By Calvin Bruce and James St. Clair
Launching a successful career as an internist depends on more than acquiring a superior education and developing top-notch clinical skills. Despite our nation's generally strong economy, the job market is tightening for many professionals, including physicians. Furthermore, younger doctors face keen competition from more established physicians for the most outstanding practice opportunities.
Candidates who have a competitive edge in job-hunting tend to receive more, and better, employment offers. Just what gives a physician candidate that important competitive edge? The following practical suggestions are offered as starting points for further reflection on the matter.
Residency programs provide in-depth, hands-on clinical knowledge of the fundamentals of medical practice and patient care. Along with receiving standard medical training, ambitious internists are advised to tailor their programs with specialized knowledge that will propel them to greater career success.
Become Technologically Savvy
Practicing medicine in the 21st century requires sophisticated familiarity with a wide variety of technology, especially the latest generation of computers and related Internet functionality.
Increasingly, medical informatics is becoming an important area of concentration for internists who want to be on the cutting edge of technological advancement. Having a working knowledge of hospital information systems, computer-aided instruction, image analysis, telemedicine, computerized medical records, and related information-based clinical applications provides a solid foundation for practicing medicine in an increasingly technologically sophisticated society.
Internists who are serious about acquiring such knowledge have numerous options. One is to pursue a medical informatics fellowship with health care organizations such as the Veterans Administration Medical System. A list of VA-based fellowship programs can be found on their Web site.
Other helpful sites are those of the International Medical Informatics Association, and the American Medical Informatics Association.
The latter site provides detailed information on Masters-level and PhD-level programs, "informatics specialization within other degree programs," post-doctoral fellowships, certificate programs, short academic courses, and online distance education programs.
Physicians who are broad-visioned in their career planning realize how beneficial it is to acquire such a knowledge base early in their career. This gives them a competitive edge throughout their professional life.
Acquire Broad Work Experience
Residency is, in a matter of speaking, a transition period from student-doctor to full-fledged practitioner. What helps make the transition smoother and more educationally beneficial is acquiring work experience in a variety of clinical settings.
Locum tenens opportunities offer such diversity of work involvement. Reputable employment agencies that specialize in placing internists are a good bet for matching a physician's clinical competence with a broad spectrum of practice opportunities.
In terms of competitive credentials, imagine an internist's CV indicating his or her total work history at only one teaching hospital. Contrast that with a doctor's CV that highlights clinical experience in private practice, at managed care institutions, and at several governmental medical facilities: Indian health reservations, correctional facilities, military installations, and Veterans Administration hospitals. Which physician presents more well-rounded work experience?
The point to emphasize is that by working locum tenens assignments, you will interact with numerous distinguished senior physicians, learn new procedures, and treat a wide variety of patients. All this contributes to an enriched learning experience and increased well roundedness as a practitioner.
Become Familiar with Medical Spanish
Persons of Hispanic descent are the fastest-growing ethnic group in the United States. According to the U.S. Census Bureau, Hispanics in the U.S. numbered 35.6 million in July 2000. This number is projected to increase to over 49.7 million by 2010 and 66.3 million by 2020 (Source: Population Division, U.S. Census Bureau, August 14, 2008).
Whether in your first job or later on, you will likely encounter a significant involvement with Spanish-speaking patients. Being able to converse comfortably in "medical Spanish" helps to maintain confidentiality during patient contact and increase the comfort level of Hispanic patients in seeking timely medical treatment.
If you were not able to learn medical Spanish during medical school, there are other opportunities to acquire such familiarity. For example, Interactive Drama, Inc. offers a moderately priced "virtual conservations" learning program covering the basics of conversational Spanish. The video component of the program is designed to make the learning experience more relevant to persons who need to pick up visual cues when using the language in a medical setting.
Other companies offer seminars and "total immersion" weekends devoted to learning Spanish and cross-cultural awareness for professionals, such as health care workers.
Consider a Dual Residency
Physicians who are skilled in more than one medical specialty certainly have an advantage over those who concentrate in one medical field. Residents who are dual trained in complementary specialties, such as internal medicine and psychiatry, benefit from acquiring a broader body of medical knowledge and skill sets.
Obviously, the cost and time commitment involved in doing a dual residency are prohibitive for many young physicians. On the other hand, those who can afford the extra cost and time commitment (one or two years) to complete a second residency are in a position to leverage their careers tremendously. Without doubt, they are more marketable from the outset, and throughout their career they will have more diversified employment options to consider.
When Job Hunting
Well before you finish your residency or internship program, it's time to seriously consider competing on the job market. Employers are most impressed by candidates who demonstrate a sophisticated understanding of the search process, have well-defined professional goals, and can make a good case as to how their career goals dovetail with the hiring objectives of the practice.
Present Yourself as a Serious Candidate
The first rule of job-hunting is to give the employer good reason to consider you a bona fide candidate based on seriousness of interest along with impressive qualifications.
Let's face it, some candidates will take almost any decent job offer that comes along. During an interview, they convey the impression that they will go practically anywhere in order to be on someone's payroll. Such over-eagerness is a drawback, not an asset, in employment consideration.
The more impressive candidates have done their homework. They understand what drives the employer's search, the market trends in the given draw area, and how an employment offer would potentially be a good match in terms of mutual professional expectations. In an interview, they clearly communicate why they consider the current opportunity to be a good, long-term career move.
Realistically, it will take several years before you become fully productive to the practice. Nevertheless, prospective employers need to be convinced that they will get a good return on their investment, including the cost of hiring you. That involves initial compensation, relocation expenses, and perhaps a signing bonus.
This being the case, be prepared to share some thoughts on how you intend to build a loyal patient base. During an interview, mention the reason for your attraction (and connections) to the area and the kinds of professional contacts you intend to develop as a springboard for practice development.
As a further indication of seriousness as a candidate, start the licensure process early, especially if you seek employment in California, Texas, or Florida. Due to the tremendous influx of new homesteaders (including physicians) flocking to warmer climates, getting licensed in any of those states is a lengthier and more involved process.
By mentioning in an interview that you have applied for the appropriate state license, you present yourself as someone who has acted on his or her commitment to start the employment process without undue delay.
On the flip side, don't minimize the importance of taking your boards prior to starting full-time employment. Increasingly, most practices stipulate in their employment contracts that physicians finishing their residency become certified as soon as possible.
Mentioning to an employer that you are ready to go to work mid-July (if you're an MD) can be construed as lack of seriousness about preparing for the boards in August. The better course of action is to indicate the importance you place on becoming certified without delay by taking the exams while medical training is fresh in your mind. This serves the employer's purposes as well as your own.
Be Flexible in Your Expectations
The second rule of thumb for job seekers is to go where you're needed. Compensation and job security will reflect this as times go by.
No doubt, you've thought about what the ideal job would be in terms of practice size, compensation, patient load, call schedule, and so on. Bear in mind, though, that attaining the elusive ideal position early in one's career is not always possible.
A more realistic outlook is to evaluate a given opportunity both in terms of the trade-offs and the opportunity for professional advancement. Rather than concentrating on what you must have in order to sign an agreement, focus on how valuable you expect to be to the practice as you establish yourself and begin to "carry your weight" as a revenue producer.
To illustrate: Ultimately, you may want to work as a hospitalist at a large, prestigious facility. Initially, the more appropriate course of action might involve working in a traditional internal medicine role to prove your abilities and demonstrate appropriate professional growth. As you establish a name and reputation for providing quality patient care, opportunities for career advancement will present themselves over time.
Indicating a willingness to fit in wherever you can make the greatest contribution will score you points in a job interview. Similarly, being flexible on starting compensation will be viewed favorably and can give you a competitive edge over job seekers who are more rigid in their expectations.
Whatever you can do to distinguish yourself as a well-prepared internal medicine candidate with a promising future will pay off now and in the future.
Calvin Bruce serves as Senior Staff Writer with J&C Nationwide in Atlanta. James St. Clair works for the firm in internal medicine permanent placement, and for the last three years he has earned the designation "Recruiter of the Year."