Transitioning Out of Residency

- by Aaron Paul, coordinator of the Premier Residency Program

Congratulations. You’ve made it. You’re a final year resident and only a short time away from completing your residency and making 'real money.' Not so fast partner, the real work is about to begin. The job search is a job in and of itself. Are you prepared?

The general rule of thumb is that most residents remain with their first practice for about 2 years. Yet the majority of residents, upon taking a position, believe they will stay for many years. This gap between perception and reality suggests that although residents are well prepared to practice medicine, they are often under-prepared to make the transition out of residency. Fortunately, there are proven strategies you can employ to help you make the right choice.

The most important pre-cursor to making wise practice decisions, is to do the necessary research. The job search is the culmination of all your hard work and deserves to be taken seriously. First, learn the process. How does the typical job search progress? Second, learn about common mistakes made by residents. Are there lessons you can apply to your search and thereby avoid the mistakes of others?

There are 3 steps in any job search:

DEFINE

The most common mistake made by residents is to skip the first step. The response I most often get when asking a resident where she would like to practice is, “I don’t know. I’ll take whatever is the best opportunity.” Realistically, it is impossible to properly identify the best opportunity, unless you have first defined what you are looking for. Don’t only define your professional needs and goals. Whether you are happy on a personal level will ultimately determine your happiness in a practice. For this reason include your spouse or significant other as much as possible in every phase, but most importantly in the definitions phase. Do you like life to be slow or fast-paced? Land-locked or near water? The first step in any job search should be sitting down with your spouse and making a list of personal or community-based factors you each find important, and then ranking them.
It is important to consider professional factors such as patient volume, proximity to a teaching facility, or the ability to perform certain procedures as well. Including your spouse and taking time to paint a realistic picture of how you want your post-residency life to be, will pay off ten-fold.

INTERVIEW

Phone interviewing is a way of narrowing down the potential candidates and is largely a weeding-out process. The most important thing is to establish a rapport with the interviewer and make yourself memorable. The interviewer must determine whether you can handle the job and it is as much in their interest for you to understand all aspects of the opportunity as it is in yours. Concentrate on being amicable and allow the interviewer to steer the conversation towards the relevant, professional aspects of the healthcare organization. If you are worried about your ability to do this, use a recruitment agency. Remember, it costs you nothing and an experienced recruiter can coach and prepare you for the phone interview. A recruiter is your advocate in the process and will not only make sure you are ready to answer questions, but will also make sure the healthcare organization treats you fairly.

After conducting phone interviews, a healthcare organization will invite the best candidate(s) (3 or 4 at most) to an onsite interview. This step is meant to affirm what you have already learned about the practice as well as give you an opportunity to see operations first-hand. The most commonly made site visit mistake is to forget to check out the community. Consider all aspects of your life and investigate the community accordingly. If you are a religious person, attending services at a mosque, synagogue, temple or church is a good idea. Check out the local schools if you plan on starting a family, or go on a real estate tour if you are planning on buying a home. Remember, money is only one in a multitude of factors which determine quality-of-life.

NEGOTIATE

If you treat the first two steps of the job search with the seriousness they deserve, contract negotiation should be a breeze. Here comes the jaw-dropper: the actual monetary compensation is the least important part of your contract. One of the mistakes most commonly made by residents is to accept an offer based only upon the offered salary. You will probably make less money in your first job then ever again. Accepting an initial salary which is lower than you had hoped for doesn’t mean you won’t be able to accomplish your financial goals. If you are a good doctor the money will come. Rome wasn’t built in a day.

The so-called “fringe” benefits are what you need to discuss most during contract negotiation.

In today’s malpractice environment, the quality of your professional liability insurance policy is probably the most important issue. What type of policy will you be covered under: occurrence form or claims-made? Occurrence is the ideal insurance because you are covered for life, regardless of when a claim is reported. Claims-made insurance is inferior because you are only covered for claims which are reported during the active period of the policy. In order to be covered for claims which are reported after the active period of the policy has expired (upon switching policies, carriers, switching practices, or retiring) an extended reporting endorsement must be purchased. This is commonly called a tail because it goes on the end of your old claims-made policy and extends the amount of time for which a claim can be reported and you still be covered. Tails are extremely expensive and can be bought in varying lengths. If you will be covered with a claims-made policy it is essential to include the tail as part of your contract negotiations. Tails are expensive, and you want it in writing that the healthcare organization will be financially responsible for purchasing it. There is no law which will force an insurance carrier to write a tail. Therefore, ideally you would like the tail to be pre-paid, or bought at the same time as the policy is purchased. Despite your best efforts during the job search, an unforeseen change in circumstances may necessitate your leaving the practice relatively soon, and that is the wrong time to find out you owe $30,000 for a tail.

Healthcare organizations spend a lot of money recruiting and oftentimes will conduct a search for upwards of a year before settling on a candidate. If an offer is made, it is the result of a lot of time, effort, and money and isn’t likely to be rescinded. Very often residents will simply decline to voice questions or raise concerns during negotiations because they are afraid the practice will then offer the position to another, less problematic candidate. This should not be a concern. They are looking to hire a physician who will lead them into the future. Therefore, it is in their best interest to negotiate until a deal is reached which will make you and your spouse happy over the long-term. You should feel empowered to raise any issues. Would you like to explore the possibility of student loan forgiveness? Do you think you need more money for moving expenses? Is the partner track structured differently than you would like? Ask.

Residents who choose to enlist the aid of a recruiter are perhaps most benefited during contract negotiations. Having a third party go-between is very helpful. A recruiter is knowledgeable about what is happening all over the country, and can be instrumental in letting both parties know what is common, and what is unrealistic with regards to their expectations. Remember, using such a service costs you nothing.

The key to being happy in a practice is knowing what you are getting yourself into before you see your first patient. Actively search- don’t just wait to see what falls in your lap. Learn to identify the qualities you are looking for in a practice, as well as those that are deal breakers. By keeping your eyes wide open throughout the interview process, and investigating practice opportunities with the same tenacity with which you study for the Boards, you can greatly increase your chances of finding the perfect practice opportunity right out of the gate.

Finally, it is important to realistically assess whether you would be wise to enlist the aid of a professional. Feel like there isn’t enough time in the day to be a resident and conduct a proper job search? Use a recruitment agency. You can piggyback on their expertise to find out about positions all over the country you wouldn’t have known about otherwise. Feel comfortable conducting the search yourself, but you have been unable to find anything exciting? Work as a locum tenens for a while. You can increase your personal network, sample different geographic settings, and experience different clinical approaches, all while making good money. The point is there is no reason to rush your job search or take a position your aren’t ecstatic about. Nor is there any reason to conduct a search by yourself if you feel overwhelmed. Recruiting agencies, whether on a locum tenens or a permanent basis, are paid by the healthcare organization. Elevating your search by using a recruiter’s expertise costs you nothing. There is plenty of free help out there. Use it.

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About MDA
Founded in 1987, MDA is one of the largest privately held medical staffing companies in the U.S. MDA is the only national multi-specialty locum tenens company that offers Occurrence Form malpractice insurance to its providers.
The company is headquartered in Atlanta, GA with a regional office in Dallas and satellite offices located throughout the United States. MDA provides recruiting expertise for all physician specialties, allied health, and healthcare professionals. For more information about MDA call 1-800-780-3500 ext. 2168.