What shapes your search?

Just like there’s no one way to interview, there’s also no one timeline that fits every physician’s job search. The search for a neurosurgeon physician couple looking nationally is completely different than that of a single family medicine resident wanting to stay in the community where she’s training. So let’s take a look at a few factors that can help you understand your own job-search timeline.

Know that different markets and specialties have different recruitment cycles

Finding a job depends on finding an employer who is looking for someone with your credentials to start at a time that meets your timeframe. Physician recruiters have both planned recruitment cycles - new positions posted due to the addition of a new site, growth at a current practice or backfilling a retiring physician - and unplanned to fill an immediate need from a physician leaving either voluntarily or otherwise.

Although the biggest interview visit surge for planned recruitment initiatives is in the winter to meet late summer/early fall start dates, know that subspecialists tend to start interviewing as much as 18 to 24 months before desired start date. The most desirable candidates are signing contracts a full year before their intended start date.

Get your CV ready

At least a year before you complete training, have your CV updated, critiqued and proofread by faculty and resources. Sara Lehman is the GME liaison for HCA Healthcare in West Florida. She is the career resource for more than 600 residents in nine programs and helps them with every phase of the job search.

She advises her residents to have their CVs done 12 to 14 months before they complete training, and to build in time for inevitable rotational struggles when there will be zero time to work on your job search.

Contact prospective employers early

Many times, residents delay their job search because they know physicians who didn’t start looking until spring and had no problem starting work a couple of months later.

"Residents who delay often do so because they don’t know there are logistical differences between their friend’s local hospitalist job and an outpatient job in another state," Lehman says. "Licensure lead time, hospital credentialing and payer enrollment take several months, so the employer for that perfectly amazing job in Idaho started interviewing candidates in late fall and made an offer in January."

The resident who waits until spring to start searching for a job misses that train entirely. "He or she is in my office, panicking because advertised jobs are moving forward with others who already interviewed," she says. "Undoubtedly, there are more doors open to residents who start the job search early."

At least a year before you complete training, contact the physician recruiters listed on some jobs that interest you. Ask them when you should start applying in that market, and for any tips to help you navigate that employer or region.

For example, recruiters in Denver and other in-demand cities like Austin, San Diego and Seattle advise candidates in highly competitive specialties not to wait for an interview invitation if they are 100 percent committed to the location.

They might suggest planning a trip at your own expense, and let practices know three to four weeks in advance that you will be in town. Usually, you will get at least a meeting, which may turn into a full-blown interview. Every year, we see candidates who present well in person "jump the line" and end up with job offers while a chief resident from a bigger-name program is still waiting for somebody to offer to pay for travel.

Beating the "why doesn’t she have a job yet?" perception

Employers suspect a resident or fellow is still on the job market in the spring because they are not receiving or closing job offers. Perhaps references are lukewarm or would-be employers backed away.

When you approach an employer in mid-spring, answer their unasked question in your cover letter or initial interview call.

If you were waiting to see where your significant other matched in fellowship, tell us. If every free weekend you traveled to the bedside of a terminally ill parent, tell us. If you just broke off an engagement and are now free to look in your dream location, explain that. Those are all reasonable explanations for being late. Some faculty advise withholding personal information on the basis that employers are only entitled to know that you are now available. That is true…but none of the possible explanations going through the employers’ minds are flattering to you. Transparency on your part can motivate a recruiter to advocate for you. Put a recruiter’s concerns to rest so they can make sure you are not overlooked.

Remember, some searches march to their own beat

Some large groups have very defined recruitment cycles designed to synch with their next year’s staffing projections, budgets and practice nuances.

One year I was helping a huge anesthesia group staff for the opening of a new hospital. We needed 13 hires to be ready to staff ORs and OB deck. Interviews started in September and ran through November. All of the other major groups in the market were on the same cycle, so it was no surprise to anesthesia residents and fellows to hear that regardless of interview date, offers would go out in December, once the partners had met all of the candidates. Offerees would have a two-week deadline to sign the letter of intent.

I remember the disbelief in the voice of a chief resident from a top-tier program who called me in February after his first-choice contract negotiations fell through. "I’m sorry," I told him. "We have offers out for all of the positions and unless we have a turndown, the committee is electing not to conduct further interviews." Was it shortsighted to not look at an exceptional candidate off-cycle? Maybe, but their process worked. It was not going to change unless they could no longer fill open spots with quality physicians.

The J-1 visa waiver cycle drives the recruitment timeline for Wesley Neurology Associates in Wichita, Kansas. Mohammed Hussain, M.D., a vascular and interventional neurologist, explains why his group starts interviewing neurohospitalist candidates 18 months before their anticipated start date.

"The state gives out J-1 visa waivers on a rolling basis starting the day the window opens on September 1," he says. "In order to make sure that we get a J-1 waiver, our immigration attorney asks that her firm receive CVs and PDFs of the signed contracts by August so that she has time to prepare the waiver applications for submission the first week the window opens."

Every year, the hospital has declined some highly qualified applicants because it is simply too late in the J-1 cycle to interview, offer and execute a contract in time to be sure of receiving the waiver.

Everything takes longer than you think

I see wide-eyed concern and occasionally deer-in-the-headlights panic when I tell a room full of last-year-of-training residents that they should have their first round of interviews by November.

Why so early? Every step prior to seeing your first patient in the new job takes longer than candidates expect. It can take days - even weeks - to get through initial email and telephone or Skype screening steps. Physicians, practice managers and administrators all have to agree that you are a likely fit with the position and the timing is right to bring you in for a visit.

Once we get to "yes" for the site visit, we have to find a date that works for everyone. Based on my Outlook e-chains, it can take anywhere from four to 32 emails to lock in a date for candidates to interview. Be patient and responsive.

To help move along site visit planning, check your schedule and have two or three possible dates in mind for a site visit. Think twice before you request a weekend or date adjacent to a holiday. And don’t offer a date you haven’t checked. Scheduling gaffes do tarnish your halo.

Before you take just one more interview…

Even the best-laid plans to be done with interviews by Christmas and under contract by St. Patrick’s Day can be derailed when Mother Nature shuts down airports with Snowmageddon. The one delay under your control is decision paralysis.

Once you have looked at several good job options and have a fair offer in a location where you and your family can thrive, resist the temptation to keep accepting interviews "just in case" the perfect job is out there. Too often, perfectionism backfires. A great offer might get rescinded because you can’t commit.

Contracting concerns

The first bumps and bruises in any new employer/employee relationship often happen after you have agreed on the major terms and before you execute the contract. You’ve agreed on salary, sign-on bonus and RVU rate…so what could go wrong?

If the practice hasn’t recruited in a few years, they may be waiting on their attorney to produce their draft. A hospital system may still need to obtain approvals if the position was not budgeted. A change in salary, an increased sign-on bonus, more PTO or CME or a new start date all have significant impact on the financial picture and must go through another round of approvals.

On your side of the table, your attorney could derail the ideal timeline. Line up your attorney in advance, and give them an estimated timeline for your contract review. Do your own research to know what your peers are seeing for RVU, PTO, CME. Read the contract thoroughly, and give your attorney a list of your questions and your thoughts. If you received instructions from your employer about negotiability, be sure to relay instructions to your attorney. Many corporate physician contracts are locked-down corporate templates, and nothing except what was filled in the blanks will change.

Once you and an employer agree to move forward to contract, a complex process kicks into gear. By the time you are ready to sign, there may have been as many as 20 professionals from recruitment, legal, operations, contract administration and finance certifying that there are no improper elements in the contract being offered to you. Anytime you have that many people involved in a process, there can be delays.

Licensing and credentialing

Obtaining a medical license takes on average three months, though it can take just six weeks for a graduating resident in many states. It can take up to seven months for physicians with practice histories or any hiccup in their records. Your licensure may be tabled with requests for more information if:

  • Your residency or fellowship was not accredited during part of your training
  • Your medical school was not accredited for any portion of your four years
  • Your residency training was outside the U.S.
  • Your residency or fellowship had any periods of probation or remedial repeat of rotations

The credentialing team can prepare for their 90 to 100-day sprint while your licensure is pending, but nothing can officially move forward until you have your state licensure. Similarly, payers will not move on the process of adding you as a provider for their health plan members until you are licensed.

Physician couples need to start earlier

As a rule, a physician couple should be at least a couple of months ahead of their classmates on the job search. This is especially true if one of you is either super-subspecialized, or in a highly competitive or highly saturated specialty for the cities in which you want to live.

Hal Anderson, M.D., contacted me about 18 months before he was scheduled to complete emergency medicine residency. His wife would be ready to start practicing family medicine the same month.

Anderson explained that his wife’s family medicine job search may look "easier" on the surface because of the number of options, but the couple will have to balance their commute times and make sure they could move to family neighborhoods in great school districts without career disruption.

"Bottom line," he says, "we have to start early because we have to talk to more potential employers to find the two very best jobs that are geographically compatible, where we can grow professionally and start paying down our education debt."

Physician specialists need the most time to carve out a two-physician relocation. Christina Wright, M.D., and James Wright, M.D., contacted practices a full two and half years before they will complete neurosurgery residency at Case Western Reserve and fellowships in complex spine surgery at the Cleveland Clinic.

"We know that few hospitals recruit two physicians in the same specialty, let alone the same subspecialty, in the same recruitment cycle - so we started early," explains Christina Wright.

"Reaching out early allowed us to identify programs that might be interested," says James Wright. "We were particularly looking for hospitals or systems with multi-year strategic plans for development in our specialty. Those facilities were very happy to talk to us this far in advance. …Several practices expressed that it might be possible to make adjustments in future hiring plans to accommodate us both."

Don’t be late to the table

If you start late, hospitals and groups will flag your file for urgent or expedited handling, pay extra fees and generally move heaven and earth to get a good physician into a great job. The back flips stop, though, when it comes to negotiating for extras and flexibility that might have been on the table six months earlier.

"I had one candidate who kept asking for the stipend we offer to candidates who sign early in fellowship," says one Florida physician recruiter. The surgeon was negotiating his contract when he had two days left in his fellowship. "It’s not happening" she told him. "That is something on the table for candidates who are willing to commit to us early and who allow us plenty of time."

At the end of this process, you will have a good job! If you start early to allow for delays and setbacks, you will enjoy the process a lot more and show up relaxed and excited for that magical first day of your new job.

Therese Karsten is the division director for physician recruitment for the Continental Division of HCA Healthcare.

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