Career Planning in

1

• Career Planning in
• Emergency Medicine

2
Objectives

• Entering the job market
• Tips for an effective search
• The interview and follow-up
• How to evaluate a position (and offer)
• Successful negotiations
• Strategies for rewarding careers in EM

3
Finding a position in EM

• Realistic appraisal of your abilities
• Discuss with family, friends, mentors
• Research various possibilities
• Consider more than one option
• Gather information and verify it
• Look to trusted advisors
• Take into account personal needs, interests
  talents

4
DEFINE Personal/Family/Professional Goals

• Most doctors choose to practice close to home, or
  within 100 miles of their training program
• Many leave original practice within 2 years due
  to unmet expectations
• Where you want to live and raise your family will
  ultimately determine where you stay long-term
  (Recruit the spouse and you will recruit the
  doctor.-- Recruiter Colloquialism)

5
DEFINE Personal/Family/Professional Goals

• Key practice where you want to live
• How much money do I need to make to meet my
  needs?
• What will fulfill my professional needs?
• What type of practice?
• Is there a documented need for my services?
• How many patients a day am I comfortable
  seeing?

6
Stages of the job search

• Stage I - Preparation
• type of position
• type of employer
• geographic location
• Stage II - Investigation
• look for possibilities
• make contact
• interview and tour ED
• Stage III - Decision
• negotiations may help

7
Career vs. Job

• Distinction
• Career defines an individual
• Job pays the bills
• Time frame
• immediate
• short-term
• long-term

8
Where do I see myself ...

• in the next year
• in the next 5 years
• in the next 10 - 15 years
• Geographic region
• Emergency setting
• Hospital environment
• Community

9
First year out ...

• Learn a new system
• Introduction to staff and consultants
• Establish a reputation
• Get to know the community
• Study for boards

10
5 years out ...

• Career re-evaluation
• Money somewhat less of a concern
• school debts often repaid
• growth in savings
• partnership
• vested in pension
• Thoughts of retirement ...

11
10 - 15 years out ...

• Make or break time
• Serious travel or time away
• Rekindle your passion for EM
• Thoughts of career re-direction
• urgent care
• occupational health
• administration

12
What makes me happy?

• Patient care
• Teaching
• Supervising
• Research
• Administration
• Learning

13
What is important to me?

• Power
• Fame and notoriety
• Personal time
• Fancy vacations
• Material goods
• Money

14
What is really important?

• Family and friends
• Career satisfaction
• Security
• position
• financial
• Respect
• Wellness

15
What do I enjoy when I am at work?

• Nice patients
• Supportive staff
• Functional facilities
• Challenging cases
• Teaching
• Camaraderie

16
Autonomy

• Physician autonomy is possible despite the
  advent of practice guidelines, managed care, and
  government agencies (although more difficult).
• Test ordering
• Decision-making
• Best practices

17
What would I like to avoid?

• Unmanageable patient volume
• Delays affecting patient care
• Difficulty getting patients admitted
• Hassles with consultants
• Non-supportive environment
• Administrative headaches
• Frustrations with ED/hospital design

18
Beyond graduation

• Fellowships
• Chief residency
• Additional residency training
• Positions
• clinical
• academic
• hybrid
• Travel

19
Clinical setting

• Rural
• Suburban
• Urban
• County
• Academic medical center
• VA
• Military

20
Learning the market

• AHA Guide to the Health Care Field
• PDs faculty (yours and theirs)
• Recruiters (companies or ED groups)
• Internet
• Hospital operators
• Family or friends
• Phone book
• EDs

21
Effective searching

• Be focused
• Be assertive
• Be creative
• Start early
• Dont take NO for an answer, it may become YES
  later

22
Job search vs NRMP

• Search ends once candidate accepts
• time and money
• mutual decision
• May be offered position at end of the interview,
  or within a short time
• Make sure your PDs and references are available
  and know when, where, and why you are interviewing

23
Foot in the door

• Telephone contact
• not Monday AM or Friday PM
• find out when someone will be available
• Personal communication
• Someone who knows the right person
• Right place at the right time
• introduce yourself at a meeting
• stop by the ED

24
Preparation

• Find out what is going on
• hospital and ED
• leadership
• research
• community
• Why is the position open? How long?
• Most recent hire? Departure? Why?
• Turnover rate?

25
Resources

• Faculty interests
• EM textbooks
• Medline / Pubmed
• Internet home pages
• Residency websites
• Conference faculty
• Your programs faculty may know ...

• Job opportunities
• Journals/newsletters
• Job catalogs
• Postings (meetings, internet, bulletins)
• Local program directors residents
• Word of mouth
• Recruiters

26
Professional recruiters

• Use judgment before giving out CVs
• Many have excellent skills / reputations
• Firms vs. recruiters for contract group
• who do they represent?
• for whom do they work? answer to?
• how do they get paid? when? by whom?
• Weigh benefits vs. downsides
• Not for everyone

27
Questions for recruiters

• Years experience in EM? Exclusive?
• Background? Previous employment?
• Knowledge of EM? Geographic region?
• Percentage of academic placements?
• Willing to give reference(s)?
• Success rate? Other data?
• Financial arrangement?
• Why them?

28
CV Cover letter

• Equally important with different roles
• Curriculum vitae lists professional
  accomplishments, abilities, interests, and
  activities
• Cover letter is a personalized attempt at
  convincing someone to offer you an interview
• Both include name/address/phone

29
Curriculum vitae

• Make it look like it wants to be read
• professional style
• use white space appropriately
• good texture
• easily read
• It should copy well
• Descending chronological order
• Include special skills, esp. language

30
Important information

• Include professional degree
• Reliable phone number
• Current contact address
• Email address
• Do not use pager, ED, or secretary s
• Keep contact information simple!

31
CV dos donts

• DO
• Emphasize your accomplishments and special skills
• Include your name on every page
• Keep it simple and legible
• Number each page

• DONT
• Include irrelevant information
• Use dark paper that doesnt copy well
• Make grammatical or spelling errors
• Inflate your accomplishments

32
Cover letter

• Personalize - address it to someone
• Send with your CV
• Check spelling (esp. names)
• Give a reason why you should be invited for an
  interview
• Include personal information that doesnt go on
  your CV

33
Interview

• Dress professionally
• Let them interview you
• Interview them
• Learn about the position, hospital, and community
• Meet as many people as possible
• Find out as much as you can about as much as you
  can.

34
Interviews

• Dont waste their time or your own
• Practice at your residency program
• Be prepared
• to present a case
• to give a lecture
• to share your CV / articles
• to discuss your (and their) research

35
Bring to interview

• Map with directions
• Change for parking
• Copies of CV and writing sample
• Interview itinerary
• Names of faculty and administrators
• List of interview questions
• Pen, paper, business cards, folder
• Toothbrush and mscll. health care

36
Interview questions

• Which questions?
• Address questions to the right people
• Ask same question to different people
• Clarify answers to questions from earlier in the
  interview process
• Ask a question when asked if you have one (even
  if you dont have any).

37
Their questions

• Tell me about yourself?
• What are your strengths? Weaknesses?
• Tell me about a mistake you made and how you
  handled it? What did you learn?
• What do you see yourself doing in ... ?
• How/what/when will you contribute to our ED?
• Why should I hire you?

38
Your questions

• Why is this position open?
• When was the last new physician hired?
• How stable is the nursing staff? Hospital?
  Physician group?
• May I speak with the most recent hire? Physician
  who most recently left?
• Credentials of MDs? Nurses?
• How can I make myself more competitive?

39
Other questions

• Anticipated changes in the ED
• staffing (MD, RN, mid-level providers)
• census (ED, hospital, community)
• facility (expansion, observation unit, other)
• Progressiveness and creative planning
• Responsiveness of hospital administrators to the
  needs of the ED

40
Wish list

• Nice practice environment
• Stable hospital / growing ED census
• Good community (growing)
• Democratic group
• Similar colleagues (family)
• Opportunity for social/family happiness
• Fairness with respect to schedule, compensation,
  and future potential

41
Chief

• Leadership
• Innovation
• Creativity
• Respect (within group? hospital?)
• Business sense/plan
• Fairness

42
Democratic group

• Competitive salary with reasonable administrative
  overhead
• Open books
• Equitable schedule with flexibility
• Evenly distributed workload
• Shared opportunity for advancement
• professional
• partnership (non-financial)
• financial parity

43
Emergency department tour

• Age
• Layout and design
• Size and space
• Telephones
• Computer access
• Waiting room condition
• Plans to remodel

44
Make sure you ...

• meet as many physicians as possible
• speak to nurses and paramedics
• talk with consultants about the ED
• meet administrators, if possible
• talk to benefits office(r)
• show an interest in the rest of the hospital and
  the community
• make an effort with (quick) good-byes

45
Interview follow-up

• Thank you
• personalize (name and experience)
• telephone, email, US mail
• additional chance to express interest
• Dont skimp
• anyone helpful or made time for you
• Timely manner
• even if you arent interested in the position
  or they did not seem interested in you

46
Contracts

• Professional review
• Reference manuals may help, but its like reading
  a foreign language
• Read, understand, and amend what is important to
  you
• Not everything can be changed
• Employee manual is contract

47
Concerns with contracts

• Termination clause
• Restrictive covenants
• Malpractice coverage
• who provides?
• type of coverage (claims-made or occurrences)?
• tail (who pays?)

48
Employee vs. Independent contractor

• Benefits
• Financial (tax) implications
• Recent pressure from IRS to redefine EM
  relationships as employee/employer rather than IC
• Security ??????

49
Negotiations

• Be prepared (find out what is negotiable before
  you begin negotiating)
• Understand what the other side needs
• Practice negotiations - getting to yes
• Keep your ego out of the deal
• Be creative
• Consider factors (skills, demand, need)

50
Negotiations (cont.)

• Look to the future
• Consider the risk vs. benefit ratio
• ending up with nothing
• getting what you want in the present
• people remember frustrations
• negotiate for a promising future
• Dont resent how negotiations turn out

51
Time

• Clinical duties most important
• arrive early
• work hard
• finish your work
• be pleasant to staff, patients families
• no distractions!
• Make yourself available for switching shifts (or
  extra duties if needed)
• Study for boards

52
Time (cont.)

• Exercise
• Sleep is a priority
• Take classes
• Develop hobbies
• Personal growth
• Commit to family and friends

53
Medical licenses

• Start early
• Consider expense
• Photos
• Fingerprints
• Diploma (translation)
• Coursework

54
Things to avoid

• Practice shifts
• Arguing with nurses or consulting staff
• Lack of interview preparation
• Not ready for first shift (get a tour first)
• You will be expected to provide expert care and
  compassion beginning with your first patient on
  your first shift!

55
Fear of leaving home

• Comfort with whats familiar
• No need to relocate
• Know what youre getting
• Already have reputation within hospital
• No one would take advantage of me here...

56
Moonlighting vs. Staff

• Advantages
• check out various opportunities
• no commitment
• schedule flexibility
• determine which ED is best fit

• Disadvantages
• why not hired?
• clinical error or staff/patient complaint
• not considered a member of the team
• someone else hired instead
• staffing needs change

57
Buying a house

• Complicated process
• Emotional experience
• May be prohibitively expensive
• Get to know the area first
• Make sure you like the position
• Make sure the position is stable

58
What can I do now?

• Improve your clinical skills
• Finish research project and manuscripts
• Develop administrative skills
• Learn coding, billing, documentation
• Practice dictation
• Improve language or computer skills
• Read about hot political issues
• Discuss your interests with faculty

59
Mentorship

• Important throughout career
• Personal and professional
• Opportunities
• research
• academic
• career advice
• Consider more than one mentor
• Mutual benefit

60
Life after residency

• Enjoy the opportunity to provide care
• Share your happiness
• Give back to your program
• Celebrate your hard work
• Know when (and how) to take care of yourself!

61
Faculty development

• EMF Teaching Fellowship
• Navigating the Academic Waters
• Research design, statistics, grants, etc.
• Leadership
• Patient satisfaction
• Time management
• Physician wellness

62
Avoiding physician burnout

• Identify stressors
• Learn to deal with them constructively
• Dont internalize
• Dont rely solely on family for support
• Listen to those who have concerns
• Seek professional help
• Know when enough is enough

63
6 Cs of graduation

• Confidence
• Collaboration
• Collegiality
• Committees
• Compassion
• Community

64
7 Habits of highlysuccessful physicians

• 1. Recognize your limitations
• (learn from your mistakes)
• 2. Dont speak ill of colleagues/staff
• 3. Make yourself indispensable
• 4. Lead by example
• 5. Project a positive attitude
• 6. A good team player is a good listener
• 7. Dont conserve kindness

65
In the long run, outstanding interpersonal skills
are desired over clinical expertise.

66
Remember, you only haveone chance to make
afirst impression.

• Good Luck!

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Author Credit-Career PlanningGus Garmel MD

• QUESTIONS?

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Postresidency Tools of the Trade CD

• 13) Negotiation Ramundo
• 14) ABEM Certifications Cheng
• 15) Patient Satisfaction Cheng
• 16) Billing, Coding Documenting Cheng/Hall
• 17) Financial Planning Hevia
• 18) Time Management Promes
• 19) Balancing Work Family Promes Datner
• 20) Physician Wellness Burnout Conrad /Wadman
• 21) Professionalism Fredrick
• 22) Cases for professionalism ethics SAEM
• 23) Medical Directorship Proctor
• 24) Academic Career Guide Chapter 1-8
  Nottingham
• 25) Academic career Guide Chapter 9-16 Noeller

• 1) Career Planning Garmel
• 2) Careers in Academic EM Sokolove
• 3) Private Practice Career Options - Holliman
• 4) Fellowship/EM Organizations Coates/Cheng
• 5) CV Garmel
• 6) Interviewing Garmel
• 7) Contracts for Emergency Physicians Franks
• 8) Salary Benefits Hevia
• 9) Malpractice Derse/Cheng
• 10) Clinical Teaching in the ED Wald
• 11) Teaching Tips Ankel
• 12) Mentoring - Ramundo