Document 6511825

The New England Journal of Medicine
How to Help Your Residents
Find Jobs
Presented by Jennifer Cognetta
The New England Journal of Medicine
APDIM
Spring Meeting
April 1, 2003
Who are we
and why are we here today?
• Represent the Classified Advertising Department
of NEJM
• In contact with almost 250 of physician recruiters
on a weekly basis who place over 20,000
classified ads each year in NEJM
• Responsible for the development and promotion of
features and services aimed helping physicians
find the jobs they desire, and recruiters find the
candidates they want to hire
1
Who are we
and why are we here today?
• Attend 6-10 recruiter conventions a year to
conduct client needs assessment for the
physician, program director, and recruiter
audiences
Presentation Outline
• I. Conducting personal and professional
needs assessment
• II. Identifying practice opportunities
• III. Working with staff physician recruiters
and search firms
• IV. Applying for and getting the job: The
CV, the cover letter , the interview and the
background check
2
Presentation Outline (cont.)
• V. Anatomy of a physician employment
contract: Avoiding pitfalls
• VI. Where the jobs are: Supply and demand
• VII. Recruitment incentives, compensation
models and salary surveys
• VIII. States in malpractice crisis
Presentation Outline (cont.)
•
•
•
•
•
IX. Review of practice settings
X. Tips for managing medical school debt
XI. Tapping into relocation sources
XII. Additional References
XIII. Q&A
3
I. Conducting Professional &
Personal Needs Assessment
Conducting Professional &
Personal Needs Assessment
•
•
•
•
What are your personal/professional goals?
Location and lifestyle considerations
Cost of living in different regions
Financial Needs and Goals: Medical school
debt? Family to support?
4
Where should residents begin?
• Start research early
– Identify Hospitals, Groups, Recruiters &
Physicians that are a consideration
– Contact organizations to find out as much
information as possible
• Be clear about professional objectives
– Fellowships, Practice, Academics, & Lifestyle
needs
Where should residents begin?
• Be realistic about opportunities in your specialty
and within geographic areas
• Market fluctuates: primary care vs. specialties
• Review physician/population staffing ratios
• Contact staff recruiters at institutions that interest
you
– A follow- up phone call is acceptable
– Physician recruiters will get back to you
– Use e- mail for correspondence if available
5
II. Identifying Practice
Opportunities
Identifying Practice Opportunities
• Networking
– Colleagues
– Program Directors
– Medical Associations
– Specialty Meetings
– Job Fairs
6
Identifying Practice
Opportunities
• Networking - #1 source of job leads
- Enables you to gain an insider’s view to different
practice settings
- Program directors can help residents make
connections with colleagues locally or where
residents may want to practice
- Program directors can also provide names of recent
alumni who are willing to network
- Tap professional associations and network with
young physicians and/or older established docs
Identifying Practice
Opportunities
• When networking, instruct residents to
provide a brief description of their
background and general career goals, so it’s
easy for someone to forward their
information on to others
7
Identifying Practice
Opportunities
• Journal Ads
– Multispecialty Journals
• The New England Journal of Medicine
• JAMA/Annals
– Specialty Association Journals
• AFP
• JACC
Identifying Practice
Opportunities
• The Internet
www.nejmjobs.org
www.ama-assn.org
www.acp-online.org
Specialty associations sites
Institution/hospital sites
8
Identifying Practice Opportunities
• Open mail
– Many institutions use direct mail to advertise
opportunities at their institutions
• Recruitment Agencies/Search Firms
III. Working with Staff
Recruiters and Search Firms
9
Working with Staff Recruiters
and Search Firms
• In-house staff physician recruiters
• Retained search firms
• Contingency search firms
Working with Staff Recruiters
and Search Firms
• Inhouse staff recruiters
- Professionals who work directly for institution,
clinic or hospital
- Generally not paid commission for placements,
may receive end of year bonus
- Career advocate for physicians as main focus is
not only recruitment, but retention
- Depending on the specialty and region of the
country, a search can cost anywhere from $25,000
- $30,000 or more for one physician
10
Working with Staff Recruiters
and Search Firms
• Inhouse recruiter is generally looking for a
strong sense of commitment and willingness
to grow with the institution
• Very knowledgeable about the practice
opportunity and the community itself
• Trying to make a good fit for both parties,
will assess work styles, career goals,
personal and family interests, etc.
Working with Staff Recruiters
and Search Firms
• Search firms
- Physicians should never have to pay a search
firm for their services; the client/institution that
iniatated the search should foot the bill – always!
- Tend to be aggressive – may even call the
doctor’s beeper number
- Search firm should know the basics about the
candidate prior to contacting them – specialty,
credenetials, where trained, etc.
11
Working with Staff Recruiters
and Search Firms
- Search firm recruiter should know much about
the opportunity, the practice, income and
partnership potential
- Be upfront about professional and personal
goals, no need to waste anyone’s time with the
“I’ll go anywhere for the right position.” attitude
- Always remember that the search firm is
primarily working on behalf of the hiring
institution
Working with Staff Recruiters
and Search Firms
• Inquire about the reputation of the search
firm before allowing them to represent you
• How long has the company been in
business?
• How many successful placements a year do
they make?
• What is their area of expertise?
• Ask for references of satisified physicians
12
Working with Staff Recruiters
and Search Firms
• Find out how CVs are handled and disseminated
• Insist (in writing) that CV not be sent, faxed, or
emailed to a prospective employer without your
prior permission
• Avoid having your CV “mass” faxed or e-mail
“blasted”
• Also, ask that your CV not be transmitted or
posted on a website if you are not comfortable
IV. Applying for and Getting the
Job
13
Applying for and Getting the Job
• CV and Cover Letter
• Do Homework/Research
• The Interview
• The Background Check
Preparing a CV
• Center contact information
– Make the contact information easy to read
– If possible give several contact methods, including
an email address if comfortable doing so
– If this info is meant to be kept confidential, only
list numbers where it is OK to be contacted
• List education chronologically: dates recent
to last
– Explain gaps in training in cover letter as they are
usually a red flag to recruiters if not addressed.
14
Preparing your CV
•
•
•
•
Supply licensure and certification information
Cite work experience: most recent to last
Mention honors and awards
Provide references on a separate sheet, have
them available. Let references know they have
been listed.
• List professional associations
• Identify any special projects, research or
published works
Preparing a Cover Letter
• Address letter to an individual whenever
possible
• 1-2 pages in length
• Use quality paper: plain white or off-white
– Do not use letterhead from your training
program, prescription pads or Post-its
• One inch margins; single spaced
• Identify position/ad responding to
– Many institutions run several ads
simultaneously, refer to job codes in ads
15
Preparing a Cover Letter
• Spell out employment objectives
– Length of time, management, academics, when
available for employment, etc.
• Highlight strengths
• Mention personal interests or hobbies
• If applying to jobs in various locations tell
the recruiters why relocation is an option
– BLT – Born, licensed and trained
The Interview
• Check out prospective employers before an
interview
– Reputation in the community
– Financial stability
– Market Competition
– What is the approximate turnover rate? If high,
why are docs leaving and what’s being done to
correct this?
– Patient Demographics
16
Write Down Your Questions
• What type of person are you looking for?
• What is the practice philosophy/mission
statement/culture?
• What is the practice structure?
• How does the practice assign patients?
• How many hours per week will I be expected to
see patients in the office/hospital?
• How many physicians are on staff?
• What is the physician to nurse ratio?
Write Down your Questions
•
•
•
•
•
•
What is the call schedule?
Are there responsibilities beyond patient care?
How do you measure performance?
What do you like best about working here?
Is there a short and long term business plan?
Will the organization help my spouse find
employment?
17
Be Prepared
for Tough Questions
• What are your views on managed care?
• Describe a clinical error that was your fault/Have
you ever been involved in an issue dealing with
patient safety or medical error?
• Patient satisfaction -have you recently been
scored?
• Tell me about a recent conflict with a nurse
• NOTE: Many of these questions are designed to
see how you react in negative situations, check
your personality, etc.
Talk Money Last
• What is the compensation model?
• What’s the starting salary? (www.amga.org annual compensation survey)
• Is there a signing bonus?
• Are there productivity bonuses?
• Is there an income guarantee for the first year?
• Is there partnership opportunity?
• What is included in the overall benefits package?
• Do you offer loan forgiveness?
• Is malpractice insurance covered?
18
Guidelines to Dress for Success
• Men
– Dark Blue or Gray Suits
– Blue, white or yellow dress shirt
– A tie with some pizzazz, yet conservative
– Be shaved/trimmed and barbered
• Women
– Conservative business attire
– Shun short skirts, spike heals, chunky jewelry, loud colors
– Make-up and perfume muted or absent
The Interview
• Don’t
– show up looking unprofessional
– forget your list of questions
– fail to give positive feedback
– fail to cite your strengths
– negotiate during your first meeting
– run up exorbitant expenses
– bring your spouse or children unless invited
19
Background Checks
• Prevent hiring institution from investing
further in undesirable candidates
• Shows inhouse recruiter documenting due
diligence in hiring on behalf of their
employer
• Hospital can become target for civil
litigation and/or bad publicity from hiring a
bad physician
Background Checks
• Recruiters are wary of candidates who are
unwilling to cooperate in the process
• Recruiter will ask you to sign an
authorization and release form prior to the
background check
20
Background Checks
• Form will ask for:
– Full name
– Other names under which you have attended
school or practiced
– Date of birth
– Social security number
• Refusal to sign form is usually a “red flag”
Background Checks
• Once the form is signed, a Social Security trace
and validation is obtained
• Provides any alternate names ulitized
• Past addresses
• Can uncover locations where candidate has
practiced not listed on CV
• Any states not listed on CV are usually prime
targets for investigation of licensure information
as well as court records - both criminal and civil
21
Background Checks
• Civil records contain information about
suits involving:
- medical malpractice
- negligence
- breach of contract
- antitrust litigation
Background Checks vs.
Credentialing
Credentialing Reports:
? Undergraduate
degrees
?Professional degrees
?Training programs
?Licensure
?Affiliations
?Referencing
? Drug Enforcement
Agency Registration
? Board Certification
? OIG Exclusions
(Medicare/Medicaid)
? Malpractice
Coverage/Claim History
? National Practitioner Data
Bank
22
Background Checks vs.
Credentialing
Background Checks also include:
?Social Security Trace and Validations
?County Court Records
?Federal Court Records
?Driving Record History
?Employment Credit Profile
?AMA/AOA Profile
V. Anatomy of Employment
Contracts: Avoiding Pitfalls
23
Anatomy of an Employment
Contract
• Employment status and scope of work
– Outlines basic expectations: numbers of
procedures or patients
– Make sure it’s clearly defined if you are an
employee, contractor or shareholder
– Employment status affects your income, tax
burden or liability in malpractice suit
Anatomy of an Employment
Contract
• Restrictive covenants
– Non-compete clauses or non-competition
agreements
– Restrict geographic area for a certain period of
time
– Some are illegal and others are enforceable
only if deemed reasonable
– The more specialized you are, the wider you
can expect your non-compete region to be
24
Anatomy of an Employment
Contract
• Work hours, schedule and call duty
– Maximum number of work hours each week or
month
– Define call duty expectations
Anatomy of an Employment
Contract
• Termination
– “with cause”: for reasons such as loss of
hospital or prescribing privileges, etc.
– “without cause”: no stated reason necessary –
typically from 30 – 180 days
– “without cause” terminations should be long
enough to allow the physician to secure other
employment
25
Anatomy of an Employment
Contract
• References: Contact national, state or local
medical societies to review sample contracts
and/or take advantage of any contractanalysis services offered
Avoiding Employment Contract
Pitfalls
• Request a “letter of intent” before receiving
the contract
– Should outline the basics: salary, job
obligations, and termination provisions
– Helps save time and attorney’s fees, as you
make sure you are all on the same page before a
contract is drafted
26
Avoiding Employment Contract
Pitfalls
• Don’t hesitate to negotiate
– Generally won’t lose the offer if you don’t
accept it as is
– Sets the tone for your future relationship with
your employer
Avoiding Employment Contract
Pitfalls
• Beware of “one-size-fits-all” contracts
– Make sure scope of work is clearly defined and
doesn’t have unreasonable provisions, such as
the non-compete geographic region
– Be wary of vague language such as “reasonable
call”, etc.
27
Avoiding Employment Contract
Pitfalls
• Make sure guaranteed compensation is
adequate
– No matter the formula, make sure the contract
guarantees you enough work each month to pay
your bills
Avoiding Employment Contract
Pitfalls
• Consider the total compensation package
– Don’t compare contracts based solely on salary
– Factor in benefits, malpractice coverage,
timeframe and conditions for a partnership, etc.
– Double-check disability policies and indemnity
clauses that require you to pay out of pocket for
a judgment if the practice’s malpractice
coverage is inadequate
28
Avoiding Employment Contract
Pitfalls
• Never accept a verbal offer or move based
solely on a letter of intent
– Do not move before seeing and signing a
contract
VI. Where the Jobs Are:
Supply and Demand
29
Where the Jobs Are
• Between 2000 and 2010, the United States will see
a 17.9 % increase in job openings for physicians
according to the U.S. Bureau of Labor Statistics
and The Center for Health Workforce Studies at
SUNY-Albany
• Job opportunities are plentiful nationwide,
however, many will fare better if they look outside
the major urban markets or in underserved areas
Where the Jobs Are – And Aren’t
• According to recent AMA report, states
with the highest number of physicians per
capita are:
– Washington, D.C
– Massachussetts
– New York
– Maryland
– Connecticut
30
Where the Jobs Are – And Aren’t
• The states with the loweset number of physicians
per capita are:
- Alaska
- Alabama
- Idaho
- Mississippi
- South Dakota
- Wyoming
Region-by- Region Overview
• Northeast
- Stable job market, with few changes in
recent years in terms of position availability
- Boston remains a tough place to land a job
with its long-standing reputation as the
country’s top medical education hub
- Low reimbursement combined with high
malpractice premiums
31
Region-by-Region Overview
• Southeast
- Growing market, especially in mid-sized
cities experiencing a “Sunbelt population”
boom
Region-by-Region Overview
• Southwest
– Steady growth of jobs, largely due to
population growth and demand for
sophisticated medical services
– Cost of living hikes and lower managed care
reimbursement rates can squeeze earnings
32
Region-by-Region Overview
• Midwest
– With the exception of large cities like Chicago,
jobs tend to be plentiful in both cities and rural
areas
– Many specialties are in high demand, which can
transalate into high salaries and signing bonuses
– Cost of living tends to be lower
Region-by-Region Overview
• Northwest
– Job opportunities tend to be plentiful with the
exception of desirable major cities like Seattle
and Portland
33
Specialties High in Demand
•
•
•
•
•
•
•
•
•
Anesthesiology
Cardiology
Child and Adolescent Psychiatry
Dermatology
Emergency Medicine
Gastroenterology
Internal Medicine
Radiology
Urology
Solucient National Staffing
Ratios 2000 and 2005
National Staffing Ratios 2000 and 2005
By Specialty
2000
Physicians
Supply per
100,000 Pop
Hematology/Oncology
2 .2 3
Cardiology
5.65
Rheumatology
0.96
Nephrology
1.37
Pulmonary
1.87
Urology
2.94
Gastroenterology
2.98
G e n e r a l S u r g e yr
7.41
Medical Subspecialties
2.37
Opthalmology
5.45
Surgical Subspecialties
4.24
Internal Medicine
24.44
Neurology
2.74
Orthopedic Surgery
6.28
Dermatology
2.86
Plastic Surgery
1.84
Psychiatry
10.09
Physical Medicine and Rehab
1.72
Otolaryngology
2.64
Emergency Medicine/Critical Care 4 . 7 0
General & Family Practice
27.87
Allergy/Immunology
1.07
Other
1.49
Pediatric Subspecialties
4.12
Pediatrics
13.47
O b s t et r i c s a n d G y n e c o l o g y
11.47
2000 Current
Physicians
Needed per
100,000 Pop
2005 Forecast
Physicians
Needed per
100,000 Pop
2 0 0 0- 2 0 0 5
Growth in
Physicians
Needed
1.95
5.99
0.73
0.95
1.31
3.16
4.15
8.71
1.51
4.62
2.30
17.11
2.40
6.46
3.38
2.72
7.70
1.84
3.05
5.63
24.42
1.57
4.93
1.32
10.69
12.02
2.13
6.51
0.80
1.03
1.41
3.40
4.47
9.33
1.62
4.93
2.46
18.28
2.55
6.85
3.57
2.87
8.12
1.94
3.20
5.90
25.55
1.65
5.15
1.37
10.92
12.19
9.1%
8.8%
8.5%
8.2%
7.8%
7.7%
7.6%
7.0%
6.9%
6.8%
6.8%
6.8%
6.1%
6.0%
5.6%
5.5%
5.5%
5.4%
5.2%
4.7%
4.6%
4.6%
4.4%
3.3%
2.2%
1.4%
th
Source: Solucient, LLC, 2001, Physician Resource Planning, 11 Edition. Note Anesthesiology,
Pathology, and Radiology have been removed. Studies are based on direct patient care.
34
VII. Recruitment Incentives,
Compensation Models and Salary
Surveys
2002 Review of Physician
Recruitment Incentives
Merritt Hawkins & Associates
Total Number of Physician Search Assignments Received
2001/02
2,220
2000/01
2,043
1999/00
1,901
1998/99
1,807
35
2002 Review of Physician
Recruitment Incentives
Merritt Hawkins & Associates
Medical Settings of Physician Search Assignments
2001/02
2000/01
1999/00
1998/99
Group
910 (41%) 817 (40%) 818 (43%) 951 (53%)
Hospital
310 (14%) 306 (15%) 380 (30%) 276 (15%)
Solo
365 (16%) 449 (22%) 304 (16%) 191 (16%)
P-ship
488 (22%) 348 (17%) 285 (15%) 169 (10%)
Assoc.
67 (3%)
82 (4%)
57 (3%)
41 (2%)
HMO
15 (1%)
20 (1%)
38 (2%)
19 (1%)
Other
65 (3%)
21 (1%)
19 (1%)
60 (3%)
2002 Review of Physician
Recruitment Incentives
Merritt Hawkins & Associates
Number of Searches by Community Size
2001/02 2000/01 1999/00 1998/99
0–
25,000
621
(28%)
531
(26%)
457
(24%)
719
(40%)
25,001 –
100,000
777
(35%)
674
(33%)
665
(35%)
641
(35%)
100,001+ 822
(37%)
838
(41%)
779
(41%)
447
(25%)
36
2002 Review of Physician
Recruitment Incentives
Merritt Hawkins & Associates
Top Ten Searches by Specialty
2001/02
2000/01 1999/00
1998/99
Radiology
252
233
126
42
Cardiology
226
228
204
127
Orthopedic 172
Surgery
Internal
152
Medicine
Family
135
Medicine
140
141
107
136
144
161
112
268
355
2002 Review of Physician
Recruitment Incentives
Merritt Hawkins & Associates
Top Ten Searches by Specialty
2001/02
2000/01 1999/00
1998/99
ANES
131
127
65
33
OB/GYN
112
87
121
139
GI
102
84
55
25
General
Surgery
Urology
90
66
53
50
61
52
31
27
37
2002 Review of Physician
Recruitment Incentives
Merritt Hawkins & Associates
Type of Incentive Offered
Salary
2001/02
355 (16%)
Salary w/
Bonus
1,110 (50%)
Income
Guarantee
755 (34%)
2000/01
347 (17%)
1,022 (50%)
674 (33%)
1999/00
304 (16%)
1,160 (61%)
437 (23%)
1998/99
289 (16%)
1,030 (57%)
488 (27%)
2002 Review of Physician
Recruitment Incentives
Merritt Hawkins & Associates
Paying Relocation
Yes
No
2001/02
2,181 (98%)
39 (2%)
2000/01
2,001 (98%)
42 (2%)
1999/00
1,806 (95%)
95 (5%)
1998/99
1,771 (98%)
36 (2%)
38
2002 Review of Physician
Recruitment Incentives
Merritt Hawkins & Associates
Amount of Relocation Allowance
Low
Average
High
2001/02
$2,000
$9,066
$20,000
2000/01
$3,000
$7,845
$20,000
1999/00
$2,500
$7,000
$10,000
1998/99
$4,000
$7,240
$20,000
2002 Review of Physician
Recruitment Incentives
Merritt Hawkins & Associates
Signing Bonus Offered
Yes
No
2001/02
777 (35%)
1443 (65%)
2000/01
590 (29%)
1,453 (71%)
1999/00
456 (24%)
1,145 (76%)
1998/99
614 (34%)
1,193 (66%)
39
2002 Review of Physician
Recruitment Incentives
Merritt Hawkins & Associates
Amount of Bonus
Low
Average
High
2001/02
$5,000
$14,270
$50,000
2000/01
$5,000
$15,176
$50,000
1999/00
$2,500
$15,900
$30,000
1998/99
$5,000
$15,000
$50,000
2002 Review of Physician
Recruitment Incentives
Merritt Hawkins & Associates
Paying Continuing Medical Education
Yes
No
2001/02
2,022 (92%)
198 (8%)
2000/01
1,861 (91%)
182 (9%)
1999/00
1,163 (88%)
228 (12%)
1998/99
1,500 (83%)
307 (17%)
40
2002 Review of Physician
Recruitment Incentives
Merritt Hawkins & Associates
Amount of CME
Low
Average
High
2001/02
$1,000
$3,097
$10,000
2000/01
$1,000
$2,967
$10,000
1999/00
$2,000
$2,800
$7,000
1998/99
$1,000
$2670
$5,000
2002 Review of Physician
Recruitment Incentives
Merritt Hawkins & Associates
Paying Additional Benefits
2001/02 2000/01
1999/00
1998/99
93%
96%
96%
85%
Malpractice 94%
98%
95%
90%
Retirement
74%
66%
67%
71%
Disability
75%
91%
66%
71%
Ed Loan
Forgive.
11%
22%
22%
25%
Health
Insurance
41
2002 AMGA Salary Survey
• 16th Annual American Medical Group
Association compensation and productivity
survey
– Conducted by the national accounting firm of
RSM McGladrey
– Contains compensation and productivity from
more than 31,000 medical groups throughout
the U.S
– www.amga.org
2002 AMGA Salary Survey
American Medical Group Association
2002 Medical Group Compensation & Productivity Survey
Physician Compensation – Cejka.com
Median Compensation
Specialty
All
P h y s i c i a n s Starting
Eastern
Western
Southern Northern
Allergy and Immunology
$192,000 $139, 0 9 9 $ 1 9 0 , 7 6 9 $191,632
$198,733 $192,000
Anesthesiology
$278,964 $ 1 7 7 , 6 0 0 $ 2 5 3 , 0 8 2 $254,870
$277,149 $282,501
Cardiac & Thoracic Surgery
$401,440 $ 2 4 5 , 0 0 0 $ 4 3 3 , 9 5 8 $326,294
$407,834 $400,000
Cardiology
$287,163 $ 2 0 0 , 0 0 0 $ 2 4 3 , 0 0 0 $274,728
$ 3 2 2 , 8 5 9 $292,50 0
Colon & Rectal Surgery
$277,441
****
****
****
**** $ 2 8 7 , 1 8 6
Critical Care Medicine
$215,462
**** $191,406
****
$187,934 $218,000
Dermatology
$220,766 $ 1 6 0 , 0 0 0 $ 2 0 4 , 2 8 3 $235,826
$240,446 $212,473
D i a g n o s t i c R a d i o l o g y - Interventional
$356,000 $237,5 0 0 $ 2 4 4 , 7 6 4 $289,577
$355,759 $356,001
D i a g n o s t i c R a d i o l o g y - N o n-I n t e r v e n t i o n a l
$302,704 $ 2 2 5 , 0 0 0 $ 3 6 2 , 6 8 1 $263,215
$295,000 $330,000
Emergency Care
$204,519 $ 1 6 2 , 0 0 0 $ 2 0 7 , 4 0 4 $204,508
$203,600 $204,172
Endocrinology
$166,929 $ 1 2 4 , 0 9 3 $ 1 4 0 , 8 0 0 $164,584
$171,730 $182,813
Family Medicine
$145,675 $ 1 2 0 , 0 0 0 $ 1 3 9 , 4 5 1 $147,982
$147,002 $145,932
Family Medicine - with Obstetrics
$159,095 $ 1 2 0 , 0 0 0 $ 1 5 2 , 3 2 0 $170,093
**** $ 1 5 9 , 0 1 5
Gastroenterology
$246,663 $ 1 8 0 , 0 0 0 $ 2 2 5 , 0 0 0 $246,181
$269,073 $246,500
General Surgery
$255,304 $ 1 7 3 , 0 0 0 $ 2 3 5 , 8 0 5 $234,555
$265,112 $272,469
Geriatrics
$152,260
****
****
****
Gynecological Oncology
$300,340
****
****
****
Gynecology
$207,000
**** $217,655
****
**** $ 2 0 7 , 0 0 0
Gynecology & Obstetrics
$230 , 8 0 4 $ 1 7 0 , 0 0 0 $ 2 1 3 , 9 9 3 $ 2 1 1 , 5 3 2
$248,000 $255,989
Hematology & Medical Oncology
$210,000 $ 1 7 3 , 0 0 0 $ 2 0 4 , 0 7 6 $202,076
$246,458 $208,149
Hospitalist
$145,018 $ 1 3 0 , 0 0 0 $ 1 4 8 , 8 2 2 $134,309
$155,800 $147,272
Hypertension & Nephrology
$205,000 $ 1 6 0 , 0 0 0 $ 1 9 0 , 0 8 9 $216,885
$248,137 $197,914
Infectious Disease
$166,156
**** $ 1 4 4 , 3 5 3 $166,355
$188,444 $165,034
Intensivist
$210,628
****
Internal Medicine
$150,534 $ 1 2 0 , 0 0 0 $ 1 4 8 , 5 1 7 $151,489
$158,310 $149,306
Neonatology
$201,702
$221,034 $206,237
**** $210,628
**** $201,69 8
****
**** $ 1 5 0 , 4 6 2
**** $ 3 5 4 , 4 9 0
****
****
42
2002 Medical Group Compensation & Productivity Survey
P h y s i c i a n C o m p e n s a t i o n – Cejka.com
Neurological Surgery
$ 3 9 1 , 2 5 0 $287,500 $320,180 $384,350 $422,303 $396,250
Neurology
$ 1 8 1 , 6 8 9 $138,000 $167,117 $167,172
Nuclear Medicine (M.D. only)
$245,868
****
**** $ 2 3 1 , 7 8 2
**** $ 3 0 8 , 0 0 0
Obstetrics
$ 2 3 0 , 0 4 4 $177,500
**** $ 2 5 3 , 2 9 2
**** $ 2 0 9 , 2 5 0
Occupational/Environmental Medicine
$166,273
Ophthalmology
$ 2 4 0 , 2 6 5 $ 1 6 2 , 5 0 0 $ 2 3 3 , 4 8 4 $ 2 2 2 , 8 5 8 $ 2 6 2 , 0 18 $ 2 7 3 , 7 7 7
Oral Surgery
$221,731
Orthopedic Surgery
$ 3 2 4 , 7 5 4 $230,000 $278,000 $301,975 $330,352 $359,500
O r t h o p e d i c -M e d i c a l
$230,971
**** $ 2 5 4 , 6 6 6
**** $ 2 3 7 , 2 2 4 $ 2 0 6 , 2 1 5
Orthopedic Surgery - Joint Replacement
$400,017
****
****
****
**** $ 4 1 0 , 0 0 0
Orthopedic Surgery - H a n d
$327,885
****
****
****
**** $ 3 3 0 , 5 0 0
Orthopedic Surgery - Pediatrics
$321,432
****
****
**** $ 3 2 1 , 4 3 2 $ 3 3 9 , 0 0 0
Orthopedic Surgery - Spine
$420,660
****
**** $ 5 1 8 , 8 1 5
Otolaryngology
$ 2 5 3 , 9 7 1 $172,000 $240,034 $226,753 $280,695 $281,895
Pathology (M.D. only)
$ 2 2 1 , 2 4 2 $162,000 $201,402 $203,381 $240,000 $237,250
Pediatric Allergy
$140,689
****
****
****
****
Pediatric Cardiology
$185,000
****
*****
****
**** $ 1 8 1 , 2 5 0
Pediatric Endocrin ology
$137,398
****
****
**** $ 1 4 0 , 0 0 0
Pediatric Gastroenterology
$165,094
****
****
**** $ 1 6 1 , 1 7 6 $ 1 8 2 , 0 0 0
Pediatric Hematology/Oncology
$174,290
****
****
**** $ 1 7 2 , 2 8 4 $ 1 7 3 , 0 4 2
Pediatric Intensive Care
$176,678
****
****
****
**** $ 1 7 6 , 9 8 2
P e d ia t r i c N e p h r o l o g y
$176,815
****
****
****
****
Pediatric Neurology
$150,480
****
****
**** $ 1 4 6 , 9 8 6 $ 1 6 9 , 0 0 0
Pediatric Pulmonary Disease
$149,375
****
****
**** $ 1 5 1 , 5 1 4
Pediatric Surgery
$270,593
****
****
**** $ 3 6 0 , 9 9 2
Pediatrics & Adol escent
$183,00 $192,000
139,000 $144,863 $161,708 $160,658 $ 1 7 3 , 1 2 6
****
****
****
**** $ 2 3 9 , 0 0 1
****
****
****
****
****
****
****
$ 1 4 9 4 2 9 $110,000 $145,938 $151,559 $146,981 $148,275
Pediatric Infectious Disease
$147,394
****
****
**** $ 1 4 7 , 3 9 4
Perinatology
$297,274
****
****
****
Physical Medicine & Rehabilitation
$ 1 7 1 , 5 4 9 $130,000
Plastic & Reconstruction
$ 2 8 2 , 8 2 5 $200,000 $253,310 $288,427 $282,720 $304,821
Psychiatry
$ 1 5 8 , 2 7 5 $132,000 $147,081 $160,284 $163,480 $163,697
P s y c h i a t r y - Child
$172,107
Pulmonary Disease
$ 2 1 3 , 4 8 3 $ 1 4 0 , 0 0 0 $1 8 5 , 0 0 0 $ 2 1 8 , 3 5 4 $ 2 2 3 , 3 1 1 $ 2 1 1 , 0 6 2
Radiation Therapy (M.D. only)
$303,750
**** $ 2 8 8 , 7 9 1
****
**** $ 3 0 3 , 7 5 0
Reproductive Endocrinology
$221,850
****
****
****
Rheumatologic Disease
$ 1 6 7 , 0 0 7 $125,000 $157,352 $166,548 $172,529 $170,240
****
2002 Medical Group Compensation & Productivity Survey
145,894
**** $ 3 2 1 , 0 4 2
**** $ 1 6 1 , 0 4 2 $ 1 7 9 , 0 4 0 $ 1 8 2 , 7 5 0
****
****
****
**** $ 1 5 8 , 0 7 3
****
Physician Compensation – Cejka.com
Sports Medicine
$159,794
****
**** $159,794
****
Surgical Pathology (M.D. only)
$242,038
****
****
****
**** $244,750
****
Surgical Sports Medicine
$350,000
****
****
****
**** $395,000
Transplant Surgery - Cardiac
$334,250
****
****
****
****
Transplant Surgery - Kidney
$217,327
****
****
****
**** $231,237
Transplant Surgery - Liver
$325,012
****
****
****
****
****
Trauma Surgery
$320,821
****
****
****
****
****
Urgent Care
$157,402 $120,000 $144,530 $149,825 $183,351 $164,003
Urology
$276,798 $190,000 $261,000 $243,389 $291,516 $315,250
Vascular Surgery
$286,286 $191,500 $276,500 $271,731 $329,780 $303,469
****
****Data is not reported for specialties with less than 10 responses
43
Starting Salaries Compared with
3-5 Years Post Residency
• Conducted by Sullivan, Cotter and Associates,
Inc.
– A human resources consulting firm devoted to healthcare and physician compensation
– Data is from their 9th annual report from November
2001
– Survey was compiled from information obtained from
218 organizations including hospitals, group practices,
and IDSs representing 18,3000 physicians, mid-level
providers, PhDs, residents and medical group
executives
Starting Salaries Compared with 3-5 Years
Post Residency
Sullivan, Cotter and Associates, Inc.
Specialty
Starting
Salary
3-5 Years
after
residency
Percent
Change
EM
$190,400
$215,678
13.3
FP
$120,932
$144,904
19.8
DERM
$113,000
$186,380
64.9
IM
$127,500
$140,312
10
OB/GYN
$152,000
$234,768
54.4
PEDS
$101,750
$143,377
40.9
PSYCH
$97,409
$131,521
35
44
VIII. States in Malpractice Crisis
States Currently
in Malpractice Crisis
•
•
•
•
•
•
Florida
Georgia
Mississippi
Nevada
New Jersey
New York
•
•
•
•
•
•
Ohio
Pennsylvania
Oregon
Texas
Washington
West Virginia
Source: Merritt, Hawkins & Associates;
www.mhagroup.com
45
Rise in Physicians’ Malpractice
Premiums 2001 – 2002
•
Source: Hospitals
and Health
Networks
•
Note: Covers
increases by
selected insurers
for internists,
general surgeons,
and OB/ GYNs
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Highest
reported
Lowest
reported
PA WV IN MT TX
Median Annual Premiums by
Specialty, 2000
Specialty
Neurosurgery
Cardiovascular surgery
OB/GYN
General surgery
Orthopedic surgery
Otorhinolaryngology
Urology
Cardiology
Premium
$33,101
$28,328
$21,446
$19,860
$17,812
$10,793
$9,903
$8,751
46
Median Annual Premiums by
Specialty, 2000
Anesthesiology
Ophthalmology
Hematology/Oncology
Radiology
$8,004
$6,934
$6,520
$6,202
Internal Medicine
Gastroenterology
Family Practice
Pediatrics
Pathology
$6,144
$6,138
$6,125
$5,213
$3,829
Median Annual Premiums by
Specialty, 2000
Neurology
$3,525
Source: American
Hospital Association
47
IX. Review of Practice Settings
Review of Practice Settings
• Fellowship
• Solo Practice
• Single Specialty
Group Practice
• Multi-specialty Group
Practice
• HMOs
• IDS Employee
• Hospital Based
Practice
• Hospitalist
• Academic Medical
Center
• Locum Tenen
• Military
• Physician Executive
48
Characteristics of Fellowships
• Potential Positives
– Delay the transition from training to active practice
– Allow you to focus on a subspecialty area
– Receive training in procedure or technology intensive
areas
– Specialists currently in high demand
– Secure long-term marketability and higher income
earning potential
– More control over the types of patients you see and the
time you spend with them
Characteristics of Fellowships
• Potential Negatives
– Postpones increased earning potential for years
– Longer hours may limit quality of life for a
while
49
Tips for Assessing Fellowship
Programs
•
•
•
•
Talk to current and past fellows
Visit the institution
Ask your program director and colleagues
Assess the stability and viability of the program
– Are the programs slots filled consistently year after
year?
– Is there frequent turnover in directorship?
– Is the institution financially stable?
– Is it accredited by the ACGME?
Characteristics of Solo Practice
• Potential Positives
– Autonomy
– Rewarding patient interaction
– Minimal competition if in a rural area
– Can join IPAs to lighten call duty, arrange for
vacation /weekend coverage
50
Characteristics of Solo Practice
• Potential Negatives
– High start-up/overhead costs
– More vulnerable by economic/market factors
– Long work week, little time off, little to no call
coverage
– Lack of colleague interaction
– Minimal administrative or clincal staff support
– Responsible for billing, financial management, etc.
Characteristics of Single
Specialty Group Practices
• Potential Positives
–
–
–
–
–
–
–
–
–
–
Small size @ 10 or so
Focused
Compatibility with colleagues - the fit factor
Colleagues and mentors available for tough diagnoses
Lighter call
Share patient duties and physical space, administrative and
clincal support
Increased financial security
More control over lifestyle
Less volatile than solo practice
Typically earn more than in a multi-specialty group
51
Characteristics of Single
Specialty Group
• Potential Negatives
– Partnership/compensation issues
– Market vulnerability – supply and demand;
introduction of new treatments or blockbuster
drugs
Characteristics of Multispecialty
Groups
• Potential Positives
– Larger size
– Multi-disciplinary approach
– Other physicians in other specialties readily
available for consults
– Ease of in-house referrals
– Less vulnerable in the market; fewer of you in the
group who are the same specialty
– More patients, more staff, more equipment and
less overhead
52
Characteristics of Multispecialty
Groups
• Potential Negatives
– Compatibility with colleagues - the fit factor,
different personality types, etc.
– Heavier call
Characteristics of HMOs
• Staff-Model
• Group Model
• Network Model
53
Characteristics of Staff HMO
• Potential Positives
– Guaranteed income: often salaried with bonus based on
productivity and/or patient satisfaction
– Paid malpractice premiums
– Reasonable call
– Regular office hours
– Fewer administrative headaches - built in administrative
support
– Offer convenient patient care – easy access to
diagnostics and other services small practices may not
have
Characteristics of Group Model
HMOs
• Potential Positives
- Physicians are contractors not employees
- HMO contracts with group on a capitated
pmpm payment or defined fee-schedule
basis
- Can be salaried and receive productivity
bonus
- Patient flow is guaranteed by HMO
54
Characteristics of Network
Model HMO
• Potential Positives
- HMO contracts with two or more
physicians groups
- Physician groups often have patient base
separate from HMO
Characteristics of HMOs
• Potential Negatives
– Salary ceiling
– Opportunity for partnership or buy-in very
small/non-existent
– Loss of autonomy- formulary, practice
guidelines and protocols, etc.
55
Characteristics of an
IDS Employee
• Potential Positives
– Income guarantees
– Great benefits
– Management services, support staff and office
equipment provided
– Academic appointment
Characteristics of an IDS
Employee
• Potential Negatives
– Hospital policies may cause conflicts
– Track record in physician management not
proven
– Some physicians are buying their practices
back, or hospitals are selling them
56
Characteristics of Hospital-Based
Practice
• Potential Positives
-
Predictable income
Steady patient base
Built-in referral network
Enjoy atmosphere of being close to “the action”
Characteristics of Hospital-Based
Practice
• Potential Negatives
- May be expected to participate in many
committees which can limit patient hours
- Limited autonomy
- Hospital politics
- Declines in hospital’s financial condition could
affect the practice
- May experience culture clashes as hospitals
merge
57
Characteristics of working
as a Hospitalist
• Potential Positives
– Great incomes
– In-patient work only
– Team player environment
– Reasonable call
– Set schedule
Characteristics of working
as a Hospitalist
• Potential Negatives
– Great communication required
– Can sometimes be under contract with company,
not institution
– Need to be prepared for emotional load since
you are the point of contact for the patient and
their family while they are in the hospital
– Don’t usually have an established
relationship/history with the patient
58
Characteristics of Academic
Medical Centers
• Potential Positives
– Access to equipment and research
– Opportunity to practice a wide variety of
medicine; may include teaching, clinical
practice, research and publishing
– Ease of in-house referrals
Characteristics of Academic
Medical Centers
• Potential Negatives
– Income may vary, can be on the lower side at
times
59
Characteristics of working as a
Locum Tenen
• Potential Positives
– Appeals to independent- minded, entreprenurial, and
risk takers
– Flexibility in scheduling, assignments and time off
– Usually earn close to market salary once expenses that
are covered are factored in
– Travel, housing, license taken care of
– Opportunity to try out different regions of the country
and practice settings without committing to anything
long term
Characteristics of working as a
Locum Tenen
• Potential Negatives
– Lack of stability, not going to the same place every day
– Could be entering a hostile work environment to
provide relief, hospital politics
– Like any contract, there are risks, make sure details are
spelled out with regard to hours, salary, malpractice
coverage and liability, call schedule, housingetc.
– Don’t usually receive health care coverage and/or
retirement plans, so you must make arrangements for
handling personal finances and investments
60
Characteristics of Military
Settings
• Potential Positives
– Substantial funding for eduaction and training and
receive loan repayment
– Armed Forces Health Professionals Scholarship
Program (HPSP) provides up to $175,000 for four years
of medical training at an accredited medical school and
a monthly stipend of about $1100
– Commitments can range from full-time to part time
– Compensation is usually good with excellent benefits,
vacation time and freedom from practice- management
headaches
– Opportunities for fellowships, research, teaching and
public health positions
Characteristics of Military
Settings
• Potential Negatives
- Housing may be on or off base
- Assignment depends on prevailing geographic
conditions
- Assignments/deployments can be tough to
manage with spouse and family
- Hazardous duty is a possibility – could be sent to
war zone or third world country
- Obligated to fulfill service requirement
- Generally decide before residency
61
Characteristics of Physician
Executive Positions
• Potential Positives
- Option as a career is growing
- American College of Physician Executives
membership is now 14,000 compared to only 5700
in 1990
- Gives physicians a new set of challenges beyond
clinical duties
- Earning potential is high
- Allows physicians to have an impact on
improving the processes involved in the delivery
of patient care
Characteristics of Physician
Executive Positions
• Potential Negatives
- Loss of patient interaction
- Need for strategic, management and other
business skills
- May require further education: MBA, etc.
62
X. Tips for Managing Medical
School Debt
Tips for Managing Medical
School Debt
• Start with financial aid office at medical
school or inquire about seminars or services
provided at hospitals and medical centers
• Establish good relationship with lenders in
advance of repayment
• Make sure all paperwork is in order if you
have requested a grace, deferment or
forebearance option on your loans
63
Tips for Managing Medical
School Debt
• Create a master file for all your loans
• Keep copies of every loan document you
sign
• Try creating a master calendar of all
important filing dates and deadlines
• Use certified mail or some other traceable
documentation to show that forms were
received
Tips for Managing Medical
School Debt
• Open all mail from lenders as soon as it
arrives
• File all paperwork on time
• Inform the lender of any change of address
or financial status
64
Tips for Managing Medical
School Debt
• Understand the relative costs of your loans
• Most lenders offer online tracking to allow
borrowers to determine exactly where they
stand
• Allows residents to establish a priority for
repaying their loans, starting with the ones
with the worst terms
XI. Tapping into Relocation
Sources
65
Tapping into Relocation Sources
• First place to look is the employing
organization or practice
• The greater demand for physicians in the
area/specialty, the more likely you will
receive financial help with the move
• Employer may have contracts or
recommended movers that they prefer you
use
Tapping into Relocation
Resources
• Inquire if your employer provides assistance
with a spouse’s job search, a child’s
educational needs or aging parent’s care
• Relocation allowance generally depends on
supply and demand
66
Tapping into Relocation
Resources
• Check with local area chambers of
commerce – can provide info on banking,
insurance, auto repair, etc.
• Request a copy of the local phone book
several weeks before you move
• The Internet can provide home resale prices,
neighborhood safety, rankings of public and
private schools, etc.
XII. Additional Resources
67
NEJM Job-seeking Services
• Early Job Alert – receive e-mail notification of job
postings that match your preferences
• Resource Center – job-seeking tips and career
focused articles posted every 8 weeks
• http://www.nejmjobs.org/resource_center/rc_inde
x.asp
• Apply for jobs electronically and attach your CV
and cover letter
• Track your application history
• www.nejmjobs.org
Resource Center Articles
•
•
•
•
The Fellowship Track: Is it for you?
Exploring Military Careers
Where the Jobs Are
Networking Know-how Can Boost Job-search
Success
• Anatomy of an Employment Contract
• Avoiding Employment Contract Pitfalls
• Managing Medical School Debt
68
Resource Center Articles (cont.)
•
•
•
•
Differentiating Among Practice Settings
Working with In-House Recruiters
When the Search Firm Calls
Moveable Medicine (Locum Tenens)
Fellowship Resources
• Resources
• Accreditation Council for Graduate
Medical Education, Chicago, Ill.
www.acgme.org
This organization accredits fellowship
programs, and its highly informative
website includes a comprehensive listing
and description of fellowship programs.
69
Fellowship Resources (cont.)
• American Medical Association, Chicago,
Ill. www.ama-assn.org/go/FREIDA The
AMA’s Fellowship and Residency
Electronic Interactive Database (FREIDA)
enables users to obtain information on 7,800
graduate medical education (GME)
programs and 200 combined specialty
programs.
Fellowship Resources (cont.)
• Association of American Medical
Colleges, Washington, D.C.
www.aamc.org AAMC’s website contains
sections devoted to GME and a listing of
clinical research training programs.
70
Fellowship Resources (cont.)
• Council on Graduate Medical Education,
Rockville, Md. www.cogme.gov COGME
focuses on physician workforce trends and
training, as well as GME financing issues.
Fellowship Resources (cont.)
• National Consortium of Residents.
www.residents.org Developed by residents
for residents, this website serves as an
information clearinghouse on issues
affecting residents and fellows — from
work hours and public policy to young
physician leadership. It also facilitates an
online forum (www.residentweb.com) for
discussing issues and problems.
71
Fellowship Resources (cont.)
• National Library of Medicine, Bethesda,
Md. www.nlm.nih.gov This website
provides information on residency and
fellowship programs, plus a handy listing of
links to other relevant sites.
National Physician Recruiter
Associations
• Association of Staff Physician Recruiters (ASPR)
– Established in 1990
– 500+ inhouse staff recruiter members
– Search member directory by last name, state or
hospital/institution
• Contact Information
–
–
–
–
Phone: 1-800-830-ASPR (2777)
Fax: 1-651-635-0307
E-mail: oei@assocmgnt.org
Web: www.aspr.org
72
National Physician Recruiter
Associations
• National Association of Physician Recruiters
(NAPR)
– Established in 1984
– 240+ search firm members
– World Job Bank
• Contact Information
–
–
–
–
Phone: 1-800-726-6513
Fax: 1-407-774-6440
E-mail: kmg-assn@worldnet.att
Web: www.napr.org
State Physician Recruiter
Associations
• Northeast Physician Recruiter Association
(NEPRA)
– Contact: Christine Bourbeau 800-892-3846;
cbourbeau@brishosp.chime.org
– www.nepra.org
73
State Physician Recruiter
Associations
• Michigan Recruitment & Retention
Network (MRRN)
– www.mimom.org
State Physician Recruiter
Associations
• Illinois Staff Physician Recruiters (ISPR)
– Contact: http://www.isprnet.org/
74
State Physician Recruiter
Associations
• Kentucky Association Physician Recruiters
(KAPS)
– Contact: Mona Wood 279-597-9266;
monawood@mindspring.com
State Physician Recruiter
Associations
• Carolinas Association of Physician Services
(CAPS)
– Contact Celeste Bondurant-Bell 843-716-7527;
cbondura@sccoast.net
75
State Physician Recruiter
Associations
• Missouri, Iowa, Nebraska & Kansas
Physician Recruiters & Retention Network
(MINK)
– Contact Mary Ann Brennan 800-788-1787;
mabrennan@healthmidwest.org
– www.mink-midwest.org
State Physician Recruiter
Associations
• Wisconsin Office of Rural Health (WORH)
– Contact Randy Munson 800-385-0005;
rlmunson@facstaff.wisc.edu
76
State Physician Recruiter
Associations
• Oklahoma Physician Recruiters Association
(OPRA)
– Contact Rich Buchanan 888-502-5300;
rick.buchanan@duncanregional.com
XIII. Questions and Answers
77