Regardless of the market demand for residents’ particular specialty, experts recommend that physicians in training start their search early and strategically

By Bonnie Darves

Physicians heading into their final year of training often are deluged — overwhelmed, possibly — by the enormous volume of emails, letters, and other communication they receive about potential practice opportunities. With such clear evidence of the demand for their specialty or — in the case of fellows — particular skill set and knowledge, physicians might think that there’s no need to rush ahead with their job search.

However, even in this employment market when jobs are plentiful in most specialties and when most physicians will start their first job within weeks of completing training, it’s not prudent to delay beginning the search for two key reasons. For one, trainees who have their sights and hearts set on a particularly desirable urban area will find that many comparably qualified colleagues have the same idea. In addition, the final year of training is typically jammed as it is, so trying to compress opportunity exploration, in-site interviews, contract finalization, and pre-employment paperwork completion into a matter of six months is, at the least, a recipe for high stress levels.

Opinions differ among recruiters regarding exactly when residents should launch their job search in earnest, but they concur on this point: Physicians who have ideal-job criteria or special life circumstances should begin exploring opportunities as early the summer before their final year. The professional criteria might be, for example, a very short list of facilities that offer particular surgical equipment or sub-specialty support services, or a desire to work in a specific or uncommon setting. The personal criteria run the gamut: for example, a physician might want to accommodate a spouse who must change jobs or who, increasingly, is also a physician in training, or he or she might have a strong desire to practice either near family or in the same city where the resident is training.

“It’s important for residents to remember that if their counterparts are already looking for jobs early in their final year, and potential employers are willing to start talking to candidates as early as the summer before the final year, they probably should not wait too long to start looking,” said Cheryl DeVita, a senior search consultant with Cejka Search in St. Louis, Missouri. “I recently worked with two 2015 [graduate] candidates who accepted offers in July 2014, and it’s no longer unusual to see physicians sign contracts during the summer before they start their final training year.”

Earlier Start Usually Expands Options
That kind of aggressive timeline is not the norm, of course, but it’s an indication that some residents are being especially proactive about their job search. At the minimum, residents should expect that the entire process — from inquiring about opportunities to going on site visits to accepting an offer and finalizing the contract — will take six to nine months, according to Peter Cebulka, director of recruiting development and training for the national search firm Merritt Hawkins & Associates.

“Residents should start their search early in the fall, especially if they’re in a less recruited specialty or if they’re very geographically focused on an area that’s relatively saturated with physicians in their specialty,” Mr. Cebulka explained. He pointed out that residents shouldn’t ignore the reason for moving ahead quickly: the potential for a longer than desired unemployment period.

“I’m talking to plenty of 2014 graduates who don’t have jobs yet,” he added. For the most part, that’s either because of unexpected issues with contracts or credentialing for jobs they presumed they would start, or because the physicians simply began looking too late and are having a hard time finding opportunities that appeal to them.

The job-appeal factor is an extremely important consideration for all new physicians, and as such, it’s key to allow adequate time to explore several opportunities to better ensure finding a good fit. “I advise residents not to push their timeline out too far into their final year because, basically, they’re limiting their options,” said Craig Fowler, president of the National Association of Physician Recruiters and vice president of recruiting and training for Pinnacle Health Group in Atlanta. He started hearing from 2015 graduates in July 2014, he explained, and “some residents even started ‘kicking the tires’ in the spring.”

According to Ms. DeVita, physicians whose list of preferred places or organizations is very short should be very proactive in expressing their interest, especially if the residents think that their eventual application would be strongly considered. “My advice to residents is if you’re particularly interested in specific organizations, reach out to them very early — even several months before your final year,” she said. “Most organizations are receptive to hearing from qualified residents who know about their programs and services.”

That’s good advice, concurred Katie Cole, who is president of Harlequin Recruiting in Denver and who specializes in job opportunities for neurosurgeons. Physicians in low-supply, high-demand specialties such as neurosurgery will surely find jobs, Ms. Cole noted, but they should back up the timeline if they want to explore multiple opportunities or are drawn to specific geographic regions.

“I advise neurosurgeons to start exploring opportunities at least one full year before they complete training — and up to 18 months before if they have a significant interest in pursuing an academic position,” Ms. Cole said, “as academic departments don’t tend to have urgent clinical needs and therefore might start initiating a search or speaking with prospective candidates earlier than private or hospital-employed model practices might.”

Setting the PGY-Final-Year Timeline
Even though actual recommended job-search timelines will differ based on the specialty and the physician’s particular circumstances, it’s helpful to think about how to allocate and segment time during the exploration and search process. All sources interviewed for this article agreed that residents are smart to begin looking at the marketplace conditions for their specialty both across the board and in any geographic area of interest a few months before they start setting interviews. That would mean conducting informal research, reaching out to older colleagues in practice, and simply reviewing the opportunities advertised roughly 12 to 18 months before they finish training.

During this time, physicians who have particular geographic areas in mind should begin researching living costs, housing, community amenities, and schools, if applicable. It’s better to do preliminary research before going to a site interview, Mr. Fowler suggested, so that the physician can arrive in the area reasonably well informed rather than be completely reliant on, for example, a real estate agent’s quick tour during a rushed visit.

Mr. Cebulka offered the following as a rule for thumb for planning the search-year activities:

• Allow two months to review the overwhelming job-offer information coming in, talk to recruiters, and settle on a “handful of opportunities and places” to explore.
• Allow at least two months to schedule and go on site interviews and possible second interviews. “Residents should keep in mind that there are a lot of busy people involved when they go on site visits — the hiring physician, prospective colleagues, practice or hospital administrators, and human resources staff,” Mr. Cebulka pointed out. “It can take four to eight weeks to get everybody on the calendar to meet with the candidate.”
• Allow up to two months to obtain an offer letter and get a preliminary contract in hand, and then have the contract reviewed legally and finalized. “With larger health systems, there can be a lot of bureaucracy, and it can take considerable time to get a contract completed,” he explained.
• Allow three to five months before the start date to get through the licensing and credentialing process. This timeline varies widely depending on the state, hiring entity, and future practice site(s), but it’s uncommon to see a start date slip because of holdups in licensing and credentialing, Mr. Cebulka added.

This essentially 9- to 12-month timeline should be sufficient for most job searches and most physicians, especially for primary care physicians who are in particularly high demand now. However, special circumstances can necessitate a longer ideal timeline, according to Ms. DeVita. International medical graduate physicians (IMGs) who are on H1 B or J1 visas should start looking for opportunities well before they begin their final year because of the paperwork required after they have received an offer. In the current environment, physicians should expect that source document acquisition and verification for licensing, and immigration review and proceedings could take several months at least — and they should know that snafus are not uncommon.

In addition, some states — such as New Jersey, Florida, and Texas — are notorious for lengthy medical licensing processes. “It can take a few months, depending on the state,” Mr. Cebulka explained. “I’ve seen candidates who sign contracts in March and expect they’ll be starting their jobs on July 15, but that won’t necessarily happen. Physicians have to remember that they can’t apply for hospital privileges until they have a license, so they should allow plenty of time to avoid being unemployed longer than they hoped to be.”

Generally speaking, most recruiters offer the same key advice to all job-searching residents: The longer your wish list, the longer your timeline should be. “Basically, the more selective you are, the earlier you should start,” Mr. Fowler said. “And be sure to spend the time allotted for site interviews wisely, by reserving that limited time in your final year for going to places where you’re really interested in the opportunities.”

Adewuni Seyi Ojo, MD, an oncologic breast who trained at Columbia University in New York and graduated in June, took precisely the strategic job-search approach that all sources for this article advised. She started looking early, focused closely on her own criteria, and limited her search to the three geographic areas of interest: Texas, the New York City region, and northern Virginia. Dr. Ojo has family in Texas and Virginia, and she grew fond of New York during training. But she eventually found her top-choice position in Texas, at the Center for Cancer and Blood Disorders in Fort Worth.

“I chose to start looking early in my final year because of my geographic criteria, and I decided to focus only on opportunities that I was truly interested in,” Dr. Ojo said, regardless of the particular compensation structures or amounts. Ultimately, she seriously considered only five opportunities and made site visits to just three. “My decision was to be practical and to avoid wasting anyone’s time, and it worked out well for me. My advice to other residents is to make a list of what’s most important to you before you look at any opportunity,” she said, and let that direct “your actions. That way, you don’t end up ‘forcing’ yourself into an opportunity that isn’t a good fit.”

Tips for Organizing and Managing the Physician Job Search
The recruiters interviewed for this article offered the following additional guidance for residents on structuring and conducting their job search:

Back up the timeline to accommodate special circumstance. “When your search is out of the ordinary, for any reason, start your search more than a year ahead of graduation,” Ms. DeVita advised. “If you want to work only part time, if you’re only interested in academic positions, or if your ideal job is to be an orthopedic surgeon affiliated with a professional sports team, start early.”

Manage your final-year time strategically. “Time management is essential because final year of training is typically the most demanding,” Ms. Cole said. “So spend a lot of time on the phone speaking with potential employers, researching the facility and location, and ideally, talking with other specialists in the locations you’re considering. You want to determine which opportunities are really contenders before you visit, because those visits and interviews are very time-consuming.”

Get help “triaging” opportunities. “A good recruiter can help you sort and distinguish the opportunities you really don’t care about from those that you ought to move forward on,” Mr. Cebulka said. “A recruiter can also help you collect data on the health care markets and geographic locations you’re interested in, to ensure there’s truly a need for your services and to avoid wasting time.”