- First Half of PGY3: determine whether or not you will pursue a fellowship
- Second Half of PGY3: start a self-reflection process for job preferences. Start networking.
- End of PGY3: Early PGY4: Begin gathering information about job postings and availabilities. Set up an online profile on the AAPM&R job board. Continue networking.
- Fall PGY4: Most academic programs use the AAPM&R Annual Assembly as the beginning of “recruitment season,” thus interviews are often scheduled during the fall/winter of 4th year
- Spring PGY4: Job offers and negotiations, signing contracts
Determining Job Preferences
A self-reflection, this is a chance to determine what is important to you in your ideal job. Create a pro/con table or make a list of your “must haves,” “want to have,” and “do not want” components. Here are some aspects you might consider:
- In what setting do you want to work?
- Academic—research requirements and/or teaching responsibilities, working with medical students/residents, patient population (often referral centers/specialty care)
- Private—group vs. individual practice, association with other departments (i.e., ortho, neuro, neurosurg, etc.)
- Government hospital setting—veteran population, access to resources not always available to civilian population
- Small vs. large practice
- Single specialty vs. multispecialty centers
- Free standing rehabilitation hospital vs. inpatient hospital vs. outpatient hospital/clinic
- What do you want to do in your clinical practice?
- Inpatient vs. outpatient
- General, MSK, Neuro, SCI, Spine (interventional?), Workers Comp, etc.
- Do you have a preference on patient population?
- Review patient demographics via Census data—consider disability status by location, HS graduates
- Underserved communities, inner city population, elderly, complex patients at referral centers, etc.
- Consider payer sources (i.e., commercial, Medicare, Medicaid)
- Is location a priority?
- Geography: Coasts, Midwest, South, etc.
- Region: Urban, suburban, rural
- Cost of living (i.e., real estate, taxes, daily living)
- Population growth trends
- Is the region PM&R-saturated?
- Additional resources:
- Do other family members’ needs impact the decision?
- Spouse employment
- Children—daycare, schooling
- When do you want to start?
- Do you need time off after graduation for personal obligations, board review, etc.?
- Is fellowship training required for a certain position?
- What are your expectations for call responsibilities?
- Full-time vs part-time?
- How does salary impact your decision?
- Salaried vs productivity-based pay (see Financial Considerations below for further description)
- Loan forgiveness offered through some institutions
- Expenses and budget based on cost of living
- Listen to several physiatrists discuss their decision making process with the AAPM&R Career Path Podcast Series
Depending on where you practice, both geographically and in clinical setting, the reimbursement structure and rates may be different.
- Reimbursement structures:
- Guaranteed Salary: a guaranteed base pay that may have a productivity bonus for what you earn above the determined salary. Academic settings are more likely to have salary-based pay.
- Productivity-based: your reimbursement is based on what you bill and earn (i.e., “you eat what you kill”). This is a common model in private practice.
- Keep in mind, some private practices will offer a 1–2 year guaranteed salary, knowing that your patient volume will be lower as you begin your practice. This “guaranteed salary” may be considered as a loan and your “debt” (what you didn’t earn to meet that salary) is tabulated during those years and then gradually forgiven over a period of time (i.e., over the subsequent 2 years, 1/24th of the debt is forgiven each month). If you leave the practice before this debt has been fully forgiven, you may be required to repay the practice.
- Reimbursement rates
- Vary considerably by region of the country
- Reimbursement rates are typically higher if you are willing to work in a more rural or underserved setting
- Private practices typically have higher reimbursement rates than academic settings
- Based on the current health care reimbursement structure, procedural practices have higher reimbursement
- Inpatient care and consult services provide higher revenue than clinic visits
- Most practices determine salaries/reimbursement rates based on fair market values
- Based on the 2012 report, full-time Physiatrist compensation ranged from $216,591–$335,154.
- Medical Group Management Association (MGMA) is a common resource that publishes a general annual report for purchase with up-to-date physician compensation data
- Additional Reimbursement Resources are also available on the Academy website.
Polishing Your CV
Creating a professional and thorough CV is of utmost importance, as this is the employer’s first look at you and your accomplishments.
- Categories include: (all entries listed in reverse chronological order):
- Educational background (medical school, graduate, undergraduate)
- Post-graduate training and fellowship appointments
- Specialty boards and certifications (licensure)
- Leadership experiences
- Committee service (include position title and role)
- Teaching experiences
- Membership in Professional Organizations
- Continuing education participation
- Sample CV:
- Links to guidelines for creating a medical CV
- CV PEARLS:
- Keep your CV up to date throughout your training; review it every few months. It can be difficult to recall all of the activities you participated in over long periods of time.
- If you are applying for an academic position, be sure to highlight educational, leadership and research experiences, i.e., adjust the order of categories on the CV
- CVs can be annotated to provide brief explanations of committee positions, awards and research
- Have several people (mentors, faculty, chiefs, and/or program director) review your CV prior to sending it out.
- The document is best saved and sent as a PDF file to avoid accidental changes when the file is opened by the recipient(s).
Writing a Cover Letter
This is used to express interest in a position. It can initially be drafted as a general letter and adjustments can be made depending on the specific institution to which it is being sent.
- A formal cover letter is a must when you are initially inquiring about a position opening.
- This can be included in the body of an email or as a separate attachment with your CV
- Length: about three short paragraphs indicating your interest in the position and a little about yourself and your practice interests (i.e., Neuro, MSK, pain, EDX, inpatient/outpatient, etc.).
- It should be clear, concise and fit on one page.
- NEJM Career Center—Cover Letters
Gathering References and Letters of Recommendation
Practices will usually request 2–3 references that they will contact to ask about you. They may or may not request formal letters of recommendation.
- One reference is typically the Residency Program Director
- Choose faculty, mentors and/or advisors with whom you have worked closely and can give an accurate and thorough description of your capabilities as a physician and colleague.
- Give your references advanced notice that they may be contacted by particular practices and the position for which you are applying
- If formal letters are requested, give the letter-writers several weeks’ notice to allow them enough time to compose a thoughtful letter.
- Provide a copy of your CV to your references and/or letter-writers
Job Search and Networking
- Begin gathering information about job availabilities near the end of PGY3 to early PGY4.
- Keep job specifics organized in a template or spreadsheet for easy comparison.
- PM&R Job resources:
- Physician Job Database Resources
- Online resources, i.e., PracticeMatch, CareerMD
- Representatives may call or page you and request information
- You can post a profile, CV and job preferences online
- Use with caution, it is not always clear to whom or where this information is disseminated
- Online Professional Networks
- i.e., LinkedIn
- Be sure to keep your information and network up-to-date
- Inquiring about a position
- This can be in response to a posting or as a “cold call” to an institution or clinic to see if they are anticipating any openings in the upcoming 6–12 months.
- Institutions/clinics may not publically advertise or recruit for a position because this also expends resources, thus it is worth contacting practices you are interested in even if no position is advertised.
- The appropriate contact person is usually an HR representative, physician recruiter, practice manager or PM&R department administrator
- You can reasonably express interest in a position about 12–14 months in advance of your estimated graduation/training completion
- Job Fairs—an opportunity to network with multiple institutions in one setting.
- The AAPM&R Annual Assembly hosts a Job Fair that includes most major academic institutions that are/will be recruiting. Also keep in mind that some institutions may be hiring but not exhibiting at the job fair.
- Act professionally at all job fairs! You will be evaluated in all settings. Wear a suit.
- Job fairs can serve as “pseudo-interviews” and are good practice for more formal interviews.
- By inquiring about a position before a job fair, a meeting at that job fair may serve as a formal interview
- State PM&R Society Meetings—another setting to meet and network with the PM&R community in your area
- Physician Recruiters—may or may not be necessary. If you take time during PGY3–4 to do your research, you can do it on your own. They often charge a fee for their services (although this may be covered by the recruiting institution) and they may not be aware of positions that are not openly advertised. They do provide a convenience factor if you prefer.
- Alumni associations—also a good resource for talking with recent grads about their job search processes.
- The alumni reception at the AAPM&R Annual Assembly is also a great networking opportunity.
- Traveling for interviews requires time and money, but some expenses may be covered by the hiring institutions/clinics and may include your spouse or significant other. Keep this in mind when scheduling rotations and budgeting finances. Strategically schedule your interviews to minimize travel and expense if possible.
- By scheduling most interviews within a two-month period in the fall/winter of PGY4, any job offers that are made will be within a few-week window, giving you the chance to compare and negotiate accordingly.
- Ideally, your goal would be to have several job offers presented within 2–4 weeks of each other.
Interview days have been described by some as "speed dating." You will likely meet with many people in the department over the course of the day, which may include the physicians in the practice, nurses, administrators, basic science researchers and others. This is the best opportunity to get a good sense of the culture and personality of the practice and the environment that you would be working in.
- What information should be presented and what questions should you ask?
- Who will I work with?
- Job specifics—Is there any flexibility to develop clinics that focus on personal interest areas? Inpatient vs. outpatient clinic, call responsibilities?
- What special expertise do individuals bring to the practice?
- Is early supervision and/or mentorship available?
- Are there any unique or special services/resources available to patients through the institution? (i.e., telehealth services, support groups, interdisciplinary “one-stop-shop” clinics)
- Are affiliated therapy services housed in the same clinic or at a nearby center/hospital?
- How many physicians have left the practice in the past 3 years?
- What information is available about the community/living area?
- Note: Face-to-face interviews are probably not the time to bring up specifics about compensation/benefits, etc. unless the interviewers address it first.
- Review MGMA data in advance to determine an approximate salary range for a physician with your skill set
- Interviewing tips
- After the interview
- Take time to write down your thoughts, experiences, emotions, reactions and content of the day. It is much easier to refer back to your notes than to recall the experience later on.
- Explore the city for a day or two following the interview. The practice may connect you with a local realtor.
- Send thank you notes promptly to important people from the interview day.
This can be an intimidating process, but very important for achieving what you feel is fair compensation and satisfaction with your position. Remember, at this point in the process, the employer wants you so the ball is in your court to make your requests known.
Note: Consider attending resident-directed lectures about contract negotiation and related topics at the AAPM&R Annual Assembly.
- When offered a contract, carefully review the employment agreement:
- Detailed job description
- Salary (guaranteed or productivity-based)
- How long a salary is guaranteed and how does it change after that time period
- Length of contract agreement
- How the contract is renewed
- Notification time if your contract is to be terminated
- Medical/dental insurance
- Disability insurance
- Life insurance
- Malpractice coverage—does it include tail coverage (see more info under “common pitfalls”)
- Moving expenses
- Vacation time
- CME time and funds
- Funding for licensure, academic fees, membership dues
- Retirement plans
- How to become a partner in the practice
- How long does it take?
- Is everyone offered the opportunity?
- What is the buy-in structure?
- What is the annual compensation for a partner?
- Restrictive covenant
- This is a non-compete clause that typically includes a time period and geographic radius (i.e., 2 years, 20 miles). If you leave the practice to work elsewhere, you are required to work outside of that radius until the time period lapses. These are very common.
- Make a list of priorities
- What you need
- What you want
- What you are comfortable compromising
- Components that may be negotiable
- Base Salary (to an extent)
- Signing bonus
- Resident stipends
- Loan forgiveness
- Moving expenses
- CME funds
- Start date
- Work Schedule (i.e. 4 day work week as full time)
- Hiring a lawyer
- It is fairly standard these days to hire a lawyer to review a contract. They can help translate legalese and identify pitfalls.
- A qualified lawyer should be familiar with contract law and/or health law
- Approximate fee range between $250–$600 per contract
- Keep in mind, your contract should be written properly because you are about to live with it. This is not the time to penny-pinch.
- Lawyers may offer reduced fee rates for residents
- Lawyers can do the negotiating with the employer directly, although this may take longer and cost more
- Common Pitfalls
- Not getting a tail policy: Tail policies refer to additional malpractice coverage for litigations that may come up beyond one’s termination date.
- Know who pays for this—is it you, the current employer, or a future employer?
- Not thinking through an exit strategy: Sure, everything looks great now, but we cannot predict the future. Be prepared if things don’t work out. Review the restrictive covenants/non-compete clauses to make sure they are reasonable and precisely defined.
- Not getting it in writing: You may discuss details of your work hours, call frequency, etc. in your verbal negotiations, but it is not official until it is on paper. Recap conversations at least in email to keep an adequate paper trail.
- Not understanding the compensation formula and method: Ask for a sample calculation of compensation. Is it worded the same way in your contract? Is your compensation salaried or productivity-based?
- It’s a good idea to establish a base salary for the first few years while you establish your practice and may not survive on wRVUs alone.
- Find out the average wRVUs for physicians in the practice
- Determine the payment formula, payer pool, collection rate, etc.
- How likely will you reach your expected RVUs compared to other physicians practicing for 3–5 years?
- Not discussing dispute resolution and how it works
- Expiration vs. termination vs. leave without cause
- Waiving your right to appeal should you have termination of medical staff privileges
- NEGOTIATION PEARLS
- It is expected that there will be some negotiation of the contract
- Make sure you understand all terms and conditions of the contract before beginning negotiations
- Negotiations can be done by email, phone or in-person
- It may be helpful to create a script for yourself for verbal negotiations
- Don’t be afraid to ask—knowing that some items may be non-negotiable
- Be confident without being arrogant
- Be respectful and realistic with your requests
- You can’t get everything you want, so be willing to compromise
- Be timely in your communication
- BARE BONES ESSENTIALS
- Always read your employment agreements.
- Never sign something you do not understand or are not prepared to live with.
- Have an exit strategy.
- Always ask questions—the worst they can say is "no."
- Get everything in writing.
Once you’re satisfied with the conditions, sign your contract! Congrats, you’ve got a job! Do send thank you notes to important people involved in your journey.
We hope this resource provides sufficient tools for you to feel more confident when navigating the job search process. Best of luck and happy hunting!
Erin Grimsby, MD, PGY4—Medical College of Wisconsin
and the 2013 Resident Physician Council Board