Med/Peds in a Changing Marketplace and the Rise of Hospitalist Programs
by Norman Toy
April 2006

A Letter to residents

by Norman Toy
Vol.2 No 2
Winter 2000

What is a MP Physician?
by Norman Toy
National Med/Peds Resident's Association Newsletter
Vol. 1 Number 3
December 1997/January 1998


When I meet with groups of Med/Peds residents, the question often comes up, Are Med/Peds residents being prepared for what awaits them in the “real world,” when they will be going out to look for their first job? The level of preparedness seems to vary from program to program. While some residents receive only a bare minimum of preparation, others cover the subject in more depth. “Career Days” at some programs include visits from Med/Peds in private practice, hospitalist programs, and academic settings, to discuss the various aspects of the numerous options Med/Peds physicians have to choose from. These sessions often include visits from recruiters like myself, to discuss some of the more important issues that will inevitably arise during the interview process.

Since so many of you are entering your fourth and final year this month, it might be worth spending a little time on the basics. Most of you probably plan on starting work in August or September of next year , and figure you have plenty of time, so will put off the tedious chore of searching for a job as long as you can. Keep in mind, however, physician recruitment can be a painstakingly slow process. What should take weeks, often takes months. Arranging telephone interviews and site visits, which will often entail making airline and hotel reservations, and coordinating schedules with many other parties -- doctors, administrative staff, significant others, baby-sitters, etc., can be incredibly complicated. These plans will need to be made around your own busy call schedules, and relentlessly demanding rotations. It is typical for there to be delays at every level of the process. To gain perspective, most candidates want to have several interviews. It makes the decision easier, but it can be draining. Some interviews require two visits. The process is repeated over and over again. Phone interview, schedule the trip, visit hospitals and practices on-site, have dinners and lunches with doctors, and administrators, discuss the contract, meet with Realtors for a community tour, get on the plane and go home. Get right back into the grueling routine. Wait for the next phone interview. Do it again. Then when you have finally decided on a practice you like, and receive an offer, you will in most cases need a lawyer to review your contract. Depending on the lawyer’s schedule, you may be facing further delays. Negotiations follow, and sometimes flounder, in which case, you will need to start all over.

When you finally accept a position, depending on the state you will be working in, licenses must be acquired, and the application procedure can take anywhere from two months to ten months, depending on the state. Since most Med/Peds will be applying for hospital privileges, very lengthy credentialing applications must be filled out and processed. In some places, it takes longer to get credentialed than it does to get a state license. Most communities will want to announce the arrival of the new physician, and advertise it in local newspapers, phone books, etc. (And you will want your name in as many places as possible!) You need to keep in mind, there are deadlines for these publications. You also want to be listed with the local insurers as both pediatricians and internists. I have heard of many Med/Peds investing a lot of time and energy convincing these companies that you really belong in both places! All of this while trying to complete two residencies! The year will fly by. In addition, eager residents who choose to visit practices early will often commit early to some excellent opportunities. Fortunately, you are in a very diverse primary care niche, and are very employable physicians, so there will always be jobs available, but if you wait, some of the best jobs will be taken.

So, my advice is, start early. Update your CV, and start thinking about what you want. Opportunities can be found through many sources: postings in your residency office, journal ads, networking, and of course, through the recruiter calls you will all receive. You should know, physician recruitment firms do not charge candidates a fee. Fees are paid by the hiring entity. When dealing with recruiters, stay open, but be careful to control the process. Make sure the person on the other end of the phone understands the unique aspects of your training, and knows how to present you to potential employers, or practices. More people have turned me down than I can count who thought I was representing a pediatrician when I mentioned the word Med/Ped. My follow up explanation to this misunderstanding will usually clear the way for a good evaluation of their needs, and what it is you, a dually trained primary care physician, can contribute to their healthcare network. Another potential hazard is dealing with too many recruiters. This could cause your CV to arrive at the same facility from numerous sources. It will not automatically eliminate you from contention, but it is better if it doesn’t happen. Make sure you know whom you are dealing with, and how and to whom your credentials will be presented.

Remember, arrange and save time for interviews. Demand help from your residency program. Draw on all sources of information, and opportunities. When the time comes to talk employment, you will need to know the difference between a salaried opportunity, and an income guarantee. There are hospital-based practices, HMO’s, MSG’s, SSG’s, private practices, and corporate employment arrangements. There are academic jobs, outpatient-only jobs, hospitalist opportunities, urgent care, and myriad combinations of the above. After 12-plus hard years of learning and training to become a Med/Ped, you deserve the great job you’ve dreamt of. Good hunting!