A Guide To Obtaining Your First Job As An Attending

When to start applying for jobs:

Residents looking to obtain competitive or area-limited positions should begin the job search about 10-14 months prior to graduation. Any earlier and the group will most likely respond with “Contact us a little closer to your graduation date.” Even if the group is not hiring at that time they may keep you in mind for when they are hiring later that year. For jobs that are not as competitive (nocturnist) or locations that are not as competitive, the timeline for applying can be slightly closer to graduation. This could be anywhere from the fall and winter in the final year of training and beyond. Ideally you want to sign at least four months before starting your new job as credentialing will take up to 90 days (if you already have your full license).

How to find jobs:

• Knowing someone with a group (friend, attending, or family referral)
• Internal recruiter
• External recruiter
• Talking/email with someone in the group directly
• Career Fairs (external and internal recruiters will be present)

Not every person seeking employment will have a family member, attending, or close friend with close contact with a group that can give a recommendation as to when and how to apply. If this is the case, maneuver your job search in alternate ways to find the job that best suits you and positions you to interact with multiple potential employers. For instance, a career fair is a good way to start looking for a job as this can introduce you to many employers in a relatively short period of time. Many residents turn to career fairs to meet face-to-face with recruiters and select groups. Here, you can discuss your interests along with learning about potential career opportunities. The recruiters will consider your needs and match you accordingly to the best fit of employers.

What are internal and external recruiters?

• Internal recruiters are employed by the group in which you are seeking employment. Internal recruiters may or may not receive a bonus for filling a position as an incentive. Many large groups such as Methodist, MD Anderson, and Memorial Herman typically have internal recruiters that may or may not receive a bonus upon placement of a physican with that particular group. This type of recruiter is usually paired with one employeer.
• External recruiters are more general in job placing. They find open positions all over a certain geographical area and they are paid when referring someone to that group once you sign the contract of employment. You most likely have received some emails or post cards from external recruiters saying something along the line of “great practice opportunity.” Those are external recruiters.

Why use an external recruiter:

One could make the argument to try to avoid an external recruiter, since if a job posting has two applicants and one did not use an external recruiter, if all things are equal they will likely go with the one who did not use an external recruiter. This is because once the external recruiter places a physician with a job they get paid a bonus for working as a head hunter. For this reason, some initially try to avoid an external recruiter; however, there can be several benefits to using one.

A good recruiter will be more interested in meeting your needs and finding a good fit for you than simply placing you somewhere with over promises so they get paid. They can provide good advice about clients (physicians) they have placed at this location in the past and may even be able to provide some references outside of what your future job gives you. Think of them in some ways like a real estate agent. A good one can walk you through the deal and potentially save you from a bad deal that can cost you headache and money. This is helpful if you might be moving to a new state, new city, or area that you are not familiar with. In my experience, external recruiters also delivered quicker results. Only days after giving them my information, I had multiple places that were interested in interviewing me as opposed to the standard "up to one month" to hear back by cold calling or emailing groups on my own.

How to apply for jobs:

Personal recommendations by networking are always best. While preparing your CV and asking for references, this is the time to also ask if they know of any jobs in the area or group that you are interested in. Use your attendings or advisers to help with find an employment that may fit your goals. If they don’t know of anyone that may be hiring, they may be able to direct you to someone who can help you.

Once you have prepared your CV and have references, the next step is to decide if you will use an external recruiter right away. If you choose to use an external recruiter you simply send them your CV + list of references and they will ask questions about location and desired practice. Soon your inbox will be full of jobs that might interest you and how to contact them.

If you forego using an external recruiter then start to look for internal recruiters and specific jobs. For example, if a certain hospital was hiring, they may have a representative at a career fair and links online for job availability or internal recruiters. Contact the one in your area to see if they have any openings at the location you want or if they have locations are other hospitals. If you know what group you wish to work then find their website and a method to contact them. All groups will have a way to contact someone to see if they are hiring. This method required more work on your part.

The waiting game:

If you decide to contact a group directly then be prepared to potentially wait before you hear a response. Some groups may meet only once a month to decide about new hires. Consider this before sending a follow up email only days after submitting your CV. If you use a recruiter results in my experience can be quicker and they will be in touch almost every other week if not sooner. Use this time to your advantage to search for more jobs in your area. If you are applying in a competitive area and you have not had any interviews then it may be time to look at a different area.

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The interview:

Some groups will ask for phone interviews first, others will ask for in person interviews right away. This is no longer like medical school or residency interviews. The group that is interested in interviewing you should pay for all travel expenses and lodging. If they don’t offer to do so realize this is not currently the normal for most jobs and you should use caution. Dress professional, be slightly early (10 minutes), turn your phone off during the interview, and research some background information about the hospital and or group.

The following are some questions you should ask during your interview day (when appropriate to your specialty):

• Discuss how many people are with the group
• How many patients a day you are expected to see or are normally seen
• What is expected of you when at work such as are you covering codes, rapid response, teaching residents, walk in patients to clini, emergency procedures, supervising PA’s, etc?
• Open or closed ICU
• How many night shifts are required, if any?
• How is the admitting structure like or new consult structure like? What days of the week are you admitting or doing procedures? Are these divided evenly, meaning between more senior partners and junior members? (If your pay is based off RVU this will matter since admissions / procedures have higher RVU than progress notes and as such will make more money)
• Do you take call?
• Is time off protected or are you expected to follow up labs when on vacation if in primary care?
• How many RVU’s do the physicians usually bill for in the group? (learn what RVU’s are before asking the interview)
• What is the pay structure like? (RVU only, flat salary, salary + incentives)
• Is there opportunity for leadership?
• Is there opportunity for partnership?
• What is the buy in for partnership?
• Insurance and who covers? (malpractice, dental and health)
• Is malpractice including tail or not? *This can be a big deal depending on the state. Thank goodness Texas has Tort reform. See below
• Is there paid CME, relocation, or sign on bonus?
• Will you be an independent contractor or paid employee in the group? (1099 or W2 this will affect your taxes)
• 401K and retirement plan

Once the interview is over ask for a contact method (business card) in order to give a follow up email to say thank you. Also, don’t tell them during the interview that you are for sure interested and if offered the job you plan on taking it if you have no intention of doing so. You are only wasting their time. I talked about pay and reimbursement in all my interviews, they actually brought it up first. In my anecdotal experience I think this should be fine but this may vary in other regions.

How many groups to interview with:

My opinion is four or five interviews is all you should need, but try to go on at least three so you can get a feel of different groups and how things work outside of residency. You will find that life with each group has potential to be very different and each contact that I received was quite different. In this sense it was nice to have multiple offers to compare.

The Contract:

If the group likes you they will send an employment agreement with usually days for you to read over and tell them if you want the job. Read over it carefully since this is, in many ways, the most important part. Each place I interviewed with had vastly different terms in their contacts ranging from straight salary with no bonus to pay based purely on RVU. Besides pay the other important aspects of the contact are insurance, work load and schedule, time off, how they can fire you and what it takes to quit, what it takes to be a partner with the group, overhead or other things that may come out of your pay, and non-compete to name a few. Once you find a job have a lawyer review it with you as I mentioned in a previous post. NO matter how much you like the group or the job its business and realize the lawyer for their group wrote the contact so no harm in having a lawyer who represents you look over it. Of course they are going to try to write the contact so that it benefits them in some way.

A word about malpractice:

Insurance for doctors comes in two flavors, with tail or without tail. Tail is coverage that takes effect once you leave the place that you were employed and practicing. This insurance covers any lawsuit that is submitted to the court from the time of you leaving this job till the statute of limitation runs out for a law suit to be submitted to the court (2 years in Texas). This type of coverage can get quite expensive depending on the state and specialty so make sure you know who is expected to cover this. For hospitalist or primary care the tail is not a huge number compared to neurosurgery, ortho (with spine) or OB/GYN. Make sure you know who is covering your tail and if you will be able to afford it if you are expected to pay.

Licensing/ Credentialing:

This can take a LONG time, meaning months depending on the state. I am in Texas and the process took me around seven months since one of my submitted paperwork got lost in the process. Look up how long it takes to go through the process in your state and plan accordingly. In order to be credentialed at the hospital you will have to have a full license. If this is not done till June when you graduate, then be prepared to wait 60 to 90 days at the earliest before credentialing is completed.

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