Getting Ready for the Rest of Your Life

Maryanne W. Lindsay, MD, Clinical Instructor, Assistant Residency Director, Department of Emergency Medicine, The Bowman Gray School of Medicine; EMRA Immediate Past President

Introduction
If you are a senior resident, you have probably reached the goals you have envisioned since entering medical school. But what do you do now? Do you know anything about looking for a real job? What will be your career? Where will you go? Where will you start? Who will you look to for advice and will these advisors be adequate? What does your spouse/significant other expect? Are you ready for this tremendous change and the preparation it will require? There are many exciting possibilities awaiting you.

This series of articles will provide residents with time-appropriate information to assist in making the change from resident to practicing emergency physician. More details on successive phases of the transition from resident to attending will appear in upcoming inserts in EM Resident. But, the time to begin preparation for your job search is now. This article will review the basics of curriculum vitae (CV) preparation, job search schedule, recommendation letters, recruiters, and interview skills.

Evaluate Your Options
The first step is to evaluate your career options. Physicians who have completed an emergency medicine residency program have many practice options following residency. These options include further training, academic practice, or community practice. Fellow-ships offer advanced training in many areas including administration, hyperbaric medicine, medical informatics, critical care medicine, medical toxicology, pediatric emergency medicine, EMS, sports medicine, resuscitation medicine, wilderness medicine, and teaching. Fellowships offering additional training in the practice of clinical emergency medicine are also available. Of these options, further certification is offered currently in pediatric emergency medicine and medical toxicology. Physicians with an interest in academic medicine should anticipate clinical, teaching, research, and administrative responsibilities. If you are not interested in further training or in academic emergency medicine, you will direct your efforts toward a community practice. All of these environments offer opportunities for involvement in community service, public relations, education (public, prehospital, nursing), hospital committees, medical societies, AMA, and ACEP. Even within your practice, there are opportunities for leadership and administrative efforts (CQI, reimbursement issues, scheduling, social activities). Essentially, the ultimate goal for all graduating residents is to find the practice in which you will be happy. It is perfectly acceptable to consider several different types of jobs. Personally, I considered and interviewed for positions in all three environments.

Write Your CV
After considering the career(s) that interest you, begin working on your curriculum vitae. Your CV is important! This document represents you to potential partners and can make or break the decision to grant you an interview. You should build your medical CV from the beginning of your residency but include prestigious honors and activities from medical school as well. The CV may include degrees and honors, medical association memberships, research activities, publications, presentations, project involvement, committee work, licensure, certifications, practice experience, and community service. You may include a personal section, highlighting the non-medical facets of your life, demonstrating "well-roundedness."

The "look" of your CV is crucial. It should be neat and easy to read, with adequate white space. Wall-to-wall print is overwhelming and difficult to read. The most prestigious items within a category should appear at the beginning or the end of a list. Select a standard 12-point font for the body of the CV. Use bold, underline, italics, and all capitals in appropriate areas. Finally, have several people review the final document and make suggestions. The accompanying cover letters should be directed to each individual employer, as appropriate. This letter is just as important as the attached CV.

Get an Early Start
If you are a senior, you should have already begun intensive work on your CV and cover letter. A well-organized job search should begin early. Figure 1 suggests a job search time-line. If you attend Scientific Assembly, make it part of your formal job search. Go armed with several copies of your CV, ready to meet potential partners or helpful recruiters. Make plans to attend the annual EMRA Job Fair, a member benefit, and submit a computer job search request at the EMRA booth. EMRA will also mail the EMRA Job Catalog to members just prior to Scientific Assembly. Browse through this on the plane and use it to target specific jobs that interest you. Most likely, you will be able to network with these employers during the meeting week. You may also find leads on jobs through colleagues, journal ads, internet ads, job postings, scientific meetings, or recruiters. If you are interested in a specific geographical area, contact practices in that area directly.

Although you should start early, allow yourself plenty of time for decisions and lifestyle considerations. Certainly, good jobs will be filled as early as the fall; however, new jobs will become available continuously. When my plans for pursuing a fellowship suddenly changed, I found several excellent job opportunities at the late date of May during my senior year. Deciding on a final job at that late date made other transitions (house hunting, financing, moving, licensure) more difficult.

Do You Need a Recruiter?
Professional placement services (recruiters) are available to assist in the job search process. Recruiters can provide valuable information to a busy resident who has little spare time to research several jobs thoroughly. Generally, fees are paid by the employer, either the hospital or the physician group. Although recruiters specialize in job placement, you must shop for a recruiter who will listen to you and be willing to investigate other opportunities. Working with a recruiter does not obligate you to sign a contract with one of their clients nor does it obligate you to disclose other working leads you may have obtained from other sources. Be sure that the recruiter understands that he/she is not authorized to circulate your CV to potential employers until you have signed an agreement.

Request Letters of Recommendation
You will need letters of recommendation. Typically, you ask for these letters from either the program director or department chair and two additional attending physicians. If the recommending physicians know the potential employer, they may speak with that individual on the phone as well. Request letters from individuals who are willing to write a strong, positive letter for you and who know you fairly well on a personal level. Do not expect the letters to get the job for you. At a minimum, most employers expect reference letters to be complimentary. In general, the recommending physicians will save the letter format in a file for multiple letters as requested. Allow several days in your schedule for the reference letters to be written, reviewed, signed and mailed.

Prepare for the Interview
When you have decided which interviews to accept and when to begin your travels, turn your attention toward refining your interviewing skills. Several books are available at commercial bookstores which may help in preparation for a dynamic, yet comfortable, interview. One I highly recommend is Knock 'EM Dead by Martin Yate. First and foremost is your appearance and social behavior. Look as good in person as you do on paper. You should be neatly dressed, mannerly, and at ease. Avoid bright colors, casual dress, and strong scents. If you have any habits, do not bring them to the interview.

During the interview, be sure to ask as many questions as possible. This not only demonstrates your genuine interest in the position, but also allows you to learn enough about the group and practice to make an intelligent decision. Questions may be related to the practice environment, hospital planning and administration, scheduling, group administration, nursing, ancillary staffing, consultants, patient population, and hospital facilities. You should also clarify what the group or hospital expects from you in terms of efficiency, leadership, administration, research, EMS involvement and teaching.

Other lifestyle considerations must be taken into account, as well as your significant other's needs. Locations vary widely in cost-of-living. Consider this when you evaluate salary quotes. Proximity to family, available activities, community resources, and school quality also need to be considered.

Evaluate Contract and Compensation
Compensation varies for different jobs; however, all emergency physicians can expect to have a fairly comfortable lifestyle. You must consider the entire benefit package and total professional expenses when evaluating a gross income. Do not assume your professional expenses will be covered by a group or hospital budget unless these benefits are specifically stated. Expenses include, but are not limited to, licensure, board certification, narcotics registration, liability insurance, parking fees, CME, association memberships, billing company fees, and social security tax. You should also inquire as to what determines your income (set salary, hourly wage, fee-for-service). This topic will be reviewed in more detail in an upcoming insert.

Regardless of the job you finally choose, you may not stay in that job for the rest of your career. Many physicians change jobs or relocate for a variety of reasons (advancement, family, variety, dissatisfaction). However, if you have plans to stay within a specific community for a long period of time, you must review your contract specifically for a noncompete or restrictive covenant clause. These clauses can limit where you practice during and even following affiliation with that hospital and may legally prevent you from assuming privileges with a competing hospital in the area or with that particular hospital, should another group buy out the contract. Contracts are negotiable and should be reviewed by legal counsel to ensure the best possible agreement for the physician. More detail regarding contracts will be available in an upcoming insert, or you may purchase Before You Sign: Contract Basics for the Emergency Physician by David Kalifon, MD, FD, FACEP, FCLM and Daniel J. Sullivan, MD, JD, FACEP, available from ACEP. (NOTE: This book is was republished in 2007:Contract Issues for Emergency Physicians, 2nd edition.)

Conclusion
Exploring emergency medicine career opportunities is exciting and challenging. You must be organized, efficient, and begin the process early. Throughout your residency, you can build your experiences and make contributions in areas that will not only increase your attractiveness to future employers and colleagues but also provide you with a greater insight into the type of career you should pursue.

For the senior emergency medicine resident, get started now! Speak with several physicians to obtain advice from a variety of knowledgeable perspectives. Search for and accept nothing less than the perfect career for you. You earned it!

Original article published inEM Resident, August 1996 edition.

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