Landing your dream hospitalist job isn't always easy. But finding a mentor, nailing job applications and interviews, and negotiating contracts can help.
Experts offered advice on these fronts during Hospital Medicine 2016, held this March in San Diego. They focused particularly on the needs of medical students and residents interested in a hospital medicine career, but many of their tips may apply to practicing hospitalists looking to move up in the field.
Find a mentor
In addition to promoting your career, the right mentoring relationship offers both personal and job satisfaction, said Dennis Chang, MD, a hospitalist and assistant professor at the Mount Sinai School of Medicine in New York.
The first aspect to understand is that the mentoring relationship is not a hierarchy, with the mentor at the top telling the mentee what to do, he said. “It is a partnership where both mentor and mentee learn and benefit from the relationship. It is not just the mentee who's benefiting; it's a symbiotic relationship.”
Before finding that perfect mentor, make a career plan and list some starter goals that are SMART (that is, specific, measurable, attainable, relevant, and time-bound), Dr. Chang said. “You may not have any idea what your goals are. And that's fine, that's OK, don't panic,” he said. “Just remember: You should have at least thought about this so that when you get in the room with a mentor...they can help you refine your goals.”
Next, do some advanced scouting and contact faculty you know and trust, as well as speak to some of their successful mentees, Dr. Chang suggested. “You can do some dating. You don't have to just find 1 name and just meet that 1 person; you can meet several people and, in fact, you should meet several people,” he said, adding that mentors can also be from outside the hospital medicine division.
The goals of the mentoring relationship should be mutually defined by both parties, Dr. Chang said. “Both of them should create the goals together, and they both have a responsibility to collaborate and make sure those goals are reachable,” he said, adding that the relationship should be about development, not coaching. “Coaching is where somebody tells you what to do for the now,” Dr. Chang said. “Development is trying to develop the knowledge, skills, and all of the abilities so that you can get from where you are now to where you are in the future.”
The ideal mentee should “manage up,” or take the responsibility of driving that relationship, which “makes it easier for the mentor to help you,” said Patrick Rendon, MD, FACP, a hospitalist, assistant professor, and associate program director of the internal medicine residency at the University of New Mexico School of Medicine in Albuquerque.
Mentees should prepare for meetings with their mentors, be active participants in those meetings, and do the work between meetings, he said.
To prepare for meetings, mentees can create a checklist of what was discussed at a previous meeting, create new SMART goals, and compose questions, which will all help to create an agenda, Dr. Rendon said. To actively participate, mentees should communicate how often they'd like meetings to take place—at the very least, he recommends once every 6 months—and take charge of scheduling meetings, he added. To best accomplish goals between meetings, work smarter by using a prioritization system, such as the Covey time management grid, Dr. Rendon said.
Don't impose unnecessary deadlines, but setting a reasonable timeline and meeting that target date early ensures progress, he said. “If you and your mentor are talking about [a deadline] 4 weeks from now, a little hint: Get it done 2 weeks from now. He or she will be really happy,” Dr. Rendon added.
Apply for jobs
For those just entering hospital medicine, there are 4 core elements of a job application: performance during residency, scholarly work, relevant documents, and strategy, said Daniel Steinberg, MD, FACP, a hospitalist and residency program director at Mount Sinai Beth Israel in New York.
Employers want to see that applicants demonstrated the same skills during residency that they will need as members of the hospitalist group, Dr. Steinberg said. “You need to think about how to leverage all the things that you're already doing as a junior hospitalist, as a resident, because there's a lot of material in there, and sometimes optimizing your application just means thinking about how to highlight it,” he said.
For instance, consider emphasizing “essential” skills, such as clinical experience, professionalism, and interpersonal communication, as well as any residency awards, participation in committees and projects, membership in professional societies, participation in quality improvement projects, and attendance at local, regional, and national meetings, Dr. Steinberg said.
Any kind of scholarly work is also important to include on an application, he said. “What hospital medicine leaders want to see is that you can take charge and lead something and show initiative and be a leader on a project,” Dr. Steinberg said. “That is probably more important than being a participant on a project, so if you can find even a small project that you can make your own, that is really valuable.”
When putting together an application, favor letters of recommendation from hospitalists, and include at least 2 from those who have worked with you clinically, he said. “It's never a bad thing to have a letter from someone who has worked with you in another venue, [such as] a research or a committee venue,” Dr. Steinberg said. “I think that's got to help, but it should be complementary to the clinical letter.” Ask for letters of recommendation about 3 months in advance, give letter-writers your CV, and remind them of when you worked together, he said.
An additional part of the application will be the residency program director's letter of recommendation. “If you don't submit that or you don't set it up that your program director will send a letter on your behalf, know that most hospitalist groups will call your program director and ask about you,” especially if you're a new or recent graduate, Dr. Steinberg said.
Keep cover letters to 1 page, and make them separate formal documents instead of sticking them into the body of an e-mail, he suggested. Describe your experience and skills, as well as why you want to work at the hospital you are applying to, but be sure not to “over-explain” residency, Dr. Steinberg said. “We know what an internal medicine residency is because we've all done one,” he said. “What you should highlight are things about your practice setting...[and] your involvement in quality improvement, committees, and research.”
Trainees should have their medical licenses by fall PGY-3 if they'd like to start working on July 1, he stressed. “This is a pitfall we see sometimes,” Dr. Steinberg said. “All other things being equal, the applicant who doesn't have their license yet and isn't ready to go is going to lose out on the offer. And licensing, as you may know, can take a number of months.”
When the time comes to interview, a common mistake is going on too few interviews to allow for comparison among different positions, Dr. Steinberg said. “I always encourage my residents to go on as many interviews as possible.”
To ascertain what interviewers look for in new hospitalists, Joshua Allen-Dicker, MD, MPH, ACP Member, a hospitalist at Beth Israel Deaconess Medical Center in Boston, surveyed about 18 hospital medicine program directors from urban, suburban, rural, academic, and community programs across the country.
“By and large, the most common thing that I heard back was the importance of showing that you can be a team player....It is key that on your interview day, you prove that you can be that person,” he said.
Before your interview, prepare to talk about the times when you demonstrated your teamwork skills during residency, such as completing a quality improvement project with several other residents or working with a nurse and a social worker to help a particular patient, Dr. Allen-Dicker suggested. Then, when the interviewer lobs the “Tell me about yourself” softball, be prepared to steer the direction of the conversation toward 1 of those stories and show off your teamwork skills, he said.
During the interview day, demonstrate that you can acknowledge others' hard work: Be polite, and say thank you to those who are spending time away from clinical care to interview you, Dr. Allen-Dicker said. In addition, demonstrate passion and enthusiasm for hospital medicine and be prepared to answer forward-looking questions about your career goals, he said.
Candidates should also ask the right questions. “What program directors are looking for is applicants who are knowledgeable not just about hospital medicine but also about the specific program they are interviewing with,” Dr. Allen-Dicker said. “So before your interview, do your homework: Google the group, PubMed the program director, and look at the program's website. In other words, be prepared when they ask why you want to come there.”
He admitted that his next piece of advice is difficult to heed: During your interview, don't fuss over the details. In Dr. Allen-Dicker's survey, several program directors stressed the importance of finding physicians who were willing to be flexible.
“The hospital is an ever-changing landscape and, as such, as hospitalists, our job description is changing....There is no way that a hospitalist program director is going to be able to tell you exactly what your job is going to look like in a year because, most likely, he or she does not know,” he said. It's OK to ask specific, detail-oriented questions—but try to save them for when you get the job offer, unless you absolutely need to know sooner, Dr. Allen-Dicker advised.
Not all interview questions will be buttery smooth. “Inevitably, on every interview that I went on, I got asked a question that I had no idea what to do with,” he said. Some examples of tough questions given by the program directors he surveyed include “How do you balance supervision and autonomy?” and “What is the best piece of constructive criticism you have ever received?”
Take a deep breath, avoid quick “I don't know” responses, and ask a clarifying question to buy some time, Dr. Allen-Dicker suggested. “When you get that tough question, just remember that it's less about the answer and more about your ability to demonstrate that you are passionate [and] that you are thoughtful,” he said.
After the interview, understanding what to expect “can really save you a lot of confusion and anxiety in the post-interview period,” Dr. Allen-Dicker said. Think about if the employer needs any additional information and clarify when you should expect to hear back, he said. Then, when you get home, write down all your thoughts about the program, the people you met with, the topics you discussed, what you liked or disliked, and additional questions to ask when you receive a job offer, Dr. Allen-Dicker said. Follow up by sending a thank you note by e-mail or snail mail, he said.
Finally, update your mentors, residency program director, and other letter-writers, letting them know about your favorite groups, Dr. Allen-Dicker said. “If you really like a program, don't be afraid to ask one of your advocates to call on your behalf,” he added. “Hospital medicine is a really small community; chances are that one of your letter-writers is going to know somebody who works at the hospital medicine group that you're applying to.”
Once you have an offer, be honest with the group that's making the offer, as well as with those that you have not heard from, Dr. Allen-Dicker said. “If you're going to need time to figure out your options, let them know,” he said.
Negotiating the deal
Before negotiating that employment contract, determine what is important to you—whether it's having a particular salary, schedule, office, or protected time for teaching—and write down those priorities, said Chad S. Miller, MD, FACP, associate professor of medicine and chief of the division of general internal medicine at Saint Louis University in Missouri.
“If you come into the negotiation as a blank slate, I'm afraid you're probably going to walk away disappointed,” said Dr. Miller. Before you negotiate, talk to mentors and trusted advisers about what you want, and they can help guide you on how to best leverage the negotiation, he said.
General salary information is available through the Medical Group Management Association or Association of American Medical Colleges. “You do need to do a little bit of local research, depending on the city,” Dr. Miller said. “The hospitalist market has been very volatile, and there are cities that I know are barely 100 miles apart that the starting salaries of the hospitalist positions are $100,000 different.”
Other points to bring up during negotiation might be backup arrangements for when someone's sick, the chain of command, how the group handles mission creep issues, and equity in rotations if bonuses are based on relative value units (RVUs), he said. “Things such as working nights, working in a skilled nursing facility, [and] doing surgical comanagement do not produce as many RVUs or as much billing as just working on a standard hospitalist service....Make sure that you are rotated through all of those appropriately, just like everyone else,” Dr. Miller said.
In the contract, understand the meaning of any noncompete clause, whether there is tail malpractice coverage, and whether there is termination without cause, he said. “You need to think about ending the relationship upfront because this is the stuff that goes in the contract,” Dr. Miller said. “If things go well, you may never look at the contract, and that's great. But if they don't, this is when the contract becomes most relevant.”
Come to the discussion with realistic expectations, he advised. “You may not get everything you want,” Dr. Miller said. “And if someone gives you everything you want, and you ask for a lot, that might be a red flag because if they give you everything you want, then they give everybody else everything they want. That's not necessarily a good business model.”
Get all agreements in writing, he said, noting that your boss may change over time. “Oral agreements are enforceable...but I recommend that you actually get it in writing, and the reason is, details get forgotten,” Dr. Miller said.
Finally, if it all doesn't work out exactly as you hoped, don't stress. “Your first job is not your last job,” Dr. Allen-Dicker said. “It doesn't have to be your dream job. The most important thing is that that first job sets you on that path to you getting that dream job.”