on getting a job in radiology: a primer for residents …...more than going in and reading films,...

Copyright © 2004 AuntMinnie.com

On getting a job in radiology: a primer for residents and fellows

Dr. Stephen Humes

http://www.auntminnie.com


Introduction “It’s time to get a job.” That’s what my wife kept telling me, and she was right. After years of undergraduate and medical school training, a year of internship, four more years in residency, and an additional fellowship year, this was the end of the training and the start of a professional career -- the proverbial carrot that’s been dangled before all of us all these years. There are countless books on the shelves on how to get a job, how to write a résumé, and how to interview. But there’s not much said about particular jobs, especially in radiology. This guide is the result of my efforts after I finally ended my training in radiology and started working as a staff physician. Topics are arranged in the order you follow as you pursue a job. The guide starts with some basic resources you should become familiar with to help you see what jobs are out there. It then goes through the process of getting a résumé and cover letter together, the interview process, how to evaluate a practice, and contract negotiations. The goal is to help people look for a position that fits their needs and expectations, because in the end, the “fit” of the job is all that matters. Radiology is without doubt one of the best careers a person can pursue -- in any field, not just medicine. My hopes are to set you on the path to finding yours.



Get philosophical first Before you start out, it ’s important to reflect on what you want in a job. It’s important to think about your needs throughout the search process, both at the outset and during the interviews. For some people the answers may be fairly straightforward: the job may have to be in a certain geographic location, or it may have to offer certain benefits. Whatever criteria you use, consider some of the following issues at the outset. It may save you time in the long run. The triad: location/compensation/vacation Job seekers have found three important factors to consider in terms of a job: location, compensation, and vacation. And here’s the rub: you will only get two of the three with each offer. The first major choice you will have to make concerns location. Up to 40% of physicians leave a practice because either the physician or the spouse does not like the location, not because of the practice itself. So it’s an important factor in your job search. For some people, this is a given. Family or other factors will align you with a certain geographic locale. That makes your search easier, in a sense, because you can focus on that one area. If you don’t have any particular ties to a place, that opens up the whole U.S. to you, which can be a good thing (many options) and a bad thing (too many options). My wife and I started with a simple exercise. We copied a map of the U.S., then colored in the states. Green meant absolutely an option. Yellow coded for a state that we would consider, but had no strong feelings for or against. Red meant no way. It was a start, and the document was subsequently lost under a pile of paper. It resurfaced after we had already signed a contract, and it proved to be right on in terms of where we looked and liked. You should try to identify the quality of life you are looking for in terms of access to recreation, cultural events, school systems, or climate. You should also look at a community in terms of its economic stability (for example, it should not depend on any single industry, health maintenance organization (HMO), or Medicare. If you go for the more desirable areas, you will take a hit in terms of pay and benefits, and pay more to be there, with the most popular states being California, Florida, North Carolina, Georgia, and New York. But as it is in real estate, so it goes with a job: location, location, location.



Once you’re on the road in terms of location, you’ll need to consider what kind of practice you want, whether it be in academics, private practice (including group size), or hospital-based. If you did a fellowship and want to focus on that area, you will have to go for a larger group (50+ members). How important is teaching to you? Are you willing to take on administrative responsibilities? What is the advancement opportunity you have in a particular practice? Is a mentor available for you? How many hours a week do you want to work, and how much call are you willing to take? Do you want to be an employee or a partner? This brings me to a fourth pillar of the job search: vocation. Don’t focus exclusively on the location/compensation/vacation equation at the expense of seeing the intangible aspects of the job, such as the satisfaction and challenges it will provide, as well as the opportunities for you to contribute and make the practice better. Being a partner is much more than going in and reading films, then going home. Partners help build a practice, and that’s one of the things you should be looking for in a job. The blinding effect of money Radiologists are by nature analytical. And in few places does this bent come out more than when it comes to money. A word of caution: I once listened to a fellow resident calling practices to discuss job options. After a brief introduction, he would ask, “And what are you paying?” It was a misdirected question, especially at the outset. People in business will tell you, “Whoever mentions money first, loses.” Not only that, it sends a bad message (money is what you’re after -- not a career). He eventually went on and took the job with the highest bidder -- and subsequently quit within a year of starting. There’s more to a satisfying career than money. Sure money is important, but most will tell you that it should not be number one on the list. Don’t let it blind you to a good opportunity that will give you much more than a big paycheck. It doesn’t matter how much you’re making if you’re miserable, if you’re working in an unfair practice situation, if you lose your marriage and children, and so on. Getting to a place that “fits”-- a spreadsheet doesn’t always work Many people told me how they looked for a job and after the interview they would take all the information gleaned from the practice and enter it into a spreadsheet. There was a column for salary, one for call and vacation, one for benefits, and so on. Again, it feeds into our analytical nature, but all agreed that in the end, it didn’t work. It all comes down to a gut feeling about working with a group.



In the end, your job should be fun. Your antennae should be forward as you walk into work in the morning. You should enjoy your interaction with your partners, both at work and outside of work. You should not mind giving up time outside of regular work hours to help build and benefit the practice. Finally, realize that the first job you get sets the tone of your career. If at the outset you are offered a position to work at a high-profile place (such as the Mayo Clinic, Cleveland Clinic, MD Anderson, or many others) and you have no other extenuating circumstances, go for it. It will only open doors for you in the future.



Getting started Most residents and fellows in radiology begin looking for a job during their last year of training. The season for hiring has roughly two peaks, one in the fall and one in the spring. Keep this latter one in mind, as it may help you keep cool if you don’t find the right job in the fall. Roughly, most radiology residents and fe llows start sending out their résumés in September, with plans to interview in October, November, and December, then do contract negotiations thereafter. Traditional starting points Your first place to start looking is with the people you already know: program directors and other physicians around you. Your colleagues often have inside information about practice opportunities in the area. Tell the people you respect and trust about specifically what type of practice you are looking for, and in turn they will explore their network for any opportunities that may be available. Don’t limit your networking to physicians only. Realize that there are many points of contact, including local sales representatives (who travel widely and interact closely with many of the practices they service), technologists, and nurses. You can also turn to your local radiology societies (city and state) to see if they have job placement services. You can also find job listings in most of the radiology journals, including Radiology and the American Journal of Roentgenology. The classified ads list positions available by state. The journals also separate jobs in terms of academics versus private practice. Realize that these listings are all available on the journals’ Web sites as well. Online resources I cannot imagine what it was like getting a job before the days of the Internet. It offers so many resources with such ease that the job search is greatly simplified. To take some stress out of the process, I would designate a time and place to do online job searches, and limit that time accordingly. A nice glass of wine at your side also helps. I recommend that everybody start with the American College of Radiology (ACR) Web site. Not only does the ACR pull you through the oral boards with their teaching files, they also set you on the track to finding the right job. You should register with the ACR Professional Bureau Job Services by posting your résumé as a job seeker. To do so, go to the Web site and click on “Jobs Postings” under the Residents tab. Follow the job links to the Professional Bureau Job Services section.

http://www.acr.org



Then follow the instructions to Post My Resume, which will place a copy of your résumé online for employers to review. A quick note about posting your résumé online: don’t include items such as medical license numbers, DEA numbers, or Medicare provider numbers. All this information is subject to identity theft, and none of this information is required at the outset. Once you’re registered with the ACR Professional Bureau, you can then search their listings using a number of different parameters, including location by state, field of radiology (diagnostic versus interventional versus nuclear medicine), and type of practice. If you plan to attend the RSNA meeting, the ACR goes a step further in helping you with the job search: the On-Site Interview Service. This service is located in Chicago’s McCormick Place (the location of the RSNA meeting), where radiologists from around the U.S. and around the world congregate for the week following the U.S. Thanksgiving holiday. It’s your opportunity to meet with potential employers and discuss the opportunities they have to offer. You can meet with anywhere from five to 15 hiring practices all in the course of a week -- something even the most ardent traveler would find taxing. And you might be taken out to dinner, which is a good thing in Chicago. If you decide to pursue this, plan ahead and register early. Other online resources include AuntMinnie.com and RSNA.org. They have similar search features and options for posting your résumé. If you’ve done a fellowship, your particular specialty’s society may also have job listings on its Web site. Handy tools It’s helpful to have a couple of things at your side during the job search. Start by getting a good atlas of the U.S. It helps in several ways. Sometimes you haven’t heard of the place and just need to know where it is. An atlas also gives you an idea of the surrounding geography, points of interest, etc. The atlas was out on my table nearly every night. Mapquest.com will offer the same services. It’s also good to have some basic office supplies. Large envelopes for sending out résumés (unfolded!) and copies of certificates are good to have around, as well as the appropriate postage. Make copies of all the documents you will need to send with your résumé (medical school diploma, certificate of internship and residency, ABR certificate, fellowship certificate, and so on). It’s also good to get some thank-you notes and have them available.


http://www.rsna.org

http://www.mapquest.com



A word about recruiters Your e-mail inbox will be inundated. The phone will start ringing. You’ll even start getting pages to strange 800 numbers. Don’t ask me how they get all this information. But there’s a reason for all this. Recruiters are highly motivated people, and given that they can receive anywhere from $10,000 to $30,000 per placement, it becomes obvious why they go to such lengths. Most people will tell you not to use a recruiter. But if you get with a reputable search firm that specializes in radiology, it can be an asset. You just have to be careful, and there’s a reason why. First, you need to realize that there are two types of recruiters: contingency and retainer. If a recruiter is paid on a contingency basis, the recruiter is paid only after a position has been filled. In a retainer arrangement, recruiters provide more service to the employer. For example, they will perform a need analysis, and advise the employer regarding an appropriate compensation package. They get paid regardless of whether or not they find a radiologist. Because recruiters provide this level of service to the employer, they should be able to provide you with a detailed description of the job, including the responsibilities, how the job stands in comparison to others in the area, an employment contract, and other details about the practice. Good recruiters should have all the financial information readily available, including starting salary, benefits, buy- in information, and restrictive covenants. Be wary if recruiters can’t answer specific questions, or if they keep saying, “I’ll find out for you.” Realize, though, that if you send them your résumé, it may put you at a disadvantage: if two résumés are on the table and yours has an additional price tag from the recruiter attached, the employer may go with the “cheaper” résumé. If you decide to use a recruiter, find out how long the firm has been in business, if it guarantees confidentiality, and if the recruiter has visited the practice. Make sure the recruiter works only in radiology. Find out how many people have been placed over the past year, and ask for the names and contact information for several of the people who were placed. A good recruiter can work in a role similar to that of a real estate agent: he or she can guide you, and help you get a better deal than you might find on your own.



Résumés and cover letters It would be beyond the scope of this paper to cover all aspects of preparing and writing your curriculum vitae (CV). Go into any bookstore and flip through the books to find one that fits your style. Instead, I would like to focus on some basic aspects of getting your résumé ready to send. The most important thing to consider in preparing a résumé is realizing that it serves as the first impression you will send. Its form will tell a prospective employer as much about you as its content. An organized and easy-to-read résumé says a great deal about you; conversely, errors in the document or disorganization will say the same. A comprehensive CV will include the following information:

• Your name with degree (M.D. or D.O.) • Address • Telephone (with area code) • E-mail address • States where you are currently licensed (Do not include license number.) • National board exams with dates passed • Education with institution, degree earned, and dates of attendance, including

undergraduate, graduate, medical, internship, residency, and fellowship • Military service, including title, branch served, discharge rank, and status • Professional experience, listed in reverse chronological order, including job title,

city and state of employer, and dates of employment (month and year) • Teaching appointments • Professional society memberships • Honors and awards • Research, including papers and presentations

On the flip side, a well-prepared résumé will NOT include the following:

• Race • Religion • Expected salary • Examination scores (let it go …) • License and DEA numbers (subject to identity theft) • Personal health problems or disabilities



In addition to the above, it’s a good idea to make copies of all your diplomas and certificates, and have them ready to send should they be requested. Professional credentials are one of the basic concerns of most medical employers when conducting a search for a new employee. The following are some general guidelines to keep in mind when sending out your résumé:

• The purpose of a résumé is not to get you a job. Its purpose is to get you an interview. It is the interview that generates a job offer.

• Do not falsify information in your résumé to make it more appealing. It is a

cardinal rule that any misrepresentation will come to the surface, such as when you get your credentialing. And when it does, it will cost you the job.

• Proofread your résumé carefully, and have others read it for you as well. It’s hard

to see your own typographical errors.

• Don’t use many different or fancy typefaces. Keep it clean and neat. Use bold or capital letters to identify subheadings.

• If you have the time to tailor your résumé to a specific job offer, do so. For

example, if you are interested in an academic position, focus on your research interests and accomplishments, rather than on your outside work experience.

• A cover letter must always be included. In it, you should make a personal

statement directed toward the practice you are sending your résumé to (no form letters). You want to include how you heard about the opportunity (“as described on the ACR Professional Bureau Web site”), your professional goals, and a request for more information about the practice at the end. It is also important to include in your letter the best time or way to contact you (“I may be most easily contacted at my home phone number after 7:00 p.m. CST,” or “My e-mail address is ____.”). Sign your name on the letter.

• Concerning references, you should have several people in line before you start

sending out your résumé. Make sure you know them well and that they know you well. I made a list of references, including name, title, and contact information that could easily be sent via e-mail or in a follow-up letter. You should feel free to ask your references what they would say on your behalf. It also helps to give them a copy of your résumé and a summary of your job objectives so they can reference certain items in their telephone conversations.



Such are the basics of getting your résumé together. Build on the one you already have and make it better. And try to keep it up to date to the best of your ability. It’s always good to list a recent accomplishment on a résumé.



Interviewing and evaluating a practice General guidelines Once your résumé goes out, calls will start coming in. Before you start the interview process, try to define your goals by writing a list of criteria you seek in terms of location and the practice. Involve your spouse or partner; he or she can play an important role in the process. You also need to shift your attitude in this interview when compared with interviews for a residency or fellowship. Rather than looking at this meeting as an interview, experts recommend that you view it as a negotiation. An interview implies that you are meeting with someone to hopefully share in their work; it implies the control is with the interviewer. If you view the situation as a negotiation, you seek to bring your skills and talent into alignment with the group for the mutual benefit of both parties. This attitude is shared by Kelly Foster with the ACR, who wrote, “I’ve seen several situations where people just going into practice did not interview the potential practice as much as the practice interviewed them. No good! Make sure you ask enough questions to know what you’re getting into.” Your first opportunity to learn more about a practice usually comes in the form of a telephone call. Your questions should be directed at learning about the nature of the practice, who the partners are, and the location of the practice. If you are the one initiating the call, it’s polite to ask, “Is this a good time to talk?” They are busy too. If the practice sounds interesting, find out how they conduct the interview. Some practices have you come alone at first, and if the interest is still mutual, a second visit with the spouse is arranged. You will then need to schedule time for the interview. Try to have several dates in mind before you call, and allow two days for the interview if possible. That gives you time to visit with the physicians, tour the hospital, explore the community, and check into real estate. You can expect to spend time at the office(s) and meet most of the staff, including the partners. You can also expect to spend an evening with the partners and their spouses; yours will be expected to attend. Most practices cover the expenses of the interview. Keep all receipts in a single envelope, and return them to the business office after completing the interview.



A few rules of etiquette Although these are all things we have heard since kindergarten, the “rules” continue to be violated by some. Just some tips:

• Dress appropriately, but comfortably. Remember, the interview is an all-day and even an on- into-the-evening event.

• Be polite to all, including the office staff.

• Delay any discussions of money. Get to know people first, and reach a certain

level of comfort before broaching the topic. It’s important, but it can wait.

• Be yourself. It’s the best policy.

• Be positive. Show enthusiasm for the work and the practice. It will only work in your favor.

• Answer questions in full sentences. It helps the interviewer get to know you

better. The role of the spouse The group will be evaluating both of you, since both will reflect the practice in the community. Your spouse also will gather tremendous amounts of information, and can help take some pressure off of you during the social parts of the interview. Also, you should realize that your spouse’s happiness in the community will be important to your own long-term happiness. Enough said. Key questions you should ask On how the group functions

• How many radiologists are currently practicing with the group? Are any of them part-time? Are any retirements expected in the near future?

• How many of the partners are fellowship-trained? If you have done a fellowship, what percent of your time will be spent reading studies in that area?

• How many cases does each radiologist read per year? • What is the volume of MR studies? CT studies? • How many locations does the group cover? • Does the group have any outpatient imaging centers, and if so, who owns the

facility?



• Have any of the partners left in the past three years? You should get their contact information, and call them to find out why they left.

• What is the call schedule? You should get a copy. • Does the group use teleradiology to cover call? Is there a night hawk service? • Do new members of the group take more call, or is it equal? • Do the interventionalists take a separate call, or do they participate in a general

call pool? • Is PACS in place? If not, are there plans for implementing PACS? • What are the long-term goals of the group? Are there plans to expand services?

Are any mergers with other groups planned? • Does the group maintain a Web site for patient and physician information? • Is there an official practice manager? Evaluate the sophistication of the

management. Make sure you meet with the business manager. Become familiar with the Radiology Business Managers Association (RBMA) and the American Healthcare Radiology Administrators (AHRA). Learn about the marketing department. Ask who does their billing.

• Are there clinical/nurse specialists? Physician assistants? • Are there diverse sources of income? For example, does the group provide

teleradiology services or provide call coverage? Do they perform overreads? • Is there a single practice site or multiple sites? Will you be compensated for travel

expenses if the distance is beyond a certain mileage? On the group’s relationship with the hospital

• How long ago was the group formed? Have there been any mergers? • Does the group have an exclusive contract with the hospital? How long? • Is the hospital part of a larger hospital system? • If you are going into academics, are there start-up funds for research/projects? • How many specialists are there within the hospital? If you trained in

neuroradiology, for example, you should know how many neurosurgeons and neurologists there are.

• Who reads the nuclear cardiac studies? The ob/gyn ultrasound? The answers to these questions give you an idea of how turf has been handled in the past.

• Are there any turf issues between interventional radiology and cardiology? Vascular surgery?

• Does the hospital have a rule about how close you must live to the hospital? • What is the size of the hospital and the number of referring physicians?

http://www.rbma.org

http://www.ahraonline.org



On your relationship with the group

• How many years to partnership? What does partnership look like in terms of your ability to effect change? For example, does partnership mean an equal vote in the decision-making process, or just in division of dollars?

• How is the buy- in structured? Is it amortized over time? If you leave, do you get it back? What are you buying with the buy- in? What are the hard assets?

• What is the salary for the first year? Second year? • What is the vacation policy? Does it change when you become a partner? • What is the CME policy in terms of reimbursement and allowances? • Is there a 401(k) or profit sharing? When do you qualify to participate? • Does the group provide disability and life insurance? Dental insurance? Is health

insurance provided for the entire family or just you? • How much malpractice insurance is provided? Know the type and the amount of

the policy. Who bears the responsibility of the tail coverage? • Is moonlighting allowed? Can vacation time be used to moonlight within the

group? • Are there any other benefits such as car allowance, licensure, home computer,

membership dues, or books? • Is there a relocation allowance? Student loan reimbursement program? • Are you allowed to make purchases through the group in terms of pretax versus

post-tax dollars? • Is there someone there you think could provide mentorship for career

advancement? In summary After the interview is over, let the emotions cool. There’s always a rush of excitement as you envision yourself living and working somewhere new. Try to make notes to yourself about the interview immediately following the meeting. But then take a break and pull back for a day or two, and think about the offer objectively. Don’t take the first offer you get. You can keep it on hold for a limited time period, and do try to get around to see other practices so you have points of reference for comparison. If you decide to go with another offer, it’s good to inform the group that’s waiting on your response of your decision to go elsewhere.



Contracts Michael Raskin with the ACR once gave the following advice in a conference: “When negotiating your radiology contract, ask for the sun and accept the moon.” This statement aptly summarizes the whole concept of contract negotiation: you will have to select what you will give and take. Realize that when you first receive a copy of the employment contract, it is written with the group’s best interest in mind. Your goal for negotiation is to bring it more toward the center for mutual benefit. Another key term associated with signing contracts is due diligence. This basically means that you investigate the contract thoroughly to make an intelligent decision. Realize that now, when you have the contract in hand, is the best opportunity you will have to get information concerning the group. You need to consider a few key issues at this point in the process:

• How stable is the organization? • Review the financial statements for the past three to five years, with an eye

toward profitability and excess liabilities. • Interview current and past employees or partners.

Realize that failure to conduct due diligence means you’ll probably be moving. Overview The following are some of the major elements you should look for in a radiology contract. For more detailed explanations, please refer to the recent comprehensive articles by Lawrence Muroff in the Journal of the American College of Radiology (JACR) as they provide much more depth in terms of legal issues. Start by realizing there are different types of contracts. If you are going toward private practice, there are contracts with individual physicians or a group. Contracts are also written with hospitals, imaging centers, and HMOs. If you have a contract with a group, before you sign you should know something about the contract the group has with the hospital. If you have a contract with a hospital or an academic institution, there is generally little negotiating room.

http://www.jacr.org



These are the major components of most radiology contracts: Terms of contract Terms of contract are generally written for one year, with a provision that allows either you or the group to terminate. It usually contains an automatic renewal and renegotiation for salary increase. You should also look for information pertaining to ownership (i.e., partnership or shareholder status). This will include the number of years to partnership, terms of the buy- in, and what it means to be a partner with equity in the practice. Compensation The employment agreement will include your base compensation, which should be a specific amount and include the basis of payment (including incentive compensation or bonuses). Call and hours of employment should be specified. There should also be provisions for automatic increases and such things as relocation expenses. Responsibilities This section is pretty straightforward. It usually contains statements that indicate you will maintain your professional licensure, you will be available for call and coverage of rotations, that you may serve on hospital committees, that you will comply with hospital policies, get your CME, and so on. Benefits These include things such as vacation time (don’t push for it), medical and life insurance, retirement and deferred compensation plans, and dues for medical societies, as well as membership in professional organizations (such as RSNA and ACR). Car allowance and professional development is also covered here (seminars, fellowships). Restrictive covenants or noncompete clauses This is probably one of the most contentious aspects of the contract. The restrictive covenant is written to prohibit an employee from providing services to competing entities in the immediate area of the group. Restrictive covenants usually include a geographic area (typically 3-5 miles) and a time frame (three to five years). The covenant must specify which geographic area, and it must be reasonable. Much of the debate around this issue is that they are not valid in all states. And they are not a required component of a contract. But realize that if your contract contains a restrictive covenant, these covenants can be enforced. And if you leave the group, it usually means you will be moving. But you should be aware of another side to the restrictive covenant. The referral pattern is what the group wants to protect. And this is a vested interest that should be protected. It will only serve to benefit you when you’re a partner.



Termination provision All contracts include an exit strategy. Termination is usually for “just cause,” which should be specified. Just cause can include loss of medical license or privileges, or committing a felony. Other provisions include loss of a hospital contract, board certification, or even a changing business environment. This portion of the contract should also include specifics on your payment upon termination of employment, as well as tail coverage or death benefits. And make sure you get a lawyer to review your contract. Spending $500 at this point could save you thousands (and thousands) of dollars down the road. Contact the ACR to find a lawyer in your area who is familiar with radiology contracts. You will never know what you’re getting into until you’re there. Due diligence is the buzzword used, but the reality is that you will start working in a new environment where your perceptions of the practice will change as you spend more time there. It will change at one month, and at one year.



Get to work Getting a job is a job, and you should view it as such. It will take a great deal of time and energy on your part to get the job that’s right for you. It won’t just fall into place. Get organized, and get going with the process. First figure out the job you want, then do what you need to obtain it. Happy hunting, and good luck to you.


on getting a job in radiology: a primer for residents …...more than going in and reading films,...

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