What do you wish you knew?

[Writer1985]

After 15 years of post-secondary schooling, I'm finally ready to look for a Real Job! Woo hoo! I have a few leads in academic departments across my preferred geographic area, but before throwing my hat in the ring, I was hoping to get some perspective from savvier folks.

What do you wish you knew before you started your attending job? I have heard that "everything is negotiable" which coming out of years of training where you are told where to go, what to do, where to sit, seems like a bit of a joke. But I also know that department chairs know that new hires are totally unaware when it comes to negotiations and I want not to get undervalued.

I have my list of must-haves (clinician-educator track* with options for formal career development in this area, supportive colleagues/chair, primarily subspecialty clinic rather than general neurology clinic, tenure track with actual criteria for educators, medical humanities division/department* in the medical school for a joint appointment now or in the future), my would-be-nices (protected teaching time* at both the preclinical and clinical level, telemedicine options), and my dealbreakers (ICU call, stroke call, inpatient-heavy load). I've thought about call schedules and service time and reimbursement for CME/conferences. What else do I need to think about?

* Yes, I'm aware that this is a pretty niche area. But I have a couple of grants and publications along the lines of education research/medical humanities, and I intend to continue in this field. What I want to know is, how much of an ask is too much of an ask?

Also, on a veeery basic level, does a cover letter get addressed to "Dear Dr. [Chair]" or "Dear Dr. [Division Chief]" (or both? neither? Dr. Who?)

Thanks in advance for helping me unlock Mystical Attending Status!

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[typhoonegator]

Administrative support, sundry funds, private office, piece of a research support person if that's your thing, parking, administrative title, starting academic rank, etc.

Division/department heads don't get any benefits from recruiting people that are going to be unhappy, because unhappy people grumble both to them as well as to people outside the organization. So job negotiations are not some zero-sum game where for you to win, your new chair must lose. They will want to set you up in a situation where you are likely to succeed, at least within reason. So if you find someone who buys-in to your vision for your career, ask them what they have seen other people in a similar situation require to be successful. There is no harm in that. That goes for resources, less so for hard money in a startup fund, which I'm not sure you're going to have much negotiating power for anyway without a track record or something big you're bringing to the table. But an annual professional fund is something you should feel comfortable asking for.

Your must have/would like list is really more of a screening tool because a lot of those things are not negotiable for you - an institution either has a well-defined clinician/educator track, or they don't. Call might be negotiable, but it may not be as well depending on needs and how badly they really want you. Educators are a luxury item for many departments, so you'll need to get a feel for why they are really interested in you -- are you filling a clinical need, or are they more focused on your academic role? That dictates what you can ask for and reasonably receive.

Division vs. department depends on, well, the division and the department. If you're cold-calling a department, then address your letter to the chief. If you're being recruited through a division chief, or have started conversations with them, then you should address your letter to them. Departments are run in different ways, and some give divisions a lot of autonomy across the board, while others don't, and still others have particular divisions that carry a lot of weight due to the stature of the division head, or the prominence of that division within the department from a legacy or financial standpoint.

 

[Hank Rearden]

The clinician-educator track may be more common than you think. 25% of the clinicians at my institution are on this track. The only thing in your wish list that sounded a bit odd to me was tenure track. Mind you, you sound more academic than most clinician-educators with some grant support under your belt, but what do you expect your research / clinical mix to be? Generally folks on tenure track are more heavily into research, spending at least 50-75% of their time on it. If you spend 75% of your time seeing patients you probably don't need tenure since your salary will be generated from your clinical revenue. At my institution tenure track people generally switch over to becoming university employees as opposed to hospital employees. Tenure is also going by the wayside at many institutions.