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							        Michigan Chapter-ACC
The Michigan Cardiology Fellows Society


 What you REALLY Need to
Know Before You Get a (Real)
            Job

            April 20th, 2005
   Michigan Cardiology Fellows
             Society
• Founded in 1990 by Betram Pitt, MD and
  Scott McCallister, MD
• Represents cardiology fellowship programs
  throughout the state of Michigan
• Mission
  – Expand medical knowledge
  – Broaden professional and personal ties within
    the medical community
        Previous Symposiums
• Starting Your Medical Career: Practice Choices,
  Tom Haselschwerdt MBA, 12/94
• Cardiac Pacing 1995, Stuart Winston, 12/95
• Advances in the Management of Pulmonary
  Hypertension, Stuart Rich, MD 5/97
• Debate: Primary Angioplasty is Superior to
  Thrombolysis for the Management of AMI
  William O'Neill, MD vs Eric Bates, MD, 5/00
       Michigan Cardiology Fellows
              Council 2005
•   Brett Eliuk, DO, Garden City Hospital
•   Bischan Hassunizadeh, MD, Providence Hospital
•   David Kenigsberg, MD, Henry Ford Hospital
•   Christopher Mackey, DO, Botsford General Hospital
•   Laxmi Mehta, MD, William Beaumont Hospital
•   Sanjeev Sanjeev, MD, Children's Hospital of Michigan
•   Hamid Sattar, MD, Wayne State University
•   Andrew Teklinski, MD, St. John Hospital
•   Thomas Tsai, MD, University of Michigan
             Supply and Demand
• Quotes from the popular press:
   – Journal of the American College of Cardiology in 2000 estimated that this
     cardiology shortage would become widespread during the 2010s and
     2020s as heart disease strikes the aging baby boom generation at the same
     time baby boomer cardiologists are retiring.
   – 2002 ACC Survey:
       • 97% of recruiters say it's "very difficult" or "somewhat
         difficult" to fill cardiology positions.
       • 83% of resident program directors believe that job
         opportunities for their senior cardiology fellows are excellent.
       • 77% of program directors would expand their first-year slots
         by an average of 1.8 positions if funds were available.
I Want You!
             Deciphering the Ads
• Cardiology Opportunity in Tennessee!!
   – Need: Interventional Cardiologist
     Excellent Community - Voted one of the Nations Best
     275K First Year with only
     2 Years to Partner
     Production Incentive Plus Bonus!!
     1:7 Call - you have the following day off
     The Group Owns their own Sleep Center
     as well as their own Ancillary Center
     Each Cardiologist Received a Large BONUS last year
     5 weeks Vacation First Year, 8 weeks Vacation Thereafter
     Pay is based on a Productivity Model
     30% of the income is split evenly and the other 70% is paid out based on
     production
     1:7 Call with the next day off
     University Town, Resort Community
           We need data…..
• Survey
  – Graduates from 10 cardiology training
    programs in the state of Michigan from 2000-
    2004
  – 130 legitimate e-mail addresses
  – 30 responses (23%)
Web-based Survey
                  Results
• What is your current job setting?
  – Academic    36.7%
  – Private     63.3%
                       Results
• What is your subspecialty?
  –   General            4/29 (14%)
  –   Interventional     14/29 (48%)
  –   Pediatrics         5/29 (17%)
  –   Echo               5/29 (17%)
  –   EP                 3/29 (10%)
  –   Non-invasive       6/29 (21%)
                  Results
• My fellowship prepared me adequately for
  my job search?
  – Strongly Disagree   20.7%
  – Disagree            27.6%
  – Neutral             27.6%
  – Agree               24.1%
  – Strongly Agree      0%
• Average 2.55
                  Results
• I had a fellowship mentor who helped me
  with my job search
  – Strongly Disagree   24.1%
  – Disagree            41.4%
  – Neutral             6.9%
  – Agree               6.9%
  – Strongly Agree      20.7
• Average 2.59
                  Results
• I am happy with my current job
  – Strongly Disagree   3.5%
  – Disagree            3.5%
  – Neutral             13.8%
  – Agree               41.4%
  – Strongly Agree      37.9%
• Average 4.07
                  Results
• My job meets my expectations
  – Strongly Disagree   3.6%
  – Disagree            7.1%
  – Neutral             14.3%
  – Agree               35.7%
  – Strongly Agree      39.3%
• Average 4.0
                  Results
• I was comfortable with the contract
  – Strongly Disagree   3.5%
  – Disagree            6.9%
  – Neutral             24.1%
  – Agree               37.9%
  – Strongly Agree      27.6%
• Average 3.79
                  Results
• I felt well prepared for my interviews
  – Strongly Disagree   6.9%
  – Disagree            10.3%
  – Neutral             27.6%
  – Agree               48.3%
  – Strongly Agree      6.9%
• Average 3.38
                    Results
• What played the biggest role in your
  decision to join a group
   – Location                   43.3%
   – Salary                     0%
   – Vacation/Call Schedule 6.7%
   – Other/Specify              33.3%
• Others-Academic opportunities; partnership; part-
  time work; member philosophy, supportive
  partners, advanced interventional training
                   Results
• I hired a lawyer to review the contract
  – No     69.0%
  – Yes    31.0%
                   Results
• I negotiated the terms of my contract?
  – No     44.8%
  – Yes    55.2%
                    Results
• How many practices did you interview
  with?
  –   1-3   55.2%
  –   4-5   24.1%
  –   6-7   13.8%
  –   8-9   3.5%
  –   >10   3.5%
          Take Home Points
• >70% of graduating cardiology fellows do
  not feel well prepared for their job search.
• >75% of graduating cardiology fellows are
  happy with their current jobs
• Location and “camaraderie” play the
  biggest role in the decision to join a group.
                      Results
• What questions did you forget to ask that you
  now wish you did?
  – Protected time?? What happens if I don’t get a grant?
  – Financial aspects of the practice, ins/outs of partnership,
    how insurance contracts were bargained
  – Is call schedule, vacation, and new patients divided
    equally? Do I get an equal voice?
  – Buy in to practice or building, contract termination
    provisions
  – What is biggest problem facing the group right now?
  – A more specific breakdown of day to day responsibilities
  – Bonus compensation formulas
                       Results
• What intangibles did you neglect to think
  about during the interview?
  –   General office expenses, computer
  –   Bonus pay before partnership
  –   Dynamics of the personalities of the group
  –   Non-partnership track
  –   Commute times
                           Results
• What is your biggest complaint of your current job
  choice?
   – A lot of driving
   – Salary, vacation, staying behind to take call for senior faculty during
     meetings
   – Poor electronic records, poor office management
   – Reimbursement less than 50% in this region
   – Have to practice medicine that is not evidence based, too much
     driving, being junior partner means always having to defer to the
     wisdom, judgment and business savvy of the senior partners. Having
     to put up with PCP’s who are practicing medicine from the 70’s.
   – Protected time for research is not really protected. Clinical
     responsibilities use up research time too often.
   – We are growing really fast and it has caused some stress…we’ve
     outgrown our own management/decision-making infrastructure
                        Results
• What is your biggest compliment of your
  current job choice
  –   Variety of care, CCU, Cath, Clinic, etc
  –   The ability to be involved in the direction of the practice.
  –   Fixed hours
  –   Flexibility
  –   Great partners, great partners, great partners.
                           Results
• What critical questions should be asked before
  accepting a new job?
   – Expectations of the group in terms of work schedule (call, CME
     time), vacation, salary (bonus), retirement plan, and partnership
     track.
   – Don’t be bashful about asking specifics regarding long term salary
     structure
   – Do I want to be a highly paid fellow or do I want autonomy?
   – Are all partners treated equally?. Partnership after the stated period of
     partnership.
   – Power structure
   – Ask the question: Daily schedule/call/travel/incentives/independence
     in patient management/expectations from the group
                                Results
•   What would you have done differently if you had it to do all over again?
     – Negotiate, negotiate, negotiate
     – I would have tried to talk to some of the staff at the hospital to find out what the
       group was really like to work with. This is really hard to find out in an interview,
       but any remotely negative vibe needs to be taken seriously.
     – Interviewed more
     – Ask for clear bonus formula, and to calculate the bonus and incentives
     – Had a grant in hand before applying
     – Ask other groups in the community about the group I am interviewing with. The
       character, personality and integrity of the individuals in the group and whether
       they are “team players” and “easy going”
     – Not to involve my trainers in obtaining their questions, seek unbiased physicians.
     – Not to seriously interview with two competing practices in the same town. Too
       complicated.
     – Would have hired a lawyer.
     – Interview in a greater geographical range, spent more time in fellowship getting
       the COCATs requirements.
                           Results
• Additional Advice
   – Ask lots of questions, nothing is off limits.
   – Don’t “settle” for a job out of fellowship. If it doesn’t feel right, it
     won’t be.
   – Don’t always look for the big dollars initially. Look for future and
     security of the position you are taking. You and your family matter
     most.
   – Everything you want in the contract needs to be WRITTEN in the
     contract.
   – Especially for women, figure out what your needs are first.
     Remember kids are only little once, work will always be out there.
     Be willing to compromise but don't short change yourself. You can
     always negotiate yourself OUT of a contract. Make sure your
     commitment is only for a year so if you're not happy, you have a way
     out. Salary is not always the most important factor. You also want
     to work with good people who practice good medicine. Good luck!
                     Results
• Additional Advice
  – Discuss job details, salary, calls, vacation and practice
    patterns with other interviewing colleagues at your
    institute and at different meetings. This is where you
    learn the most and even with limited interview experience
    you will learn to bargain more as you will know about a
    lot of different practice patterns and offers out there.
  – Choose a group whose philosophy of patient care and
    "doctor care" (i.e., what makes them tick) matches yours.
    When I had my first dinner/interview the casual
    conversation that went on all around me was about
    family, community, and personal passions, not who had
    the newest Mercedes or Lexus.