(Pictured L to R) By Aleksandra Yakhkind, MD, Neurocritical Care Fellow, University of Pennsylvania; Pouya Ameli, MD, MS, Assistant Professor of Neurology Neurosurgery, University of Florida College of Medicine; Naomi Niznick, MD, Chair, NCS Trainee Section, Neurology Resident, University of Ottawa, Chair-Elect, NCS Trainee Section
Did you miss our first selection of Frequently Asked Questions about finding a job in neurocritical care? Here is part two, including advice on how to interview, how to ask about compensation, and what the heck are RVUs.
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Please enjoy Part Two of Frequently Asked Questions on neurocritical care jobs answered by experts in NCS.
Our Experts: (pictured L-R) Andy Fadenholz, MBA, Recruiter for Rosman Search Inc.; Angela Hays Shapshak, MD, Associate Professor of Neurology and Anesthesiology, University of Alabama at Birmingham; Ali Mahta, MD, Assistant Professor of Neurology, Neurosurgery and Neurocritical Care, Brown University; Christa O’Hana S. Nobleza, MD, MSCI, Assistant Professor of Neurology, Neurosurgery, Director, Neurointensive Care Unit, University of Mississippi Medical Center; Dionne Elizabeth Swor, DO, Assistant Professor of Neurology, Wake Forest School of Medicine; Katharina Busl, MD, MS, Associate Professor of Neurology, Neurosurgery, James E. Rooks Jr. Professor and Chief of Neurointensive Care, University of Florida College of Medicine
What are “red flags” you have seen in applicants? What interview process faux pas’ should I avoid?
AF: Lack of communication – If you interview at a program and you’re not interested, close the door professionally. Do not just ignore them. Neurology, especially neurocritical care is a very small field and the hiring person may move to a program of interest to you in the future. Try to not bring up compensation and benefits during early stages, as it normally makes for a bad first impression. Prepare for the interview. Dress professionally (even for video interviews), have questions prepared, remember to send thank you letters/emails (you would be surprised how far a quick thank-you email goes).
AHS: Interviews are to assess professionalism, communications skills, and if your vision and philosophy are a good fit for the institution. The biggest red flags are applicants who can't maintain professionalism, or communicate effectively during the interview process. Always be polite – the people who answer the phones, arrange transportation, etc. are frequently solicited for feedback. Emails, phone calls, etc. should be returned in a timely manner—24hrs is appropriate in most cases--and should be professional in tone. Communicate any disruptions in travel as soon as feasible. Don't hit on the residents or nurses (Yes, I have seen this). Don't drink too much. Having a drink with dinner is fine, but don't overdo it. I also paid attention to how applicants interact with waitstaff, back when eat-in restaurants were a thing.
KB: Be honest: About your CV, your goals, and what you seek. Don’t bend your responses to please interviewers.
When is it ok to ask interviewers about compensation?
AF: We recommend letting the employer bring up compensation, benefits, etc. There are circumstances where it is appropriate to bring up compensation during the early stages – i.e. if you have a standing offer from another program you may say: “I am very interested, but before I commit to a site visit, I want to be sure it is going to be competitive with the other offer I have. I currently have an offer from program _X__ in _X_ area. I am not sure if you can match that, but would you mind providing a range?”
AHS: I recommend leaving this until after the first round of interviews conclude. Often (at least pre-COVID), there is opportunity for a second visit if both parties are interested, and this is a reasonable point. I have generally allowed the chair or HR person to open the door to the discussion, but in terms of strategy it often behooves the applicant to be the first to put a number on the table (i.e. benchmarking).
CN: Good question. This is tricky. Some institutions have you meet a business administrator on the interview day. However, compensation is often tied to an offer letter and that offer will have the compensation. The majority of the time, you do not have to ask. Unless you find a deal breaker on the front end, I would recommend to wait until the compensation package is given to you.
How much should I negotiate?
AF: You normally get one shot to negotiate the contract. We recommend creating a list of your non-negotiables (If you can’t change this, I cannot accept the offer), would be nice to have (if this is not changed, I would still consider the offer), and could you clarify or have any flexibility (even if this is not changed I am likely to accept but wanted to ask). There are certain things in agreements that are system wide and no flexibility to change.
AHS: Never take the first offer.
AM: Flexibility of payment depends on several factors: academic vs private practice, location, how much clinical work is expected vs expectations for research/grant support. You should clarify this if you're looking for academic job.
CN: Compensation is a complex concept. Factors that go into it are the compensation model, the fair market compensation, the number of shifts you are expected to work, other effort allocation and other sources of funding like grants. None of these factors should have anything to do with your gender. The general "rule" for negotiation is to ask for about 10-15% more than what is offered, knowing that some organizations do not negotiate salary. You can also negotiate for things like equipment or time. The NCS compensation survey has good information on the salary range based on years out of training.
Do I need a contract lawyer?
AF: We always recommend having a Medical Contract attorney review the agreement (not a friend who does real estate law). The job of the attorney is to make you aware of anything that you need to be concerned about, not word smith the agreement. Again, there are certain things in most contracts that will not be changed. You should always be the one who brings the concerns to the employer.
AM: I personally don't think it’s necessary, but people do it, particularly for private practice settings.
CN: Yes, if you do not have a good understanding of the terms of the contract. There are details that may allow the employer to change what they ask from you. For example, unlimited coverage, assigning you to another location, adding telehealth without compensation, not sponsoring your green card, etc.
KB: The general notion is that for private practice, it might be advisable, but for academic places with generic contracts, a contract lawyer may not be to offer much. In the end, you will have to be comfortable with your decision, and a contract lawyer might add to this, or not.
What are RVUs and should I care about them?
AF: It is important to understand how the agreement is structured and if your compensation is based on productivity. We normally see inpatient neurologist have a guaranteed salary with some productivity or quality-based bonus structure. If you are going to have a productivity component to your compensation, be sure that your expectations and the expectations of the hospital are discussed.
AHS: Yes, you need to care, but how much depends on how your contract is structured. RVUs (relative value units) are a measure of how a physician spends his/her time, that translates into payments from CMS or insurers. Your institution likely has an idea how much a neurologist or intensivist should be paid for an FTE (full time equivalent) and how many RVUs that person should generate. If your RVUs >> than expected, you might be eligible for productivity bonuses; if your RVUs << expected, then they are going to want to know why. Sometimes the answer is documentation/billing, sometimes it's the patient population (lots of routine post-ops taking up your beds), etc. But it does have implications for raises, bonuses, and contract negotiations.
AM: I don't think RVUs are important for job interviews per se. At least, they're not so important for academic positions.
KB: Important concept to read on and understand, at least in part. For a job, it’s important to know whether your salary is contingent upon RVUs. Even if not, it is still helpful to understand the concept, to give you an estimate of your workload based on standardized expectations.