HOW TO FIND A GENERAL PEDIATRICS JOB Bridget Sweeney Gotsch, 2009

I. Purpose of this Guide This guide is targeted toward those looking for primary care general pediatrics jobs. There will be a few tips for hospitalists, but will mainly focus on primary care. It is meant to help streamline the process and suggest things to think about (and watch out for). Note: less time is spent on hospitalists because: 1. I looked for primary care jobs, 2. I modified this handout from an original handout found during my job search which was collected through sources: experiences of class of 2007 University of Chicago (I tried to collect my classes experience but had a poor response). Information gleaned from a conference on finding a general peds job by North Carolina Peds Society.

My hopes are that someone from each future class will attempt to gather their class’s experiences and continue to modify the document.

II. When to Get Started

A. Houston area: September

B. Out of town: This depends on how competitive the local market is. In general popular urban areas tend to be competitive, while more rural areas are always looking. For instance, in North Carolina, in the Raleigh/Durham/Chapel Hill area there are so many pediatricians it is recommended you start looking in July, and even then many people cannot find jobs in the area. Get started earlier if you are looking out of town! You are going to have to arrange travel time for interviews.

TIP: Try to send out your letters 2-4 weeks before your residency schedule allows you to interview. People tend to respond about 1-3 weeks after getting your letters and it is better not to have to say “I can’t interview for a month” because you’re in the PICU.

TIP: Be prepared for the telephone calls from practices and recruiters. Having a small notebook on your person when answering phone calls will allow you to document the caller, caller’s phone number and email as well as the conversation about the job description. This will allow you to have a reference of recruiters to call back 2-3weeks before heading out on an interview trip to aid in setting up additional interviews with the most current job listings. It also will help in going on interviews to refresh what was originally described in the job over the phone.

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III. Considerations Before You Start: Is this the place where I want to practice and learn pediatrics for the next ____ years?

A. Hospitalist vs. Primary Care: while it is possible to look for both kinds of jobs, most people focus on one or the other. Some recruiters or future employers won’t like it if you say you are undecided—you need to have that “passion” for one of them. So if you are undecided don’t tell.

B. Schedules: a. Common Hospitalist schedules: Most non-academic hospitalist jobs tend to be in

24 hour shifts. 2 or 3 local hospital programs I’ve heard about do 7 24-hour shifts a month. I’ve heard some do 11 a month.

b. Full time primary care: This can be just about anything. Ask about schedule when you visit. Most practices are doing some evening and weekend hours now. Typical would be one evening a week and a shared weekend schedule. In general 4 to 5 days a week in the office, plus rounding is typical.

c. Part Time: If you plan to find a part time job, allow yourself more time to find a job! It is apparently possible to find this kind of job, but most people I’ve heard of who succeeded did not have a job lined up after they graduated—it can take quite a while for one of these to open up, even at practices who have a lot of part time people.

i. DO YOU ASK ABOUT PART TIME UP FRONT? If you have to have a part time job, yes. The only way to find one is to ask. However, frequently candidates looking for full time will be hired over you. If you don’t have to have one, you can take your chances with seeing if they will let you go part time later. Many practices do, but even if they already have people who went part time later, it does not mean they will let you.

C. Practice Ownership: a. Classic Private: owned by one person or group of partners b. Private acquired by larger entity: practice sold to and overseen by larger

administrative group (i.e.: TCPA groups) c. Primary Care formed and administered by larger entity (i.e.: Kelsey Seybold) d. Academic with primary care group combination

D. Location: a. Metropolitan

i. Usually a major medical center nearby with subspecialists, teaching conferences, teaching opportunities

ii. Less complicated care on your own given availability of subspecialty care and specialty unit

iii. Social and Cultural Life b. Rural

i. No major medical center: difficult subspecialty access due to time and distance

ii. More complicated care: need to take care of neonatology, emergency care with continued needs, chronic care follow up

iii. Social and cultural life very different from the city.

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E. Solo/Group Practice: a. Solo Practice

i. Incentives: 1. You are the decision maker and have total control. 2. Entrepreneurial Spirit, 3. Financial Control

ii. Difficulties: 1. Expensive and inefficient, 2. Who takes call? (call group vs. just you?, what do you do for

vacations?), 3. You must handle all contract negotiations with insurance

companies. b. Group Practice

i. Two or more pediatricians who share: office space, equipment, income, patient care responsibility

ii. Advantages: 1. facility and equipment (multiple waiting rooms, special rooms like

vision/hearing, lab, teen rooms, consult rooms), 2. High ticket items like computer, coulter counter. 3. Office Staff: Business manager for personnel and financials; staff

for insurance, collectibles, referrals; clinical specialists like dietician, lab tech, lactation, nurse educator, psychologist.

4. Colleagues: shared night call, individual expertise, different personalities, sharing interesting patients.

5. Varied Patient Mix iii. Disadvantages:

1. Need to play nice: share income, share decision making, share vision, represent all members

2. Care for each other’s patients

F. Big Practice/Little Practice: a. Big Practice:

i. Advantages: More colleagues to get help, back up, advice from. Splitting up the call schedule. Likely easier to rearrange schedules. Hopefully more established/financially stable practice.

ii. Disadvantages: May be more hierarchical, or may not be. Some people just don’t like the feel.

b. Little Practice (i.e. joining a solo practice as the 2nd Dr.): i. Advantages: Getting in on the ground floor—more equality when you

make partner. Potentially better financial rewards. ii. Disadvantages: Potentially less financially stable. Potentially worse call

schedule (depends on if you split with a call group). Usually more rounding. More of an on your own feeling—this is a good or a bad depending on your personality as a new attending.

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G. Academic/Private: a. Academic: Affords teaching opportunities and possibly research opportunities.

May pay less and afford less leadership opportunities. b. Private: may pay better and afford partnership opportunity (with share of

leadership and financial rewards). Usually less teaching opportunity, although some private practices have residents and medical students come through.

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IV. Actually Looking: Sources to find potential jobs.

REMEMBER: MANY/MOST JOBS ARE NEVER ADVERTISED.

A. Ask attendings for contacts. Dr. Drutz is a good resource. Also think about finding people who trained other places in Houston (like UT Houston), as they will know people that TCH would not. Ask permission to use the attending’s name who gave you the contact.

TIP: The highest yield in terms of getting responses from jobs is when you use someone’s name.

a. If searching out of state, contact the residency programs in the nearest big city to your search. They can direct you towards the personal with the greatest knowledge of job opportunities in the area.

b. If searching within TCH:i. TCPA Recruiter: Marketta Beneke, 832-824-2319,

Marketa Beneke's email address is mjbeneke@texaschildrens.org 

**The TCPA main office is at 1919 South Braeswood, Houston TX 77030.  When applying for a TCPA job, you need to send your CV and cover letter, along with a copy of your med school transcript and your USMLE scores.  While I sent an 'official' copy, it may be that they'll take a Xerox of the scores.

ii. TCPA job listing http://www.texaschildrenspediatrics.orgiii. FIS - Please send your CV to Dr. Paul Sirbaugh at sirbaugh@bcm.edu

and/or Geeta Singhal at gsinghal@bcm.edu

B. Emails about job postings forwarded by chiefs/Office Job Binder/On-line posting of the Job binder. These are places that are definitely looking, so they tend to get back to you.

C. Internet: a. Job Board siteshttp://www.webmd.com/ = Just type in your starting location and define a mile radius. http://www.practicelink.com/ = good resource for Healthcare groups organizations (i.e. Kelsey Seybold)http://www.careermd.com/ = helpful because detailed when job was posted and immediate contact informationhttp://www.mdsearch.com = posts how many days the job has listed but most have separate log-in to apply for job (i.e. send information to recruiter) http://www.pedcareer.com/ = must have login to site but will flag jobs that are new since your last searchhttp://www.pediatricianjobs.com/ = will post down to the minute how long job has listed but may be difficult to find contact information as list is collected from a variety of sources (Monster, Web MD, etc.) which may require a log-inhttp://www.pedjobs.org/ = post your CV here and recruiters with occasional private practices will call you but don’t expect to find many job postings herehttp://www.doccafe.com/

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http://www.practicematch.com/

Other Helpful Websiteshttp://www.memag.comhttp://amapress.orghttp://www.aafp.org

b. www.aap.org : Go under find a pediatrician. You can search by name or location. A good way to find a name an attending gave you. c. http://www.yellowpages.com/: look in the area you are targeting under pediatrician for practices then call/send cover letter and CV to each individual practice; very time consuming process depending on the number of letters sent.

Copy and paste Practice name/ address/ phone number/ website into Microsoft Excel Spreadsheet as such:A B C D

1 Name: Address 1: Address 2: Phone:2 123 Pediatrics 123 Main St. Houston TX 77030 (123) 456-7890 This format will allow you to create a mail merge in Microsoft Word for your

cover letter.

TIP: One can also use http://www.thedoctorjob.com/ to generate cover letter and CV in a large bulk mailing process which will save you a lot of time but significantly increase the cost of your search. Just remember to keep your receipts as job searching can be tax-deductable.

TIP: To figure out if you are looking at a large group or a small practice look at the number of doctors listed with the same address.

D. The list of Baylor grads and contact info in the Peds Office: A database list has not been created last I inquired.

E. Finding Federally Qualified Health Centers, i.e. Medicaid. All of these can be found by county at: http://www.bphc.hrsa.gov/ .

F. Other tools: a. Friends and Family – if returning home for the job search then ask who they use for their children’s physicians, send a personal letter and resume; I was pleasantly surprised how many practices off of this list was looking or at least could direct me to good practices.b. Ads at back of journals c. State Pediatric Society list of members d. Tertiary Care/Referral centers (do they know of anyone looking) e. Drug Reps (often know who’s looking) f. Hospital Medical staff office

G. Should I use a recruiter?

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a. Staying Local? The short answer is no. Recruiters charge practices a finder’s fee, so you may look less attractive than other candidates if hiring you will cost the practice money. b. Moving out of state? This is in general the accepted use for recruiters. The finder’s fee mentioned above still applies, so think about looking on your own first. If you contact a practice through a recruiter, you can’t go back and try to contact them on your own. c. In no particular order recruiters who contacted me who were free of charge. I did not find many of them helpful as they were national recruiters and I was very targeted on my geographic location for my job search. However, some of them did forward my information onto the local hospital recruiters:

i. Marquin group – Sandy Quinter 561-302-8400 {referred by GME office}ii. Medplacement – John Ivekich 414-688-7800ii. Excel Recruiting Services – Becky Zeising 800-228-8857

iii. Medicus Partners – Robert Clarke 888-260-4242 x239iv. Recruiting Advisor – Drew Webb 877-267-4635v. All Star recruiting – Jamie Bruno 800-928-0229 x112

vi. CompHealth – Mckenzie Ruddy 800-365-8901 x2122vii. Born & Bicknell – Linda Alwais 800-376-2676 x206

viii. Weatherbe Locum Peds - Brett Gittelman 800-586-5022 x3827ix. Staffpointe – Megan Davis 402-261-8456x. Medical Doctor Associates – Darren Montgomery 866-859-0042 x247

xi. SeniorStaffing Specialist – Eric Knight 888-346-3624 x121xii. Pediatrix Med. Group – Ron Grattan 800-243-3839 x5635

xiii. Timeline Recruiting- Charity Hall 877-884-6354xiv. Locum Med group – Barbara Birkel 888-638-5712xv. Physician Referral Network – Peter Steven

psteven@mdreferralnetwork.comxvi. Medsource Consultants – Robin Harrington 800-575-2880 x319

TIP: Local area hospital recruiters tend to be free of charge and are a great resource in finding private practice jobs. It will difficult to work with the recruiter for a hospitalist job or a private practice job so one should decide between the two before contacting the recruiter.

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V. C.V./Cover Letter – There is a document on the http://www.bcmpeds.org website about making a CV/cover letter with nice examples to help launch the project.

A. Making your CV a. You are a commodity and practices need you, don’t sell yourself shortb. List all of your qualifications such as teaching in local schools, significant

experiences. c. Businesslike but personal (go ahead and list that membership in a mountain

climbing organization—it makes you more interesting).

B. Cover Letter/Letter of Intent a. Prose/Business letter format b. Detail your interest in a given location. They always ask this stuff in the interview

too. (Ex: My mother lives in that town or it has been my lifelong dream to practice in Timbuktu.)

c. Detail your interest in a particular field (such as if you like behavior and development within general peds say so. Practices like to have people in niches. You will be asked about this in the interviews too.)

d. Address any questions in your C.V., such as why you took a year off, etc.

TIP: If searching outside of Texas know that despite Baylor having an outstanding Pediatric residency program, many people still think it is located somewhere in Waco. You will need to brag about Baylor’s success as well as your own.

C. Options re: references (They WILL call your references) a. At end of letter state: “References are available upon request.” Then bring a nice

printed list of references and contact info (phone, email, address) to your interview. (I did this).

b. Include a list of references and contact info with letter. c. Actually include letters of reference—makes your letter bulky and increases

postage. It’s up to you. If you plan on this, collect letters early.

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VI. Contacting Jobs, Getting the interview.

A. Get your name out there ! “We’re not hiring” means “we’re not hiring today.” While having a reference is very helpful, most practices are not hiring every year. Blanket the market with your resume—if a job suddenly opens up (maternity leave, someone’s moving) they won’t call you if they don’t have your resume.

B. To whom do I send my letter? A random doctor in the practice is the lowest yield way—if that person is not a decision maker in the practice your letter may end up in the rubbish bin. If you have a name reference definitely send a letter to that person. But there is no substitute for:

a. Calling the practice first! There are two types of phone calls to make: i. Find out the person to whom you should send your letter. This can be

done with the receptionist usually. Ask the name of the practice manager (get correct spelling) and verify address. Send that person your letter even if you are told the practice is not looking. If the practice does not have a practice manager the receptionist can usually tell you who the senior doctor is. If you are outgoing proceed to step two below (not for the shy but probably better option). I was not able to do the second option (I knew I would be nervous and weird on the phone and might hurt my chances), but it didn’t seem to hurt me finding a job.

ii. Actually talk to the practice manager or decision making doctor. Introduce yourself and express your interest in any job openings. This will help them notice your letter when it arrives and show your interest. Ask to send them a resume just in case even if they aren’t looking.

TIP: Send a letter both to the practice manager and a doctor in the practice when given a reference by an attending. The practice manager will forward the letter to the decision making doctor in the practice.

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VII: Planning a Visit (Some practices plan a 1st, 2nd and even sometimes a 3rd interview.)

A. The visit a. See the practice in action (work flow, staff smiles or not) b. At the hospital (what are rounds like?) c. Socially (Do they get along?) d. See the community (drive by schools, business districts, neighborhoods, find out

about school districts, how diversified is the economy?—all one factory?)

B. The interview: In general these interviews were much easier than for residency and rarely included any “hard” questions.

a. How big a practice are you looking for? (I got asked this everywhere). Try to know the size of the practice before you talk to them so you can answer this one.

b. Are there any particular areas of pediatrics that interest you? i.e. endocrine, neurology

c. So you are a _______huh? (This is the question about your varsity tennis playing, your climbing of Everest, or whatever unique thing you listed).

d. You will be asked about any gaps or unusual things in your C.V. (i.e. “Why did you take a year off?”)

e. Are you willing to move to the suburbs? Are you willing to stay in the city? f. I did get asked once to talk about how I dealt with a difficult patient.

C. Specific Questions to ask about the practice (can be asked on a second look interview) READ THIS OVER AND DECIDE WHICH ONES ARE IMPORTANT TO YOU

a. Their Makeup i. How many? Ages? Full time vs. Part time, extenders? ii. Where did they train? Board Certified? FAAP? iii. What are their interests, hobbies, advocacy?

b. Their business i. Who owns it? Who owns the real estate? (is the practice paying rent to

one of the partners who owns the building? If so, is the rent fair or too high?)

ii. How do you become a partner? Is this a partnership tract position? (A good question to ask—it shows your interest)

iii. What does partnership mean? (More responsibility? More pay?) iv. Practice in parallel? (everyone follows their own patients) or Shared

Patients? c. WHY do they need a new physician?! d. Their Practice

i. Old school vs. New school practice style (use of handouts, extenders, internet)

ii. Where do they get their CME? iii. Do they teach? iv. Any Malpractice Suits? (Check their personal records on the state board

website). v. Triage System: Who covers daytime calls? Who covers night time calls? vi. Responsibilities: shots, treatments, sutures, orthopedics

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vii. Front Office Turnover (The front office is the most often reason patients switch practices—it’s important they are treated well, paid for experience and expertise).

e. Location i. Thriving expanding area or not ii. Satellite offices

f. Condition i. Plans for a change?

g. Exam rooms separate from offices? h. How many rooms per provider? (3 is good) i. Specialty areas?

i. Lab ii. Lactation iii. Procedure iv. Pharmacy v. Pelvics vi. Separate waiting areas vii. Conference rooms viii. Storage

j. How many patients in a typical day? i. Sick vs. well per hour ii. After hours visits—who’s responsible? iii. What are weekends like?

k. How long do rounds typically take? i. Who makes rounds? ii. Nursery and c-section coverage iii. ED coverage? iv. How many hospitals?

l. How many calls at night? i. Phone triage? ii. Charges for after hours calls?

m. How frequent is call? i. Weekdays/ weekends? ii. Who makes the schedule?

n. Who controls the flow? i. Nurse triage ii. Standing orders for some kinds of calls? iii. Incentives for seeing more patients? Or more complicated patients?

o. How are holidays/vacations handled? p. Look at the daily schedule

i. More lines for complicated patients? ii. Schedule in January vs. July (are checkups blocked?) iii. Who controls the schedule? Protocol? Physician? Nurses?

q. What is the patient base? i. Community growth vs. stagnation ii. Age of community? (building elementary schools?, new birth centers? iii. Size of practice (# of active charts)—need 1400-2000 per provider iv. Local businesses

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1. diversified vs. monopolized 2. expansion vs. downsizing 3. how many other local pediatricians

r. Patient Care i. How are patients assigned?

1. portion of newborns? (you need new babies) 2. Taking over a panel? 3. Scratch and claw? 4. THIS IS WHERE YOUR INCOME IS!

ii. How complicated are the patients? 1. Use of referral centers 2. “Don’t waste your training” 3. How accessible are specialists?

s. Charts i. EMR vs. paper

1. Any expected change? 2. If paper: legible and intuitive? 3. Loss of productivity with EMR?

ii. Organization? 1. Problem list 2. Immunizations 3. Correspondence

t. Insurance i. Diversified? Medicaid? (how much Medicaid?) ii. Who is their biggest insurer? iii. At what percentage? iv. Who negotiates contracts? v. Who sets charges? vi. How often changed? vii. Any big important negotiations coming up? (can they suddenly find

they can’t afford a new doctor?) u. Collections

i. In house or outsourced? ii. Collection percentage (should be 70-80%)

v. Hospital i. Community or referral center? ii. Pediatric equipment/staff iii. Ward/ICU iv. ED—ED attendings or you

w. CLIA, OSHA, HIPAA i. Who is responsible? ii. Any failures or fines?

x. Acceptance of new ideas i. Follow AAP guidelines? AOM, UTI? ii. As a practice or individually iii. How will your ideas be accepted? iv. What are the learning opportunities?

1. Do they share experiences, cases, expertise?

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v. Talk to younger partners/ providers (the real story)

y. Niches i. Can you carve a niche if you want to based on your interests? ii. Are you being hired to fill a role?

1. ICU specialist or hospitalist (since recently out of residency) 2. research organizer 3. gynecology (because you are the girl) 4. Talk to younger providers

z. Income—check AAMC and medical economics i. How is it earned?

1. eat what I kill? 2. salary plus incentives? 3. production based?

ii. Bonuses—production based or shared? iii. Real Estate—what are ownership options iv. Research dollars—how is money, responsibility shared?

aa. Partnership i. How long until earned?

1. Full time vs. part time ii. Buy in?

1. How much? 2. What period of time? (i.e. lump sum vs. over time)

iii. What does it mean? 1. Shared profits/bonuses? 2. Shared responsibilities? 3. Are you on your own financially?

bb.Work Week 1. 4 or 4.5 day work weeks? (the half day really tends to be a full day) 2. Static vs. flexible day off 3. Who makes schedule?

cc. Benefits 1. CME—how much time/money? Accrued vs. static? 2. Vacation—How much? Progressive? What’s the pecking order? 3. Profit sharing/pension plan 4. Credentialing, licensure, DEA

a. How much is paid for you b. Who handles the paperwork? c. Needs to be started MONTHS ahead of time…

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VIII: The Contract.

A. Finding a Lawyer a. Bar Association – look for a Healthcare Lawyerb. Word of Mouth: Below in no particular order is a list of lawyers whom were

recommended to me by various individuals:i. Robert Corrigan 713-651-5183

ii. Leonard Tatar 713-552-1100iii. Harry Scarborough 713-222-6400iv. Therese Ford 832-251-9595v. Simon Hendershot 713-783-3110

B. Finding a CPA - Personally did not use a CPA in the contract negotiations. I had a difficult time finding others in my class who had a lawyer review their contracts yet alone a CPA. I did turn down a contract because I had my suspicions that the practice was not viable and the practice was not eager to give me financial information. I did meet an individual on the interview trail whose 1st two paychecks bounced because the private practice was in bad financial standings. Below is a list of financial reports a CPA should review:

a. Profit & Lossi. Look for “fluff line items i.e. Care lease, office gifts

ii. Payroll for docs is in expense totalb. Cash Flows

i. Shows how the practice pays toward liabilitiesc. Balance Sheetd. Accounts Payable Aging Summary

i. Shows bills i.e. Is the practice late paying billse. Aged Receivable Report

i. Percentage of money due in each aging column i.e. pay attention to money beyond 60days, look at distribution among physicians

Last Updated 6/2009

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