A reference should provide an honest and detailed assessment of an employee's current professional and interpersonal skills and his prospects to a potential employer. It can be provided in standard letter form, template evaluation, or verbally, either in person or over the phone, but many references these days are provided by email. They are often the deciding factor for an employer choosing among candidates, and those agreeing to provide references must recognize the inherent responsibility in that.
I have found that reference issues can arise with even the most marketable of candidates. The most prevalent problems are difficulty with gathering references in a timely way, cookie-cutter references that could have been written about anyone, unusually short and incomplete references, and those that omit the relationship with the candidate and contact information.
Most graduating residents approach the residency director, the department chair, and a faculty member for references. Although some pay special attention to the progress of every resident, those department chairs are the exception rather than the rule. A prospective employer may expect this reference, but a new graduate shouldn't expect it to be his major sales asset. The strongest reference for a graduating resident comes from the director of the residency program.
When choosing a faculty member, a graduating resident should select the instructor who has had the most influence on him and is most aware of his growth and performance as a physician and an individual. That a faculty member is your favorite basketball partner should not be a deciding factor. Choose someone who is intimately aware of your work, growth, and strong points who can explain how you overcame any weak points. If you are academic faculty seeking a reference from a colleague, the same rules apply.
Neither graduates nor experienced job searchers should ignore department heads and faculty from other medical departments with whom they've had positive and significant interaction. These references demonstrate your ability to work well within the medical community, not just emergency medicine and your ability to handle consults.
If you are a graduate, another strong reference source is the director of any department where you have contributed a minimum of 100 hours of moonlighting. Positive commentary from an employer where you work in a paid, unsupervised capacity packs a much bigger punch than the usual faculty reference. It states that the physician has gained significant experience in the real world, and has weathered the transition well. Moonlighting references also reassure prospective employers about a candidate's ability to contribute at a higher level in a shorter period of time than the average graduate with no paid experience.
One candidate I know won a hotly contested position on the weight of one reference, and it came from the ED nurse manager. Of the hundreds of candidates with whom I have worked over the years, only a few have thought of the nurse manager for a reference. A strong consideration to any prospective employer is a candidate's ability to work well with nursing staff. A positive detailed reference from a nurse manager will nip those doubts in the bud. If you have a stronger working relationship with a nurse in the department who is not the nurse manager, she can give an equally compelling reference, and you shouldn't hesitate to use her.
Everyone, not just graduating residents, should attempt to be more creative when it comes to choosing references. You absolutely need three, but four or five is better. Like prunes, however, eight or more are too many unless you are going for a chairmanship. Of course, for graduates, the residency director and department chair references will always be required. More experienced physicians leaving one job for another will have to provide supervisory and colleague references, but the other two or three can be more adventurous. Don't ignore the possibility of using a personal or character reference. I'm not talking about the waitress from the diner across from the hospital but someone of importance within the business sector, the community, or even the clergy, who has known you for a long time and can speak of your good character. Family members don't qualify; they usually have to say nice things.
Next month: How to ask someone for a reference, what should be included, and how to overcome potential reference problems.