It never fails. Every year graduating emergency medicine residents go out into the market with the best of intentions to search for jobs that fit their professional and personal goals and wham! A large number of them end up getting sucked in by dazzling dollars or a dog-and-pony show that would make P.T. Barnum blush. As a result, at least 60 percent of graduates leave their first jobs within two years. The trouble is, by the time enough years have gone by for them to learn from the school of hard knocks, many are so embittered and lacking in trust that they lose the ability to recognize and appreciate a good opportunity when it does arise.
Poor first job choices can have a long-term negative effect. Because many residency programs provide little to no career guidance, it is up to physicians to educate themselves. One of the best ways to avoid a career of missteps is to set goals and stick to them throughout the search process, not allowing yourself to be blinded by a buck, a beach, or a title.
All hail the almighty dollar! It's astounding how a previously intelligent, sensible individual with defined goals and a strong career plan can be reduced to a quivering greed machine with short-term memory loss at the first sight of big numbers behind dollar signs. All of a sudden, brain functions cease to operate, and all senses are overwhelmed by the smell of money. When presented with uncommonly high dollars in a potential income package, the smart response is not “wow,” but “why?” What's the trade-off?
If a group or facility is offering uncommonly high income for its region, there is a reason, and it is usually not a positive one. Some groups keep their coverage low so the partners can see a larger piece of the profits, a high-risk scenario and one to be avoided unless you want a one-way ticket on the malpractice train. An environment like that also would serve to increase stress and physician burnout. Another reason for uncommonly high compensation is location. There are areas of the country that don't make the “Best Places to Live” list by a long shot.
If an employer doesn't have anything to offer from the lifestyle angle, they may be reduced to “buying” physicians with higher potential incomes. Still other employers create dangerous environments of competition between their physicians by offering bonuses and income strictly based on billing/RVUs, without applying any safeguards or structure to patient and physician assignment. I'm not saying there is anything wrong with searching for a job with the highest possible income as your first priority, as long as you fully understand and are willing to accept the potential risks. Just don't be blinded by a buck. Take off the green-colored glasses, and examine the entire picture, as well as the price you will have to pay to earn it, before you sign on the dotted line.
“Come live and work in paradise! Frolic with the dolphins and sip piña coladas while enjoying breathtaking sunsets on pristine, white sand beaches. Call for an interview at….” We've all seen them. They're called “come-on” ads, mostly run by recruiters to entice physician candidates to contact them. When you see a job posting like this, rarely will you see any significant details about the job. That's because either there is no real job and they are simply trying to wrangle physician candidates for other jobs they need to fill, or the job is so lousy the specifications would be a turn-off.
The cautionary tale here is simple. When you are surfing the net or classifieds for job opportunities, make sure the actual position is the target of your search. In other words, search with your time spent working as your primary focus, not your time off. Don't let yourself be sucked in by sparkling water. Never forward your CV to an employer or recruiter without first getting solid details about the facility, the department, and the position being offered. Don't, however, expect an independent recruiter to spill the beans on who the employer is or specifically where without your forwarding a CV. Once you have that information, there's nothing preventing you from contacting the employer directly, completely cutting out the recruiter they've hired.
Any reputable recruiter knows about protecting his interests from “job shoppers” or someone posing as a candidate to learn confidential information. And, surprise, surprise, most employers will not appreciate your circumventing the screening agent they've chosen. A professional recruiter will provide enough detail in a job listing and on the phone to allow you to make an informed decision about whether you want to forward your CV, without revealing the specific client until they've received it. On the other hand, there are some unscrupulous types out there who will use your CV without your permission to lure employers to use their services. Be stingy with your paperwork and only provide it to those you believe will utilize your CV for a solid, viable employment opportunity.
Every year a few grads come out of residency convinced they are ready to run the show. While I applaud those hearty souls who want to pursue an administrative career, I shudder at those who are not willing first to learn the vast variety of business skills necessary to helm an ED. Fortunately, administrative fellowships are cropping up around the country, but even they do not have enough training to step directly into a commander's role. Why, you might ask, would any hospital hire a graduating resident as a director? The answer is quite simple; it's called desperation. My experience has shown mostly smaller, rural hospitals with nothing much to offer a residency trained physician may try to appeal to a physician's ego by offering a directorship to any graduate willing to put his ego ahead of his good sense. Unfortunately, the results are nearly always disastrous, and most physicians who bite the extended apple never really recover from this major career blooper.
Anyone seeking an administrative track should be concentrating on a sizeable group with growth potential and administrative/business training. It also can help to find a department director who is willing to act as a mentor, and who is known to delegate responsibilities to worthy physicians. Not everyone is cut out to be a director, and it can be a very tough road from a failed administrative career back to a clinical one. Every subsequent interview begins with the same question, “What happened?” Like any other profession, emergency physicians need to pay their dues to move up the career ladder so don't let your ego get in the way of your good sense. Titles will come if and when you earn them.
Perhaps the important word to use here is patience. Careers are not built in a day, and poor judgment can haunt you for years. Use your head, and remain true to your goals.
Emergency Medicine News welcomes opinion pieces from physicians on any topic related to emergency medicine. Articles should be about 800 words, and submitted if possible by e-mail. Contact: Lisa Hoffman, Editor, Emergency Medicine News, 333 Seventh Ave., 19th Fl., New York, NY 10001; firstname.lastname@example.org.