Nitesh N. Paryani, M.D. First Radiation & Oncology Group 21 st Century Oncology Instructor of Oncology, Mayo Clinic Courtesy Professor, University of

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1 Nitesh N. Paryani, M.D. First Radiation & Oncology Group 21 st Century Oncology Instructor of Oncology, Mayo Clinic Courtesy Professor, University of Florida

2 About me Born and raised here in Jacksonville A.B., Princeton University, Political Theory Worked as a management consultant before medical school M.D. at University of Florida Internship, Residency, and Chief at Mayo Clinic Now in private practice, but hold academic appointments My wife is on faculty at UFHealth

3 Life After Residency It s time to get a job Unless you want to declare bankruptcy Or you find a sugar momma/daddy But how to choose? Your last job was chosen for you!

4 Employment training during residency

5 How prepared are you to handle the business side of medicine

6 Best type of job for you Three options for doctors today Employed position working for Hospital Health System Large corporation Private practice True Private Practice Partnership track Ownership Management True Academics Research time Teaching responsibilities Tenure

7 Best type of job for you How do I know what s best? Survey 0-11 Solo Practice (good luck) Partnership Material = Employed Position

8 PRIVATE PRACTICE vs ACADEMIA Flexibility in Practice Entrepreneur Technology Costs Income Fluctuation Variable Benefits Coverage Issues Locations-Larger Choice Structured Environment Research Teaching Front Line Technology Prestige National Organizations Predictable Salary Fixed Benefits

9 SOLO vs GROUP PRACTICE Self Reliant Prefer Control Entrepreneur/Risk Taker Values Income over Coverage Likes to Select Equipment Enjoys Business Aspects Believes he is PRIMARY contributor to Success Team Player Needs Other Consultants Likes Stability Coverage over Income Adjusts to Any Equipment Prefers not to do Business Believes Collective Efforts of Group are Better than Individual

10 HOSPITAL vs FREE STANDING Professional Contract Privileges Tied to Contract No Technical Revenues (20% typical) Future Dependent on Hospital Restrictions on Practice Entrepreneur Still Need Hospitals Technical & Professional Revenues Financial Risk Future Dependent on Group/Location More Risk/Reward

11 WHAT TYPE OF PRACTICE ARE YOU APPLYING FOR?

12 Which Practice Setting Are You Open To?

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14 Timeline How to Apply For a Job Deciding what you want to do Thinking about Applying Applying for Jobs Medical Students, Interns, & Juniors Juniors Seniors

15 In-Depth Timeline For Seniors Send Cover Letters and CVs Follow-Up with Phone Call Interview Receive & Consider Offers; Possible Negotiation Decide Senior Year Fall-Winter 1-2 weeks later Senior Year Fall-Spring Senior Year Fall-Spring Senior Year Fall-Spring

16 FACTORS INFLUENCING YOUR DECISION Practice Style Preference Location Professional Relationships Salary Cost of Living Environmental Factors- Housing, Schools Hospital System Technology

17 Which is Most Important for your Practice Opportunity? * Merritt Hawkins Consulting Survey of Final Year Residents

18 Three Main Decisions Pick Area of Country Type of Practice Pick Specific Practice

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20 Geographic Factors

21 REGIONAL DIFFERENCES BEST-Southwest Region Worst-Northeast High Cost of Living, Taxes, Lower Comp

22 How to Find Out About Job Opportunities Job Market Reality Fewer jobs available in some parts of the country than there were before the economy took its downturn, but still many jobs available Many different choices (i.e., you can do what you love most) Many jobs are not listed People learn about them by word of mouth or networking Also specialty society job boards, web sites Recruiters generally the least desirable jobs

23 Two Truths About Job Market There are always jobs out there Whether you can find them depends on your methods of job-hunting

24 The Worst Ways to Find a Job Mail out resumes at random (7% success) Answering ads in professional or trade journals (7%) Answering non-local newspaper ads (10%) Answering local newspaper ads (5-24%) Going to private employment agencies (5-24%)

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26 The Best Ways to Find a Job Ask for job leads (33% success rate) Knocking on door of prospective employer (47%) Creative Approach to Job- Hunting (86%)

27 Creative Approach Do thorough homework, and inventory, upon yourself. Know in what kinds of fields you want to use those skills. Talk to people who are in those kinds of jobs. Find out if they like their job and how they found their job.

28 Creative Approach (2) Choose organizations where you want to work. Do research on those organizations. Seek out the person who actually has the power to hire you for the job you want. Use your personal contacts to get to him or her. Show how you can help your prospective employer solve their problems. Cut no corners, take no shortcuts.

29 Remember, Every Job Is temporary, that is, of uncertain length Is a seminar Is an adventure Is one where the satisfaction must lie in the work itself Might not get praise If you like it, you will be good at it

30 What if it doesn t work out? You ll be one of more than 50% of residents that changes jobs within the first two years out of practice You will survive

31 CHANGE IN PRACTICE TYPE Academic to Private Practice 64% Group to Solo 0% Solo to Group 9% Private to Academic 0% No Change 27%

32 COMPARE UPS DRIVER vs MD

33 UPS DRIVER vs MD

34 AVERAGE SALARIES

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36 SALARY SURVEY* SPECIALTY AVERAGE SALARY ANESTHESIOLOGY $366,000 C-V SURGERY $507,000 FAMILY MEDICINE $198,000 GENERAL SURGERY $340,000 HEM-ONC $313,000 OB/GYN $301,000 OPTHALMOLOGY $325,000 RADIOLOGY $450,000 RAD ONC $413,000 UROLOGY $389,000 *Modern Healthcare, 2009

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38 Changes You May Wish to Make in Your Practice: Interns Start to identify career goals Start to identify mentors Meet with mentors, seek advice Consider rotations off-site for junior year Consider attending national conferences

39 Changes You May Wish to Make in Your Practice: Juniors Begin working on your CV Continue identifying career goals Continue identifying mentors Meet with mentors Consider rotations off-site for senior year Consider attending national conferences

40 Changes You May Wish to Make in Your Practice: Seniors/Fellows Talk about potential job opportunities with your Advisor, Program Director, Associate Program Director, Chief Residents, etc. Create your CV and Cover Letters Review CVs and Cover Letters with mentors Arrange interviews Interview Weigh job offers and discuss with mentors

41 If you had to start your career again, would you study:

42 After You Have Received an Offer Think about it Talk about it with family and friends Talk about it with a trusted mentor/advisor Consider negotiating your contract Consider having a lawyer review the contract

43 Offers Initially, may receive verbal contract Ensure you get written contract shortly thereafter Compensation = Salary + Bonuses + Benefits Clarify what the salary will be Clarify what bonuses depend on Clarify job being offered What will the job consist of? Number of hours/week Number and type of call Expected non-clinical contributions Dedicated administrative time

44 Benefits Vacation CME Time Sabbatical Health insurance How much are you expected to contribute? Dental/vision insurance Retirement plans 401K, 403b, Pension Plans Matching vs. non-matching Benefits for Domestic Partner, Spouse, Children Life Insurance Disability Insurance Child care accounts Reimbursement for Boards Medical License DEA CME/Education Stipend Tuition Benefits for Dependents Housing Benefits Other Benefits

45 Benefits (cont) Maternity/Paternity Policy Loan Repayment Malpractice Insurance Insurance that covers you while you are at a practice. Tail Insurance Malpractice insurance that covers you after you leave the practice Example: Tail insurance will cover you if a patient you treated during your time at a practice sues you and/or the practice 5 or 10 years after you actually saw them

46 Contract Negotiation When to negotiate? Different organizations have different expectations Some places don t do any negotiating Others don t take you seriously unless you try to negotiate

47 Contract Negotiation (cont) Things that are negotiable: Job specifics (ie. % primary care vs. urgent care) Percent FTE Salary Comparison with other offers you have received Exit clauses Usually Non-negotiable: Non-compete clauses (where you can practice after you leave) Benefits Moonlighting outside system if working more that a certain percentage of FTE

48 Contract Negotiation (cont) Balance: Knowing your bottom line vs. you will be working with these people in the future Find right venue/person to negotiate with Know who you are negotiating with (know their background, ask people in the area) If people say best and final offer, it is usually true You normally have at least 2 weeks to decide on your offer

49 Benefits (cont) Benefits are very important may represent 1/3 of your overall compensation Example: If you are offered a salary of $140,000/yr, often the benefits can be worth $50,000-$70,000/yr For part-time work, clarify what proportion of benefits you will receive

50 PATIENCE..

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