Job Search

[chicagosurgres]

Does anyone have any good suggestions about how to begin the search for a job as the hell known as residency draws closer to being done? I have a few tentative offers, but they all came about by word of mouth and I feel like I may be missing out on a better opportunity. Thanks for any input.

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[ArrogantSurgeon]

Originally posted by chicagosurgres
Does anyone have any good suggestions about how to begin the search for a job as the hell known as residency draws closer to being done? I have a few tentative offers, but they all came about by word of mouth and I feel like I may be missing out on a better opportunity. Thanks for any input.

Most general surgery journals advertise job opportunities at the back...both for academic and private positions. I'm sure the specialty surgical journals also advertise for jobs in the particular specialty that the journal is geared towards.

 

[pjr]

You will probably find, if my experience holds true for others, that you will get a lot of recruiting email, phone calls, etc. from various agencies that act as intermediaries for hiring in various regions of the country. My wife is actually starting to get pissed at how often I get called at home at night for things like this, and I probably get 5 emails a day about the same thing. This will start at the end of your fourth year of residency (where I am now). One group that has been helpful to me is called PracticeMatch -- I don't know the website link, but you can probably find them by looking them up on Google or some other search engine. They have positions for private practice, surgical specialties and academic positions all over the country. I haven't set up any interviews through them, since I am now diverting for a couple of years through a fellowship, so I can't vouch for the quality of the jobs they are trying to find people for, but it's a place to start.

good luck

 

[chicagosurgres]

PJR:
Thanks for the input. I will check out practicematch. I know what you mean about the recruiter calls. They are non-stop over the last few months, and they always start calling around 8pm when on the one night I get to have dinner with my wife. I was mainly wondering if anyone has used a reputable headhunter in the Chicago area. I might just do a fellowship to delay having to find a real job for awhile. Thanks again.

 

[chicagosurgres]

Skylizard:
Thanks for stating the obvious...because I was not going to expend the time and energy to respond to his ridiculous reply. I think someone has a little too much free time on their hands based on those multiple postings. Thanks for the advice.

 

[womansurg]

I found my job when my group advertised in Archives of Surgery. I sent the admininstrator my CV by email, then had several email and phone conversations with the surgeons. Then flew out, met the gang, and the rest is history.

My job is a dream job - for me. Other people have different ideas about what they are after. It's pretty variable and individual. For instance, many people want to live in an urban area and practice out of a big medical mecca. Not at all to my tastes. I love being 'the town doc'; I love the diversity of a well supported regional rural referral center: chest, vascular, trauma, endocrine, general...without the pain of rural solo practice: every night or other night call, having to do OB/gyn, endoscopy, or *shudder* butt flaps . Some people really want to work with residents on a regular basis. Some want a bread and butter practice with lots of outpatient cases and peaceful nights spent in their own bed.

There's no prototype of THE great surgery position. It depends on what you're looking for .

 

[surg]

As I continue to get harried by these head hunters (just how do they get my name?!), any tips on how to sort out the good ones from the bad ones. So far I've been lucky in that since I am delaying looking for a job (ahh.. the wonders of lab work), I haven't had to deal with them except to say, "Not looking yet, thanks!" but eventually I have to come up with a battle plan.

 

[womansurg]

A good headhunter is any one which happens to be holding the position that you want, pretty much.

Really it all comes down to you. You have to decide a whole bunch of stuff up front: what part of the country, what scope of practice (do you want to do vascular, trauma), academic vs private, how large of a population do you want to serve...

It's hard at first to know what exactly you do want - all we really know is the way surgery is done under the umbrella of our training program, usually. Think about those things, talk to docs in different types of practices. When you have a formed idea of what it is you're looking for, then disseminate that info to every headhunting agency and to all of the surgical community in the area you're interested in. Then the offers start to come in a more focused fashion: only western US positions, only practices with 1:3 or fewer call, only gen surg with no chest or vascular, only those with no trauma....whatever it is that you have specified.

 

[obgynthoughts]

Two good sources for info on job search:
1. A great book, for $22 at Amazon, "The Ultimate Guide to Finding the Right Job After Residency", By Dr. K Shaw. Excellent, easy and fast to read, covers all areas, including how to choose recruiters
2. A Blog called "A Physician on Job Search", which goes into the detail of how to find the right job, consists of about 10 blog posts including a list of good links. Written by your Truly.
3. Look at what recruiters have to offer, but don't let them distract you from what you want.

 

[Winged Scapula]

Two good sources for info on job search:
1. A great book, for $22 at Amazon, "The Ultimate Guide to Finding the Right Job After Residency", By Dr. K Shaw. Excellent, easy and fast to read, covers all areas, including how to choose recruiters
2. A Blog called "A Physician on Job Search", which goes into the detail of how to find the right job, consists of about 10 blog posts including a list of good links. Written by your Truly.
3. Look at what recruiters have to offer, but don't let them distract you from what you want.

First...whoa...maybe a new record, pulling up a 4+ year old thread!

Secondly, I wholeheartedly agree with the suggestion about the book by Dr. Shaw. I purchased it and have been very happy with it. It echoes everything I was taught in a couple of seminars during fellowship about contract negotiations, etc. and is right on the money with other advice.

Recruiters are a painful reality...they are not working for you, but sometimes they do have access to positions which you may not otherwise hear about. Be circumspect if they seem to be promising things which the job can't seem to deliver or are extraordinary in your field.

 

[MossPoh]

Hopefully they found a job by this point.

 

[NDESTRUKT]

Is it tough to get a job if say you're from a lesser known program? Let's say one goes to a decent community program in the East and wants to work in LA.

Hard to do?

 

[Winged Scapula]

Is it tough to get a job if say you're from a lesser known program? Let's say one goes to a decent community program in the East and wants to work in LA.

Hard to do?

Not necessarily although if you plan on working at a big name academic place, it helps to have trained at such a place.

I found something interesting about California if that is your goal location. My PDs got no letters looking for surgeons (either during residency or fellowship), none of the major specialty websites listed jobs for surgeons in California and I could only find a couple on any of the Job Search sites. However, in speaking to my colleagues in California I found that many of them knew about and had interviewed at, hospitals in the area which they had heard about by word of mouth. So not a lot of cross-country recruiting but more local.

In addition, the jobs which I did see in California, like a lot of other medical jobs in popular places, were offering MUCH less than I could make elsewhere. A few thousand here or there is fine, but when we're talking about $50-$100K/year less, that's a problem (especially give the cost of housing). I don't need to be THAT close to my family.

So, to answer your question, if you have trained at a smaller program out east and are looking for the same out west, it generally isn't a problem outside of the possiblity that you may not hear about the jobs. To do so, its just a matter of doing some cold-calling or further footwork on your own.

 

[Castro Viejo]

In addition, the jobs which I did see in California, like a lot of other medical jobs in popular places, were offering MUCH less than I could make elsewhere. A few thousand here or there is fine, but when we're talking about $50-$100K/year less, that's a problem (especially give the cost of housing). I don't need to be THAT close to my family.

In talking to recruiters recently Los Angeles-Long Beach-Santa Ana and the Bay Area are pretty impenetrable, as is the New York Metropolitan Area unless you're willing to settle for low pay, high competition, and basically being a slave for the rest of your life.

There's much more money outside of these two geographic areas.

Hopefully I'll soon be able to engineer my Anesthesia-robot, sell it to some infomercial company, make my millions and settle in sunny Southern California for the rest of my life.

Interestingly, I did get a mailing about some General Surgery group in San Jose looking for someone to do bread-and-butter stuff, take 1:5 call (includes bariatrics, no trauma), and a first-year guarantee of $250,000 with incentives and stuff. I didn't think this was too bad for the Bay Area. I also came across one in Sacramento for just under $400,000 for 1:3 call doing bread-and-butter stuff, no bari, no trauma, no vascular. Not bad too.

 

[Winged Scapula]

In talking to recruiters recently Los Angeles-Long Beach-Santa Ana and the Bay Area are pretty impenetrable, as is the New York Metropolitan Area unless you're willing to settle for low pay, high competition, and basically being a slave for the rest of your life.

There's much more money outside of these two geographic areas.

Hopefully I'll soon be able to engineer my Anesthesia-robot, sell it to some infomercial company, make my millions and settle in sunny Southern California for the rest of my life.

Interestingly, I did get a mailing about some General Surgery group in San Jose looking for someone to do bread-and-butter stuff, take 1:5 call (includes bariatrics, no trauma), and a first-year guarantee of $250,000 with incentives and stuff. I didn't think this was too bad for the Bay Area. I also came across one in Sacramento for just under $400,000 for 1:3 call doing bread-and-butter stuff, no bari, no trauma, no vascular. Not bad too.

Money's not too bad, but you'd have to live in or near Sac-a-tomata! 1 in 3 call as an attending is pretty brutal unless its got a really small ER call schedule with little work.

 

[NDESTRUKT]

Kaiser Permanente

 

[Winged Scapula]

Kaiser Permanente

What about KP?

 

[NDESTRUKT]

Oh haha, what I meant was KP hires a ton of people and I'm sure it wouldn't be that difficult getting a position there considering.

 

[Pilot Doc]

If KP is hiring en masse, that means one of two things

1) Their surgical volume is expanding dramatically, or
2) They cannot retain employees, and there's a reason

I would bet on #2

 

[mdjobexchange]

I have a keen interest in physician employment and have written quite a bit about it on this site. For general surgery, a good way to start is to pick your desired geographic area and contact some of the major health systems in the area. They typically have in-house recruiters, who are employed by the health system and will give you the skinny on what they have. I would steer away from agency recruiters, they do not always have your best interests at heart.

When you do finally find a few jobs you are interested in, ask them how many work RVUs they are billing. Yearly average for a general surgeon is 7000. Each case is worth so many wRVUs. A hernia is about 11 RVUs. The typical general surgery practice gets about $42 bucks per RVUs when all payors are considered. Multiply 7000 x $42 and you get $280,000, which is a typical compensation package for general surgery.

If you get some ridiculous offer for $550,000 in the middle of nowhere, ask them how many RVUs they are billing. If they say 4000, they are full of crap. The $550k number is a lie and you will most likely never see that. There is the possibility of them getting a hook-up thru the hospital, such as a big call stipend, but you never know when that could disappear.

Make sure a practice is willing to talk to you about their numbers. If they aren't, they are probably hiding something.

For sure, never accept a job with an income guarantee. I have been doing quite a bit of reading on these and they are garbage. They are yet another way that hospitals are taking advantage of doctors. If they really want you, tell them you want to be an employee of the hospital. Income guarantees are very complex and not usually to the doctor's benefit. There are a lot of good jobs out there, you just have to do some extra work to find them.

 

[Winged Scapula]

I could be wrong but I think most income guarantees are offered in one of two situations:

- when a private practice wants to hire you and guarantees an income while you build a practice, but especially in those first few months while you are getting credentialed, etc. they don't have the income to pay your salary, benefits, etc. so they get a hospital to recruit you and pay the salary

- when a hospital has a by-law which says they cannot hire physicians as employees.

It is true that the hospital is making more than what they are paying you, but for someone in private practice, it is almost impossible to start a practice without an income guarantee from a hospital.

 

[Pilot Doc]

When you do finally find a few jobs you are interested in, ask them how many work RVUs they are billing. Yearly average for a general surgeon is 7000. Each case is worth so many wRVUs. A hernia is about 11 RVUs. The typical general surgery practice gets about $42 bucks per RVUs when all payors are considered. Multiply 7000 x $42 and you get $280,000, which is a typical compensation package for general surgery.

Sorry, but I don't see any merit in your methodology there. To say the "average" practice nets $42/RVU is not a useful statistic. It entirely ignores collection rate and overhead which do vary substantially between practices.
It's quite possible that two practices both billing the same number of RVU's could support widely disparate salaries without any traps or hidden dangers lurking.

 

[Castro Viejo]

Money's not too bad, but you'd have to live in or near Sac-a-tomata! 1 in 3 call as an attending is pretty brutal unless its got a really small ER call schedule with little work.

I've never been to Sacramento. Is it that bad? Is that why the Governator still lives in So Cal?

 

[Winged Scapula]

I've never been to Sacramento. Is it that bad? Is that why the Governator still lives in So Cal?

Eh...its just the central San Joaquin Valley (where I'm from).

Hot as heck in the summer.

Foggy and dreary in the winter.

Unsophisticated, although after living in PA and NJ for the last several years, I've gotta say Sacramento looks like Soho in comparison.

Gang activity overflow from Stockton and the surrounding areas.

Old town Sacto is pretty nice though. And frankly, its better than the other "big" central valley towns of Fresno and Bako.

 

[Castro Viejo]

Gang activity overflow from Stockton and the surrounding areas.

How interesting. I obviously don't know California all that well as I had always thought the gang activity was confined mainly to the Bay Area and L.A.

That's like saying there are gangs in Albany, NY, and for anyone who's ever been there, I can't possibly see what Albany-based gangs would ever do in that dump.

 

[Winged Scapula]

How interesting. I obviously don't know California all that well as I had always thought the gang activity was confined mainly to the Bay Area and L.A.

That's like saying there are gangs in Albany, NY, and for anyone who's ever been there, I can't possibly see what Albany-based gangs would ever do in that dump.

When I lived in Fresno, there was quite of bit of gang action...mostly SE Asian and Mexican. Typically if you stayed out of the "bad parts of town" you would have much problem, other than maybe some property theft (my car was broken into several times at the VA and stolen once). I did a surgery rotation at the University Medical Center and it was not uncommon to have some gang bangers in the trauma bay.

I have a friend who is a adolescent psychiatrist in Stockton...he works quite a bit with young gang members. So it is definitely not true that they are focused on LA and SF - especially when it comes to drug dealing, that's everywhere.

 

[mdjobexchange]

The data for RVUs is located many places on the internet. Medicare sets its RVU reimbursement every year via the conversion factor (CF), for this year, it is $37.32. Many insurance companies these days reimburse at some percentage of Medicare. Most are paying 110% to 120%, which equals about $42 or $43. MGMA and AMGA put out numbers all the time in articles in Medical Economics and Physician Executive. There are even national benchmarks for RVU production and practice overhead. Many of the practice management companies help physicians try to achieve these targets.

These numbers are rough guides and you have to know the difference between an RVU and its components. An RVU is broken down into physician work, malpractice, and practice expense RVUs. The 6500 number is work RVUs which reflects the "physician's work" and already has the overhead accounted for. The wRVU accounts for about 50% of the total RVU value. So, if you do a hernia, it gets you about $400 and is about 10 total RVUs. 5 of those RVUs are work RVUs, so the physician work is worth about $200 if you are getting $40 per unit. You can look at it the other way, that average overhead is 50%, so the surgeon sees about $200 (50% of $400). Total RVU production for general surgery is about 12,500 annually. wRVU annual production is 6500. wRVUs are about 50% of total RVUs.

Income guarantees were dreamed up to help non-profit hospitals recruit doctors. Its creation came because of the Stark Law and anti-kickback laws which prohibits physicians from receiving payment for referring Medicare/Medicaid patients to a hospital. Non-profit hospitals are in an even stickier situation, as they cannot profit from this either. Hence, the income guarantee. Basically, this invention is allowed by the IRS.

If there is another doctor there that can tell you that there is enough business for a second doctor, then fine. An income guarantee may be OK. The problem is that I know of a number of physicians who took income guarantees where they were the only physician of their type there and after the guarantee ran out, they found that their income was significantly less than promised. Then, you are stuck at that place for 3 more years, or you have to pay back the money from the income guarantee. That is where you need to know about RVUs. For example, if there is a general surgeon in that same area that says, "I am only billing about 5500 wRVUs a year." Then they may not really need another general surgeon in that area. The hospital may want one, because the current surgeon does not do enough big cases to populate the ICU.

As far as starting a practice right after finishing training, an income guarantee can really be a disaster. Without much "real-world" knowledge upon which to draw, what happens if you find out that you either don't like running a practice or that the practice the hospital set you up with sucks? Then, again,you are stuck with 3 years of indentured servitude or pony-ing up the money. If a hospital by-laws state they cannot have physician employees, then maybe they should change them or go look for another job. I would say that in income guarantee would be a better situation for somebody with 2 or 3 years of experience under the belt.