Finding your first job can be a challenge for early-career clinicians. Luckily, Endocrine News talked to some seasoned pros with advice on how to find a setting that appeals to you, your family, and your professional goals.
What’s the best way to find a clinical position as an early-career endocrinologist? Flexibility, focus, and knowing what drives you and makes you happy.
“When advising someone, you’re trying to understand how they see their future careers and, as much as possible, keep as many doors open along the way,” says Stephen M. Rosenthal, MD, a professor of pediatrics in the division of pediatric endocrinology and the medical director of the Child and Adolescent Gender Center at the University of California in San Francisco. “At the early phases of your career, you are potentially exposed to the great breadth of what endocrinology is. Given that you’ve made the choice of endocrinology, you have almost limitless opportunities to find out what excites you.”
Know Your Choices
Clinical positions exist in academic, medical center, and private settings. Each has different attributes.
“When working in a purely private setting, there is probably more autonomy than there would be in a larger work environment regarding patient flow and hours,” says Howard B.A. Baum, MD, associate professor, Division of Diabetes, Endocrinology, and Metabolism at Vanderbilt University Medical Center in Nashville, Tenn. “There are probably fewer opportunities for teaching or research; you would have to do outreach to pharma or academic settings to make that happen.”
In an academic setting, the physician will have less responsibility for staffing, hiring and firing, purchasing, furnishing an office, while “there are typically more opportunities to interact with trainees and you can find opportunities for research,” Baum says.
For physicians working in a private setting as an employee of a hospital, “it’s sort of a blend: some administrative details are handled by someone else and you can engage in the full-time practice of medicine; though, it’s not easy to engage with trainees or research,” he says.
“At the early phases of your career, you are potentially exposed to the great breadth of what endocrinology is. Given that you’ve made the choice of endocrinology, you have almost limitless opportunities to find out what excites you.” – Stephen M. Rosenthal, MD, professor of pediatrics, Division of Pediatric Endocrinology; medical director, Child and Adolescent Gender Center, University of California, San Francisco, Calif.
When choosing where to work, consider geography, your family’s or partner’s needs, and the merits of a particular program or location. “When you look at it, what strengths come to mind,” Rosenthal says. “I don’t think every center can be outstanding in every area. Are their strengths aligned with your interests? What is their reputation and the track record of the people on faculty there? Do they have an established mentoring program? Do they do committee work in things like professional societies? Is there a consciousness about the pipeline?”
Also, what about the money?
“For some people, finances have an influence on the choices people make,” Rosenthal says. With some carrying significant prior educational debt, cost of living and salaries can be a major factor. “Some people might really want to be in a place and say that money isn’t everything. But for others with a huge burden of debt, they need to find something that will work for them.”
Do Your Research
Once you have a sense of what you want, talk to others to find out what they offer and who they know, especially your mentors and prior graduates in your specialty, residency, and/or fellowship. They will have professional and personal contacts all over the country and may even recommend you for particular programs you are interested in, Baum says.
Talking to people a year or two ahead of her professionally was vital for Kelsi Deaver, MD, an adult endocrinologist at the Denver Endocrinology, Diabetes & Thyroid Center in Colorado. “Even if they aren’t hiring,” she says. “Doing so helped me get a lay of the land for job opportunities in my area, and eventually put me in contact with my current employer.” She also cites the importance of touring a program or employer’s location, talking to the support staff, and asking about turnover rates and noting whether people seem to be enjoying their jobs.
When you’ve landed a new position, you’ll typically receive an employment contract detailing the parameters of the job. Points typically include what your work schedule is, who determines it, how compensation be determined, and whether there is the opportunity to benefit financially from taking on a more demanding patient schedule versus working for a flat salary, according to Baum.
Other elements may cover include the parameters for being named a practice partner, whether there is a buy-in element, and who would determine the value of the practice at the time of the buy-in. Deaver cites other possible benefits such as loan payback, relocation assistance, CME funds, vacation time, and 401k matching. Additionally, find out how many patients you are expected to see in a day, whether there is protected time for patient calls or administrative work, and what support services (such as a medical assistant, scribe, nurse, ultrasound, lab/cytology tech) are available. Finally, ask whether malpractice insurance is included and if tail coverage will be provided if you change jobs.
“All of these are things a good healthcare attorney would be familiar with,” Baum says. “I think an attorney should always be part of the process for any big life change, especially if it will affect your livelihood for the next several years.”
To find an attorney, ask colleagues, family members, or other career connections for recommendations. “Even if something is standard in a contract, it might not be standard for you,” Baum says. “Everything is negotiable.”
Yet, negotiation can vary depending on the type of system you join, Deaver says, adding that large hospital groups are much less likely to alter their contracts, while a private group was more likely to do so. “I met with an attorney and found that no matter what changes he suggested, the corporation was unwilling to make adjustment to their standard contract,” she says.
“You can learn more about contract negotiations and the business of medicine at websites run by the American Medical Association, the NEJM Career Center, and especially at conferences like the Endocrine Society,” Deaver says. “I learned countless tips from these meetings and from talking with recent graduates. Stay eager, flexible, and optimistic during this challenging time!”
Ultimately, knowing your own wants and needs will serve you best. “What makes you the happiest and most productive person,” Baum says. “It sounds fundamental, but even though I got messages about what to do or where to go for prestige as a young trainee, I ultimately figured it out.”
— Alkon is a Massachusetts-based freelance writer who is the author of the book, Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom, Healthy Baby. She wrote about inspiring patient loyalty in the January issue.