AMA about Contract Job searches/Contract Negotiations

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VA Hopeful Dr

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Over in the attending section, we get lots of questions from new attendings about job searches, contract negotiations, and all sorts of stuff related to finding first/new jobs. Since that part of SDN is fairly restricted, it was suggested that we start a similar thread in a more open area where it could be useful. Especially since new grads are well-known for lacking business experience when it comes to employment.

Some background: I'm a family doctor who finished residency in 2013. I'm on my 3rd job since then, starting a 4th in November and a 5th in May (don't tell the 4th about that one). I am not a lawyer nor anything approaching one so don't take anything here as legal advice - just the limited wisdom of a guy who's been through lots of contract negotiations and had to find several jobs in a few short years.

A few general pieces of advice to get things rolling:

Get everything you can in writing. If its not in your contract, your employer doesn't have to do it. I started a new job once (urgent care) that was supposed to last 2 months before moving me to a regular outpatient practice. After 1 year, I was still in that urgent care because I didn't get that part in writing. Always get everything that you are promised in writing.

Assuming a decent job market (sorry Rad Onc), it rarely hurts to ask for exactly what you want. I've asked for (and gotten) smaller non-compete area, more days off, larger moving allowance, loan repayment. Heck, my first job even paid for my board exam. I've also been told No on those same things in the past and still ended up with the job.

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What's the best way to start looking for jobs while in residency? Website postings? Recruiters? Cold calling practices in locations we want and seeing if they're hiring?
 
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What's the best way to start looking for jobs while in residency? Website postings? Recruiters? Cold calling practices in locations we want and seeing if they're hiring?
All of those can work, and I've found jobs doing all of those.

I think it depends on what type of job you're looking for. Hospitals tend to have in-house recruiters that may or may not advertise in journals or things like Practice Link. So if you know what area you want to move to and want to be employer by a hospital, I'd advise calling their recruiters directly.

Private Practice jobs rarely advertise so cold-calling those tends to work better. Depending on your field, the faculty at your program may have connections that way as well and can help steer you towards good PP jobs.

I've found that website postings, like Practice Link, tend to be jobs that are having a harder time filling for whatever reason, generally speaking. Those are often good for higher initial salary/loan repayment/signing bonuses.

I take a somewhat systemic approach to actually finding a job. First, decide whether location matters. If no, then do you want a job to pay off loans/get a nest egg fairly quickly or do you want to settle down somewhere. If the former, go away from the coasts and away from large cities and start looking based on salary and loan repayment options. If the latter, decide what either type of area you do want to live in - city, town, rural, coastal, mountains, north, south, whatever OR decide what type of practice you want - academic, hospital employed, private practice, VA, and so on. Then narrow down from there. If location does matter, then at all the jobs in that area and decide what looks promising and what doesn't and go from there.
 
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What's the best way to start looking for jobs while in residency? Website postings? Recruiters? Cold calling practices in locations we want and seeing if they're hiring?

I have a never ending stream of emails, post cards, and sometimes cold calls about amazing opportunities, within 43 minutes of a "major city" with lots of golf and excellent restaurants. Those jobs are usually terrible. If they have to pay $$$$ to a recruiter to get someone to take the job its probably not that desirable.

Posts in journals can be legit.

The best jobs are rarely advertised, even in academia, but especially in private practice. They also might not be looking to hire but if the right CV comes around they will make it work.
 
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@IM2GI Those emails never stop. It's funny. They always show a picture of a river with a red building or two on the water. The ones for the CA Central Valley are my favorites (positioned perfectly 2 hours to the Bay Area and 2 hours to Lake Tahoe, blah blah blah). People should be smarter than me and use a throwaway email account for anything related to recruitment.
Networking seems nebulous but there are some things you can do. Your senior residents when you were a junior/intern have all gone on to find jobs or fellowships. Reach out to the ones that liked you. Find out where they practice and, if you'd go there, let them know. They are now part of that community and may know about jobs with their group or even other groups. I've referred a person I liked to other local groups. If you are trying to stay in the area, you can network at events that are more community physician focused. Residents don't tend to go to these sorts of external meetings because they get enough of that but the local community guys do. You'll end up sitting at a dinner table drinking a couple glasses of wine and they will be interested in you.

If you are considering a big multispecialty practice (ie Intermountain, KP, etc), realize that they are a big bureaucracy and they won't be able to give you a clear answer until your graduation is within the year.

If you are considering VA or other federal jobs, read the websites that explain how to write a USAJOBs c.v. to ensure that you get past the computer filters.

This feels like a very high-stakes decision but it isn't really. Look at the OP. You are more likely than not to change jobs in the first few years. Just don't make entangling personal financial decisions until you're sure you have settled in.
 
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My seniors (new attendings lol) have said much of what has been stated. My one friend was extremely particular about having everything in writing. And let's face it, it's the world we live in, even as (future) providers/attendings, fellow PGY3'ers. DOCUMENTATION. If it's not written down, it doesn't happen basically. Even at my home program, they will say: "Just be a nocturnist for a month or two, then we will switch you to days." Shake your hand w/ a smile, whatever. That's all useless, I doubt a handshake is negotiable between lawyers let's say. Cuz then lo and behold that (PGY-5) has barely seen the sun through a hospital window since residency.

For me, I'm trying a "smattering" of each. I am using one recruiter, but I've also found a lot of jobs on my own (via Doximity, for example). I have not investigated some of the other things posted like Practice Link, but I currently have a bunch of phone calls coming next week, so I'll see what shakes loose from it first.
 
@VA Hopeful Dr : Is this the only AMA thread we talk about in the other thread?

Regardless... CAQH. Do employers normally input all of your practice information when you get a new job? Or, are individual providers always expected to maintain their own profile? If so, when is the most logical time to start working on your profile (in relation to when you are finishing training and when you are starting your first job)?
 
@VA Hopeful Dr : Is this the only AMA thread we talk about in the other thread?

Regardless... CAQH. Do employers normally input all of your practice information when you get a new job? Or, are individual providers always expected to maintain their own profile? If so, when is the most logical time to start working on your profile (in relation to when you are finishing training and when you are starting your first job)?

Never had to sit down and actually do it myself but of course I had to provide information regarding hospital affiliations among other things.

Most places have professionals that make sure everything moves through. I wouldn't worry about it.
 
Never had to sit down and actually do it myself but of course I had to provide information regarding hospital affiliations among other things.

Most places have professionals that make sure everything moves through. I wouldn't worry about it.
Thanks. And, why aren't you verified? You're missing all the good conversations in the grown-up forum.
 
Thanks. And, why aren't you verified? You're missing all the good conversations in the grown-up forum.

I like to think that I still have a semblance of anonymity on this forum and forwarding my state license/credentials would threaten that.

I'm probably being a little paranoid.
 
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How do I join the grownup forum?


Sent from my iPhone using Tapatalk

Quoting from a sticky there: (It's the practicing physician forum)

FYSA: To simplify access to this forum, it now only requires being a verified physician. Secondary application process is no longer required.

Direct your colleagues to: Doctor Verification to obtain verification.

Forum access otherwise remains unchanged: Non-verified members can see thread titles, but cannot read threads.
 
Thanks fantasty! Done


Sent from my iPhone using Tapatalk
 
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Also, as far as the thread goes... I recommend that people in the last year of training start asking questions now, rather than waiting until it is too late. I don't necessarily want to point out of the stupid mistakes I made coming out of residency. And, I think a lot of people can rely on their program and their GME office to give you a lot of the necessary information that you need. But, unfortunately, I'm in a small specialty that tends to get overlooked (even at my training institution, we're somewhat of a forgotten step-child). So, almost anything I could add to the conversation is about what *not* to do.

A few pointers...

Get your license as soon as you can. It's worth the cost even if you aren't moonlighting, and you might not be informed that you need to have your active license to register for your boards. I was interviewing in different states so I thought "Oh, I'll wait to see where I'm going before getting my license". Dumb***. (Of course, most people probably already get their license asap... again, weird specialty)

Recruiters can be a PITA. And, someone later pointed out to me... they might be getting the money for making the deal that could have been your signing bonus. As I think the OP said, some markets are easy to find jobs even though they might have recruiters working on filling the positions, too. I was advised to "cut out the middle man" whenever possible.
 
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@VA Hopeful Dr : Is this the only AMA thread we talk about in the other thread?

Regardless... CAQH. Do employers normally input all of your practice information when you get a new job? Or, are individual providers always expected to maintain their own profile? If so, when is the most logical time to start working on your profile (in relation to when you are finishing training and when you are starting your first job)?
Yes, this is the one.

I've had employers do it and I've had to do it myself. My experience has been that the larger the employer the more likely that they will do it for you.
 
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For an IMG looking to work in a desirable area (socal, DFW) as a family physician, how should I approach job negotiation? Would I be in as good a position as you were when you where looking for jobs?
 
For an IMG looking to work in a desirable area (socal, DFW) as a family physician, how should I approach job negotiation? Would I be in as good a position as you were when you where looking for jobs?

You are in the same boat as everybody else. The fact that you are an IMG should have no bearing on your negotiations. You are an attending physician. You are not interviewing for medical school or residency. In all likelihood they want you more than you want them.

Some people would say that in reality you are interviewing them and not the other way around.

Happy hunting!
 
For an IMG looking to work in a desirable area (socal, DFW) as a family physician, how should I approach job negotiation? Would I be in as good a position as you were when you where looking for jobs?
@PlutoBoy pretty much nailed it. As long as you speak English well and went to residency in the US you're fine.

Now that being said, the more desirable the location usually the lower the pay since there is more supply of docs looking for work there. Still plenty of jobs, they just don't pay as well as BFE Idaho.
 
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Now that being said, the more desirable the location usually the lower the pay since there is more supply of docs looking for work there. Still plenty of jobs, they just don't pay as well as BFE Idaho.

Thank you and @PlutoBoy for the response. But the above quote suggests that when it comes to negotiating a contract I'll not be in a position of strength because there are multiple others competing for the same job, and someone will bound to take the lower offer, no?
 
Thank you and @PlutoBoy for the response. But the above quote suggests that when it comes to negotiating a contract I'll not be in a position of strength because there are multiple others competing for the same job, and someone will bound to take the lower offer, no?

No problem.

Some markets are more saturated than others. If you want a position in a saturated market such as SoCal or the Baltimore/DC area you should expect lower pay and less benefits but that is true for everyone, IMG or not.

So my answer remains the same: your IMG status should have no bearing on your negotiations, all things being equal.
 
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No problem.

Some markets are more saturated than others. If you want a position in a saturated market such as SoCal or the Baltimore/DC area you should expect lower pay and less benefits but that is true for everyone, IMG or not.

So my answer remains the same: your IMG status should have no bearing on your negotiations, all things being equal.

Correct, people tend to look at the last place you trained for jobs - so if you want to be an internist, they'll look at where you did IM. Cardiology, they'll look at where you did you fellowship. The more time you put between you and medical school the less they will care.
 
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Very useful thread, thank you.

Is now a good time to start putting your CV out there?
What do you do if you receive an offer or two this far out ahead of graduation and aren't ready to lock yourself down for July 2018 yet?
Any recommendations for how/where to learn about becoming a better negotiator?
 
Very useful thread, thank you.

Is now a good time to start putting your CV out there?
What do you do if you receive an offer or two this far out ahead of graduation and aren't ready to lock yourself down for July 2018 yet?
Any recommendations for how/where to learn about becoming a better negotiator?

Yes, put your CV out there. Bear in mind that credentialing and licensing can take months, so the more lead time you have to get that done, the more likely you are to start on time. It took me about 2.5 months to get credentialed for my current job despite turning everything in right away and already having a license in this state. If I'd needed to get a license, that would have been at least 4 months here, but can be 6 (or more?) in some states. So you're looking at signing a contract in the first quarter of 2018 at the latest. That's within the next 6 months. Will also mention that now is when groups will start looking for fresh 2018 grads and begin plans to recruit; to have more options, get your CV out there early, i.e. now.

Getting an offer is a process. If you're still in residency, you'll need time off to go to the interview, if they like you, you may get a contract soon after. Most people will interview at a few places before signing so you can also let a potential group know you have other interviews set up and that you expect to not make a decision until after that. However, you have to be willing to accept that some groups may not want to wait as they may have several good prospects. Also, once you start interviewing, you hopefully will feel comfortable deciding where you want to be and will get comfortable with the idea of signing a contract. It's hard to wrap your head around it until you see what's out there and actually get excited.
 
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Yes, put your CV out there. Bear in mind that credentialing and licensing can take months, so the more lead time you have to get that done, the more likely you are to start on time. It took me about 2.5 months to get credentialed for my current job despite turning everything in right away and already having a license in this state. If I'd needed to get a license, that would have been at least 4 months here, but can be 6 (or more?) in some states. So you're looking at signing a contract in the first quarter of 2018 at the latest. That's within the next 6 months. Will also mention that now is when groups will start looking for fresh 2018 grads and begin plans to recruit; to have more options, get your CV out there early, i.e. now.

Getting an offer is a process. If you're still in residency, you'll need time off to go to the interview, if they like you, you may get a contract soon after. Most people will interview at a few places before signing so you can also let a potential group know you have other interviews set up and that you expect to not make a decision until after that. However, you have to be willing to accept that some groups may not want to wait as they may have several good prospects. Also, once you start interviewing, you hopefully will feel comfortable deciding where you want to be and will get comfortable with the idea of signing a contract. It's hard to wrap your head around it until you see what's out there and actually get excited.
Completely agree with all of this.
 
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Completely agree with all of this.
What's the easiest way you've found to get in touch initially? I was in the city I'm planning on working a few weeks ago and heard anecdotally from someone in my field that a couple systems are hiring. The jobs aren't listed on their websites and I presume its more a word of mouth thing. What's the best way for me to actually get ahold of someone there? Call the clinic? Try to get a random email address of someone who works there? Just really starting the job search now.
 
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What's the easiest way you've found to get in touch initially? I was in the city I'm planning on working a few weeks ago and heard anecdotally from someone in my field that a couple systems are hiring. The jobs aren't listed on their websites and I presume its more a word of mouth thing. What's the best way for me to actually get ahold of someone there? Call the clinic? Try to get a random email address of someone who works there? Just really starting the job search now.

If it's a hospital employed job, there is probably an in house recruiter.
 
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What's the easiest way you've found to get in touch initially? I was in the city I'm planning on working a few weeks ago and heard anecdotally from someone in my field that a couple systems are hiring. The jobs aren't listed on their websites and I presume its more a word of mouth thing. What's the best way for me to actually get ahold of someone there? Call the clinic? Try to get a random email address of someone who works there? Just really starting the job search now.
find out who the physician recruiter is and contact them...or the practice coordinator if its a PP.
 
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What's the easiest way you've found to get in touch initially? I was in the city I'm planning on working a few weeks ago and heard anecdotally from someone in my field that a couple systems are hiring. The jobs aren't listed on their websites and I presume its more a word of mouth thing. What's the best way for me to actually get ahold of someone there? Call the clinic? Try to get a random email address of someone who works there? Just really starting the job search now.

The person you heard from probably has a direct connection. Ask to have your cv and contact info forwarded.
 
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find out who the physician recruiter is and contact them...or the practice coordinator if its a PP.
This is advice that I got in my thread, too. I got further with local opportunities by contacting the in-house recruiter than responding to job postings or external recruiters when I was looking, and I believe you now.
 
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