Picking Your Position

You’re nearing the end of your medical training, and suddenly your email inbox is flooded with messages from physician recruiters alerting you about jobs that may interest you. Then the phone calls start, inquiring about your potential willingness to move from north to south, from east to west —and everywhere in between.

Though at first it can be exciting to feel so popular, that euphoria can turn to anxiety as you anticipate making long-term decisions about your career and lifestyle. But being in demand is a plus, as long as you can convert a practice’s initial interest into a job offer you’d like.

Your goal should be to express interest in certain opportunities without eliminating the possibility of others that may also turn out to be a good fit—while turning down those you’re not seriously considering.

Fortunately, there are strategies you can use to zero in on the opportunities you’d most like while not damaging the possibility of future work. That’s the trick to handling multiple expressions of interest in a professional manner and picking your position.

Determine your career priorities

“It’s kind of a dance,” explains Chandler Park, M.D., board-certified hematologist and oncologist and clinical assistant professor at the University of Louisville School of Medicine. “The key is to remember that there is no perfect job and to keep in mind the factors that are most important to you and your family.”

Some of the major factors many doctors weigh—about both the job and the city—include:

• Salary
• Geographic location
• Climate
• Outdoor activities
• Lifestyle fit
• Public school quality
• Proximity to an airport or train line
• Call schedule
• Academic practice, hospital employment, or private practice
• Research opportunities
• Opportunities for mentoring

Park says he has heard that of the three overarching things doctors can choose from—money, lifestyle, and location—only two are possible. For this reason, he put location—specifically, being closer to his hometown in Kentucky—at the top of his requirements, followed by the lifestyle choice to work in a hospital setting. Money was not a determining factor for him, though it was for several of his classmates. In fact, one colleague moved several states away in order to maximize his starting salary.

Regina Bailey, M.D., J.D., facility medical director at First Choice Emergency Room in Humble, Texas, says compensation was her primary concern when she took her first job. But she also knew it wasn’t a position she would have to keep long-term. “There is a huge shortage of emergency room doctors in Texas, so there are always options being thrown at you,” explains Bailey, who is also a clinical assistant professor at the University of Texas Medical Branch (UTMB) in Galveston. “So there is less pressure to choose something that’s perfect for the long term.”

Still, Bailey advises physicians to pursue positions that are good fits for their goals and lifestyles. For her, that meant good backup and flexible hours. With her full-time position squared away, she began looking for part-time work to fill in around her primary job. She found it two hours away at UTMB. Because Bailey had been upfront with the facilities where she interviewed for full-time work, she knew there would be no non-compete issues or scheduling problems if she decided later to take on additional part-time work. By being completely honest about her goals from the start, Bailey found the best fit for her.

Be open to possibilities

Abhishiek Sharma, M.D., an attending neurosurgeon at Honor Health System in Scottsdale, Arizona, advises figuring out what you want in a position while keeping an open mind about other types of opportunities that may also be a good match.

The number of neurosurgeons, he explains, has not changed in the past few years despite increasing demand. The American Association of Neurological Surgeons confirms this trend, reporting in 2008 that, though the U.S. population had increased by 20 percent in the previous 15 years, the number of practicing neurosurgeons had remained static over the same period. The result of such a shortage, says Sharma, is that neurosurgery residents receive about three offers each.

Some of those interviews and resulting offers may be in locations you hadn’t initially considered—and that’s OK. The differences you encounter among areas and organizations can enrich your options or confirm your initial vision.

How to juggle various job offers

There’s no question that physicians are in high demand. As a result, you may find yourself fielding inquiries from recruiters and hospital systems before you’ve done much evaluation of your career priorities and goals. Sharma reports receiving an average of one or two emails per day listing positions available in neurosurgery. Bailey, too, received plenty of information on available jobs.

The information you’re sent will vary from personalized, detailed inquiries to brochure-like information. Much of the initial contact depends on the recruiter’s style, the organization’s approach, the confidentiality of the search, the urgency of the need, and other factors. After you’ve responded with interest, you may be invited to submit your CV if you haven’t already. A screening call is generally next, during which the recruiter continues to assess your fit and qualifications. If all goes well, more phone discussions or an invitation for a site visit may follow.

If sitting back and waiting for news of an opening in the city you want seems too reactive, be direct and go on the offensive—it can work.

One of Sharma’s friends decided to be proactive about his job search to increase the odds of landing a position in his hometown. Instead of sifting through incoming emails and taking phone calls as they came, the physician called the town’s main hospital and spoke with the in-house recruiter.

He said, essentially, “I know you’re not advertising an open position at the moment, but would you be interested in discussing future openings?” Given the low supply of available candidates in the specialty, the hospital was only too happy to begin a conversation. That call resulted in subsequent phone calls and, later, an invitation for a site visit, followed by negotiations for a new role created just for him.

Sharma looked at almost 10 places over the course of two years, narrowing that list to three based on geography: one in Wisconsin, where he was in residency; one in Chicago; and one in Arizona, which he ultimately took. All three jobs were appealing, so to break the tie, Sharma ranked each position based on three main factors: geography, the job itself, and intangibles about the opportunity. Then he weighted each factor, with geography counting for 30 percent of the decision, the job, 50 percent, and the intangibles, 20 percent.

With that formula, it became clear that Arizona was going to be the best fit for him.

Park interviewed at 12 places during the first round, focusing most on where he could become part of the community and be closer to family. He then whittled the list to three practices where he was confident he could be happy. After the interviews, he sent thank you notes to all the programs for taking the time to meet him; he was completely honest about whether he wanted to consider pursuing employment there.

“Some recruiters were surprised by my forthrightness,” he says, but he didn’t feel comfortable keeping hospitals hanging after he had determined they were not the right choice.

He advises physicians to be completely honest about where they are in their decision-making processes. Doing so enables you to uphold your professional reputation and avoid burning bridges you may need later in your career, especially since most physicians eventually move on from their first jobs.

That said, it’s also important to let a potential employer know when you just need more time. It’s OK to tell a recruiter you want time to check out more options. “No one goes on one interview and decides that’s it,” says Park. He says the typical number of subsequent interviews is two or three.

“Telling other practices that you’re considering other options doesn’t make you less appealing,” he says. “It actually makes you more appealing.” It means you’re a desirable candidate.

Simon Gordon, director of search operations and physician recruitment at Healthsearch Group, based in Westchester, New York, advises physicians to explore their options—but not to go overboard. “You can have too many [options],” he says.

If you want to have initial discussions with several organizations, that’s fine, but once you have enough information to determine you’re not seriously interested in a position, don’t string that organization along. “Don’t pursue a role you know won’t ever be your final choice,” says Gordon. That only leads to wasted time (yours and theirs) and potential irritation. For this reason, limit your site visits to only those facilities that are serious contenders.

The job search is a process

Investigating job opportunities is not an all-or-nothing decision, says Park—it’s a process. After an initial on-site interview, you may be invited back for a second interview. This lets you know that the hospital or practice liked you. If you also liked what you heard and saw on the first visit, you can accept the second.

“This allows you time to learn more about the program and tells the hospital that you’re interested. It lets them know how serious you are,” says Park. Similarly, declining a second interview conveys that you didn’t feel there was a fit and aren’t interested in continued conversations about the job. Don’t pretend to be interested once you’ve decided that you aren’t.

After an on-site interview, a recruiter may ask for feedback about the job opportunity. They may ask, “Is there anything you don’t like about our program?” Park strongly advises against getting specific about disadvantages you perceive early on, but instead wait for a second visit to bring up your concerns with their current physicians. If the negatives are significant enough to cause you to lose interest right away, however, consider reaching out to a physician to ask for their honest input about your concern.

Gordon recommends being transparent and honest throughout the process. If you saw something on your visit that concerned you, bring it up. Ask questions to better understand the internal operations; strive to learn more about the day-to-day activities you’d be part of. And when asked for feedback, it’s important to express enthusiasm and to explain why it’s appealing and what value you can bring (if you think you’d like to work there). You can let the recruiter know that you’re considering other opportunities as well, but conveying enthusiasm about the job is essential if you want it, he says.

How to field job offers

Once you have an offer from a facility, it’s time to get serious about making a decision. Sharma took the opportunity to provide feedback as a step toward negotiating a more advantageous offer. To each of the three hospitals he was considering, he pointed out what he really liked and what, in particular, was holding him back from accepting their offer. He also asked if they could do any better. His script went something like this:

“I have an offer from another hospital, but I really like the opportunity at [your hospital]. One thing that concerns me is the amount of call you require. Would you consider giving me a physician assistant to reduce the amount of call I have to do?”

Or:

“I have an offer from another hospital, but I really like the opportunity you’ve presented. One thing that concerns me is that the salary you’ve offered is substantially lower. Can you do any better, or can you offer a signing bonus or cover my moving expenses?”

Gordon recommends letting a practice know if you have reservations about any aspect of working for them before you make your final decision. “They’ll be frustrated” if you tell them after you’ve accepted another offer and your complaint was something they could have addressed, he says. Long-term, that reaction could limit future opportunities at the practice, should you ever change your mind.

“Relationships are of utmost importance during schooling and the hiring process,” says Gordon. Developing and nurturing relationships with decision-makers, even if you don’t ultimately choose to work at their facility, can be beneficial for your career, especially if you determine you’d like to make a move a few years down the road. For that reason, it’s important to be considerate during your job search. “Don’t burn any bridges,” he underscores.

After the second visit, many physicians are offered a contract. Park recommends responding right away if you receive a preliminary term sheet. After several months of conversations, on-site visits and discussions, both parties should have a good sense of whether there is a match, and making a decision should not take several more months, says Gordon.

Accepting the job offer

Although it can take weeks or months to get an offer, once you receive a contract, the hospital or practice will expect a decision within about a week. “They want an answer quickly,” says Gordon. As they’ve been carefully vetting you, you’ve been vetting them and must be interested in being employed there. Once you receive an offer, the decision to accept should be fairly easy—at least that’s the hospital’s assumption. Some physicians think that they can take their time deciding because the practice took so long to make their decision, but that’s not the case. “You have to be ready to move quickly at the end,” Gordon says. By the time they’ve extended an offer, they assume you’re as excited about working there as they are about hiring you.

When you’ve narrowed your choices to the top two or three, it’s important to let the other practices know when you’ve received an offer. That gives them the opportunity to expedite their decision-making and potentially make an offer as well. Some hospitals, however, can’t move as quickly, Gordon points out, and you may have to decide between accepting an offer in-hand and waiting for an offer that may never come. “You need to understand that, until you get a contract or a signed offer letter, it’s still just an opportunity, which could get derailed,” he warns. It’s not concrete until you get that offer. Given the amount of time required to secure a medical license and credentialing in other states, Park recommends that physicians start their searches early—like the middle of their second-to-last year of residency.

If you don’t start your search until the beginning or middle of your fourth year, you may not be able to start working until months after you finish residency. “The whole process is slow,” Park says, though some states are slower than others.

In neurosurgery, whose residency lasts seven years, physicians start receiving information about jobs in their fifth year. Since it takes 12 to 18 months to recruit a neurosurgeon, says Sharma, it’s rarely too early to start reviewing and evaluating opportunities.

Although much of the job hunt seems reactive—receiving emails and phone calls and following up with those that are of interest—physicians have a lot of control in the process.

Rising demand for healthcare services means physicians are often in the driver’s seat when it comes to considering job opportunities. This is especially true in locations such as Mississippi, Idaho and Alaska, which have the fewest physicians per capita according to a recent report from financial advising website WalletHub.

“Doctors have a fair amount of bargaining power,” confirms Sharma. As long as you stay in touch with the practices you’re interested in, communicate about where you are in your job hunt, and are honest about which positions may be a good fit, you’ll quickly become adept at juggling multiple job opportunities successfully.