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Too much of a good thing?

March 2006

Published in the March 2006 issue of Today’s Hospitalist

Editor’s note: In this month’s story on the booming job market for hospitalists, Today’s Hospitalist examines the perspective of hospitalists with recent experience looking for work. For more on how hospitalist programs are struggling to increase their ranks, see the February 2006 issue of Today’s Hospitalist.

When Danielle Scheurer, MD, started searching for a new academic hospitalist position a year and a half ago, she planned to spend several months exploring her options. While Dr. Scheurer was working in Charleston, S.C., as a general internist, her husband, a pediatric cardiologist, had a job lined up in Boston starting in the summer of 2005, and the family was planning on relocating.

As it turned out, Dr. Scheurer could have allocated only a few weeks for the entire undertaking. “There were several positions to choose from in Boston,” she recalls. “There are three programs side by side, and all of them were hiring. But I only ended up interviewing at one, Brigham and Women’s, because that was my first choice.”

Some might chalk up Dr. Scheurer’s lightning-speed job hunt to her impressive CV. While she graduated from medical school in 1999, she had already helped launch two hospitalist programs, one in an academic center, before starting the Boston job last summer. That made her a sought-after candidate, especially in the current job market.

“I felt that I was a bit of a hot commodity because I had academic hospitalist experience,” she says.

While Dr. Scheurer may have had an edge in finding work as a hospitalist, the speed with which she landed a job is far from unique. Even hospitalists who are entering the job market without years of experience are finding there are so many opportunities that it can be difficult to decide.

That plethora of opportunities, some worry, may be one of the downsides of the current employment market for hospitalists. Physicians and recruiters alike worry that faced with so many offers, hospitalists, particularly those who are relatively new to job hunting, may have a hard time finding a position that’s a good match for them “and prospective employers.

Where the jobs are

When Steve Tran, MD, completed his residency at the Medical College of Georgia, he didn’t find his path to the perfect job quite as smooth as Dr. Scheurer, but he says that’s probably because he was holding out for a specific location.

“I was looking specifically for an urban setting and preferably an academic program, and I had identified only a few cities “Atlanta, Houston and Seattle “that I wanted to work in,” he explains. “So it took me a little longer.”

When Dr. Tran eventually took a job with the Emory Hospital Medicine Unit in Atlanta, he had spent about two months exploring his options. While that may not seem like a particularly long time to find a job, he says he found the pickings were plentiful ” and job searches even faster “for hospitalists who aren’t totally set on a specific location or type of program. Some of his fellow trainees were snapped up “in a matter of days” by programs in rural and suburban areas in the Atlanta area.

“A whole host of hospitalist programs came to our job fair last year,” Dr. Tran explains. “I got the sense that if you’re fl exible, there are a lot of opportunities out there.”

Dr. Tran’s observation that jobs appear to be more plentiful in the suburbs and rural areas is echoed by recruiters and industry observers. They say that’s the case because mid-sized community hospitals in these areas are “bringing up the rear” in starting hospitalist programs in some markets.

That’s not to say that hospitalist programs in urban areas aren’t hiring; many academic and community programs in the cities are in the expansion mode. But experts say that the number of jobs outside of urban areas translates into an issue of timing.

Recent trainees who have their heart set on a particular city, they say, might need to either start the job search earlier “three to six months before their desired start date, for example “or be amenable to working for a program that’s their No. 2 or No. 3 choice.

Finding the right match

When veteran hospitalist Mathew Mathew, MD, recently began looking for a new position, he knew that finding a job would be relatively easy. But instead of taking the first offer that comes along, he says he is taking an intentionally long route in looking for his next position.

Dr. Mathew, who is currently medical director of the hospitalist program at Mercy Health System in Philadelphia, says he is finding the situation much the same as Dr. Tran describes: There are plenty of jobs, but not always in the right situation or location.

“The jobs are available,” Dr. Mathew explains, “but finding the one you want in the location you want might be more difficult.” He notes that because he entered hospital medicine in his forties, he is now trying to figure out where he wants to spend “the duration” of his practice years.

“I’ve had several people contact me from different places to ask about my interests,” Dr. Mathew says, “and there are a lot of opportunities for people with experience to help start new programs. But I haven’t made up my mind yet, and I’m going to take my time. I’ll make a decision when the right opportunity comes up.”

Dr. Mathew adds that based on what he’s heard through the grapevine, opportunities were fewer in programs located in “nice-lifestyle areas,” such as the large cities in the Pacific Northwest and Northern California. Jobs seem to be particularly plentiful, however, in the South, Midwest and the smaller cities and rural areas in the West.

The downside of a buyer’s market

It’s no secret that the booming job market for hospitalists is causing pain for hospitals and hospitalist programs trying to recruit physicians. (For more, see the cover story in the February 2006 issue of Today’s Hospitalist.) But the plethora of opportunities, combined with pressure from programs that are anxious to fill their openings, can cause headaches for physicians as well.

It’s one downside of a buyer’s market, according to Sanjiv “Ben” Panwala, MD, a hospitalist with Providence St. Vincent Hospitalists in Portland, Ore. Dr. Panwala, who has been in the field for nearly a decade, found his third hospitalist position three years ago.

“Right now,” he explains, “if I went out there with nine years of experience, people would be tripping over themselves to recruit me. The needs have gone up and the pay scales have gone up, but the recruitment strategies have also become more intense.”

He worries that hospitalists, particularly physicians who are new to the job-hunting process, may lose sight of what they’re really looking for in a job, creating a bad situation for everyone. “Residents can get overwhelmed easily and shuttled into positions that don’t work for them individually,” he says.

A problem of supply

As a first-time job seeker, Dr. Tran quickly found himself immersed in managing inquiries from prospective hiring entities. Before he landed his job at Emory last summer, he talked to several recruiters and program directors in non-academic, nonurban programs.

Dr. Tran says he got the sense that the proliferation of programs and the limited supply of hospitalists were creating a quasi-desperate situation for those trying to start or expand programs.

While he didn’t encounter an overt bidding war, Dr. Tran and his counterparts were asked on occasion “what other programs were offering and what it might take” to entice them to work for certain programs.

“I got the sense that it was very competitive out there,” Dr. Tran says, “like a bidding war. No one cited any dollar figures. They just indicated that they would ‘try to meet our requirements.’ ”

With the market booming, the pressure shows no signs of easing up any time soon. Dr. Scheurer points to Charleston, where she worked as a community-based internist, as one example of how the market for hospitalists is booming.

“Four years ago,” she says, “there were no hospitalist programs in Charleston. There are now four. The university program is now up to seven hospitalists, and they’re looking for 12 FTEs to do the work that’s available.”

Choosing town vs. gown

To her younger counterparts who are trying to choose a first position, particularly those who are trying to choose between community hospitalist work and academia, Dr. Scheurer offers some advice. For one, she says, don’t necessarily expect a much lighter workload in academia than in community hospitals, just one that may be more evenly distributed.

“In academics, there tends to be more ‘off-hours’ work “readings and research,” she notes. While the academic workload tends to be manageable overall, Dr. Scheurer adds, the “60-hour week is not uncommon.”

And when academic programs are understaffed, either temporarily or during startup, she adds, hospitalists can pay the price through increased patient loads and difficulties juggling teaching and patient-care duties.

“I have been in a new program that was profoundly understaffed because the demand for expansion outpaced the recruiting efforts,” Dr. Scheurer says. “The workload was absurd at times.”

But that’s not the case at Brigham and Women’s, a point Dr. Scheurer makes while uttering an audible sigh of relief. “I’m fortunate in that when I came here, the program was at a steady state,” she explains. “I got here at the right time, and I couldn’t be happier.”

Help for young hospitalists

To help physicians navigate a marketplace that can be overwhelming, Dr. Panwala and other leaders in the specialty are working with the Society for Hospital Medicine to give hospitalists, particularly those entering the job market for the first time, some help.

Based on the steady input it’s received from newcomers to the field and the leaders of hospitalist programs who are trying to do damage repair when physicians jump ship, the society is creating a special Young Physicians section on its Web site. The section will be devoted largely to educating residents on the myriad options within hospital medicine, and on the basics of engaging in a strategic job search and performing the requisite due diligence before making a decision.

“What we’re trying to do is create useful resources for residents so they can come out of training with some basic understanding of job processes,” says Dr. Panwala, who is part of the SHM effort and a frequent speaker on the topic of hospitalist recruitment. “That’s the biggest value you can create for residents: helping them understand that there are many kinds of positions out there and helping them identify and find the kind of job they’re looking for.”

Bonnie Darves is a freelance writer specializing in health care. She is based in Lake Oswego, Ore.

Interested in exploring the job market? Try these strategies

Hospitalists who are seeking positions for the first “or even the third “time in their careers may indeed find themselves in a buyer’s market, but that’s no assurance they’ll end up choosing either the right position or a solid program. That’s why veteran hospitalists and industry observers say that performing due diligence is just as important in the current “hot” market as it would be in less one-sided conditions.

Here are some of their suggestions to help you make the right choice:

“¢ Look outside of the interview setting to get information.

Experts say that means making an effort to identify and speak to in-the-trenches hospitalists, both current and former, whenever possible. That’s not to suggest that the interview team won’t give a straight scoop, but just that other perspectives can and should inform your decision.

“Go behind the scenes and outside the interview day to meet people,” says Danielle Scheurer, MD, a hospitalist at Brigham and Women’s Hospital in Boston. “You’ll get a lot more information that way.”

She suggests e-mailing every single physician in the practice. If it’s possible, also talk to physicians who have left the group. “Ideally, you want to hear from the newest hire and the most recent departee,” Dr. Scheurer says.

She notes that when she left her last practice in Charleston, several physicians who were considering taking her place called to ask why she left. While Dr. Scheurer says she explained she was relocating, she adds that she’s sure those physicians made better decisions based on that information.

Dr. Scheurer acknowledges that getting the real story “teasing out the pros and cons of a program “is easier said than done. She also admits that she didn’t go to that length her first time around, but she now knows that the effort can pay off.

“Job satisfaction [of prospective colleagues] can be one of the hardest things to get at, especially if you’re an inexperienced physician,” Dr. Scheurer says. “But it’s much more important than salary. A difference of $10,000 over a year’s time is negligible compared to whether you enjoy what you do.”

“¢ Get a good sense of the program’s “underpinnings.”

Many young physicians don’t ask the right questions in this regard, according to Sanjiv “Ben” Panwala, MD, a nocturnist with Providence St. Vincent Hospitalists in Portland, Ore.

Before choosing a program, he says, hospitalists should know the program’s history and evolution. They should also try to get a picture of its support “both financial and administrative “and its standing within the institution.

“I get the sense that many residents are not making informed decisions,” Dr. Panwala explains. “I know a bunch of residents who came out last year who are very disappointed with their job selection.”

All too often, first-time job seekers are lured by high salaries, or they base their decision primarily on what a recruiter or program director tells them.

“They aren’t looking at the longevity of the practice,” Dr. Panwala says. “Many residents don’t understand that the difference between a good program and a bad one “which might simply mean a program that isn’t right for that individual “is night and day.”

He says that working for the VA, for example, is completely different than working for a mid-sized regional group. That’s why he says at the very least, candidates should “try to ascertain whether hospital leadership is responsive to hospitalists’ concerns. That’s the sort of thing that will have a huge impact on your ability to perform.”

“¢ Identify issues that may affect professional and personal life.

Don’t neglect to ask specific questions about issues that will affect your lifestyle. That includes factors like the number of nights and day shifts you’ll work, the length of those shifts, and the expected patient load.

Those factors will affect job satisfaction, according to Martin Buser, MPH, a founding partner of the consulting firm Hospitalist Management Resources LLC.

“You also want to ask about the backup plan for high-census periods and whether the ED backup panel is properly manned,” he adds. “Those issues can become hugely important.”