What do physician groups look for when hiring?

[AzEMMD]

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Naturally, it seems that connections play the biggest role when getting a job after residency. However, I also here a lot about the importance of having a strong CV...what does that mean exactly? Research experience? Involvement with state and national advocacy efforts? Being a chief resident? I'm about to start residency and would like to know what I can do over the next three years to make myself a desirable candidate.

 

[EctopicFetus]

Im in AZ too. Wondering where you matched Copa or u of A..

I work in a private physician group. Basically a non academic group would look for things that are pertinent to them. Being a chief resident undoubtedly helps but research only matters if the area is pertinent. Ill give you an example. One of my colleagues did research on border crosser deaths and related it to temps, another one looked at the LWOBS or LPTMS (pts leaving prior to being screened) and checked their insurance status. The one looking at if paying customers are leaving is more pertinent and will teach you more about how a private group operates than one looking at border crosser deaths.

Certainly being involved in politics EMRA or state ACEP would be looked upon fondly especially if you are actually doing something.

Above all else though is performance in residency. If you suck as a doctor and arent efficient at work the other stuff doesnt matter. Of course if that were true you would never be a chief.

Best of luck and if you have more specific questions Ill get to em on here or you can PM me.

 

[deleted109597]

A pulse. Also, some look for BE/BC.
Academics is different.

 

[Ceez]

A pulse

co-sign

 

[Arcan57]

A pulse. Also, some look for BE/BC.
Academics is different.

Now to be fair, most places will require you to have a license in that state as well. But with 24 hours in the day and increasing patient volumes the norm, EPs are something of a commodity. Which is good in the being able to be hired almost anywhere, and bad in the "can be fired at anytime for any reason" sense.

 

[EctopicFetus]

Depends on the group. If you want a job in a tight market or a prestigious group the stuff i mentioned helps. If its a large group in a big market then its as above.

 

[Entgegen]

Now to be fair, most places will require you to have a license in that state as well. But with 24 hours in the day and increasing patient volumes the norm, EPs are something of a commodity. Which is good in the being able to be hired almost anywhere, and bad in the "can be fired at anytime for any reason" sense.

Seeing as how there is a shortage of ER docs, isn't physician retention in hospitals' and physician groups' best interests? I would think that being on the good side of supply/demand = job security.

 

[fuegofrio17]

One of the negatives of the specialty is that we are viewed only as a commodity, as Arcan stated, that can be hired and fired easily at the whim of the CEO. I think residents and students should be aware of this prevalent negative in the community environment.

In the region I work, almost all EPs are independent contractors who are members of a group contracted to cover services for a hospital or system. Although, we are not employees of the hospital, the hospital controls the contract for the group. If the CEO does not like you for any reason, a bad outcome occurs, a political mistake occurs, or if the nursing administrators don't like you, you can be fired or pushed out in a heartbeat. The CEO just contacts the director of the group and states you either lose Dr. XYZ or we will pull your contract. The next day you notice Dr. XYZ is crossed off the schedule for all of his shifts and you never see or hear from him again.

I have seen this happen many times and generally to the older less efficient physicians or the physcians who fail to bend to the adminstration's "requests". With the abundance of new residency grads, positions in big cities are easily able to be filled. New grads are easier to be molded and indoctrinated into the desires of the CEO.

The CEO does not care what is the best practice of medicine or what benefits the patient the most. All he cares about is what the Press Gainey scores, Door-to-Doc times, patients per hour, and time-to-disposition metrics are. He doesn't care if you are good doc or not, only if you perform for the metrics.

As an EP you are not viewed as the other physicians in the hospital to the CEO. You make no money for the hospital in their eyes, bring in no prestige for the hospital, and only serve as a liability. The cardiologists, GI docs, neurosurgeons, etc, bring in money and prestige to the hospital. The ER just loses money. You are a metric, not a person, and one that can be easily fired and replaced.

With the probable future decrease in medicare reimbursement, hospital administrators will be further squeezed to milk out any profit they can. This only means more unreasonable "requests" of ED physicians and more unreasonable metrics to follow.

This is the future of EM.

 

[DrVanNostran]

One of the negatives of the specialty is that we are viewed only as a commodity, as Arcan stated, that can be hired and fired easily at the whim of the CEO. I think residents and students should be aware of this prevalent negative in the community environment.

In the region I work, almost all EPs are independent contractors who are members of a group contracted to cover services for a hospital or system. Although, we are not employees of the hospital, the hospital controls the contract for the group. If the CEO does not like you for any reason, a bad outcome occurs, a political mistake occurs, or if the nursing administrators don't like you, you can be fired or pushed out in a heartbeat. The CEO just contacts the director of the group and states you either lose Dr. XYZ or we will pull your contract. The next day you notice Dr. XYZ is crossed off the schedule for all of his shifts and you never see or hear from him again.

I have seen this happen many times and generally to the older less efficient physicians or the physcians who fail to bend to the adminstration's "requests". With the abundance of new residency grads, positions in big cities are easily able to be filled. New grads are easier to be molded and indoctrinated into the desires of the CEO.

The CEO does not care what is the best practice of medicine or what benefits the patient the most. All he cares about is what the Press Gainey scores, Door-to-Doc times, patients per hour, and time-to-disposition metrics are. He doesn't care if you are good doc or not, only if you perform for the metrics.

As an EP you are not viewed as the other physicians in the hospital to the CEO. You make no money for the hospital in their eyes, bring in no prestige for the hospital, and only serve as a liability. The cardiologists, GI docs, neurosurgeons, etc, bring in money and prestige to the hospital. The ER just loses money. You are a metric, not a person, and one that can be easily fired and replaced.

With the probable future decrease in medicare reimbursement, hospital administrators will be further squeezed to milk out any profit they can. This only means more unreasonable "requests" of ED physicians and more unreasonable metrics to follow.

This is the future of EM.

Great post. Scary, but great. I've been hearing more and more negatives about EM recently than previously. 😱

 

[xaelia]

Great post. Scary, but great. I've been hearing more and more negatives about EM recently than previously. 😱

Find me a specialty forum on this board where the sky isn't falling.

 

[Entgegen]

Find me a specialty forum on this board where the sky isn't falling.

The sky falls harder in some than in others...and this forum has a minimum of that.

 

[anothercaliapp]

I bet getting a job is fairly easy but what about making partner in a practice group? How easy or hard is this? I believe the "sweat equity" period is anywhere from 1-4 years. How prevalent is the practice of hiring junior docs, profiting from him or her, but not making him or her partner to avoid dilution of profits?

 

[MasterintuBater]

fuegofrio17 sums up a lot of the challenges of community departments very well.

As far as getting hired in a community setting, a warm body and a valid license will suffice for now.

 

[bravotwozero]

As an EP you are not viewed as the other physicians in the hospital to the CEO. You make no money for the hospital in their eyes, bring in no prestige for the hospital, and only serve as a liability. The cardiologists, GI docs, neurosurgeons, etc, bring in money and prestige to the hospital. The ER just loses money.

Isn't the ED supposed to be the cash cow of the hospital? Aren't they the ones who bring in patients that may need consultants? I can understand a county hospital ED losing money, since the majority patient population has no insurance there, but surely more patients at private community hospitals are insured and can pay?

 

[gutonc]

Isn't the ED supposed to be the cash cow of the hospital? Aren't they the ones who bring in patients that may need consultants? I can understand a county hospital ED losing money, since the majority patient population has no insurance there, but surely more patients at private community hospitals are insured and can pay?

They're so cute at this age, aren't they?

But seriously...while the payor mix is better at private hospitals than at county or university places, it's still a mix. And there's this little thing called EMTALA that requires the ED to evaluate and treat - as appropriate - everybody who walks in the door regardless of ability to pay.

 

[bravotwozero]

Alright, let me put it this way: How much money is the hospital going to make if their ED was shutdown?

 

[Arcan57]

They're so cute at this age, aren't they?

But seriously...while the payor mix is better at private hospitals than at county or university places, it's still a mix. And there's this little thing called EMTALA that requires the ED to evaluate and treat - as appropriate - everybody who walks in the door regardless of ability to pay.

For our hospital, we're the second largest money maker (direct net income) after cardiology. Well run EDs with good payor mixes make money, poorly run EDs hemorrhage money regardless of payor mix. However, we are viewed as a commodity in a way that a CT surgeon that does a ton of CABGs or an internal medicine doctor that admits exclusively one hospital are not.

 

[UnderwaterDoc]

They're so cute at this age, aren't they?

That made me LOL 😀

There is so much doom and gloom in these threads that the uninitiated would come here and think that being a physician is the worst there is.

 

[ER-ER-Oh]

There're two ways of looking at the job of EP. One is to bitch and moan about how bad it is that we're not being looked upon as the true heroes of medicine, cry about the metrics we're supposed to live up to, and basically whine about all the crap we face on a daily basis. The other is to define ourselves as we'd like to be viewed DESPITE the **** the administrations and the nurses and the patients throw at us.

For me, as a medical director, I look for someone who loves war and battle. That's what we do. Sometimes it's clinical, saving someone's life or limb. But most of the time it's logistical; keeping patients flowing, happy, and healthy, while simultaneously being unflappable. George f***ing Patton. If you get the results the administration is looking for while keeping your own personality and unique individualism then I want you to work for me. If you can get angry at some knuckle headed idiot demanding pain meds, throw him out of the ED, speak caringly and compassionately to a dying patient's families, throw in a central line, intubate, get the patient to the OR, and move the meat without making them feel they're being dismissed (they are, we know) then I want you working with me.

Show me you're the calm boss while being squawked at by 50 people demanding your time. Show me you can shove 50 pounds of **** into a 10 pound bag and still not get it on your tuxedo or motorcycle boots

 

[spiderpete]

There're two ways of looking at the job of EP. One is to bitch and moan about how bad it is that we're not being looked upon as the true heroes of medicine, cry about the metrics we're supposed to live up to, and basically whine about all the crap we face on a daily basis. The other is to define ourselves as we'd like to be viewed DESPITE the **** the administrations and the nurses and the patients throw at us.

For me, as a medical director, I look for someone who loves war and battle. That's what we do. Sometimes it's clinical, saving someone's life or limb. But most of the time it's logistical; keeping patients flowing, happy, and healthy, while simultaneously being unflappable. George f***ing Patton. If you get the results the administration is looking for while keeping your own personality and unique individualism then I want you to work for me. If you can get angry at some knuckle headed idiot demanding pain meds, throw him out of the ED, speak caringly and compassionately to a dying patient's families, throw in a central line, intubate, get the patient to the OR, and move the meat without making them feel they're being dismissed (they are, we know) then I want you working with me.

Show me you're the calm boss while being squawked at by 50 people demanding your time. Show me you can shove 50 pounds of **** into a 10 pound bag and still not get it on your tuxedo or motorcycle boots

👍
"I'll take that hill sergeant!"

 

[txterp98]

Alright, let me put it this way: How much money is the hospital going to make if their ED was shutdown?

Bravo, keep in mind that we do not bring patients to the hospital. We just staff the ER. Unlike the other services who bring the hospital their private patients and thus revenue, we are seeing people who have already decided to come to that specific hospital.

Arcan57 is absolutely right. A good ER group can make money with the right payor mix whereas a poorly run group might still end up losing money. Document well, meet core metric goals, etc. A group that can show they consistently turn a profit has bargaining power to the hospital. An efficient group will maximize revenue and thus stay on the good side of the hospital administration.

Hopefully that helps some.

 

[EMDoc0411]

There're two ways of looking at the job of EP. One is to bitch and moan about how bad it is that we're not being looked upon as the true heroes of medicine, cry about the metrics we're supposed to live up to, and basically whine about all the crap we face on a daily basis. The other is to define ourselves as we'd like to be viewed DESPITE the **** the administrations and the nurses and the patients throw at us.

For me, as a medical director, I look for someone who loves war and battle. That's what we do. Sometimes it's clinical, saving someone's life or limb. But most of the time it's logistical; keeping patients flowing, happy, and healthy, while simultaneously being unflappable. George f***ing Patton. If you get the results the administration is looking for while keeping your own personality and unique individualism then I want you to work for me. If you can get angry at some knuckle headed idiot demanding pain meds, throw him out of the ED, speak caringly and compassionately to a dying patient's families, throw in a central line, intubate, get the patient to the OR, and move the meat without making them feel they're being dismissed (they are, we know) then I want you working with me.

Show me you're the calm boss while being squawked at by 50 people demanding your time. Show me you can shove 50 pounds of **** into a 10 pound bag and still not get it on your tuxedo or motorcycle boots

Are you hiring?

 

[The White Coat Investor]

Naturally, it seems that connections play the biggest role when getting a job after residency. However, I also here a lot about the importance of having a strong CV...what does that mean exactly? Research experience? Involvement with state and national advocacy efforts? Being a chief resident? I'm about to start residency and would like to know what I can do over the next three years to make myself a desirable candidate.

Be the smiley guy. The guy who when he comes in for a shift the nurses smile and say how happy they are it is you on duty. The guy who always smiles the whole way through the shift no matter how crappy or busy it is. The person everyone else wants to be around.

And don't kill anyone that didn't come in dead already.

That's about it.

 

[docB]

Isn't the ED supposed to be the cash cow of the hospital? Aren't they the ones who bring in patients that may need consultants? I can understand a county hospital ED losing money, since the majority patient population has no insurance there, but surely more patients at private community hospitals are insured and can pay?

I think this is a valid question. I can tell you that in my shops we know exactly what our payer mix is and our admit rates and so on. We also know what percentage of the total admits to the hospital come through the ED. But as far as how much money the hospital makes on our patients and how we figure in the cost center vs. revenue center thing it gets tougher. That's a lot of proprietary info and the hospitals are guarded about sharing it. They're also not above skewing the data to make arguments about how we need to be doing X, Y or Z better.

You can ask a lot of EPs if their shop is a net winner or a net loser for the hospital and while they may think they know many don't really know.

There're two ways of looking at the job of EP. One is to bitch and moan about how bad it is that we're not being looked upon as the true heroes of medicine, cry about the metrics we're supposed to live up to, and basically whine about all the crap we face on a daily basis. The other is to define ourselves as we'd like to be viewed DESPITE the **** the administrations and the nurses and the patients throw at us.

For me, as a medical director, I look for someone who loves war and battle. That's what we do. Sometimes it's clinical, saving someone's life or limb. But most of the time it's logistical; keeping patients flowing, happy, and healthy, while simultaneously being unflappable. George f***ing Patton. If you get the results the administration is looking for while keeping your own personality and unique individualism then I want you to work for me. If you can get angry at some knuckle headed idiot demanding pain meds, throw him out of the ED, speak caringly and compassionately to a dying patient's families, throw in a central line, intubate, get the patient to the OR, and move the meat without making them feel they're being dismissed (they are, we know) then I want you working with me.

Show me you're the calm boss while being squawked at by 50 people demanding your time. Show me you can shove 50 pounds of **** into a 10 pound bag and still not get it on your tuxedo or motorcycle boots

I hear what you're saying and I know how valuable that can be. It's the used car salesman phenomena. It's not enough to be competent. Now we've got to kiss their asses too. I know it's how we have to be but I am honestly tired. This aspect may mean my days are numbered.

 

[docB]

Bravo, keep in mind that we do not bring patients to the hospital. We just staff the ER. Unlike the other services who bring the hospital their private patients and thus revenue, we are seeing people who have already decided to come to that specific hospital.

Arcan57 is absolutely right. A good ER group can make money with the right payor mix whereas a poorly run group might still end up losing money. Document well, meet core metric goals, etc. A group that can show they consistently turn a profit has bargaining power to the hospital. An efficient group will maximize revenue and thus stay on the good side of the hospital administration.

Hopefully that helps some.

Dang it! I meant to hit this one when I was multiquoting and I missed it. I'm pretty tired and to be honest when I first starting picking posts to quote I almost accidentally deleted all of these😱.

This is a great point and even if a lot of ER docs, residents and students aren't aware of this point of view (it's not a fact, it's really a point of view) EVERY hospital admin in the known universe is very aware of it.

To put it another way, the way a hospital CEO would say it: I allow you to work in my ER that I have set up so masterfully than insured patients are beating down the doors. Bend to my will or I shall pull your contract.

The reason it's a point of view rather than a fact is that a lot of things go into what makes an ED attractive and busy or not. The point doc groups counter with goes: We provide superior service with appropriate resource utilization to maximize the profits you are able to wring out of this ramshackle little hole you make us work in.

Of note is that usually the most important factor affecting an EDs volume and payer mix is... location. Often the CEO and the physician group have way less impact than the real estate agents.

 

[anothercaliapp]

I bet getting a job is fairly easy but what about making partner in a practice group? How easy or hard is this? I believe the "sweat equity" period is anywhere from 1-4 years. How prevalent is the practice of hiring junior docs, profiting from him or her, but not making him or her partner to avoid dilution of profits?

My question seems to have gotten lost in the mix. Not trying to instigate anything but trying to get some real, practical information about how EM private practice works. Thanks!