American College of Physicians: Internal Medicine — Doctors for Adults ®

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In a red-hot job market, some residents are taking time off

The booming demand for internists has some young physicians waiting longer to start looking for that first job

From the May ACP Observer, copyright © 2004 by the American College of Physicians.

By Christine Kuehn Kelly

In today's job market for internists, residents are in the driver's seat when it comes to finding work after training. Some recruiters even say that the red-hot market is encouraging some young internists to not push themselves in their second or even third years of residency to land their first job.

"Some residents are waiting until their training is complete to look for jobs," said Mark Smith, executive vice president of Merritt, Hawkins & Associates, a Texas health care staffing firm. "Some are even taking a year off."

Because of the demand for internists, recruiters say that residents who put off the job hunt are unlikely to be out of work for long. And they point out that young physicians—just like their older colleagues—are taking advantage of abundant locum tenens possibilities.

They also warn, however, that whether they're taking a year off or already lining up job interviews as a first-year intern, young physicians may not want to base their job choices purely on geography or salary when considering their first job.

Booming market

According to Mr. Smith, recruiters have definitely noticed a trend among some residents to put off their job search until their training is over. "Half of the 'residents' we're interviewing aren't residents at all, but 2003 graduates," Mr. Smith said. "They're looking to be employed for the first time."

Furthermore, Mr. Smith said, employers no longer take a dim view of candidates who are taking their time. Not too long ago, he pointed out, employers would say, "February and he's still available? There must be something wrong." But that's no longer the case, said Mr. Smith, because many well-qualified residents have put off interviewing for permanent positions.

What's behind that trend? The booming job market is one major factor. Residents who wait until their third year—or later—to look for a job still find many options available. Some are deciding to take time off to study for their Boards, Mr. Smith pointed out, while the growing prevalence of two-physician marriages may help take the heat off one spouse needing to find a job right away.

Going locum

Another factor is the ready abundance of locum tenens positions, which younger physicians—as well as their older counterparts—are availing themselves of.

"Many residents want the opportunity to 'test drive' different locations and arm themselves with a bit more experience and education on how to evaluate a practice," Mr. Smith said. After young physicians have spent time filling a handful of different locum tenens positions, they typically feel much more comfortable being able to assess different permanent job offers, he added.

According to a survey done by CompHealth, a Salt Lake City health care staffing firm, locum tenens now has moved into the mainstream of medicine. The number of physicians working as locum tenens increased from 4% in 1987 to 15% in 2000.

The survey also found an almost equal age distribution for physicians working the temporary assignments—with 21% of all survey respondents in their 30s. In addition, 15% of physicians accepted their initial assignment right out of residency, while an additional 9% chose their first assignment within three years of completing training.

Physicians considering locum tenens positions need to take some precautions, however. For example, they must make sure their expenses, including malpractice insurance and housing, are properly reimbursed. And they need a "get out of Dodge" clause in their contract that permits them to leave the temporary position in a timely manner if things aren't working out. (See sidebar.)

Job hunting

Whether or not you've given yourself a year off, filled several locums slots or are a first-year resident getting an early start, experts say there are some job-search pitfalls to watch out for.

One major one is basing your job search purely on geographic location—which a survey by Merritt found is a deciding factor when most residents choose their first permanent job.

"Location is the first thing residents talk about, even before the specifics of the practice," Mr. Smith said. The problem is that by insisting on being in one particular city, young physicians "lose their negotiating leverage skills," he said, and perhaps end up having to pick the best of several not very promising options.

Instead, when physicians open themselves up to considering positions in, say, the entire state of Florida instead of just in Miami where they think they want to practice, "you can really change your financial outcome, at least on your first job," he said.

He pointed out that one Merritt survey found that an offer's location accounted for as much as 80% of residents' decision to take a job. Other surveys have shown that 70% of residents or fellows leave their first job within two years- two factors, he suggested, that may be linked.

At the same time, experts warn young physicians not to take a position based purely on salary, a temptation when residents are struggling with huge educational debts.

"Don't pursue money over personal fulfillment and end up taking a job you won't be happy with," counseled R. Hal Baker, FACP, associate director of York Hospital's internal medicine residency program in York, Pa. "Although the money can entice you to a practice situation, you may find the practice cannot sustain that income level. In order to meet future productivity, there may be demands to work harder. Or a higher salary may be in compensation for a bad situation."

And if taking time off is not for you, experts advise starting your job search sooner rather than later.

"I advise my PGY3 residents to start looking early because there is a four-to-five month lag time after you find a position," Dr. Baker said. You'll need a state license, hospital and insurer privileges, DEA and Medicare numbers—all in a specific sequence. "The process can be slow," Dr. Baker explained.

That advice also stands for residents who have a specific position in mind. For example, third-year resident Colin H. Combs, ACP Associate, didn't waste any time lining up a position with the Kaiser Group of Colorado. As a resident at Exempla St. Joseph's in Denver, Kaiser's major Colorado hospital, he made working at Kaiser a top career priority and began interviewing in June of his second year.

One of the advantages for both him and his employer, he said, is that he feels he will be ahead of the learning curve with his knowledge of Kaiser's computer documentation, reimbursements, formulary, guidelines and patient population.

"Getting in early in the application process proved beneficial to me," said Dr. Combs, who said his prior experience with the Kaiser system helped him land the job.

Christine Kuehn Kelly is a Philadelphia-based freelance writer specializing in health care.

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What you should know about locum tenens positions

When Geoff Wiss, MD, began a fellowship at the same institution where he worked, he realized his exposure to other health care systems was limited. So Dr. Wiss, an emergency physician at Sinai-Grace Hospital in Detroit, decided to take short-term locum tenens assignments at other institutions in his area. "It's an adventure to go into new environments," he said. "I can choose how many days a month and where I want to work."

Taking a temporary position as a locum tenens can give new physicians an opportunity to assess practices, geographic areas and even subspecialty work. If you are looking for the position that can lead to a permanent job, you'll be able to decide if your goals correlate with a practice's location, patient population, income potential, practice style and administration. Some internists simply enjoy the opportunity to move around the country, experiencing different locations and patient populations.

A quick Internet search will turn up dozens of organizations that place locum tenens. Before you sign a locum tenens contract, however, be sure to address the following:

  • payment for your services;
  • expenses, including lodging, transportation and car rentals, plus state licensure and other administrative costs;
  • malpractice insurance, including "tail" insurance if "claims-made," not "occurrence-made" insurance is offered. ("Claims-made" insurance covers claims made only if the insuring company at the time of the occurrence is the same company you are using at the time of the claim. "Tail" insurance covers claims made when covered by your original "claims-made" insurer.)
  • on-call duty and daily hours; and
  • a clause to let you leave the position within a reasonable amount of time.

You can expect an internal medicine locum tenens position to pay about $450/daily for an eight-hour day—and you won't earn benefits such as profit sharing. It's not a way to maximize income, Dr. Wiss said, but you will have the benefit of seeing many different types of practice.

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