By Jennifer A. Kim
After putting in so many years of studying, then blood, sweat and tears into residency and fellowship, it’s finally time to apply for a job! But, having only experienced life transitions in applications and matches, the job search process is daunting. Despite having extensive training, the logistics and “business” of job hunting can feel mysterious. To help alleviate those anxieties, Dr. Karen Hirsch, medical director of neurocritiacal care at Stanford, shares her advice. (Note: The interview has been paraphrased for brevity.)
How should applicants approach the job search?
There are some initial major decision points, including whether you want academic or private, if you have geographic limitations or visa/immigration issues. The NCS website is a good place to start and most positions are posted there, but some are by word of mouth. There are also headhunters who can help. And, no matter what, definitely utilize the network. You know a lot of people in neurocritical care, and they know a lot of people, so let them/us help you!
How are most job selection processes conducted?
First, places identify a need, such as clinical staffing for a new program, growing a research infrastructure or expanding to meet Joint Commission requirements. In academics, the division or department will then work with a finance person to figure out a business plan that includes the cost of the hire (e.g., salary, benefits, relocation, etc.) and the anticipated productivity. Productivity can be money generated from clinical work or from research and administrative activities. Clinical productivity targets are usually based on national and local benchmarks and compared to existing faculty. Positions are usually described in terms of a full-time equivalent (FTE), where a given position is 1.0 FTE and can be divided accordingly by activity (e.g., 0.5 research, 0.5 clinical). Once a description of the position is determined, hires can proceed with internal candidates or through a broad search. Many institutions have a requirement to advertise a position to solicit applications. Additionally, an applicant can always try to build a position even in a place that may not be actively looking if you can show you would be a value-added hire.
Once you’ve identified jobs, you then apply through the job posting. This leads to a phone interview in which you discuss factors that are important to you and what the institution is looking for, after which you may be invited for an in-person interview. The first interview is meant as a mutual evaluation to see if both the applicant and the institution feel it is a good fit. Usually an institution interviews multiple candidates. Candidates should try to interview at between three to seven places depending on their circumstances. Even if you think you are set on a given position, it can be helpful to interview other places to learn about different positions and models, network and develop interview skills. During the interview, you are often expected to give a job talk in which you will present your current work and to comment on your future role and goals. This is often a research-focused talk but can focus on quality improvement, programmatic development or educational activities as well. The institution will then invite one or two candidates for a second look. This is when you usually go through the details of the job offer, which you then negotiate. Once the candidate and institution agree on terms, then an official offer is made and the contract is signed.
What should an applicant focus on to see if a place is a “good fit”?
The main thing to get at the first visit is to see how the position is structured (e.g., which department are you in, who do you work for, what are your responsibilities, who supports you [residents, fellows, advanced practice providers, admins], etc.) and what the expectations are (e.g., grant funding or university-paid salary, educational/teaching commitment, administrative work, call load, procedures, etc.). One important aspect is the role of the NCC team in the greater hospital/university setting — are they respected, where can you make an impact as junior faculty, what is the relationship between other services/ICUs. This is especially important in places where the NCCU is relatively new. See if your career vision matches the vision and direction of the place you are interviewing.
What are the different components of a job offer that applicants should consider?
There are many parts to a job offer that the applicant should be aware of, the details of which are usually addressed in the second look. This is when an applicant gets into the nitty gritty of expected service weeks, a start-up package, research plan (if applicable) and meeting with the division chief, chair, admin, figuring out office/lab space, etc. Negotiations then often continue after the second look. It is important to get many of these terms in writing. For instance, with service time expectations (i.e., weeks and weekends), clarify clauses like “contingent upon needs of a division” to determine if there is a hard cap or not. For salary, what are RVU productivity expectations, what happens if you don’t meet targets and how are bonuses calculated? For instance, you may want to have a guaranteed base salary that accounts for the bulk of your income regardless of how busy your clinical service is, versus an “eat what you kill” model where your clinical productivity is tied directly to financial reward. Most jobs use a combination of a guaranteed base plus incentive pay based on clinical productivity.
This is the time to ask for sign-on and/or relocation bonuses and clarify what counts toward your FTE calculations beyond clinical time (e.g., teaching, QI, etc.). Physical and personnel resources are important to determine: office space, computers, admin support, medical license/board/DEA cost coverage, educational funds (including professional development/leadership training). If you are negotiating a start-up package for research, then determine the space, equipment, time on shared equipment, and lab personnel hiring and resources. Be sure to clarify what your grant writing, teaching and/or administration expectations are. For instance, is guaranteed salary support for a limited number of years after which time you are expected to support yourself with a grant? Will you be expected to take on teaching or major roles in fellowship/ residency program administration?
While everything is technically negotiable, there may be restrictions based on division, department or hospital policies. It is also important to understand whether there are different faculty tracks and what those imply regarding promotion criteria. Finally, understanding how funds flow may give you some insight into negotiation strategies.
Who do you do talk to regarding the business logistics?
Usually, you talk to the division chief and/or department chair and the business person (department financial analyst) during your second interview. The department financial analyst can sometimes help clarify how the department is structured and the ways in which financial allocations are made. Once both parties agree on the terms of an offer, the offer is usually still nonbinding until you go through background checks and credentialing, then finally a contract can be signed.
Should you have a lawyer review your contract?
Generally speaking, yes. This is particularly important if you are going into private practice. They will help you understand terms like “noncompete agreements” (i.e., you can’t practice within a certain radius if you leave) and “tail coverage” (i.e., how long after leaving you are covered by medical malpractice). However, in academics, many terms related to these types of things are nonnegotiable as they are standardized at the university level.
Advice for how to approach the negotiation?
Don’t be afraid to negotiate, but do it politely. After all, these may be your colleagues (and boss) in the future. Ask lots of people for advice, both at your own institution and outside as to what the process is like and what are reasonable targets. If you are asking for something, try to frame it to the institution in terms of how it will benefit them, as well.
What are the differences in job search logistics for academic versus private practice?
Make sure you understand the hospital or practice model you are getting into. Again, understanding how funds flow will impact your salary and other resources. In private practice especially, it is important to determine what the coverage expectations are if you get sick, there is a malpractice suit, etc. Private practice is often based on high clinical volume and can be a high-stress environment, so knowing what support exists and how your colleagues have shown support for each other in the past is important.
Any parting words of wisdom?
Ask lots of people about their experiences and for their advice. Then take it with a grain of salt and figure out what sits best with your goals. Also, educate yourself about the business end of things. Doing so will allow you to navigate the process more easily. Good luck!
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