What you REALLY Need to Know Before You Get a (Real)

Job

April 20th, 2005

Michigan Chapter-ACCThe Michigan Cardiology Fellows Society

Michigan Cardiology Fellows Society

• Founded in 1990 by Betram Pitt, MD and Scott McCallister, MD

• Represents cardiology fellowship programs throughout the state of Michigan

• Mission– Expand medical knowledge– Broaden professional and personal ties within

the medical community

Previous Symposiums

• Starting Your Medical Career: Practice Choices, Tom Haselschwerdt MBA, 12/94

• Cardiac Pacing 1995, Stuart Winston, 12/95• Advances in the Management of Pulmonary

Hypertension, Stuart Rich, MD 5/97• Debate:  Primary Angioplasty is Superior to

Thrombolysis for the Management of AMIWilliam O'Neill, MD vs Eric Bates, MD, 5/00

Michigan Cardiology Fellows Council 2005

• Brett Eliuk, DO, Garden City Hospital• Bischan Hassunizadeh, MD, Providence Hospital• David Kenigsberg, MD, Henry Ford Hospital• Christopher Mackey, DO, Botsford General Hospital• Laxmi Mehta, MD, William Beaumont Hospital• Sanjeev Sanjeev, MD, Children's Hospital of Michigan• Hamid Sattar, MD, Wayne State University• Andrew Teklinski, MD, St. John Hospital• Thomas Tsai, MD, University of Michigan

Supply and Demand

• Quotes from the popular press:– Journal of the American College of Cardiology in 2000 estimated that this

cardiology shortage would become widespread during the 2010s and 2020s as heart disease strikes the aging baby boom generation at the same time baby boomer cardiologists are retiring.

– 2002 ACC Survey:

• 97% of recruiters say it's "very difficult" or "somewhat difficult" to fill cardiology positions.

• 83% of resident program directors believe that job opportunities for their senior cardiology fellows are excellent.

• 77% of program directors would expand their first-year slots by an average of 1.8 positions if funds were available.

I Want You!

Deciphering the Ads

• Cardiology Opportunity in Tennessee!!– Need: Interventional Cardiologist

Excellent Community - Voted one of the Nations Best275K First Year with only2 Years to PartnerProduction Incentive Plus Bonus!!1:7 Call - you have the following day offThe Group Owns their own Sleep Center as well as their own Ancillary CenterEach Cardiologist Received a Large BONUS last year5 weeks Vacation First Year, 8 weeks Vacation ThereafterPay is based on a Productivity Model30% of the income is split evenly and the other 70% is paid out based on production1:7 Call with the next day offUniversity Town, Resort Community

We need data…..

• Survey– Graduates from 10 cardiology training

programs in the state of Michigan from 2000-2004

– 130 legitimate e-mail addresses– 30 responses (23%)

Web-based Survey

Results

• What is your current job setting?– Academic 36.7%– Private 63.3%

Results

• What is your subspecialty?– General 4/29 (14%)– Interventional 14/29 (48%)– Pediatrics 5/29 (17%)– Echo 5/29 (17%)– EP 3/29 (10%)– Non-invasive 6/29 (21%)

Results

• My fellowship prepared me adequately for my job search?– Strongly Disagree 20.7%– Disagree 27.6%– Neutral 27.6%– Agree 24.1%– Strongly Agree 0%

• Average 2.55

Results

• I had a fellowship mentor who helped me with my job search– Strongly Disagree 24.1%– Disagree 41.4%– Neutral 6.9%– Agree 6.9%– Strongly Agree 20.7

• Average 2.59

Results

• I am happy with my current job– Strongly Disagree 3.5%– Disagree 3.5%– Neutral 13.8%– Agree 41.4%– Strongly Agree 37.9%

• Average 4.07

Results

• My job meets my expectations– Strongly Disagree 3.6%– Disagree 7.1%– Neutral 14.3%– Agree 35.7%– Strongly Agree 39.3%

• Average 4.0

Results

• I was comfortable with the contract– Strongly Disagree 3.5%– Disagree 6.9%– Neutral 24.1%– Agree 37.9%– Strongly Agree 27.6%

• Average 3.79

Results

• I felt well prepared for my interviews– Strongly Disagree 6.9%– Disagree 10.3%– Neutral 27.6%– Agree 48.3%– Strongly Agree 6.9%

• Average 3.38

Results

• What played the biggest role in your decision to join a group– Location 43.3%– Salary 0%– Vacation/Call Schedule 6.7%– Other/Specify 33.3%

• Others-Academic opportunities; partnership; part-time work; member philosophy, supportive partners, advanced interventional training

Results

• I hired a lawyer to review the contract– No 69.0%– Yes 31.0%

Results

• I negotiated the terms of my contract?– No 44.8%– Yes 55.2%

Results

• How many practices did you interview with?– 1-3 55.2%– 4-5 24.1%– 6-7 13.8%– 8-9 3.5%– >10 3.5%

Take Home Points

• >70% of graduating cardiology fellows do not feel well prepared for their job search.

• >75% of graduating cardiology fellows are happy with their current jobs

• Location and “camaraderie” play the biggest role in the decision to join a group.

Results

• What questions did you forget to ask that you now wish you did?– Protected time?? What happens if I don’t get a grant?– Financial aspects of the practice, ins/outs of partnership,

how insurance contracts were bargained– Is call schedule, vacation, and new patients divided

equally? Do I get an equal voice?– Buy in to practice or building, contract termination

provisions– What is biggest problem facing the group right now?– A more specific breakdown of day to day responsibilities– Bonus compensation formulas

Results

• What intangibles did you neglect to think about during the interview?– General office expenses, computer

– Bonus pay before partnership

– Dynamics of the personalities of the group

– Non-partnership track

– Commute times

Results

• What is your biggest complaint of your current job choice?– A lot of driving– Salary, vacation, staying behind to take call for senior faculty during

meetings– Poor electronic records, poor office management– Reimbursement less than 50% in this region– Have to practice medicine that is not evidence based, too much

driving, being junior partner means always having to defer to the wisdom, judgment and business savvy of the senior partners. Having to put up with PCP’s who are practicing medicine from the 70’s.

– Protected time for research is not really protected. Clinical responsibilities use up research time too often.

– We are growing really fast and it has caused some stress…we’ve outgrown our own management/decision-making infrastructure

Results

• What is your biggest compliment of your current job choice– Variety of care, CCU, Cath, Clinic, etc

– The ability to be involved in the direction of the practice.

– Fixed hours

– Flexibility

– Great partners, great partners, great partners.

Results

• What critical questions should be asked before accepting a new job?– Expectations of the group in terms of work schedule (call, CME

time), vacation, salary (bonus), retirement plan, and partnership track.

– Don’t be bashful about asking specifics regarding long term salary structure

– Do I want to be a highly paid fellow or do I want autonomy?

– Are all partners treated equally?. Partnership after the stated period of partnership.

– Power structure

– Ask the question: Daily schedule/call/travel/incentives/independence in patient management/expectations from the group

Results

• What would you have done differently if you had it to do all over again?– Negotiate, negotiate, negotiate– I would have tried to talk to some of the staff at the hospital to find out what the

group was really like to work with. This is really hard to find out in an interview, but any remotely negative vibe needs to be taken seriously.

– Interviewed more– Ask for clear bonus formula, and to calculate the bonus and incentives– Had a grant in hand before applying– Ask other groups in the community about the group I am interviewing with. The

character, personality and integrity of the individuals in the group and whether they are “team players” and “easy going”

– Not to involve my trainers in obtaining their questions, seek unbiased physicians.– Not to seriously interview with two competing practices in the same town. Too

complicated. – Would have hired a lawyer.– Interview in a greater geographical range, spent more time in fellowship getting

the COCATs requirements.

Results

• Additional Advice– Ask lots of questions, nothing is off limits.– Don’t “settle” for a job out of fellowship. If it doesn’t feel right, it

won’t be.– Don’t always look for the big dollars initially. Look for future and

security of the position you are taking. You and your family matter most.

– Everything you want in the contract needs to be WRITTEN in the contract.

– Especially for women, figure out what your needs are first. Remember kids are only little once, work will always be out there. Be willing to compromise but don't short change yourself. You can always negotiate yourself OUT of a contract. Make sure your commitment is only for a year so if you're not happy, you have a way out. Salary is not always the most important factor. You also want to work with good people who practice good medicine. Good luck!

Results

• Additional Advice– Discuss job details, salary, calls, vacation and practice

patterns with other interviewing colleagues at your institute and at different meetings. This is where you learn the most and even with limited interview experience you will learn to bargain more as you will know about a lot of different practice patterns and offers out there.

– Choose a group whose philosophy of patient care and "doctor care" (i.e., what makes them tick) matches yours. When I had my first dinner/interview the casual conversation that went on all around me was about family, community, and personal passions, not who had the newest Mercedes or Lexus.