Open, but leery.

    I’d be interested in hearing how academic jobs differ, in your opinion?  I’m sure there are plenty of issues there that we’ve never considered.

     

    #228516 Reply
    Avatar mjohnson 
    Participant
    Status: Physician
    Posts: 64
    Joined: 05/05/2019

    A year left is definitely not too early to start looking, interviewing, etc. If not pursuing academic I would recommend looking at both employed vs straight private practice. Starting early gives some flexibility to see differences and find a good fit. Some red flags can come out which is a benefit of looking early and at multiple practices.

    #228517 Reply
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 3339
    Joined: 09/18/2018
    Lots of good info above. Remember you get to choose two of three: location, type of job, money.

    Click to expand…

    a). Location is one of the most difficult choices. How open are you folks really? It’s not only geography, it’s the type of lifestyle and size of the town or city as well as the type of employment. If you have a top three, add another that is different. Now is the time to explore your options. “Research places thoroughly, and consider family, cost of living, your job prospects, etc.”  Now you have four locations to look.

    b). Does she want academics, hospital employed, private? Please note that healthcare systems cover multiple hospitals and regions as well. It’s easy to find academics and hospitals, but much more difficult to track down private practice opportunities. Use your academics and mentors (network) as much as possible. It can be invaluable if they have a connection and provide any type of introduction. “LEAN ON CONTACTS and other people who can help her out. This is vital.” Most likely the best jobs aren’t even advertised, filled by contacts and referrals. Just a note, bottom of the list of jobs would be recruiters. Hard to fill locations or positions. Professional meetings have a component of recruiting as well.

    c). If anyway possible, have a timeline, when contacts are made, phone interviews, site interviews, offers received, evaluated and a decision made. This allows you to set expectations upfront and explore her options. Having four offers to choose from in December or January is a huge advantage. If it doesn’t work out, adjust and you still have time. The goal is to have a signed contract 6 month’s prior to starting.

    d). There are many anecdotes about positions that didn’t workout and supposedly 50% leave in the first contract period. You have 6-7 months to find her dream job and be one of the ones that is content and satisfied. Once the site interview takes place, timing will really depend on the employer. If out front you indicate a December decision timeframe, so be it. They took the position of timing if you let them.

    Summary, if she has a dream job in a dream location go create it. She may find employers or groups that are willing to buy in.

    Do not explore opportunities that she has no interest in. Interview trips take time and you will be stuck with a tax bill on the interview expenses.

     

    #228520 Reply
    Liked by Doc Spouse
    Dreamgiver Dreamgiver 
    Participant
    Status: Physician
    Posts: 894
    Joined: 03/09/2017

    Academics vs PP (big or small group) is the first decision to make. These jobs are very different. True, most academic jobs come with decreased financial compensation, but that is only the tip of the iceberg. Most good jobs you’ll never see an ad for.

    #228543 Reply
    Avatar ZZZ 
    Participant
    Status: Spouse
    Posts: 729
    Joined: 06/18/2018

    “We’ve talked about this extensively, and she’s leaning more towards a larger group/academics rather than small private practice.”

    Large private group and academic aren’t a ‘/’ type thing. They’re typically significantly different work scenarios, with oft different compensation, both in terms of income and benefits. The sooner you get some interviews lined up the sooner you can compare offers and decide which direction will be best for you.

    #228564 Reply
    Liked by Doc Spouse
    MPMD MPMD 
    Participant
    Status: Physician
    Posts: 2606
    Joined: 05/01/2017

    @DocSpouse this is literally my job — I’m in charge of helping graduating residents find a job. Here are my thoughts.

    CV: there is a right way and a wrong way to do this, the first thing she should do is find the promotion and tenure section of her uni website, they will have a CV format, every uni does. she can start there. if you PM me I am happy to edit her CV, like I said this is my day job. the difference between an academic and a PP CV for a graduating fellow should be zero except possibly references. @ENTDoc is mostly right but 2 disagreements: first of all your CV is as long as it needs to be. a 20 page CV for an academic doc in their 40s would not be uncommon or unexpected. late career academics often have CVs that run into dozens of pages. the CV is NOT a resume, it includes everything. hence the name. many cardiology fellows may have CVs running to 10 pages. secondly do not list hobbies on a professional CV. again like I said happy to look at it.

    Cover letter: equally important to the CV, again I’m happy to help with examples of this if you PM. this is of critical importance if her CV is relatively thin as you hint that it might be? one rule of thumb that I like to say is that the CV generally speaks loudest for educators and academic docs with pages of lectures, abstracts etc whereas the cover letter speaks loudest for PP and admin oriented people where they can do narrative highlights of accomplishments that might not come through on a CV. for example if your partner led a QI project where she improved standardized care of Impella pts post cath in the CCU that may be very hard to list on a CV whereas (“CCU Quality Committee” or something like that) whereas on a cover letter she can discuss it a bit.

    Timeline: stop worry about this especially for PP. Sept is a pretty good target but private practice groups may know well ahead of this that they are hiring. I have grads with letters of intent signed in July. There is no rule on this. The worst that can happen is to say “check back with us later.”

    #228565 Reply
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 3339
    Joined: 09/18/2018

    Take MPMD up on the offer of assistance. Academics is a small small world. Your attendings and PD went through the academic route. Squeeze every drop of juice from every opportunity to connect in the academic world.

    #228574 Reply
    Liked by Doc Spouse

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