End of Training / Getting a Job

I am copying this post from my Diary as I hope it will spark a conversation about a process that you get ZERO preparation for during your medical education & training.

  • OldManDave Said:
As you might imagine, finding physicians is a very competitive & lucrative field of work. As such, it attracts both very professional, hard-working people, a few turds out to turn some quick cash and all variations in between. Essentially, there are three braod paths to finding a job: doing your own legwork, internal recruiters & external recruiters.

Doing it yourself works well if you have inside lines into the region or facility/facilities you are seeking. This is the old-fashioned 'networking' was to get a job. Or, you can also accomplish this by cold-calling &/or responding to advertisements in professional journals. Obviously, if you know someone - esp if you trust them to give the inside poop - this is an easy way to go. Cold-calling is a bit more risky, in my eyes, because it is more challenging to know the inside line on the group & facility. Responding to ads in journals can the most risky of this tactic as the ones who so advertise tend to be - not set in stone - the jobs that people are struggling to fill. Look at it like this...maybe there is a reason they are having to spend $$$$ to attract someone to this position. So, due scrutiny is in order. The advantage is that no one is earning a bonus; so your recruiting process costs the group less & that money is more likely to go into your pocket instead of bonused into a recruiter's pocket.

Internal recruiters are employees of the facility or healthcare system. They tend to be salaried & do not live/die by their bonus $$. In my opinion, this is the best route to go. These guys do not have an incentive to gloss-over or falsely represent the opportunity - they get paid whether you come or not. These guys also typically do not get bonused for landing docs.

External recruiters - a/k/a: headhunters - range from very professional, helpful & honest people to unscrupulous, dishonest & tell-you-anything bastards. A solid %-age, but not all, of the positions these guys represent are also among the more challenging ones to fill - NOT always because it is a shitty job, but there are lots of $$ at stake. For example, many of these guys fees are in the 10~15% of the first year salary of the docs they secure. Sometimes there are bonuses on top of the fee for certain hard to get physicians. I was told that for the south, southeast & mid-west, headhunters can earn as much as 30~50k in fees + bonus for securing an anesthesiologist. So, be leery when working with these guys. At the same time though, do not ass/u/me that since an external recruiter is approaching you that the job is a shit. My Lafayette job's initial referral was through a external recruiter who was wonderful - her husband is an anesthesiologist about 1 year ahead of me. She was superb. And, I worked with 2 others who were equally as good & worked very hard to refer me to opportunities that really fit with what I wanted.

OTOH, most of them never listened & just referred en masse indiscriminantly. Or, they would try to correct me, tell me where I should look or that position x,y,z would be a perfect fit, but it would be in mid-town Manhattan or some such absurdity. One a-hole I gave a copy of my CV to - before I learn to stipulate in precise language to not submit my CV w/o my express approval - submitted my CV to a huge number of opportunities yielding me phone calls from all over the country even though I had specifically defined 2 regions of the country to work.

Finally, nothing about med school or residency teaches you diddly-shit about finding a job, practice structures or avoiding getting raped. I very nearly got sucked into a very bad situation in Marion, IL. It seemed awesome at first, but a few things just "felt" wrong. Some statements just did not add up. Several issues I wondered when or if it would be appropriate to bring up. When I did ask questions, instead of clearing up the issue, the answers made it more cloudy. I was never able to get anything nailed down on several items. Finally, my gut told me - dude, you have to get these questions answered even if it does piss someone off. And, if it does piss someone off, that should be a massive clue that things are not what they appear. The more I pressed, the thinner the veil became until I finally pulled the plug. Even though I had made a verbal commitment, no papers had been signed & I told both the group owner & the headhunter that until I had concrete answers ON PAPER over a signature to my questions that this deal would not progress one iota. And, if that info did not mainfest w/i 5 business days, the deal was off. That was when they showed their true colors & refused to reimburse me for thr $2500 I spent - at their request & after promise of repayment - to bring my family to Marion, IL to visit the city, facility & region to see if we wished to settle there. Yeah, I lost $2500 at a very very bad time, but it prevented me from getting really & truly soaked financially.

The moral of the story - if it does not sound right or you have questions - ASK THEM! Even if you are uncertain if the timing is correct, just pre-empt that by stating, "I am sorry, I am new to this & this may not be the appropriate time to discuss this, but I have a question..........". If it is not the right time or the right person, an honest person will tell you when or who. If they get pissed or start blowing smoke, start lacing up your tennis shoes to run. While you may not be asking your question at the right time or to the right person, this is your job, your PROFESSION and there is a TON at stake - there is nothing that is off limits & you have a right to know. No, you may not be a full-partner, but you must know how the $$ is generated, how much will come your way & what you will have to do to secure that $$. Unlike working at Wendy's where it is taboo to ask who makes what or how big is so&so's bonus, in private practice, it will be partly YOUR business & you simply have to know the details. If they balk, tell'em to eat shit & leave.

You are no longer begging for employment. As a physician, you are a highly trained, very valuable commodity that stands to earn a substantial chunk of revenue for that group &, in exchange, will be well remunerated yourself. It is a business and it is NOT personal. Approach it that way...do NOT let personal feelings get in the way of clear-headed, logic-driven, wise decisions.

I have not read either of these books but at the ACEP website they are selling:

EMRA Career Planning Guide for Emergency Medicine, 2nd Edition


EMRA Contract Issues for Emergency Physicians, 2nd Edition

I was lucky…as a 2nd year we did a community ED month…I got to know the people and fell in love with the place. I signed with them a few months later.

Rachel Yealy, DO