m arching i nto t he r eal w orld, b est f oot f orward marianne carim md pgy3 internal medicine...
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MARCHING INTO THE REAL WORLD, BEST FOOT FORWARD
Marianne Carim MDPGY3 Internal Medicine
George Washington University Hospital
OBJECTIVES
A. TimetableB. Goals and Objectives
ProfessionalEconomicPersonal
C. Finding Job OpportunitiesD. Preparing your CV/Cover letterE. Interviewing ProcessF. Contract Issues
Malpractice InsuranceDisability Insurance
G. Locum Tenens
TIMETABLE FOR SELECTING PRACTICE OPPORTUNITIES
12-18mos: define goals and objectives Prepare CV Research practice opportunities
7-10mos: Begin the interviewing process 6-9mos:
Conduct second interview Revisit new community Evaluate the opportunity
4-6mos: choose your practice
SETTING GOALS AND OBJECTIVES
Most important step: setting clear realistic goals
Define what your are looking for in professional and personal life
Design a plan
PROFESSIONAL ASSESSMENT
Strengths Greatest achievements and with what skills? What does patient care mean to me? Define your ideal patient population Importance of clinical interactions with
physician colleagues? Pen and paper!! Practice discussing them
IDEAL AND NIGHTMARE SCENARIOS Location Partnership track Type of common patient care activities Pace of office activity Extent of interaction with other MD’s Staff management responsibilities Total hours and on call hours required per week Technology Compensation Teaching and research opportunities Advancement opportunities Other non-patient care activities required Career/financial security Competition Reputation
PERSONAL ASSESSMENT
Special family needs Partner’s career aspirations Rural vs urban location Cost of living/house pricing Community support (religion, education,
healthcare) Recreation/culture/arts Climate and transportation (public, commute
patterns, airport access Crime rate
ECONOMIC ASSESSMENT
Define your financial position How does my economic situation influence the options Relocation expenses Know what benefits are important for me
Know your budget to know income requirements Know your loan policies. Call them often! When
do you start paying? Are you consolidated? Consider paying interest which may have accrued during residency
before it capitalizes. Are there benefits to direct debit or paying on time? Advantages to paying early?
Lowest salary figure to live comfortably Life/health/disability insurance and levels
needed
TYPES OF PRACTICE SETTINGS Solo Practice Group practices
Established vs forming a new one Multispecialty vs single specialty Affiliated MD’s vs space-sharing arrangement only
Health Maintenance Organizations (HMO’s) Urgent Care Industrial/occupational medicine Health insurance company Administrator Federal/state/local government (VA, PHS, Military,
Licensures, disability determination) Medical research centers (universities, private centers,
government agencies) Hospital-based medicine Locum Tenens
PREPARING YOUR CV – SIMPLE GUIDELINES
DO NOT include: DOB, SS#, DEA#, pictures
Explain any time gaps
Use “active” words, be grammatically consistent Highlight achievements, explain what is not
obvious Highlight leadership roles as separate from
participation
Any lectures you’ve given (TR talks), papers you’ve written, poster presentations, or research assistance are fair game
PREPARING YOUR CV - OUTLINE Education Licensure and Certifications Professional Experience Professional Societies/Memberships Honors and Awards Second Language Skills Personal Interests Publications/Presentations• You can consider Hobbies/interests to make you
more interesting, but this is not typically done on medical CVs
PREPARING YOUR CV – LAST POINTS Consider more than one version if
applying for different types of jobs to highlight different things
Have someone you trust in and outside of medicine read it
Save it as a PDF file, not just on Microsoft. If you email it to folks in the future, always
send the PDF file (This eliminates layout problems)
COVER LETTER
Essential part of CV package Can set you apart One page Includes:
Name and address of prospective employer Date Include how you heard about the opportunity Brief paragraph End with call to action, ask them for more
information about the practice Sign your name and make sure to include your
address and information in case cover letter separated from CV
REFERENCE LETTERS
Crucial piece of application Usually get asked specifically for Chief
Resident, Program Director, Attending What they say and don’t say is very
important Be sure to ASK FOR PERMISSION and alert
your references of requests Be mindful:
Reference should be able to give specific examples about job performance and social skills
Employers are looking for physicians that are known for their great relationships with patients and staff
CREDENTIALING FILE Copy of vaccinations (tetanus, hep B and titres, MMR, varicella
illness or vaccine) Copy of last PPD within one yr (if positive, cxr) Copy of medical school diploma Copy of Residency diploma Copy of ABIM certificate Copy of DEA certificate Copy of all state licenses (even expired ones) and copy of
license application List of dates you were at all schools (undergrad, med, other)
and training programs, and phone # or address where you can get proof/transcripts
Copy of CV Professional references: 3 names and phone #s copy of USMLE scores NPI# Copy of CPR/ACLS certification cards Copy of all CME credits as you take them
FINDING PRACTICE OPPORTUNITIES Internet primary source Specialty journals, newsletters, direct mailings Job fairs and specialty conventions Networking with friends/colleagues from previous
years Search Firms In House Recruiters: permanent basis for
hospitals and medical groups **Know any docs in that city? Ask your attgs!!** Send CVs even if no openings: call and ask for
appropriate contact, can email, fax, mail
It is up to YOU to manage your career search!
INTERVIEWING STRATEGIES
First appearances ARE important Presentation:
Wear a suit. Wear nice shoes. Average doc looks like your dad (Wear something your dad would
like!)
Ask in advance who you will be interviewing with and Google them!
Google yourself! Bring copies of your CV and be prepared to talk about
EVERYTHING on it Have questions prepared
INTERVIEWING STRATEGIES
Ask the right questions of the right people: nuts and bolts questions probably answered by a chair or
person in charge of hiring day to day questions probably answered by other docs. Some docs will be put-off if you ask about salary/hours!
Consider writing notes: Jot down something you discussed with each person so you
can thank them and reference it! Get business cards/contact info from everyone you meet with
Send thank you letters/cards or emails to everyone you met with. Offer to give them professional references Ask what the next steps are and when you should expect to hear
from them!!
INTERVIEW LOGISTICS
Cover travel, lodging and even meal expenses at times
Significant other can accompany you to location
Long days - meeting most staff and most partners
Spend evening with partners and their spouses with your significant other if applicable
Few pointers: don’t drink alcohol even if offered!
INTERVIEWER’S CRITERIA Training program and skills 20% focus on technical skills 80% on social skills, goals and objectives and
behavioral characteristics Questions regarding career goals, conflict resolution
skills, ideal practice, medical philosophy, other practices, salary
Criteria to be evaluated: Communication skills Maturity Adaptability Motivation Work orientation Organization Judgment
Be true to yourself!!
EVALUATING THE OPPORTUNITY
Refer back to your goals and objectives
Guidelines developed by American Society of Internal Medicine (ASIM)
MALPRACTICE INSURANCE Claims-made Occurrence-made Tail coverage: necessary for claims-made
One time fee 1.5 – 2 x annual malpractice insurance premium 50% of practices provide it
Nose coverage Know your coverage and ensure that it is adequate
Pure loss vs ultimate net losses Lost wages Services provided
Premiums Exclusions: ex. Defense costs, deductible, third
party
DISABILITY INSURANCE Definition:
1. Own-occupation2. Modified own-occupation3. Any occupation
usually coverage to equal approximately 60% of earned income
Max monthly benefit $15,000 Premium rates Renewability Provision:
Guaranteed renewable Non-cancelable and guaranteed renewable
Residual Disability Rider: if greater than 20% loss of income
RESTRICTIVE COVENANTS
Also known as Non-Compete Clause Protect the practice that hires you Laws and norms vary state to state 2 main aspects:
Duration Restricted area
Termination and leaving practice Grace Period
UNDERSTANDING CONTRACT TERMS Salary Non-salary benefits Ownership/partnership Outside Activities Duties and Requirements Restrictive Covenant Non-solicitation clauses Term and Termination Gap/Tail insurance
http://www.acponline.org/running_practice/practice_management/human_resources/
NEGOTIATING THE CONTRACT
Gather information and be prepared Treat people with respect Negotiate from the perspective of mutual
benefit and fairness Set priorities Develop a strategy
Easy points first, hardest issue midway Know your practice to know the easy points Conclude with light ones
Goal to have a win-win solution!!
A LAST LOOK AT THE CONTRACT Get a lawyer! Term:
1 to 2 yrs Cancellation partnership
Duties: Forbidden issues Moonlighting Teaching Call
Salary and Benefits Base salary, incentives, bonuses
Final issues
LOCUM TENENS Definition: Substitute physician or “one holding
the place” 4-15% of physicians worked LT Great way to experience “risk-free” the lifestyles
associated with various geographic locations 26 recruiting firms that provide placement
services National Association of Locum Tenens Malpractice insurance - priority task
30% basic claims-made malpractice insurance without tail coverage
Very competitive salary – but for a reason! No Health Insurance, no sick days, taxes are as an
independent contractor (tax 1099), no “vacation”
TURNING DOWN OTHER OFFERS
Don’t burn any bridges – you might want that job next time!
Be honest, tell them as soon as you know Best to do this by telephone
THANK YOU!
Resident GME Committee Dr. Catalanotti Jeffrey Pecore, Esq James Doherty Jr, Esq Dr. Jim Fitzpatrick Maureen McCarthy, CPA
REFERENCES
JABFP Vol 16 No. 3 A Physician’s Guide to Working as a Locum Tenens
ACP website http://www.acponline.org/residents_fellows/
career_counseling/guidance.htm AMA website http://www.ama-assn.org/ama/pub/about-
ama/our-people/member-groups-sections/resident-fellow-section/succeeding-medical-school-practice.shtml