Life After Residency & the Business of Medicine

If you’re like most 3rd year IM residents then you’re probably feeling a little less pressure than the preceding 2 years.  You are probably studying for your boards and thinking about your next step.  For some it might be a continuation of your training through fellowship.  For others it will be a career choice.  Either way, you will need to make a whole lot of decisions!  No longer will you be a doctor in the protected training environment but to you will be hired as an independent and real world physician.

Everything up to now has been pretty prescriptive: Apply to med school, take required classes, take your USMLEs, graduate, residency, and take your boards.  That’s it!  Now you are largely left to fend for yourselves.  The subsequent application and interview process is similar to everything else you have done with a twist.  There is no class offered to teach the next steps but there are some “must knows” before you begin your journey.

Your CV

The days of listing your name, education and contact information is a thing of the past and no longer applies in today’s fact paced and changing market.  The last CV you prepared was probably for application to residency.  Perhaps you updated it occasionally to include a recent publication but it is largely the same.  That version of your CV is a great starting point but not adequate for your job search.  It needs to be concise and specific to the job you are applying for.  For example – your CV for a hospitalist position will look very different then if you are applying to a private physician group.  Know the difference.  For example: hospital based appointments they want to focus on Length of Stay, Core competencies, Quality and Safety.  For Private groups they want to know what you will bring to the table to build the practice, ability to work safely with efficiency and grace. 

Organization is also very important as structure and content must be appealing to the reader.  The average recruiter scans a CV in less than 7 seconds before making a preliminary decision.  Some basics to include are:

  • Opening summary paragraph – This is your 30 second bio.  Think patient “sign outs.”  Only hit relevant items that tell the reader who you are.
  • Bulleted highlights of strength areas – these are one or two word phrases (a.k.a. buzz words) from the industry.
  • Use relevant key terms throughout – more buzz words. Particularly if there is an online version as recruiters can scan a document looking for particular buzz words.
  • Education – Just list the school, its location and the years you attended.  Graduating with honors is acceptable but please do not add “prestige fluff” about your school.  Remember the CV is about you.
  • Publications – Keep it to recent publications.  Most academic centers want a 5 year history because it can be used for ACGMEs “scholarly activity.”  If your applying to a private facility this becomes less important.

You do not need to include every club and interest group you’ve ever participated in.  It is resume filler and does not add value.

Interviews

Much like your residency interview, you will be competing against other candidates.  As such you need to look and present your best (See previous post for interview tips).  You will want to ensure you have your letters of recommendation.  You will want to have done some research on the facility you will be applying to as well as the folks who will be interviewing you.  In all likelihood your social media profile was reviewed prior to your interview so why not search whose interviewing you.  You will be surprised what you can find.  Common ground is a key element to establishing rapport.

Contracts Negotiations

Congratulations! If you made it thus far you have been preliminarily offered a position.  Here is where you have the opportunity to excel or fall flat on your face.  There are many elements to a contract that you have never heard of so before throwing money at a lawyer you don’t have here are the main points to be cognizant of that exist in all worthwhile contracts:

1.    Compensation – Probably most folks will understand the bottom number: your total compensation.  But how they arrive at that is sometimes not as straight forward.  For example, few if any employers are paying physicians’ straight salaries.  Today there are “models.”  Understand the model being offered.  Each employer sticks to a particular model so chances of changing it are slim-to-none.  However, altering the elements in the model is fair game.  Let’s run through a basic split RVU comp package: You are being offered total comp of $200,000.  You will have a $125,000 guarantee and have to earn the balance of $75,000 through RVUs.  RVUs are tied to volume, procedures, and if you’re in an academic setting there is a small percentage for teaching and administration.  There are literally dozens of combinations with these models so understand if the goals are achievable or are you being set up for a short fall salary.  Don’t find out at the end of the year.  Know before you sign.

2.    Restrictive Covenants (a.k.a. non-compete clause) – While no one thinks of this as a major issue it does present a problem should you decide to change jobs.  Don’t think if you decide to move on you can open up-shop next door and have all your patients follow you.  Know what’s restricted with regards to “distance to practice” from the employer and “who has rights” to the patients. Ultimately this will restrict you from practicing in a particular geographic area for a specified period of time.  Geography is relative so consider where you are working.  I recall working with a physician who showed me a 10 mile restrictive clause.  I told him to understand that will bar him from practicing pretty much anywhere in the 5 boroughs of NYC.  This was successfully negotiated to 3 miles after some discussion.

3.    Malpractice – Generally covered and not much of an issue.  However, you will need to understand what “tail” liability coverage means and if possible ensure that it is part of the coverage.  Essentially the tail refers to the period of time when the policy ends and when a claim is filed.  If there is no tail liability coverage the physician will be left “bare.”  You can purchase this separately but will cost you substantially after the fact.  If it’s not included negotiate for it.

Credentialing

Not much to say here other than every piece of official paper you ever accumulated will be needed.  Have it ready or you will be scurrying when asked.  The number 1 cause for credentialing delays is missing documents.  Keep things organized and you will be prepared.  The biggest drag on credentialing is the insurance piece which can take up to 6 months for certain carriers.

Wealth Management and Insurance

I know you are in serious debt from medical school and got paid very little during residency, “why would I ever need to know about wealth management,” you ask.  As a physician you will be exposed to potentially making more money than the average person.  Up until now you have not known about having any surplus.  You will need to learn how to budget to pay off any loans, apply for a mortgage, and take into account supplemental disability and life insurance.  I know you are just starting out your career why do you need to think about its end?  In the unfortunate circumstance that you find yourself unable to work because of disability, you will want to still manage your expenses without too much compromise.  Life insurance is just a necessary evil to protect your family at least until the kids are out of college and your house is paid for.

So good luck and remember my motto: EVERYTHING is negotiable!

 

As always, comments and suggestions are welcomed.  If you have an idea for future topics please share and we can collaborate.

Michael Farca served as a residency program coordinator for the Department of Medicine at one of the largest training programs in the country.  He became the Department Administrator with continued oversight of the residency program, 2 primary site fellowships and 3 rotating fellowships.  As administrator he was responsible for all physician recruitment, contracting, and negotiations. Michael has dedicated over a decade to graduate medical education and is board certified in Teaching Administrators for Graduate Medical Education (C-TAGME).

Disclaimer: Michael Farca is an entrepreneur and is part owner and operator of Master the Wards, which provides Observership U.S. clinical experiences for IMGs, CV and personal statement development.

This article is based on personal experiences but acknowledge Journal of Graduate Medical Education, September 2015 for inspiring to write.