and Ravi Patel, M.D.
As you are approaching the finish line in your training to be an ophthalmologist, you may be wondering 'how do I start my job search? What questions should I ask and what will be asked of me?' Aside from the basics of polishing your curriculum vitae (CV) and drafting a cover letter, here are some tips on where to start.
Finding your first job out of training may seem like taking on a part-time job and truthfully it really is. Regardless of when you start your search, you may wonder – should I talk to a physician recruiter? Yes. Should I search online? Yes, the American Academy of Ophthalmology (AAO) and Association of University Professors of Ophthalmology (AUPO) have job listings which are free for the applicant. Should I contact groups in the community where I want to practice? Yes. How about local ophthalmologic societies? Yes. Even asking equipment/pharmaceutical representatives in your desired territory can be fruitful. You can check advertisements in trade journals as well as ask your training program faculty if they know of practices in your desired geography. The more opportunities and potential avenues you pursue, the better position you will be in to negotiate a better offer with your dream practice. It really is never too early to start.
As you begin to discuss opportunities, be methodical and keep track of who you speak to and where you are with your discussions with each practice. With your first interview, it may seem easy to keep all the details in your mind, but very quickly as a few more offers to interview materialize you will find yourself reminiscing over residency and fellowship interviews where your choices blur together. What is finally different is the ball is completely in your court whether you decide to accept or reject an offer.
Word of caution, practices that are looking to hire a new ophthalmologist for their group are often in a better position to discuss fringe benefits, partnership tracts, signing bonuses, Ambulatory Surgery Center (ASC) ownership, etc. whereas ones that are willing to make an offer to “the right candidate” often have little incentive to offer these perks. But, as in real estate, the most important factor you have going for you is location, location, location.
Consider the Medical Group Management Association (MGMA) survey report that the average starting salary of an ophthalmologist is $215,000 per year for a full-time position. While this is probably a 4-5 fold increase in your current salary, not an insignificant percentage of new ophthalmologists leave their first job. The Young Ophthalmologist (YO) section of the AAO conducted a survey of ophthalmologists approximately 5 years out from their training. What they found is just under 1 out of 4 ophthalmologists leave with their first full-time position. For those who left their first full-time position there were various reasons cited including finding a better position (52%), poor pay (31%), poor relations with their fellow doctors (31%), felt work was not shared equitably (26%), lack of sufficient patient volume (24%), disagreement over partnership agreement (21%).
As you complete more interviews you will find that practices may start contacting you extend you an offer. While you should clearly be excited and screaming on the inside, I would caution you to complete all of your interviews before committing to any single offer in writing. Often a practice will extend a terms letter to you rather than an actual contract for the sake of negotiation. These are more often written in English rather than “legalese,” but the essential terms are spelled out including salary, benefits, call coverage, partnership potential, restrictive covenant, to name a few. There are other factors during the interview process which will help to narrow your decision-however they are more qualitative rather than quantitative. For some it is simply a feeling of belonging and often a favorable dialogue with the other physicians in the group.
During your interview you should be able to get a taste of the culture of the group. You should carefully review your growth potential or partnership potential with the practice, especially if it is not a practice that is specifically looking to hire a new associate. Speak with ophthalmologists who have left the group and really discuss what they liked and disliked about the group. Sometimes you may find that a doctor has left a group for personal reasons like geography and not related to any interpersonal conflicts, in other instances you may find an associate left due to ethical concerns-which should be a red flag for any applicant.
The interview and contract negotiation process is really the opportunity for you to evaluate the practice to make sure it is a good fit for what you are looking for. Former senior residents or former senior fellows (for those of you who are in multi-year fellowships) can be an invaluable source of information and guidance into what to inquire about. Some have had 1-3 years of experience in practice and have invaluable insight into what they wish they had done differently.
Other issues to consider are whether the practice has an Electronic Medical Record (EMR) system or when they plan on transitioning. You should speak with the practice manager who will give you a really good idea of how efficiently a practice is run (which is crucial if you are on a partnership track) and if there is high employee turnover. As important as it is to working with amazing colleagues, your support staff plays a key role in your success and satisfaction with your new position. Take a tour of the facilities and ASC, for many of you coming out of an academic training model, you may be surprised to learn that your practice doesn’t own an spectral domain OCT or have a license to a Holladay IOL Consultant. It may even surprise you that YAG laser procedures have to be scheduled in the ASC or that there is no minor procedure room in the outpatient office.
The final piece of advice is to carefully weigh all of your options before making your final decision. Choosing the ideal practice is literally finding another life partner, sometimes you are not looking for the offer with the highest salary, least amount of call, latest and greatest equipment but you are looking to see where you WANT to build a practice, which community you WANT to live, and work with people you WANT to be your friends.