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


How to get the job you really want

From interviewing strategies to contract negotiations, tips for a successful transition

From the September ACP Observer, copyright 2006 by the American College of Physicians.

By Yasmine Iqbal

Although residency prepared William D. Surkis, MD, to be a good doctor, he found he was less prepared to actually find the right job. Instead, he felt unprepared and anxious as he plowed his way through interviews for eight different positions.

“At every point during your training, things are more or less set out for you,” acknowleged Dr. Surkis, who finished his internal medicine residency at the Hospital of the University of Pennsylvania. “And then, suddenly, the next step is uncertain. It’s nerve wracking.”

William D. Surkis, ACP Member, researched employers and spoke with other physicians before finding his ideal job at Cooper University Hospital in Camden, N.J.

He eventually found his ideal match as an assistant professor of medicine in the division of general internal medicine at Cooper University Hospital in Camden, N.J., where he started working last August. But today's job-hunting residents can have an easier time finding the right job for themselves, he said, by recognizing that the process requires forethought, research, initiative, flexibility and brief courses on interviewing etiquette and contract negotiation.

Starting out right

Experts say interviewing for eight positions is to be expected, even if you have a clear idea of what you want. You never want to settle for something that isn't a match and you want to make sure the position you pick has most of want you want. Consequently, they say a successful search should start with the following:

  • Figure out what you want. Determine what you want in terms of money, hours, geography, etc., said Joan M. Roediger, JD, a partner and health care attorney with Obermayer Rebmann Maxwell & Hippel LLP in Philadelphia. “Finding the right job is a matter of pouring all of these ‘ingredients’ into an ‘employment funnel’ – what comes out the other end is the job you want.”

    Dr. Surkis received this advice when he networked with former residents who had recently entered the workforce. “Before applying blindly for just any position, they advised me to organize my thoughts and evaluate what my ideal position would be.”

  • Create two checklists. The first should include all the elements of your dream job and the second should include the potential deal breakers, such as a requirement to move out of state if you’re committed to staying in the area, said Bruce D. Armon, Esquire, a partner and health care attorney with Saul Ewing LLP in Philadelphia.

  • Test the waters. If you don't know exactly what you want, start exploring what’s out there. Dr. Surkis, for example, considered a private practice position requiring him to work four days a week doing outpatient care. “But then I asked myself if this job would be challenging enough and really help me create a career pathway,” he said. He decided to focus instead on obtaining a position that allowed him to do both inpatient and outpatient care in an academic setting.

    Realize that the first job offer may not be the best. According to Ms. Roediger. “Don’t glom in on one opportunity early on,” she said. “Until you have a signed contract in hand, keep your options open and cast a wide net.”

    Dirk Stanley, MD, who just completed his internal medicine residency at Albany Medical College and started as a hospitalist at Rhode Island Hospital in July, also tested the waters in different job environments. He said he considered one small community hospital where the interviewers’ questions were focused on billing, productivity and similar issues. “There was absolutely no mention of anything academic, like continuing medical education or developing my clinical skills. That was a real turnoff, and it helped me decide to come to Rhode Island, where I felt that although productivity is important, it’s also an academic environment.”

  • Stay flexible. Even after you’ve developed your checklists, your priorities might change and lead you in unexpected directions. For example, James Hobley, MD, was certain that he’d stay at Penn State Milton S. Hershey Medical Center after he completed medical school, residency and his gastroenterology fellowship there. Then his mother-in-law was diagnosed with colon cancer. After speaking with her physician, he started considering moving to Shreveport, La., where she lived and where he and his wife had grown up. This August, he’ll start working with the practice that is managing his mother-in-law’s care. “It turned out to be a perfect match for me,” he said.

  • Start early. It's challenging to fit a job hunt into an already-packed schedule, but it’s to your benefit to start early. “Begin scoping out opportunities as early as possible and definitely by the beginning of your last year of training,” Ms. Roediger advised. If you’re thinking about taking a job in another state, start the process of getting licensed immediately, said Dr. Surkis, who trained in Pennsylvania and knew that it could take up to six months to get a New Jersey license. “It was up to me to make sure everything was in order,” he said. It took him about 10 days to assemble all the paperwork, which he drove down to the medical board office in Trenton. He then followed up regularly to ensure that he got his license in two months.

  • Prepare a curriculum vitae and a resume. “Many times, residents will prepare a CV that lists their accomplishments, but they won’t take the time to create a resume that highlights their skills,” said Lisa Bellini, MD, internal medicine program director at Penn. “You need to prepare both, as well as targeted cover letters, for each job opportunity.” She also advised saving them as Acrobat PDF files to make them easy to retain formatting when e-mailed.

Let the interviews begin

Once you've taken all of these steps, it's time to move on to interviewing. While this may intimidate some residents, think of it as a time to learn as much as you can about the position and determine if it’s going to be the right fit for you.

“Think of the interviewing process as a dating game,” said Mr. Armon. “You want to find out if you and your prospective employer share the same short term, long term and overall philosophical goals and get all your issues out on the table.”

It’s important to ask as many questions as you answer, added Alwin F. Steinmann, FACP, program director of internal medicine at Albany Medical College in Albany, N.Y. “You want to find out if your expectations are in line with the expectations of your employer.”

Don’t underestimate the importance of any part of the interview process, noted Ms. Roediger. “Most residents know that they have to present themselves well during an in-person interview, but many underestimate the importance of a phone interview, which may be the first interaction with a prospective employer.”

“If you get called at a busy time, always reschedule so you can be focused and articulate,” she said. “Remember that you’re not going to be the only person that this employer calls, and at every point during the interview process, you have to be ready to make your case.”

If you’re asked to come in for a face-to-face interview, find out as much as you can about the hospital or practice. “If you’re interviewing with a private practice, for example, go to the local hospital’s cafeteria, introduce yourself to the other doctors and ask them what they think of the practice,” Ms. Roediger said.

Dr. Surkis read about each prospective employer online and tried to speak with current physician employees about their experiences before each interview. “As a result, I was able to show employers that I knew about their practices and that I was interested in the job,” he said.

Be prepared to articulate what you’re looking for, and come prepared with a list of questions, using your checklist of must-haves and deal breakers as a guide. Ms. Roediger suggested asking:

  • how long the waiting list is for new patients and regular appointments,

  • the average length of an office visit,

  • if any doctors have left the practice recently and why,

  • about issues that are important to you (e.g., continuing medical education), and

  • about other perks, such as retirement funding, insurance, or leave time, all of which can add to the overall compensation package.

Also, anticipate questions about your training, goals, strengths and weaknesses. If the interviewer’s first question is “Tell me about yourself,” be prepared to refocus the question by asking, “What would you like to know?” and targeting one of these areas.

Finally, be prepared to state your preferred salary range. “It used to be that salary issues were frequently not discussed in the first interview, but it’s becoming much more of an up-front thing,” said Dr. Steinmann. This could be because graduating residents are facing higher debt burdens than in the past , he said, and because residents today are more confident about their negotiating power, especially in fields experiencing shortages.

How to handle job offers

If you’ve followed most of this advice, experts say you’ll soon be considering multiple job offers. At this point, it's critical not to underestimate your leverage to negotiate in such areas as practice duties and salary.

“Many residents have this attitude that they’re not entitled to anything—they’re happy to get what they get and have a place to work,” said Jennifer Loh, ACP Associate, a former chief resident at Penn who counseled residents on their career plans. “They don’t realize that employers expect them to negotiate.”

For example, Cooper University Hospital initially offered Dr. Surkis a position that only involved outpatient primary care. He met with the head of the hospitalist program at Cooper and negotiated a position that allowed him to practice inpatient medicine half of the time.

Salary also is always up for negotiation, experts say. First, you should know average starting salaries for the position you are considering. For example, the average starting salary for internists, according to the Medical Group Management Association, was $133,641 in 2004.

Next, know what you want. One of our residents asked for a $10,000 salary increase, and she was shocked when she got it,” Dr. Loh said.

Before you sign ...

When you get a job offer, you’ll likely receive a verbal offer, followed by a letter of intent, then by an employment contract. Before you sign, here are some helpful hints:

  • Take the time to read everything. “I can’t tell you how many times I’ve gotten calls from doctors who never read their contracts and realize too late that they’ve made a terrible mistake,” Ms. Roediger said.

  • Hire an attorney. Allow a minimum of two weeks to have a contract reviewed by a health care attorney. “It’s foolish to spend six figures on your education and not spend $500 to $1,000 to have your contract professionally reviewed,” Ms. Roediger said.

    Focus on:
    • restrictive covenants—agreements that restrict the geographic area you can practice in if you leave your employer,
    • malpractice tail coverage—which provides coverage for incidents that are litigated after you leave your employer,
    • termination language—which determines how you can be fired, and
    • hospital sponsorship contracts, also called income guarantee agreements, practice loans or hospital recruitment agreements. In these agreements, a hospital financially assists a practice with recruiting costs, and if a physician leaves, he might be obligated to reimburse the hospital for these expenses.

  • Obtain two signed copies of the contract before you start working. One is for you and one is for your attorney. “The best contract is one you put in a drawer and never look at again,” Ms. Roediger said.

Of course, you might not be able to get every detail of your job in black and white. When Dr. Surkis got his contract from Cooper, for example, he was surprised to find the 20-page document was strictly boilerplate and didn't include anything about giving him the opportunity to do both inpatient and outpatient care, which was a major part of his interview discussions.

“I was told that the hospital’s legal department couldn’t manage to write individual contracts for every faculty member hired and that contracts at Cooper did not reflect finer details, such as patient mix,” he said. Nevertheless, Dr. Surkis felt confident that his supervisors would stand by their verbal agreements, and following an attorney’s review, he signed the contract.

A year later, Dr. Surkis now feels just as good about his job hunt as he does his clinical skills. He’s thrived in his position and was recently voted Teaching Attending of the Year.

“My job is everything I expected and more,” he said. “I found that when you’re looking for a job, if you do your homework, commit to being ultra professional and are prepared to be open to anything and everything, things tend to work out. I’m happy that I found an employer that cares about helping me succeed.”

Yasmine Iqbal is a freelance writer specializing in healthcare.


What not to wear—or do—during an interview

If you haven't been through the standard interview process recently you may not be up-to-date on etiquette. Experts say it's worth noting that following these tips—as obvious as some may seem—may actually give you an edge:

  • Show up on time. If you’re traveling a significant distance to an interview, make sure you have your travel plans worked out so you arrive on schedule and refreshed, experts advised.
  • Dress appropriately. Even though your prospective employers might be wearing scrubs, your interview attire should be business conservative. For women, consider a suit and coordinated blouse and accessories; for men, a suit, long sleeve shirt and tie.
  • Follow up with a thank you note. Thank the interviewers for their time and restate your qualifications. “This is a gesture of courtesy, but it also puts the employer on alert that you’re interested in working for them,” said Joan M. Roediger, JD, a partner and health care attorney with Obermayer Rebmann Maxwell & Hippel LLP in Philadelphia.
  • Be alert during the interview. One candidate said he might have lost an opportunity by going to the interview when he was extremely tired. “I’d been on call, and I yawned a few times during the interview,” he said. “I think I sabotaged myself because of that.”

William D. Surkis, MD, who recently found just the position he was looking for at Cooper University Hospital in Camden, N.J., found, to his surprise, that etiquette not only played a role during his interview, but was even brought to his attention.

“One of my interviewers told me that he was really glad I wore a suit,” Dr. Surkis said. “Apparently, other candidates hadn’t, and he had felt that they weren’t taking the opportunity seriously.”


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