Keeping a Promise: A Concise Primer to Finding the Right Job

AD04

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God has blessed me immensely. I love psychiatry and I am very blessed to be where I am at right now. With time, I expect things to be better and better.

The wonderful people of SDN have helped me immensely and it is about time I give back. I hope you, dear reader, will also find much satisfaction in this field.

Jobs are easy to find. However, finding the right job is a bit more difficult. To maximize income and to minimize hassle, you want to get it right the first time -- find the best job and hold onto it until you retire. Every time you switch jobs, you will interrupt your earning periods. You will have to deal with applications and paperwork. You may even have to uproot your family and move to a new environment. There is a huge cost that comes with changing jobs.

The aim of the guide is to help you make the minimum amount of mistakes when it comes to your career.

What You Will Need Before You Start

- CV: Make it one page. Busy people have only enough attention for 1 page.
- cover letter (optional): Make it 1 page. I didn't write a cover letter, but it isn't a bad idea if there are a lot of applicants and you want to stand out.
- burner phone: I use Google Voice as the recruiters will call constantly. There is a do-not-disturb option so the phone won't ring when they call. It will also transcribe voicemail. You can also send text.
- burner e-mail: Make a new account just for job search as recruiters will e-mail you constantly.

Once you have everything, you are ready to begin.

Step 1. Know yourself deeply.

Sun Tzu said, "If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle."

Before you do anything, you must first know yourself.

What do you want in life? Do you want an easy life and the security of knowing you will be taken care of? Do you want to work your butt off and make bank? Do you want to be around family? Do you want to explore the world?

Some people want to be around family. Other people want freedom to work as much or as little as they want. Others want to grow an empire. Be truthful to yourself.

My goal is high, sustainable income for the long-term. And the best way to reach that goal was a facility / practice that is small enough, yet growing rapidly. The place had to be small enough that the decision-makers know me. The business had to be their baby in the sense that they are not going anywhere for a long-time. My payment had to be tied to productivity so our incentives are aligned (the more I work, the more I get paid, and the more the facility / practice makes). The decision-makers have to be more competent than me -- which is shown by their history of success. Most important of all, decision-makers have to be trustworthy. Trust is based on a gut feeling, but if possible I would verify what they say with another source and match what they do to their words.

I am not thinking just about income, but also about how much I can learn from working there. As our favorite President said, "Manage the downside; the upside will take care of itself." In case the job doesn't work out, I would have knowledgeable that would pay dividends. But if the job works out, great!!

Step 2. Know your options.

Factors to consider in a job:
- location: physical vs virtual (telepsychiatry)
- entity: government, academic, for-profit corporations, small businesses
- type of work: inpatient, outpatient, anything in between
- patient demographics: age, disorders
- hours required
- income: salary, independent contractor, production

(Tip: As a general rule, avoid being an employee of for-profit hospitals.)

You can't always get everything you want. Some factors will be more important than others. So choose the top 3 factors and focus on that.

To find out what options you have, do a lot of research. Talk to people in your current residency class. Talk to people from the prior years of your residency program. Reach out to experienced psychiatrists. Read about other people's experiences. Talk to recruiters. Do a lot of phone interviews with potential employers. Ask questions on SDN.

It took me about 3 months of research to really understand what's available and the pros and cons of each choice.

Step 3a. Finding Jobs When You Are Limited by Location

When you are limited by location, you are very limited when it comes to finding jobs. Therefore, you will have to take a more active approach.

a) go onto your favorite search engine and look up potential employers then reach out to them

- cold-call: this option could work if you can reach a decision-maker, but the chances are slimmer the bigger the organization
- cold-email: this option is my default way to reach out
- cold-mail: this option will require extra effort (and money) from you but could be effective especially if you hand-write the address on the envelope (make sure you include a cover letter with a signed CV)

b) network

Knowing the right people is the best way to find jobs as the good opportunities are not posted anywhere. However, networking is tricky to do if you're not already in the area. Therefore, the location of the residency often plays a big role in where you end up after training. Personally, I've hooked my peers up with interviews and I secure interviews through my peers.

Remember how you act towards others will contribute to your reputation. If you're a dick to people, they will remember and won't help you. If you're lazy or incompetent and others have to pick up your mess, they won't help you. There absolutely are people I would not help because they've screwed me over in the past. If you already know people working in the place you're interested, you will have access to inside information. This is huge!!

I try to be nice to drug reps and talk to them when I'm not seeing patients. I would ask them about the demand for psychiatrist in the area they serve. I would ask about which psychiatrists I should know. I would ask about dinners and attend them, not because I want to hear about Trintellix or Spravato, but to know other psychiatrists in the area. That is how one of my peers got into residency.

One of my friends is extra nice to drug reps and would "tip" them (if you get my drift), but you don't have to go that far.

Lastly, keep in touch with people. In my life journey, I selected several people I like or who are winners or who can potentially be helpful. I reach out to them once in a while to update them, to find out how they're doing, to wish them happy birthday or whatnot. I keep the relationship warm. If something happens to my job right now, I can make a few phone calls and can get a good contact in hand within a week.

Your network is important, so build it now if you plan to stay in your current area!!!

Step 3b. Finding Jobs When You Are NOT Limited by Location

When you are willing to go anywhere, the world is your oyster and you will have lots of options. You will have more options than you can entertain. You will have to screen out jobs. Establish criteria. For me, a major criteria is if the job meets income benchmarks -- salary (i.e. $250k for 40 hours a week with no call), hourly (i.e. $150 / hr), production (either % of collection of $ / patient).

Because there are so many options, you can be less proactive.

a) job posting sites

The two sites I used are Indeed and DocCafe.

I like Indeed because there are a lot more job posts from employers instead of recruiters. There is a lot less spam and dead-end posts. Paying money -- skin in the game -- weed out the wannabes from the real-deals. I only want to deal with the real-deals.

DocCafe is 100% recruiters. I don't browse it that much, but I posted a very generic CV to generate passive leads from recruiters. The CV has my name, e-mail address, job title of physician / psychiatrist, and then a line on the bottom that says "Contact me for an updated CV." I didn't list my medical school or my residency or my address or any other details in this generic CV. The CV isn't meant to be given to employers, but to generate leads. The leads give me a general idea of the demand and the pay.

b) recruiters

I didn't have much success with recruiters but I got to speak to a lot of potential employers through them. I was able to do a lot of research because of their help. Many of my peers found their jobs through recruiters. Just understand that recruiters are not your friends. Their objective is to make money by getting their clients physicians. They will not go out of their way to make sure you are the right fit for the job.

They are easy to work with. They tend to be very optimistic about the jobs and may know some details about the jobs. Ask about salary. But then ask the employer about salary too as recruiters often get the details wrong.

Overall, the jobs you get from recruiters are not the best. They are however an easy source for locum jobs, some which pay a pretty penny.

After You Submit the CV

If the employers are interested in you, they will reach out to you to schedule a phone interview. During the phone interview, ask whatever questions you want. Make sure the questions you ask would help you decide of the opportunity is worth an in-person visit. One of the questions I always asked is the salary.

see also: What Do You Need to Know About a Job Before You Will Interview?

After phone interview, they will want to an in-person visit. In my experience, 100% of the phone interviews have ended with invitations for in-person interviews. Based on the answers, you can decide if you want to go or not. If you want to go, have the employers pay for the expenses. One of the people from my previous residency program boasted about how he went on 10 different interviews. I view that as a poor use of time. There are other things I would rather do than to be on a plane or in a hotel room for a job you will most likely reject. If you do the proper research and ask the proper questions, you can minimize the amount of in-person visits you do. I attended 2 in-person visits and both of them resulted in good job offers.

If they pay for the in-person visit, they will most definitely want to hire you due to psychiatrist being in high demand and the sunk cost fallacy.

Good luck.

P.S. From July to October of my PGY-4, I spent almost every day researching and applying. I Interviewed in October. I gave a verbal commitment in November. Then I signed a contract in February. To be on the safe side, I should have started the research process around January of PGY-3. One of the main attributes to my success was building a system and making the job search a habit. Contact 5 people a day. Send 5 emails a day. Whatever. But you must take consistent action. Some days will feel like a drag. But good jobs are hard to come by. Once you understand the process, you can do it a second time around much more efficiently (if you need to).
 
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Sushirolls

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Search Physician Jobs in the PracticeLink Job Bank also is another decent job search site.

And to be a bit of a downer, at the end of the above, don't be surprised after several months into the job you realize the job is a severe disappointment. Once you realize that, don't wait, don't delay, exit as fast as you can and take the learning experience to lock in what you want. That's when step 1 & 2 above will carry a greater valency.
 
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Thank you for the helpful post.

Jan of PGY3 seems a little early, no?

How did you bring up salary during phone interviews? Did you usually get a number from your interviewers?

Did office space matter to you? (*WINDOW*)

Although the topic has been touched elsewhere recently, what is your reason for advising against for-profit hospital employment?
 
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powerof0

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Does anyone have tips on how to find desirable jobs online? I am looking at the job postings in larger cities, but the vast majority of them don't seem very good...
 

AD04

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Jan of PGY3 seems a little early, no?

For some, it may seem early. But it took about 7 months to finalize and sign the contract. What if negotiations broke down? I would rather not delay working as an attending too much. And if you are about to graduate and don't have a job lined up, you're more likely to accept sub-par offers just to have something. I would have preferred a signed contract in September of PGY-4.

How did you bring up salary during phone interviews? Did you usually get a number from your interviewers?

I asked straight out, "Can you tell me about the remuneration?"

I first asked about patients per day, call expected, work hours, and malpractice / sovereign immunity. Find out what they are looking for. Sell yourself a bit. Then you have to discuss what the other side has to offer. When talking about the job requirements, it felt natural to ask about pay because they're all very much related. If there is call, I always asked if they paid extra for call.

People who offer good pay will not shy away from talking about that. After all, they want to persuade you to join too. It is people who do not or cannot pay well that shy away from that topic.


Did office space matter to you? (*WINDOW*)

No. But my current office has a window. My other option that I did not go with offered me a glass wall, so it feels like the room is one with nature.

Although the topic has been touched elsewhere recently, what is your reason for advising against for-profit hospital employment?

It is very productivity focused. You will work hard, but the pay isn't that great. And I don't think there is a long-term future as the work environment can change as quickly as the administration changes. Some for-profit hospitals even monitor the amount of time physicians spend in a bathroom.

If you want to work for a for-profit hospital, it is best to do it as a contractor instead of an employee. You'll make more money for the abuse you're going through.
 
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AD04

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And to be a bit of a downer, at the end of the above, don't be surprised after several months into the job you realize the job is a severe disappointment. Once you realize that, don't wait, don't delay, exit as fast as you can and take the learning experience to lock in what you want. That's when step 1 & 2 above will carry a greater valency.

This is a very real risk. Try to get it right the first time but it is common if you can't. That is why it is important to work for / with people you can trust. These people will let you know beforehand what you're getting into. They also will not push you to do things that risk your license.

Another option is to spread out your risk and work multiple jobs. And then after a bit, you can choose the best one(s).

No matter if you work just one job or work multiple jobs, always have options. Never be desperate. (Which is my philosophy for love as well.)
 
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liquidshadow22

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Im fairly naive when it comes to this stuff. Can you talk about, contracts, the types of reimbursement models, and what reimbursement models tend to make the most sense? Here are a few examples I am aware of:

1) I ran into a psychiatrist recently who told me that he works at an inpatient unit. He however is not an employee of the psych hospital, but essentially has privileges to do his own billing and told me that he bills each patient he sees directly. He said that by doing this he cuts out the middle man and states that he ends up doing very well for himself.

2) Typical salary position when you are employed by someone else.

3) RVU model, where you essentially eat what you kill and make money per RVU generated?
 
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Shufflin

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Starting out, what's more important is finding your direction. You won't know that until you try a few different jobs. How they pay you is not as important since you most likely will change jobs in the first few years once you know your direction. Don't worry too much about revenue models yet.
 
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