Job market/considerations for non new grads

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pf12

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I haven't seen many posts on this issue, and was curious about the job market, process, and folks' experiences with changing jobs after being in practice for a while. I have some general topic areas and was was hoping folks would be able to speak to one or more of these areas in their replies based on their experiences and observations (either as the applicant or the employer):

*Getting the job - networking (potentially from afar if switching geographies), confidential inquiries, timeframe (how long ideally vs needing to look quickly due to a family move). Not letting your current employer know, getting references (especially if there has been conflict in the job you're leaving)
*Switching PP to academia or vice versa
*Timing in a career to do this (optimal # of years out)
*Switching to nonclinical and back or not
*The reality vs expectation: reasons for making the switch (did it get "better" in your new spot or are there just different challenges? Are you happy?)
*Differences in job availability or appeal as a non new grad (esp for those who have been on the hiring end)
*Folks switching in a local market and addressing noncompete issues - any tips
*Leveraging old mentors/contacts - residency contacts still useful in helping land a job?
*Things you learned in your first job and you now knew to look for in a new job?

And any other perspectives appreciated. Thanks!

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I haven't seen many posts on this issue, and was curious about the job market, process, and folks' experiences with changing jobs after being in practice for a while. I have some general topic areas and was was hoping folks would be able to speak to one or more of these areas in their replies based on their experiences and observations (either as the applicant or the employer):

*Getting the job - networking (potentially from afar if switching geographies), confidential inquiries, timeframe (how long ideally vs needing to look quickly due to a family move). Not letting your current employer know, getting references (especially if there has been conflict in the job you're leaving)
*Switching PP to academia or vice versa
*Timing in a career to do this (optimal # of years out)
*Switching to nonclinical and back or not
*The reality vs expectation: reasons for making the switch (did it get "better" in your new spot or are there just different challenges? Are you happy?)
*Differences in job availability or appeal as a non new grad (esp for those who have been on the hiring end)
*Folks switching in a local market and addressing noncompete issues - any tips
*Leveraging old mentors/contacts - residency contacts still useful in helping land a job?
*Things you learned in your first job and you now knew to look for in a new job?

And any other perspectives appreciated. Thanks!
I moved from academics to pp about 8 years ago.
The lateral job market is so horrible right now in most major metros that I am not sure anyones past experience has much relevance.
 
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What do you think about the switch? Glad you did it?
Thats a complex question. I left because my salary was very low, well below the 25% (in desirable metro), and felt somewhat underappreciated as I had highest RVUs in department. I do really miss the institution, its technical resources, and day to day interaction with high quality colleagues both within and outside of the department. There were certainly more politics within the department that are not really an issue in a smaller community hospital, but that carries its own set of frustrations. In academics, so much is dependent on the department chair and the support/furthering career of junior faculty. Would I go back if I had the opportunity? A: Sure, when kids leave college and income is not as important.
 
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Thats a complex question. I left because my salary was very low, well below the 25% (in desirable metro), and felt somewhat underappreciated as I had highest RVUs in department. I do really miss the institution, its technical resources, and day to day interaction with high quality colleagues both within and outside of the department. There were certainly more politics within the department that are not really an issue in a smaller community hospital, but that carries its own set of frustrations. In academics, so much is dependent on the department chair and the support/furthering career of junior faculty. Would I go back if I had the opportunity? A: Sure, when kids leave college and income is not as important.

How long were you in the academic practice. Also where do you find the number for what the 25% percentile or was that gestalt?
 
How long were you in the academic practice. Also where do you find the number for what the 25% percentile or was that gestalt?
I was in academics for 5 years, 25% based on presentation at resident seminar on ASTRO. Today's job market would make me much more cautious about leaving a stable job.
 
I was in academics for 5 years, 25% based on presentation at resident seminar on ASTRO. Today's job market would make me much more cautious about leaving a stable job.

Do we have access to that presentation or those numbers? Good advice regarding staying put in stable job
 
There are some benefits to being out in practice already. You are already boarded, and you can fill a spot in December (vs every resident finishing in July). It's a lot easier to go from academics to PP of course, but more academic centers are opening satellites and looking for skilled private practice docs. The benefits of that relationship is stability, infrastructure, education at the expense of reimbursement.
 
Stability of a university satellite RadOnc job is not guaranteed. Usually, there are no contracts, just kind of perpetual year-to-year employment. Once in a while, the Dean or RadOnc Department Chair resigns and a new maniac comes onboard with guns blazing.

There are some benefits to being out in practice already. You are already boarded, and you can fill a spot in December (vs every resident finishing in July). It's a lot easier to go from academics to PP of course, but more academic centers are opening satellites and looking for skilled private practice docs. The benefits of that relationship is stability, infrastructure, education at the expense of reimbursement.
 
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Stability of a university satellite RadOnc job is not guaranteed. Usually, there are no contracts, just kind of perpetual year-to-year employment. Once in a while, the Dean or RadOnc Department Chair resigns and a new maniac comes onboard with guns blazing.
very true.
 
Stability of a university satellite RadOnc job is not guaranteed. Usually, there are no contracts, just kind of perpetual year-to-year employment. Once in a while, the Dean or RadOnc Department Chair resigns and a new maniac comes onboard with guns blazing.

Stable as compared to a private practice. I've had several friends in PP that come to the staff meeting to meet, for the first time, their new boss because the senior staff sold the practice from underneath them. A couple friends lost their practice to Urorads and had to leave the city and house they loved. I think that kind of turbulence is less. Most places don't have long contracts....or I haven't seen a 10 year contract for anyone. If that's a thing in PP it's news to me....until you're a "partner" it's moment to moment is my impression.
 
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Stable as compared to a private practice. I've had several friends in PP that come to the staff meeting to meet, for the first time, their new boss because the senior staff sold the practice from underneath them. A couple friends lost their practice to Urorads and had to leave the city and house they loved. I think that kind of turbulence is less. Most places don't have long contracts....or I haven't seen a 10 year contract for anyone. If that's a thing in PP it's news to me....until you're a "partner" it's moment to moment is my impression.
Just like hospitals, there are still good private practices out there. Large private practices like the one I'm in have a fixed "time to partner" schedule and a fixed buy-in and deal for each and every one of our physicians.
 
Just like hospitals, there are still good private practices out there. Large private practices like the one I'm in have a fixed "time to partner" schedule and a fixed buy-in and deal for each and every one of our physicians.

Based on the job market article I think good private practice jobs are the hardest to find at this point in time. I was really surprised that the market is now roughly the same between "academics" and PP. If you are in a good one that's fair I think you're pretty fortunate. :)
 
The "stability" of academics seems relative to me. I've certainly seen my share of academic rad oncs who were fired or so miserable that they did anything (even go home with no job!) rather than keep their academic position.

Non-competes are also a major problem. Having to "leave the city and house they loved" is a common scenario in academics which enforces huge non-competes anywhere I've looked. The contracts are written in such a way that they can put you in an awful situation, and then your only possible response is to uproot your family. With the bad job market, what choice or bargaining power do you have other than to sign on and take your chances?
 
The "stability" of academics seems relative to me. I've certainly seen my share of academic rad oncs who were fired or so miserable that they did anything (even go home with no job!) rather than keep their academic position.

Non-competes are also a major problem. Having to "leave the city and house they loved" is a common scenario in academics which enforces huge non-competes anywhere I've looked. The contracts are written in such a way that they can put you in an awful situation, and then your only possible response is to uproot your family. With the bad job market, what choice or bargaining power do you have other than to sign on and take your chances?

Does anybody know the answer to this question: does the same non-compete radius apply to the satellite centers as to the main campus?

I am aware of situations where the main academic center has a con-compete that is sufficient to cover most of the large city but then if they aquaire or strategically build additional sites with the same non-compete radius can they just box in an entire metro area with 1-2 additional little satellite centers?

How about those academic centers with satellites several hours or even states away? Doesn’t the Mayo Clinic literally have satellites or affiliates or whatever scattered throughout the country? It seems impossible but if you leave Minnesota your non-compete screws you out of applying for jobs in the same city in Florida or Arizona as their satellite?
 
Does anybody know the answer to this question: does the same non-compete radius apply to the satellite centers as to the main campus?

In my experience they do for systems in one state (n=3). That is, either the non-compete radius includes distances from every satellite in the health system OR they include things like every county and every neighboring county to one of their satellites in the state. You can imagine that this typically becomes a very large area.

For multi-state systems I don't know.
 
Contracts I've seen define non-compete radius as one around the LINAC where the physician does "majority" of his/her coverage.

Does anybody know the answer to this question: does the same non-compete radius apply to the satellite centers as to the main campus?

I am aware of situations where the main academic center has a con-compete that is sufficient to cover most of the large city but then if they aquaire or strategically build additional sites with the same non-compete radius can they just box in an entire metro area with 1-2 additional little satellite centers?

How about those academic centers with satellites several hours or even states away? Doesn’t the Mayo Clinic literally have satellites or affiliates or whatever scattered throughout the country? It seems impossible but if you leave Minnesota your non-compete screws you out of applying for jobs in the same city in Florida or Arizona as their satellite?
 
Contracts I've seen define non-compete radius as one around the LINAC where the physician does "majority" of his/her coverage.

That seems much more reasonable but it seems like there isn’t a standard. Hopefully there is room for negotiation and I know the market isn’t what it used to be but I find it hard to believe that the non compete would be deal breaker for the employer.

Since it’s actually related to the original theme of the post does anybody actually know what happens if you violate the non-compete? I’ve never heard of a set fine but I’ve honestly never heard of a former employer actually “going after” somebody for breach of contract. Anybody know if it’s enough to just take another job within the pre-determined radius or do you actually have to prove a loss of something (money, referrals, intellectual property, etc) because the employee left and what’s the threshold for the burden of proof? Is it even worth the effort and lawyers? Anybody ever actually heard of it going to litigation?
 
It's state-dependent is my understanding: Certain states are "right to work" states where a non-compete contract can be broken, but it takes a court case to do so. A general surgeon in town recently won one against her former partners, so she is now allowed to work in the same city as her prior practice.
 
It's state-dependent is my understanding: Certain states are "right to work" states where a non-compete contract can be broken, but it takes a court case to do so. A general surgeon in town recently won one against her former partners, so she is now allowed to work in the same city as her prior practice.
Do other specialties that are highly dependent on the hospital system/network for referrals still have noncompetes in big academic/locoregional hospital systems i.e radiology, path, anesthesia? Surely, no one could make a good argument that a pathologist/anesthesiologst could take patients from one university to the next.
 
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In California, restrictive covenant is deemed legally unenforceable. However, some people still put it on contracts because they know it will still cost money to legally extricate oneself. I know of local situation a few years ago where an MD joined a larger group and later left to join another group in the same area.

Cost to extract from non compete was in the $50-70k range. Always better to go to mediation if possible otherwise only the attorneys win.


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In California, restrictive covenant is deemed legally unenforceable. However, some people still put it on contracts because they know it will still cost money to legally extricate oneself. I know of local situation a few years ago where an MD joined a larger group and later left to join another group in the same area.

Cost to extract from non compete was in the $50-70k range. Always better to go to mediation if possible otherwise only the attorneys win.


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Interesting. What do you exactly mean by it cost $50-$75k to extract from non-compete? He paid the old practice that much (or the legal process cost that much and lawyers won?). If the former what if he said “not gonna pay I dare you to sue me!”

I just can’t imagine that it’s actually worth it for the old employer to do so but I honestly don’t know.

What about the new employer? Can they get in any trouble?
 
Yes, supposedly non-compete is ultimately not enforceable. I'd search hospital news / call people to see how recent cases turned out in your part of the state.
 
Yes, supposedly non-compete is ultimately not enforceable. I'd search hospital news / call people to see how recent cases turned out in your part of the state.
State by state level issue, like most things legal. They are most definitely enforceable in FL.

Interesting. What do you exactly mean by it cost $50-$75k to extract from non-compete? He paid the old practice that much (or the legal process cost that much and lawyers won?). If the former what if he said “not gonna pay I dare you to sue me!”

I just can’t imagine that it’s actually worth it for the old employer to do so but I honestly don’t know.

If you don't enforce it for one departing associate, you might as well take it out of the contract since you likely won't enforce it again. It basically is to bring home the point that the group means business. In many areas, the non compete is what allows a private practice to protect itself from neighboring hospital systems from "picking off" physicians with an established practice from the group.
 
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Interesting. What do you exactly mean by it cost $50-$75k to extract from non-compete? He paid the old practice that much (or the legal process cost that much and lawyers won?). If the former what if he said “not gonna pay I dare you to sue me!”

I just can’t imagine that it’s actually worth it for the old employer to do so but I honestly don’t know.

What about the new employer? Can they get in any trouble?

As I understood this situation as an outside observer, the old practice sued the partner for violating the non-compete. This had no legal basis but as you know, you can basically sue anyone for anything. It cost the physician $50-70k in legal fees (to his own attorneys) to gather evidence, perform depositions, etc. The new practice did not pay. Generally it is more advantageous to go after the offending physician rather than the new practice. The reason for this (as medgator wrote) is to provide a legal "penalty" to prevent people from leaving the practice and joining a competitive one.
 
I have seen non competes (at large hospitals) effectively used to lower salaries. If you cant leave the area, and they decide to cut your salary... not much recourse
 
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Since we are talking legal jargon... what about in regards to leaving prior to your committed term?
 
Since we are talking legal jargon... what about in regards to leaving prior to your committed term?

It depends completely on the state in which you are practicing. In California, we cannot lock people in to long-term, multi-year contracts. All contracts are renewable on an annual basis - this is mean for protection of the employee.

In regards to terminating the contract early we have a clause for 90 day without cause - meaning that either party can terminate for any reason with 90 day notice. Again, in California, this disproportionately protects the employee. If you are terminating someone, you really have to have pristine/impeccable documentation and even then if they are a member of a protected class the attorneys can get rich off of you.
 
Very interesting. I'll leave the field and medicine all together before I leave my current job but this is very interesting and useful for both those thinking of switching jobs like the OP and new graduates, and it obviously isn't something you learn in residency (but will become increasingly important for the foreseeable future as the job market "tightens" at best).

Does that guy who was or still is a lawyer still come to ARRO meeting at ASTRO to touch upon these issues? If not (no idea if he is still practicing or around since that was 15 years ago for me but I'm sure the older posters know who I'm talking about). It would probably be very helpful if ARRO asked him to give a podcast or lecture.
 
I have seen non competes (at large hospitals) effectively used to lower salaries. If you cant effectively leave the area, and they decide to cut your salary... not much recourse

You can end up with a completely different job than the one you signed up for and saddled with a non-compete. It's a common situation. With the super tight job market good luck finding something else.

The contracts are written vaguely with plenty of out clauses for the employer (i.e. we can do whatever want to you and the non-compete is still enforceable). When I was out of residency looking for my job, the two offers I got after a national search were all with no startup package and NON-NEGOTIABLE. I even tried to negotiate a bit (not even anything major) and was simply told "good luck elsewhere." I was just happy that I wasn't doing a clinical fellowship, because this was mostly what I was offered by my home program and some others.

Since it’s actually related to the original theme of the post does anybody actually know what happens if you violate the non-compete? I’ve never heard of a set fine but I’ve honestly never heard of a former employer actually “going after” somebody for breach of contract. Anybody know if it’s enough to just take another job within the pre-determined radius or do you actually have to prove a loss of something (money, referrals, intellectual property, etc) because the employee left and what’s the threshold for the burden of proof? Is it even worth the effort and lawyers? Anybody ever actually heard of it going to litigation?

The threat is typically enough. People don't want to hire you if they know you're under a non-compete because they're afraid it might stick, you might miss out on work defending yourself, or you might end up dragging them into it somehow. Also, they can cost a lot of money to defend, so most people don't want to take the risk.

Whether it actually is enforceable is state dependent. My state is one of the most enforceable and word is that they have been enforced on docs in other specialties.
 
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People don't want to hire you if they know you're under a non-compete because they're afraid it might stick
That's the real "teeth" of a non-compete nowadays. They are able to be broken but expensive to do so. If you try to fight it, the non-compete basically gives you a form of professional B.O.
 
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Do other specialties that are highly dependent on the hospital system/network for referrals still have noncompetes in big academic/locoregional hospital systems i.e radiology, path, anesthesia? Surely, no one could make a good argument that a pathologist/anesthesiologst could take patients from one university to the next.

Employers put restrictive covenants in all sorts of employee contracts, professional and otherwise.

Heard about it in therapists, physicists and dosimetrists contracts before.

Housekeepers: With unemployment low, some businesses try to bind employees with noncompete clauses :: WRAL.com

Noncompete clauses: They're not just for executives anymore
 
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