Wednesday, July 23, 2014

Say What?!? Time to find a job!

It’s that time of the year. Career preparation time. I am applying for community pediatric jobs in the D-M-V (Washington DC-Virginia-Maryland) area and it feels surreal. Medical school in the area was extremely enjoyable and our family hopes to return and lay some roots (is it weird to really want to be on House Hunters?!?).

What didn’t happen:
- I didn’t get Chief Resident. I was pretty bummed out for several weeks, but I think it’s for the best. My mentors reminded me that I pretty much have all of the skills I would have been able to obtain (leadership, administrative) and if I am totally honest with myself acting as an Inpatient Attending for several weeks and crazy hours is not my cup-of-tea! I’m all about outpatient medicine and am ready to have regular hours, my own patients, and more time with my family. No pseudo-residency-with- poor pay increase for me.

What has happened:
- started talking to my Academic Advisors about my interests in community pediatrics
- had a few outstanding people offer to serve as references (Clinic Director, Chair of our Peds Heme-Onc Department, Mentor, etc . . .)
- written and revised my cover letter
- written and revised my Curriculum Vitae (CV)
- gotten considerable feedback from my Clinic Director, Academic Advisor, family and friends including an amazing sorority sister who's a Lawyer who cut my cover letter up so much that I basically rewrote it and it's soo much better
- started regularly visiting the PracticeLink and Pedsjobs websites
- registered for the AAP National Conference in San Diego in October

What I still have to do:
- finish reading “Lean In” (loving this book, so enlightening and inspiring. I’m all about leaning in!)
- send out my cover letter and CV to personal contacts in the area letting them know I’m ready to “discuss employment opportunities” (loving the sound of that)
- actually find some jobs to apply to
- go to the AAP Conference’s career fair and professional development sessions and dazzle some program/practice reps and learn about interviewing and contracts
- finish the last 11 months of residency
- start work as a Pediatric Attending Physician (woo-hoo!)

Alright practicing physicians - any suggestions? Anything you see missing in my list above? In applying for jobs after Residency what mistakes did you make? What do you wish you’d done differently?


  1. I started working on my job third year (of six) in residency. I wanted to stay in my hometown but path jobs are few and far between. I got the job offer during my 5th year. I lost the job offer - big time tears down by the Arkansas River. I started working on another job while on mat leave #2 before fellowship - year 5 - think I got half of the group interested. Then got offer from preferred job again. Switched up fellowship for their needs. It was a crazy roller coaster ride but seven years into practice it's a distant bad memory and I'm doing great. Good luck sounds like you've got all your ducks in a row. Be sure to advocate for yourself - put your desires into job negotiation you are worth it. I'll bet there are lots more peds jobs than path jobs out there. We are just considering hiring for the first time since I got my job for the 2016 year. I know I am good, but I also know that my timing was so lucky and am very grateful for all my mentors and advocates that plugged me for my current (dream) job.

  2. First of all, congratulations on launching out into practice. You have already solved an important issue, what type of position, and have decided on community practice. With your enthusiasm you will do well and enjoy it.
    Now, for the nitty gritty. No more warm fuzzies, this is business.
    1. You need a contract attorney. Not just any attorney, not your friends brother in law just out of law school. A contract attorney, and one who specializes in medical contracts.
    2. Try to go on many interviews, even offers that may not especially appeal on first look, because it is good practice, and you get good ideas of what is being offered and what you should be asking.
    3. Go to interview with enthusiasm but be business like. Let them know your strengths and what you would expect to contribute to their practice. Try to get a feel for who is in charge. If it's the practice manager and he/she will have control over your professional activities, run.
    4. Have some ideas ahead of time what the expected salary range is for your area, and some idea of what sort of benefits you expect. You will not agree to anything on a first visit, but you will have some concept of what questions to prepare. You should be told even on first pass how you will be paid - ie, straight salary or hourly or dependent on revenue or dependent on work units, etc. Also, how will your overhead be calculated? Equal percent for all physicians, dependent on your hours, dependent on your revenue ?
    5. You do not want a job where you have to supervise a PA or an NP. This happens to be a personal bias. But even if you decide to assume such risk eventually, as a new physician in practice you are putting yourself in a very vulnerable position.
    If you need name of a good contract attorney in the geographical area you mention, contact me at drnanamd@gmail

    1. Can you comment more on your #5? This seems to be a very popular way to practice, and I wonder what the data are on benefits vs. risks.

  3. You can't get the history and examine every single patient seen by the PA or NP. If you could, why not do it yourself and save their salaries? On the other hand, if you simply sign off on charts, you don't know what was missed., because they often don't know what they don't know. My partner got involved in a nasty malpractice suit (are any not nasty?) even though she picked up the chart to review one day after multiple NP visits, with the life threatening diagnosis being missed. She saw the pt immediately, only on that one visit, and arranged immediate hospitalization. But when the suit was eventually filed, she got named as the only MD name on the clinic chart and the NP's skated away. We were supervising at that time in a forced relationship at a university clinic. Another episode, I randomly came in on Saturday and pulled all labs off the computer. There was a set of liver enzymes >3000. NP was handling on her own, hadn't told me about the case. So, when partner and I launched into our own practice, no midlevels. We are in Internal Medicine primary care, and I think the specialty may make a difference.
    I can see that in surgical specialties you don't need a board certified surgeon to hold your retractors for the chole case or to take out the staples. And in peds, an NP can probably alternate well child visits with the pediatrician and follow an immunization schedule. But see my sick family members - Uh - no thanks.

  4. Thank you for the feedback. Question - does the contract lawyer have to be geographically located where you will practice? I am in training in the South Atlantic region but plan on relocating to the DC-Maryland-Virginia area.


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