There are many reasons for a really good job to become a really bad job, anything from financial issues and administrative personnel changes to the group's leader leaving and the ED contract changing hands. Whatever the reason, the result is the same. Trust is broken, and a physician can experience what I call Post-Traumatic Stress ED-style or PTS-ED.
I have found that the less experienced the physician, the more drastic the case tends to be, particularly if it happens during the first job out of residency. The symptoms are quite obvious to a recruiter. Instead of looking for opportunity in a new job, these doctors are seeking a cure for what ailed them in the old job. Calling them gun-shy doesn't even begin to cover it. The tragedy with this syndrome is that the negativity of the physician comes through in interviews and spooks prospective employers. What director wants to be saddled with the responsibility for erasing the sins of a previous employer?
If you're one of these physicians, you have good reason to be disgruntled and distrustful, but to move forward effectively and find a great job, you first have to find a cure for your PTS-ED. Over the years, I have developed an effective formula for treatment: the 4/5 Exercise. It is comprised of four lists and five decisions, and this is how it works.
This exercise should include the input of your spouse or significant other. If you don't have one of those, you may want to bring in a friend or colleague to help with the process. The key to performing this successfully lies in the Godfather films: “It's not personal; it's only business.” Keep emotions as far out of it as possible. The exercise begins with the lists.
List 1. The What-Was-Right List: To understand what went wrong, you first have to remember what was right about the job when you accepted it. Make a detailed list of the things that made the job a good one, the things that spurred you to accept it in the first place. Then put it aside.
List 2. The What-Went-Wrong List: On another page, list all the things that made the good job go bad. Be detailed, name names, make it big, yell at it, stomp on it, tape it to the wall and throw darts at it, burn it in your backyard grill, and then get over it! This is your mourning period, an opportunity to dump the emotional aspects. Once done, you don't need this list or its content anymore. You are moving on.
List 3. The Must-Have-List: Using List 1 as a guide, begin the reconstruction phase of the exercise. Create a list of all the elements you must have in a new job to make it attractive enough to sign a contract. These things can include a volume range, coverage stats, peer qualifications, availability of certain technology, availability of subspecialty opportunities like EMS or administrative duties — whatever you require in a job. Don't ignore lifestyle issues. This is where your significant other's input really comes in. Define your geographic borders, and list the lifestyle elements of primary importance to you, everything from schools to recreational opportunities. This list will be your guide for the decision-making portion of the exercise.
List 4. The Like-to-Have List: This is your wish list. It's all the things you'd like to have in a job but don't necessarily need to sign a contract. It will be useful when it comes to comparing opportunities and offers later in the exercise. Just keep it reasonable and at least on the periphery of the real world; forget the Jacuzzi in the locker room.
The Five Decisions
Physicians suffering from PTS-ED tend to expect guarantees. They want all their questions answered before they set foot in the facility, and they want the answers guaranteed. Unfortunately, life doesn't work that way. I've found that the best way for these physicians to approach a job search is to compartmentalize. Take it one step and one decision at a time using the decision portion of the 4/5 Exercise.
Understand that job searching is a process of discovery as well as a process of building trust. You won't get all your answers on first contact even if you are working with a professional recruiter. There are some questions that can't be answered verbally. They must be felt in the gut and seen with the eyes, and a thorough site interview is the only way to get those answers. The five decisions are the best way of effectively accomplishing the process of discovery and the process of building trust.
Decision 1: Is it interesting enough to start the process? Whether you're job searching on the Internet, reading the classifieds, or working with a recruiter, your first decision is the one that determines whether a job description that's caught your eye is worth pursuing with an initial contact. If the decision is no, move on to the next one. If the decision is yes, make initial contact with a phone call or email. The information you generate from initial contact will lead you to decision 2.
Decision 2: Is it interesting enough to submit a CV and do a phone interview with the director? This one determines whether you submit your CV on a position and get the ball rolling. Use your must-have list as a guide. It is essential to realize that your mission is to communicate with the people at the top. Only they have the details that can help you complete this portion of the exercise and move to decision 3. Remember, your confidentiality is assured so don't be afraid to move forward.
Decision 3: Is the phone interview information interesting enough to schedule a site interview? Once you've had a phone interview with the physician in charge of the group or department, you will have answered all of the employer's questions and had your own queries responded to as well. This is when you decide if it is worth your time to visit the facility in person. If the answer is no, be honest and say so. Be polite, give specific reasons why, and thank the person for his time. If the decision is yes, be prepared to provide potential dates that work for you and your significant other (if applicable).
Decision 4: Is the site interview experience good enough to consider an offer? When you visit the site and meet with the members of the department and administration, don't forget to take notes. Use your lists. They will help you objectify the experience and collect your thoughts. If you decide you want an offer, let them know either verbally before you leave or in a thank you letter shortly after returning home. If you decide the position is not for you, call the principal hiring authority, and once again, be polite, be specific, and thank him for the opportunity to be considered.
Decision 5: Is the offer good enough to accept? Having followed the steps, if you are made an offer, the decision should be a fairly easy one. If the answer is no, you've lost nothing. If it's yes, congratulations!