Sometimes I’m asked what the future holds in physiatry needs. When one considers that the vast majority of physiatry residents are going into interventional fellowships, one might conclude that the market demands this service and it is being satisfied. On the other hand, we may be at a saturation point of interventional specialists. One might also conclude that the need for inpatient physiatrists is growing even though some rehab units and facilities have or are in the process of closing.

The upcoming election will have a strong impact on the future needs. With Obamacare, one might predict very large health care systems like Kaiser. Either way, the matter of economies of scale predict large physiatry health care systems and large physician groups. Everything seems to be consolidating. Some solo practitioners have called me looking for work as it’s too dificult to maintain referrals and deal with the business side of the practice.
My stance is to provide a variety of services so that you are not affected by the downturn of any particular service. Census’s vary, the ability of private payments vary, and the payment for interventional services changes so, as such, one has to be flexible and responsive to the marketplace.

Recently a physiatrist who is considering making a practice change asked me what I would do with her cv.  As is the norm, she and I talked and I shared information in writing with her about the practice opportunities of potential information with her.  This is my routine procedure.  I find out where  and about what you have an interest.  If I have matching practice opportunities, I present them to you and provide them to you in writing.  I always want you to know as mmuch about the opportunity as I do.  I then follow-up with you in a few days to see what you think about the practice opportunity(s).  It is at this point that I ask for your cv if you respond that you are interested in the opportunity(s).

I’ve written earlier that you should hesitate to provide a cv to a recruiter unless they have done the same process as I described above.   I do not circulate any doctor’s cv to any practices.  Your cv is your possession so it shouldn’t be released without your knowledge.  Although it’s not my practice, some physician recruiters use a blind cv to canvas for potential practice opportunities.  Or, they present your cv before securing your agreement to do so.  Of course, this is not an ethical practice.   For this reason, I always advise against presenting your cv until you have heard about a specific opportunity and have an interest in it.

I recently came upon some hard-hitting questions which might come up during a job interview for experienced physiatrists.   Even if these questions aren’t asked, it would be a good idea to bring the subjects up during an interview presuming the answers that you have are impressive.  These questions mostly focus on experienced doctors doing inpatient work.

1.  What is your current acuity level/CMI?  What is your typical average length of stay?

2.  How many patients/day are you accustomed to seeing and how many would you like to see?  How many would you consider to be a full load?

3.  What are your patient satisfaction scores?  What type of survey process is your hospital using?

4.  What is your discharge to community rate?  Discharge to SNF?  Discharge back to Acute Care rate?

5.  Describe your relationship with your current hospital administration.

6.  What type of financial support are you looking for in your new position, e.g. stipend, income guarantee?

7.  What types of physician in-services have you done in the past year?

8.  Describe your record regarding quality outcomes such as functional improvement gains and program development and growth.

9.  Describe your ability to sell and market the rehab program.

10.  Describe your ability to build physician and staff relationships.
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PREPARE

It sounds silly but it really helps if you prepare for an interview.  Ask yourself sample questions.  Some of these questions can be found on my website under the Practice Search Tips button.  Better yet, find someone who will ask you the interview questions.

DON’T BE NEGATIVE

Never say anything that is negative during the interview.  This is particularly true of any negative comments about your current employer or practice.  These comments can be construed by the interviewer as comments that you would make over time about your new jobs.

BACKGROUND INFORMATION

Do research on the practice/facility so that you can speak to it during your interview.  If you’re working with a recruiter, ask him/her to give you as much information about the practice/facility as possible; most places have a website that you can visit.  Try to find out about the organizational culture and structure, the job responsibilities, and the reason why the practice/facility is looking to add someone.

ASK QUESTIONS

The interview dialogue should be like a good conversation with both parties actively involved.  A good question is “What can I tell you that would convince you that I am the best one for the position?”  Questions such as this that focus on what you bring to the table are better than asking what the practice/facility can do for you.

It is worthwhile, if not necessary, to document the job contacts you’ve made.  It’s best to start documenting this information when you start your practice search.  This is important too because the practice search process is often an extended one which takes months from start to finish.  Document who you talked with, when you talked with them, their contact information and what you talked about.

You will get alot of information about alot of different practice opportunities so it is important to have a process of retrieving it at a later date.  It can be a paper or an electronic storage system.   You should file it by each practice opportunity.

You may need to contact someone that you haven’t heard from in months.  Or, they may contact you and if you have taken notes and filed information, you will be able to talk from an informed point.  It’s always impressive when you can recall and provide information to the caller about the points of their opportunity.

A physiatrist recently went on a job interview and was checking his blackberry several times during the interview.    The employer later informed me that he was not interested in the physician because he did not seem to have an interest in the job because he was  checking his blackberry often.  When I checked with the doctor, he said that he was on call so that was why he was checking his blackberry and that he indeed had an interest in the opportunity.   This was an unfortunate turn of events.

Don’t use telephones during an interview.  If this is not possible, explain the reason to all the interviewers and limit your use.

The most common interview  no-no’s are appearing disinterested, appearing arrogant, and talking negatively about current or previous employers, according to Career Builder’s poll.  It’s important to inform the practice/hospital of your abilities but not to the point of bragging.

Always leave plenty of time to get to an interview.  It’s easy to get caught up with patients, get caught in a traffic jam, or get lost.  First impressions are key and late arrivals do not make a good impression.

To show your interest, look at the person who is talking with you.  If you truly are disinterested, maintain an aura of interest because who knows, you might run into the same practice/hospital another time so you want to leave a positive impression.

What should you say about why you’re looking for a new position when you’re leaving a bad job or you’ve been fired?   As I’ve said before,  you should never be negative about your current employer.   You can be negative about a situation but not about a person.  When negative about a person, the interviewer thinks that you will end up being negative about him/her in a year or two.  You can be negative about an aspect of your work but be sure that it isn’t about something that is vital to the new position.  A common answer is that you’re looking for professional growth and advancement and that your current place of employment doesn’t offer this ability.    You could say that the doctors in positions above you, don’t seem to have any plans to leave so there is no room for growth.

If you’ve been fired/laid off, then honesty is the best policy.  You can explain that there were differences of opinion.  Again, be sure that this explanation will not describe a situation that will happen in the new job.

It’s best to start looking for a new position as soon as you know you want a new position.  For residents, you should begin at the start of your senior year.   The job search process takes awhile – the time it takes to get a new state license, to obtain a contract from the employer, to negotiate a contract, etc.  NJ and CA are some states that take 6+ months to get a license.  Starting early as with everything is advantageous however some employers aren’t actively looking until October/November when the Annual AAPMR meeting occurs.

On the other hand, it’s never too late to start looking when you’re a resident because even if you start looking then, there will be positions available that for one reason or another haven’t been filled.  It’s not that all positions that have been available for awhile aren’t good.  Sometimes, the parties can’t come to a compromise or the practice settles on one doctor who then decides to take another position.