Hi, everybody. Thank you for joining this evening and spending some time with us. My name is Manish Tiwari. I'm the Physiatry Training Council President. I am a current PGY-4, about to graduate, knock on wood, at Ohio State University. And I'm going into a Pain Medicine Fellowship at George Washington University in Washington, DC. I also need a job. And I'm Elizabeth Martin, as was mentioned earlier. I'm currently the Co-Chair for the Early Career Physiatrist Membership Group. I'm currently an Assistant Professor at Vanderbilt. I do Pediatric Rehabilitation Medicine, and I'm the Medical Director of Pediatric Rehabilitation Medicine there. This is my second job of training, so I finished fellowship in 2018. And so I've had a little bit experience with job interviews and the job hunt, which will hopefully be helpful. OK. And as the introduction slide, I'm Linda Farr. I specialize in physiatry recruitment. I've been doing physiatry recruitment for 30 years, and the first seven years of which I was the Director of Physiatry Recruitment for what was formerly the nation's largest rehab system. And then they were bought out by a little entity called now Encompass, at which time I started my own business. I was tasked tonight, moving on to the questions topic slide, with, and I want to first of all thank AAPM&R for having me tonight. That goes before saying anything else. I was tasked tonight with coming up with the five most important questions that you could ask an employer. Well, that is a big assignment. So what I tried to do is rack my brain for what are like the categories of the most important kind of questions that you can ask an employer. So those categories are, what is the compensation? What is the work culture chemistry? What are the responsibilities? What are the future plans of the employer? And then questions specific to the type of work. Since some of you may be entering the practice search process, Dr. Tiwari, I wanted to spend a few minutes to explain to you how the process works. I actually today just talked to a 2024 graduating resident who was asking me that whole process as she's starting that search. So the way that it works is that, and I'll just give you my little universe. You approach me or vice versa. And I ask you where you're interested in and what you're interested in. Where meaning geographically and what meaning spinal cord, interventional, TBI, pediatrics, can't forget pediatrics. And then from there, what I do is I have contracts with the employers and I obtain information from them regarding all of the very pertinent points. Like what's the affiliation type? What are the responsibilities? What's the compensation? What's the compensation type, practice features, et cetera. So I try to give you as much information as I have from the practice, which is hopefully very helpful to you because when I look on different websites and practice opportunities, I usually find very little information. And when you see my information on my website, it's fairly detailed to include the city and state where it's located. So anyhow, I provide you the information and then you say, Linda, I'm interested in that opportunity at which time I ask for a curriculum vitae. I then take that curriculum vitae and provide it to the employer. The employers typically, physician recruitment is not their number one priority. They're busy with their medical practice. So usually it takes a week or two before they have a chance to review your curriculum vitae. And oftentimes they'll ask me to interview you to kind of give some basic information, credentialing, basic kind of interview questions. And then from that point, they will usually by phone or nowadays by Zoom, they will contact you and have a first discussion. From that stage, then if all goes well on both party sides, then the next step would typically be for reference checking. And then if that all looks good, then the next step is for you to actually visit the practice and of course that's very important. And then from that point, when you visit the practice, sometimes they'll provide you with a contract, sometimes they won't. And then after that process of meeting with them and then ultimately, hopefully, knock on wood, providing you with a contract, then you want to share that contract with a lawyer. And all of this information that I'm talking about tonight is on my website. If you, there's a search bar and you can search on compensation and RVUs, whatever. So, and the practice search process. And so you want to have a lawyer review it and there are a number of lawyers on there. There's also some practice management consultant companies listed on my resources tab and they can also help you with the contract. And then final stage is you agree to the terms and off to a new job. On to the first question that we have is compensation. In the real world today, most entities have a salary base and a incentive. And an incentive is just the way the word sounds. It's an incentive for you to see as many patients in as efficient and effective means possible. The incentive, there can be a gazillion ways of doing this incentive. I'll just give you some four basic ones that you can take varieties thereof. The first one is that they, the practice, the hospital, at the end of the year, identifies what you have brought in in accounts receivable. And from that figure, they then deduct your salary and your share of the overhead expenses. And then from that, whatever the differential is, they provide you with, usually the first year, it's 20%, could be 25% of that difference. The second type of compensation is without an incentive, they're gonna provide you a base salary for the first two years. And then at the third year, at which time, hopefully both parties are chugging along and understanding the whole system, then you are on a production, a solely production basis. Eat what you kill is the terminology for that. From that, another way of doing the incentive payment is that they typically take like two or three times what your salary amount is. And then whatever you make above that, you get 20, 25% up. And the last but not least one is the relative value unit, which is very hard to understand. Actually, I've had some practice managers tell me that of all the ways they do not favor the relative value units process, but the federal government puts a number. Right now, it's $33.89. $33.89. And each procedure that you do has, it could be like 10 RVUs, 10 relative value units, that's 33.89. So you multiply 10 times 33.89 to come up with what you're gonna get for any one procedure. And then of course you expound that throughout the year. So now that we've talked about what is the incentive formula, is the incentive achievable? This is something which you can use your best in negotiating your best communication skills to talk with the practice, get the data from them on other doctors, get the trends from them on finances. And also what also is best to do regardless of all of these questions is to try to identify in the process a doctor in the practice who is someone that you can really in simpatico with. So that aside from the group meetings where everybody has to kind of say the group line, if you have someone who's you really sync with, that would be ideal for you to try to get the true story of what the potential is for compensation. Another point on that is that you should also identify throughout the year, what kind of data am I, the physiatrist going to get on the accounts receivable numbers and how often is that information going to be available to me? What are the components and costs of the practice overhead? I can tell you that years ago, actually one of the first doctors that I placed when I started on my own, he said, Linda, he said, I just joined this practice and oh my goodness, you should see what the lease, how much this doctor is paying for a lease for the year. He said, it's really making my potential for achieving the bonus. It really is, the incentive is really making it difficult. So try to find out what the components and what their related costs are for the overhead. Find out what the collection rate is. Usually the collection rate should be around 95%. The payer mix, if it's a high Medicaid, you're gonna have lower reimbursement, private pay, insurances are a good payer mix. Excuse me, is there compensation for ancillary services? This is typically for those who are interventionalists and joining practices that have a ambulatory surgery center. And again, this can be done in a number of ways. Is partnership an option? This is something that I do recommend you find out early on. I can also tell you that although I always thought partnership was the goal, I was really surprised when one practice manager said, well, when you're a partner, you're also partnering in the debt of the practice. So the other thing about the partnership, excuse me, I have a little cold. The other thing about the partnership is that sometimes, and it's happening less now, but in a multi-specialty group they may not have a partnership track for you. And that's not necessarily a negative because if you look at the finances, you might ultimately make the same without being a partner, the same compensation, same compensation. Do you have a student loan repayment program? This is typically in public non-for-profit systems and typically also they're in academic programs. And then is moonlighting permitted? This is a question which you can ask. I don't know that it's the most well-received of the questions. Typically practices, the answer to that question is no. They want you to be devoting yourself to them. A little bit about terminology. We talked about salary, which is pretty easy. Everybody knows that. We talked about the incentive. Other terms are guarantee and income guarantee. And this can happen in any setting, but it's basically a guarantee that you're going to make X number of dollars, but don't go by the word guarantee because some of these guarantees are income or salary with a payback. Stipend, stipend if you're going into a group like Encompass and you're a medical director, they're gonna pay you a stipend for X number of hours as a medical director or associate medical director for that matter. So it's kind of like a salary because it is guaranteed as long as you're working there. A bonus is like a sign-on bonus. And that's something that I'm hearing more and more about as you're in a wonderful world as I just, because everybody wants you and the supply is much less than the demand. So a sign-on bonus is a negotiable. Full-time equivalent or FTE means full-time equivalent. And that, for example, today, I was talking to an employer and a candidate, doctor candidate, and the work was 0.5 FTE. So half of a normal workload. And RVU, we already talked about. So now that I've talked about compensation, I wanted to talk a little bit about the work culture and the group chemistry. So the question is when you go to a practice or a hospital, what is the philosophy? What is the practice style? And this is something that when you visit the practice and you always wanna visit the practice, from the moment you walk in the door, be mindful of what's going on. How well are you received by the receptionist? How well does the group, the doctors, converse with each other? Do you see a team kind of atmosphere? You can tell a lot from the body language and from what is said or is not said, but is underlying what's not being said. And some of the questions related to this are why do you wanna add a doctor? And that would be, usually there's two cases. It's a replacement, which you wanna try to find out why. And that's kind of tricky to find out. Sometimes they kind of hide that from you. And then other times it could be a new position because they're expanding. So it's good to find out why they wanna add a doctor. Who's involved in the decision-making process? This will help you identify how democratic the practice is, how much of a say you're gonna have in the practice opportunity. And it's going to show you how perhaps bureaucratic it is or democratic, whatever. Is there a non-compete in the contract? The non-compete is what that terminology means is that once you join a practice that you cannot practice within X number of miles. It could be of the practice, it could be of the hospitals in the system, like the whole state of New Jersey. It depends on what geographic kind of area you have, metro versus rural. The thing about this is that the point that's to be made is that when you're entering a contract, don't only think about it from the front end, but also think about it from the back end. Like when you, like Dr. Martin, she was with a practice for a few years and then she went on to something else. So you wanna know what happens to you when the contract, when you wanna leave a place. So in terms of the non-compete, the government, the federal government would like to end non-competes for physicians and other entities, other people. And they had a decision, well, they didn't have a decision. They presented this in January of this year. And in April of this year, they had the, April 19th was the end of the public comment period. So now I think, I'm not a lawyer, but I think that they're waiting for that to happen in terms of giving the conclusion there. But I can tell you that at this point in time, what's the case with non-competes is that they are not enforceable, but you're gonna have to get a lawyer to get you through that process, which obviously is dollars and cents. Is there mentorship? This is a question which is great to ask. It's something which you, I don't know, when people say things, you don't know whether to believe them, yes or no. So you have to really look for examples in the, have other doctors that have joined there, have they seen mentorship? I would say it's probably less inclined than more inclined for mentorship because, it takes away from that productivity of whoever is mentoring you. And then what's the difference between working at a private practice versus state universities? And this is my perception. I'm sure everyone has their own ideas, but working in an academic program typically is much more bureaucratic. It's, in terms of decision-making, it's a much slower process. It can take months. It is, the difference is that when you're in an academic program, you're going to have a very deep, you're gonna be doing like pediatric rehab or TBI or spinal cord, whatever your specialty is, amputee, whatever. When you're in a private practice, you're gonna have a breadth of services typically that you're going to be providing, a variety of services, which might be, depending upon the person, more enjoyable or less enjoyable. Typically academic programs have a less, in terms of compensation than the private world. And of course, in the academic world, you're going to be asked to do research. And one thing you wanna ask, another question is, do I have protected time for my research? Which I said that in a presentation recently and one of the academicians said, yes, that's a very important question to ask. So now that we've talked about the compensation and the work culture, one is to talk about another question, which is what are the job responsibilities? Which sounds very simple and basic, but you really wanna get to the nuts and bolts of what are the job responsibilities? They might say inpatient. Well, how many inpatients on average do they want you to see a day? They might say about call schedule and then you find out that, they really don't have a call schedule that it's kind of a haphazard mix of people who are available at certain times. So what EMR do you have? Which question may be that, might be an EMR that you're already familiar with, which would be great. And then a good question asked one of the physicians in the practice is, at the end of the day, how long does it take to complete your charts? I know some physicians are taking charts home to complete them. And then is there staff support? Some practices are great about providing staff support. They have an MA, they have ancillaries that are helping you with support and other practices that you aren't, it's a rarity. And now that I've talked about the compensation, the work culture, the responsibilities, the next question, broad category is, what is your vision for the future? The last thing you wanna do is get into a practice that is not well positioned for the future because ultimately you don't want a curriculum vitae that shows job jumping. You want a curriculum vitae where you're at certain jobs, not forever, but for a good period of time. So you wanna find out, and these are questions that when you ask them, you will automatically know how well they are prepared by the way they answer these questions. So what is your vision for the future? Short and long range plans. How are you prepared for the future? Like what is the community? How's it changing? What's the payer mix? How's that changing? Referral sources. You can have some systems where unless you are a member of that hospital system, you cannot be in the referral pattern. So you're really up a creek without a paddle if that's the case. And then do you have thoughts of selling? This is nowadays with private equity firms, this is an important question to ask because I was just talking to a doctor the other day. He went into a practice where they sold the practice to a private equity firm. Doctors left as a result of that because it was not the type of practice that it used to be. So that's an important question. And then what kind of marketing, social marketing do you do? And now that I've talked about the responsibilities and the compensation, the work culture, and how well positioned they are for the future, last but not least, service specific questions, which these are questions that depending upon like Dr. Tiwari, who's going to be doing an interventional fellowship, depending upon what your interests are, are you a needle jockey that wants to do procedures every day, all day? Or are you wanting to do one or two procedure days and the other clinic days? And if you're doing inpatient, who determines the admissions for the inpatients? Which you can get a variety of answers to that question, some of which are not really most desirable. And then nowadays, if you do inpatient, you don't necessarily have to be doing the, you don't necessarily have to be the primary physician for the patient. Some people prefer, some physiatrists prefer that, but it seems like more and more preferring having a hospitalist as the consultant. And then for outpatient, I have doctors who come to me because they're doing too much chronic pain. They're seeing too many drug abusers, et cetera. So again, some people enjoy the chronic pain aspect, but many do not. So to ask the question, what is the percent of acute versus chronic pain does the practice prescribed opioids? So with that, I will turn the program back over to Mona and the doctors. So I'm going to open up the webinar now for Dr. Tiwari and Dr. Martin to ask Linda questions that they may have so that she can help answer and then after that we will take some questions from the attendees of the webinar. Dr. Martin, take it away if you'd like. All right. Well, thank you again so much, Linda. This is very, very useful and I think especially for those who are coming out of the early stages of training and going into their first career. A lot of this information are things that we don't technically learn during our training phases and so we're kind of thrown into this pool with trying to find resources. So I'm wondering, you've done a great job explaining some of the terminology, especially around the compensation part, which can be a little bit challenging sometimes. Do you have any other resources that maybe early career members could be turning to to try to find more information about this? Well, in terms of the information, for example, the compensation information that I provided to you tonight on my website under the tab compensation, it gives all of those descriptions as well as many more descriptions on that. I would defer to AAPMNR for whatever information they might provide and now with the days of technology and Google, you can find a lot of things out that way. So those would be some of the resources that you could use as well as, of course, position recruiters and peers and colleagues, your faculty. And I think this webinar is another great resource. It looks like someone has asked if it's possible to get a transcript for the presentation. I don't know if that's something that AAPMNR is planning. Yes, we can plan for that. I will look into it. I know the recording will be available. I will look into it to see that the transcript will be available as well. Awesome. So, Linda, thank you again for this presentation. I wanted to ask, could you talk a little bit more about people who are perhaps early career or late that are interested in, you know, going to a new geographic location and what that would entail or look like? Yes, definitely. If you're going to a new area, and maybe I'm old fashioned, but I think the best way to approach it is to send out a letter and follow up by a phone call to, you know, if you want to go to Los Angeles or wherever you might want to go to, otherwise, I mean, you can you want to get to know the area. So, you know, use your vacation time to go and visit these places that you have an interest in and you can stop by and talk with the physicians. Certainly, you know, I've had doctors who, for example, wanted to go to Canada. And so I've connected them with Canadians who were in the U.S. and now are in Canada to give them information about it. So, you know, for any of you watching tonight, you know, feel free to contact me anytime and I can try to connect you with some doctors that I know in that area and would be willing to talk with you about the dynamics of Los Angeles, for example. And how about getting a sense of the health care landscape? Like, I don't know, researching who the big players are or kind of understanding where your practice or the practice you're interested in kind of fits into the hierarchy. OK, well, in terms of the hierarchy, it depends on what field of physiatry we're talking about. If we're talking about inpatients, you've got Encompass out there, which is probably the big boy. And then you have other companies like Post Acute Medical, Vibra, Earnest Healthcare. I'm sure I'm leaving out several, but those are the big players in the inpatient world. And those are typically independent contractor relations. Otherwise, you have entities that are, I call them middlemen, for lack of better words. They don't have any bricks and mortar. And they're like U.S. physiatry. There's a lot of subacute companies that have arisen. Many of them are not founded by a physiatrist. So it's the corporate world. And so you have to be kind of careful in working with them. Some physiatrists have told me, Linda, this wasn't through my client, but I've been to some subacutes and they're really dirty and not places that I would want to work. So in terms of the interventional world, to get to your world, for example, I have some interventional positions in New Jersey. And so in New Jersey, I was working with a group out of Princeton, an orthopedic group. There's also an orthopedic group with physiatrists, a multi-specialty group in northern New Jersey. And they have a consortium of a number of different practices that they have gotten together. And so they can have a lesser overhead and marketing costs, et cetera. So the interventional world that I'm familiar with is the private practice world. I'm not as familiar with the academic interventional world. It looks like we have a question from one of the attendees. Is it generally reasonable for a new graduate to request a relocation stipend and sign-on bonus in the first contract? Yes, definitely. The relocation, if it's an organization worth staying with and worth going to, I should first say, and staying with, they will give you a relocation expense. That's pretty standard. And if they don't do that, again, you might wonder what kind of practice they are, hospital they are, whatever. And the sign-on bonus, I used to years ago, I'd never hear of a sign-on bonus. Now it's, I would say, 50% of the practices are offering sign-on bonuses. And they typically are anywhere from $10,000 to $50,000. Not bad. Sort of similar on that note. So I know that there are several types of student loan repayments. Do you talk about kind of the various forms that that can come in? That I'm not as familiar with, because the entities that I work with, very few of them have that student loan repayment. And one thing, if they don't have that, doesn't mean that that's not a group that you don't want to go with, because they can provide you with monetary amounts that are equal to that student loan repayment system. Yeah. And just to add on to that, I think there are also, depending on the location that you're practicing, there's some different policies. So California, for example, had a state-based program that offered student loan repayments for certain types of practices and certain percentages of Medicaid. So I think it's also helpful to look into what is there at the federal level, what is there at the state level, as well as the individual practices. It looks like we have another question. Could you speak to the advantages of utilizing a third-party recruiter versus an in-house recruiter, versus just emailing or calling leadership staff? OK. Well, Dr. Tiwari kind of asked this question earlier to me. And his comment was, all these openings that you hear about, they're like, wonderful. They're the best thing since apple pie or whatever. And I can tell you, I've been in a lot of places, and I've been in a lot of places where and I can tell you that practices, when I prepare that description, I'm a pretty much black and white kind of person. I'm not a marketing kind of used car kind of salesman person. So actually, I have practices, Dr. Tiwari, that say, Linda, spiff that up a little bit and make that sound like we're all these ones that sound wonderful. And I also hear comments from physiatrists who say, oh, they're offering x number of dollars, and that's totally impossible, especially like some of the, I've worked with subacute, physiatry practices that are independent that are doing subacute. And they say that what is being pro-offered by these subacute companies is not possible. So in working with recruiters, it's just like working with anybody in the service industry. Some people you can trust, and some people you can't trust. I would say that if it's an entity, and I'll give my competition credit that any entity, and there's basically only two other entities besides myself that do only physiatry recruitment, I think you can trust them and that they're not going to lead you astray. When you talk to anybody, I don't care if it's an in-house recruiter, if it's a recruiter like me, get as much information as you can from them. And if their information is vague, I've had physiatrists say, Linda, I went to Texas to interview, I don't know where they were in North Carolina. They've made this big trip to Texas. They said, when I first talked to them on the phone, they really didn't give me much information, but I figured, oh, I'll go there and they'll tell me more. He says, it was a total waste of an interview time. So as much information as you can get up front, and I deal with in-house recruiters myself, and they are, they're not just recruiting physiatry typically, they're recruiting every specialty under the sun. So, and not to toot my own horn, but all I do is physiatry. So I know the terminology, I know, you know, I don't intimately know Dr. Martin or Dr. Tewari, but I know of some reputations in the field. And, you know, like today, you know, if you catch me in a private conversation, I will be as honest as I, as I am to say, you know, this practice is good. This one I want, you know, put on the top of my list. To add to that a little bit. So when you say that they shouldn't be vague and they should give you as much information, like the recruiting emails I get very often, they say like a sunny location, located 45, like how specific is specific and like what is an acceptable level of like they left it up to the imagination to some extent? Well, I can tell you that the, in my world, the physician recruitment universe, it's a dog eat dog kind of world. Luckily, I'm kind of a niche. First of all, I'm doing physiatry. And second, because I've been doing it so long and people know me and trust me. But when recruiters, maybe not, not so much hospitals, but when recruiters post things, they don't put down the specific location because they don't want another recruiter to steal it from them. So that's one behind the scenes example. And I will just say too, when I was coming out of fellowship and looking for jobs, I think it's important to know too, that it's okay to network and it's okay to explore opportunities. And it's also okay to look for opportunities that may not be there in the first place, because you can create jobs. And I think as trainees, we get in the mindset of, you have to match, you have to do everything you can just to get that placement. But when you're interviewing for jobs, it's a much bigger field out there. The hard part is often knowing what your priorities are and looking for a position, because it might be as simple as I need to be in this location for my family, or it might be, I need this certain type of practice set up for a certain practice style. And it may be that there's a job opening that you can find through a recruiter or find through networking that's there, but that's not always the case. And often as you start to connect and talk with people, you can promote your skills and there often may be something that they could create for you if that's something you're interested in and you present that well. So I will just add that it's great to look at the opportunities that are out there, but don't be afraid to also maybe explore some opportunities that you can create as well. It looks like there's another one here talking about part-time opportunities. So are there part-time physiatry opportunities available other than locum tenums that you've helped place over the years? Sure. Yeah, there are. I would say that the exception is the rule, but yes, there are part-time practice opportunities. Some practices, I have an EMG opening in Tennessee and they're just needing someone part-time. So yes, a lot of, well, from New York City, a lot of physicians in New York City work here and there. They piece together jobs because of the marketplace. Now it's becoming less so with the lack of supply of physiatrists, but yes, there's a number of part-time. Some people ask me, Dr. Martin, about like job sharing, and I don't see that as much available as would, you know, where one doctor works one week and the other doctor works the next week. I don't see that too often, but part-time, yes. Do you have any advice around part-time? Because I think, especially after the pandemic, we've seen a lot of people transition into part-time positions, but I've heard both good and bad things about how that might affect compensation versus actual work hours and such. I don't really have too much information on that. I'll leave that to you for what you've heard. Well, again, I think negotiation is important because you do want to make sure that you're being compensated appropriately for the time that you're putting in, but I think it's helpful to know from your end too that there are part-time positions that that's an okay option for people to choose and a reasonable option for people to choose. Just to quickly piggyback off that, I think we have a few questions in the chat, which I'll get to in a moment here, but do you feel that there bears any stigma to those seeking part-time work as in like, you know, this firm is looking for a full-time partner, and if someone comes out with asking for part-time that they may kind of sequester them and not offer them the same sorts of partnership tracks or things like that? Well, you're not going to be a partner working part-time. That was a bad example. That was a bad example. Yes, it has a, you know, it depends. If they're looking for part-time, yeah, that works fine, but if you walk into a full-time and want a part-time, no, that's not going to happen. Sure. I can read the next question here. So somebody asked, are there tools you can recommend that are helpful to understand what a competitive salary is based on specialty and location? Some of our subspecialties are very small communities, and so there's not a ton of data out there. Right. Medical Group Management Association, which puts out a survey, a salary survey every year, they're a good source. Now, they're not going to speak, you know, Societree, I've asked APMNR this many, about once a year I ask, are you doing a salary survey or not? Because it's been a long time since they've done one, but I think one's maybe in the work. But they're not going to give you all the details, you know, like, I don't know, Bismarck, Idaho, or whatever, what the comp is there, but they will break it down to medical director, et cetera. And you can find that survey, that MGMA survey, at your academic programs. Your residency program should have the copy of that. And then there's two other studies, which I don't remember the name of, but they're done by independent groups. I want to say Sullivan and something, but there's two other salary survey companies. It's hard to get information on Societree compensation. The numbers are all across the board. And the survey sampling, when you do get them, are very small, so they're not statistically significant. So it's hard, but, you know, I would throw out for those who are maybe looking for work, 2024 grads, maybe listening now. That's the average compensation, I would say, for an inpatient. Inpatient, doing a little bit of inpatient, a little bit of outpatient would probably be around 250 plus incentive. And for an interventionalist, again, it depends on the area, but I would say 350 plus incentive. And an outpatient generalist is probably more like 225. I have another one here. Is there a trend for four day per week work schedule while maintaining 40 hours a week? And I can speak just a little bit. My first job out of fellowship was actually the standard for each of the physicians was four days a week doing full clinical work. That was a slightly different setup than the academic position that I've been now, where we all standardly are five days a week for full time. However, you have a certain amount that's academic time that you might then be doing other responsibilities. So that's from my perspective. But Linda, I'd love to know what you've seen. I don't hear much about four day work weeks. And when I do, it's a real selling point for the practice. I would say that my first job out of fellowship was one that, as I was saying earlier, did not actually exist when I was interviewing. And so I had experience interviewing for positions that were out there that were common knowledge, had a good experience with that. But I also knew the type of practice I was looking for and the people that I wanted to work with. And so I actually just did some dinners and meetings with people. And that led to a formal creation of a contract and offer and such. But I think as you're thinking again about these priorities, if it's important for you and your family to be a four day a week work schedule, if it's important to be part time connecting and looking at these different practices and seeing where people have successfully done that and not been penalized for it or in some way had a negative experience with that is very important. That reminds me, Dr. Martin, where I see a flexible schedule is if you're going to go into subacute work because you don't have to necessarily be there at seven, eight o'clock in the morning. As long as you work eight hours, 10 to five or whatever the eight hours is, you can make your own schedule. But the best jobs are the ones that aren't going on. Also, what you said, Dr. Martin, the best jobs are those that aren't advertised. And if you know yourself, and that's what Dr. Martin said, if you know what you're looking for, you can go out and find a job that really wasn't there. And that's where, you know, Dr. Tiwari, if you're going to go out to L.A. or whatever, when you're dialoguing with these people, you can maybe, you know, they will find a need for you. Dr. Martin, while you're here, I mean, what would you say you're given? What avenues of networking have you had experience with or been successful with? How do you even approach that conversation? What setting? Where to whom? So a variety of different ones are possible. I mean, obviously, as you're going to like APMR annual assembly, you meet a lot of people in your field of interest. There are networking opportunities within that. If you have a particular location that you're interested in, and you can identify which facilities are doing the type of practice you're in, you can start reaching out. There was one hospital facility that actually didn't have a PM&R practice at that time, but I reached out just, you know, making inquiries and they were actually interested in creating something. And that wasn't actually a position that went anywhere, but it was a really interesting experience and meeting with, you know, the hospital CEO and talking about what the possibilities were. And I mean, you'll certainly find situations where you're shut down pretty quickly because it's not something that they're interested in, but there are some exciting opportunities potentially. And again, you know, with mentors that you've met with throughout your training, with other colleagues who might have connections, you know, PM&R is growing, but we're still sort of a small community. And so you really can reach out and think people can be very helpful. Sure. And I think to that end, I can read the next question. So perhaps well for you, Dr. Martin, in pediatric PM&R academic practice, what percentage is reasonable for clinical time, academic time and research time? So I will say most academic centers have, you know, pretty standard expectations in what you're doing based on your track. So if you're an assistant professor, for example, you might be on a clinical track or a research track. And so they'll have outlines of what those expectations are, what you need from promotion. So that will give you some guidance on that. And each department will have some expectations on what they typically offer. But that being said, you know, some academic jobs, you might be more doing more research and others, you might be more clinical and you have some opportunities to negotiate that based on your interests. So I would say that a very common one for an academic job in pediatric PM&R where you're primarily clinical, you typically would have about a half day per week of academic time. But if you have additional responsibilities, like you're serving as a medical director, you're maybe doing more education with the residents or the fellows, those can be negotiated. And so you want to show value in that time. Obviously, it's not just free time, but there are opportunities there to potentially discuss what your other interests are. And obviously, if you're going to be doing research and bringing in additional research dollars, that gives you additional time. So there are opportunities to discuss that as well. So Manish, where are you in your job searching process? Have you come across any of this yet? Not on the spot or anything like that. So I have not started because, so I think that I talked to some people, recruiters and other people, and they said maybe around like the early fall, somewhere around September would be an appropriate time to kind of start, because you know, it's only a year fellowship and I have a specific location once, which includes Chicago, if anyone listening. And so, I actually did try to reach out to some people and I know some people in the Academy and all that, but they kind of said that this far out over 18 months, it's a little bit too early for that sort of thing and recommended I ask within a year was typically the hiring timeline as I understand it. So that's so on hold for now, I guess I got to focus on learning pain medicine. Well, and I think that's a really good point though too, is it's never too early to start exploring and learning about the different options and the things that you're going through, but you also don't need to feel panicked if you don't have a job yet. And there, you know, it is a process getting, especially credentialed at certain centers, it can be a time consuming process. License and I can assure you, it's a time consuming process. Exactly, but I do think that, you know, a lot of people do tend to go into like, you know, our timeline of frequent annual assemblies and things like that, where you have a lot of connections with people, you can talk, do your interviews at those places and start that process and still have plenty of time before you're finishing. In the timeline, you know, you kind of have to back into it like Dr. Tiwari, because when that whole process that I described early on, where you're interviewing, et cetera, when that concludes and even, you know, to the point of you have a contract, then unless like you, you're smart, because if you want to go to California, go ahead and get your, wherever you want to go, if you like have a definite, get your license there, because if you don't, and you wait till the contract is signed, then you have to wait for the licensure process. Then once you get your license, then that's needed in order for the entity to credential you. So there's, you know, a lot of work that needs to be done beforehand. Sure, I think we have a few more questions in the chat and Dr. Martin looks like you're typing an answer to one of them, so I'll read the next one. How and when would you bring a lawyer into the contract negotiation? I guess this question would be a tad out of scope, but if you have an opinions or experience with this, I'd be appreciative. Okay. The practices that I have dealt with, I understand that most people, and you know, I'd say everyone should go to a lawyer. They don't respect, and I'm being bold in my statement, but they don't respect doctor candidates who use the lawyer to negotiate. And I'm, again, painting a broad stroke here. They want to be able to talk with you directly as to your items that you want to negotiate as opposed to a lawyer to a lawyer. So you definitely want to have a lawyer. You don't want also to have a lawyer who nitpicks and dots every I and crosses every T, because I've had some doctors who have lost jobs because of their lawyer. Do you think you need a lawyer that's specific or familiar with PM&Rs especially, as opposed to just a lawyer who does contract negotiations? I think that it's not necessary to have one specific to physiatry. And perhaps myself, again, as the part of this out, I would like to speak to the how of this. So where exactly are good resources to find said lawyers? Okay. Well, if you go on my website under the resources tab, I have some lawyers listed and I can't vouch for them, but there's not only, I have lawyers, like independent lawyers listed. I also, there are entities, I forget like phys amp or something that are companies that have, because this is such a need, they do contract review, they do practice management, and they typically, you'll have a lawyer, but it might be less expense than if you had like a particular lawyer. And we also, the thing with them is that I was talking to a doctor just the other day, and I didn't mention this in our discussion, but another term is a letter of intent. So when you go to a practice, before they take the time and effort to make a contract, which you would think in the practice of five, whatever, even two or three doctors, they would already have a contract. But even a big company like Encompass, every time that they bring on, offer you a contract, they go to their lawyer, because I guess there's changes in law every day. So it's gonna take two weeks plus to get a contract from a lawyer. So in general, a contract lawyer is like what you'd be looking for, a medical contract lawyer? Right. Okay. That's at least helpful for something to Google, I guess. Right. Well, there's some resources online and the one, everything that I put on there for resources for the lawyer review are, I've gotten from physiatrists who have used them. So they've been physiatry tested. I think we can transition to the next question. So this one is, thank you, of course, firstly, and then I have a question regarding multiple job offers. Once you have an offer from hospital A, if you're waiting to hear back from hospital B, when and how is the best time to let hospital B know about the pending offer? How long is the offer usually good? Which is a great question. Right. That is a tricky situation. There's no great way I don't think to address that, but I think honesty is the best policy. I know that some physiatrists, just like some people, use one contract to barter and try to get a higher fee, a higher compensation salary, whatever, from another entity. So there's, I guess, nothing wrong with that, but if you're doing that with a practice more than once, they're going to sniff out that you're just hunting for the best offer and probably will only extend that offer for so long. Typically, a contract offer, again, it varies by practice and location, but I would say that typically they're going to give you no more than a month to make a decision. And to that prior thing, so let's say you do sign the contract, that month wouldn't include your credentialing and things like that. It would be for a negotiated start date, correct? Like at some point in the future, okay. So you wouldn't have to race to get that all together. Right. And there's often sort of a period where you're, obviously getting the paperwork, they're credentialing the things going after you've signed a contract, lots and lots of paperwork, but even once you officially have your start date, there might be some variability based on the type of practice and how well they're set up, but there's often sort of an easing in period. And that's also a good thing to think about as you're negotiating too, is like, what will that period look like? Are they going to have you come in and have 700 patients that are ready and about to be scheduled on your template, or do you have some time to sort of ramp up and support as you're doing that? Oh, that's a good point. Thank you. How? Linda, in one of your slides, you'd mentioned the importance of asking about mentorship as you were negotiating. Are there different types of mentorship? Because I think trainees will often think about mentors in the training setting, but are there different types of mentors they might want to consider asking about or thinking about in the workplace? Okay. Well, actually that was Dr. Tiwari's question to give credit where credit's due. I'm not really that familiar with mentorships because my knowledge is that in a private practice, they want somebody to hit the ground running so that they understand that when you start as, Dr. Tiwari is going to start a new job, you're not going to feel comfortable. You're not going to be bringing in the type of income in the first year because there is that training ramp that you mentioned, Dr. Martin. So that they're familiar with that and they know that most residents come out because you're working with an attending and you're seeing maybe 12 patients a day that when you get out into the real world, you're not going to just jump to see 25 patients in a day. So they seem from the practice's eye, they're understanding of that learning curve. And again, it's when you are visiting the practice, you get a sense for how kind and considerate and how some practices are very dollar, just like certain hospitals, very how many inpatients do you have today? What's the average daily census in private practices? What, how many procedures are you doing a week? How many EMGs are you doing? Whatever. So you have to kind of feel them out and get a sense for it. And that's why I had one time I was talking to a person that was a chairperson and was interviewing. I was like, gee, why is this chairperson interviewing, obviously for a job. But, and she made the good point that, interviewing is like a learning, the more you interview, the better you are at it. So, look at it as a learning process and what you learned from one experience helps you in the next interview that you go to. Thank you. I think that's really valuable. And that first six months out of training in your first job, that can be a really challenging time because there's such a steep learning curve. So I, yeah, I absolutely agree. Having that support, feeling support during that time as you're going through that is very important. Can't wait. Well, thank you all.

Physiatry

job offer

compensation

work culture

responsibilities

future plans

types of compensation

contract negotiation

mentorship