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Physician's Guide to Transitioning from Training to Practice

2013 OnCall Advisors, LLC

Physicians undergo one of the most drastic transitions of any occupation when graduating from their final year in training and into their first year of practice. This transition requires great preparation both personally and professionally. Those who transition well will have the ability to reduce their personal and career risks while taking advantage of opportunities afforded to very few. Those who do not transition well find many obstacles hindering their opportunities and putting their careers and families in unnecessary jeopardy. The purpose of this guide is to help residents and fellows prepare for, and make, a successful transition from training into practice.

Overall Transition Plan

First, we will look at the overall plan of transition before delving deeper into its various components. Like a roadmap, a training to practice transition plan will guide you from your current destination in training, to your eventual destination of a successful attending career. The main elements of such a plan include the following: 1. 2. 3. 4. 5. 6. Preparing or amending of your CV Job search Contract review Contract Negotiations Financial planning Monitoring

If prepared correctly, a transition plan that fully considers and takes action in all of these areas will give you the greatest chance to successfully transition into practice.

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Preparing or Updating Your CV

Most physicians develop their CV between medical school and residency. Of course, there are many skills and experiences acquired during residency and any subsequent fellowship. All of these updates must be made to your CV before you send it to any potential employers and they must follow very strict rules of citation and format as well as incorporate the current best practices of CV writing. Some of the rules include:

Following AMA formatting for citations Proper grammatical structures and sentences No misspellings No misleading or overblown information or descriptions of experiences

Some of the best practices include: Keeping all dates to the left and text descriptions to the right Placing the most pertinent or impressive items towards the top of the page Condensing your CV to two pages maximum (one page if possible) Leaving white space between items in order to be more easily scanned Since your CV will most likely be one of many considered, it must not stand out negatively and allow the reader to scan it quickly and still pick up the important information.

Job Search
One of the biggest fears conveyed to us by residents and fellows through the years is that they will somehow leave training without a job or will end up in a first practicing position that is less than desirable. This is not an unfounded fear as we have seen it happen numerous times to physicians of all specialties and geographic areas. However, weve noticed that physicians who employ the following job search tactics tend to have no problems in finding satisfying first job outside of training:

Obtain multiple offers - allows you to use the strengths of each offer to make the other offers better. 2013 OnCall Advisors, LLC


Learn as much as you can about the other physicians and working environment. The number 1 reason physicians leave a practice is...the other physicians! On top of any interviews, search the employer and physicians online for reviews/comments and ask if you can interview a couple of employer-approved employees. Physicians mostly dont complain about their choice of occupation, but their employment situation.

If you had to do it all over again, would you *2

Dont accept an offer based on compensation alone. Ask us about The Hamptons Surgeon sometime for a humorous example. Location, location, location. If you are looking to land a longer term position, be sure to consider location and choose somewhere you will want to live. Many residents and fellows follow the higher salary to a less desirable location and regret it later. If you choose this approach, make sure you plans are shorter-term. Use a job search agent like Cejka Search, PracticeLink, LeapDoctor, etc.

Also, understand that there may be differences between what a recruiter tells you and what the employer may say or do. Be sure to verify any and all terms communicated to you by a recruiter with the actual representative of the employer who is in charge of hiring you.

Contract Review
A large percentage of physicians from previous generations went without employment contract reviews for their first practicing job after training. Many others simply let an older physician, a friend, or some type of non-contract attorney review their agreements. After decades of these mistakes and countless stories of bad contracts and their consequences, todays residents and fellows are trending wisely towards using physician contract specialist attorneys. These attorneys have been trained in contract law and have a great deal of experience with physician contracts in particular. When choosing an attorney, it is important to ask the following questions: 4 2013 OnCall Advisors, LLC

Do you specialize in physician contract reviews? What percentage of your time is devoted to physician contracts? How long have you been reviewing physician contracts? How many physician contracts do you review per year? Have you recently reviewed a contract in my state and specialty? (It is not important for an attorney to be licensed in your employers state - unless you need representation in court - but it is important that the attorney is well-versed in that states specific laws and regulations.) What are your levels of service and corresponding fees? Do I get to interact with you at all service levels? Do you provide any financial expertise with regard to the compensation and benefits?

It is also very important to visit their website. Many will tell you that they are physician contract experts but one visit to their website may convince you otherwise. If physician contract review services are not prominently or exclusively featured, you may not want to use that particular attorney.

Contract Negotiations
Negotiating your first employment contract can be intimidating and many physicians simply accept their contracts as they are first offered to avoid coming across as greedy or argumentative. Also, many of them are told that the employer will not negotiate their contract. However, if done correctly, almost all employers will negotiate some points and failing to do so could be a huge

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mistake! In order to have the best chances of success, employ the following tips for negotiating with your prospective employer: Decide before the meeting what are points you can compromise and what are the nonnegotiable for you and your family. Be respectful, cooperative, and optimistic. The opposite would be to come across as argumentative, selfish, and skeptical. Remember, contract negotiations often represent the first time you will work with your employer on something and could actually be very helpful in laying the foundation of a good working relationship.

Also, most physician contract review attorneys will offer to coach you in your negotiations or agree to negotiate on your behalf. Residents and fellows typically report that any added cost for this service well worth it as the attorney is much more trained and experienced in such matters.

Financial Planning
Once you have signed your contract, it is important to get a head start on developing your first financial plan. A mistake that many physicians made in the past was to think that they should wait until they were making their attending salary to begin financial planning. To the contrary, there is less stress and a higher likelihood of financial plans being completed if they are made before you begin your first attending job. If this is not accomplished, many physicians act impulsively out of fear or excitement when they receive their first attending paycheck and may develop bad financial habits that last for years and prove hard to break. The main components of a good financial plan include:
1. Budgeting

a. All sources of income b. All expenditures c. Current Assets and Liabilities 2. Assessing Your Current Financial Position and Life Situation a. Single/Married b. Children c. Debt 3. Tax Planning a. Identifying tax status b. Minimizing tax liabilities c. Developing a tax payment strategy (quarterly estimates, annually, etc.) 6 2013 OnCall Advisors, LLC

4. Developing Life/ Financial Goals






a. Travel b. Charitable giving c. Research d. Starting a practice Crafting a Debt Repayment Strategy a. Sources b. Rates c. Consolidation opportunities d. Minimums e. Schedule Savings/Investment Planning a. How much to save/invest b. Risk profile Retirement Planning a. When you would like to retire b. How much would you like to live on Catastrophe Planning a. Life insurance b. Disability insurance Creating Action Steps to Reach Your Goals

The physicians who develop a financial plan before they receive their first attending paycheck will most likely waste less money and move more effectively and efficiently towards their goals.

Now that you have taken the necessary steps towards landing the best job and being financially prepared for your first attending position, it is important to monitor both your contract and financial plan. When keeping track of your contract, be sure to consider the following questions: 1. Are the duties and obligations I am actually experiencing in my everyday job line up with what is in my contract? 2. Am I being paid what I was promised? 3. Am I on track to receive any bonuses or other incentives promised in my contract? 4. Have I been asked to do anything not in my contract? 5. Are the benefits outlined in my contract being provided? 7 2013 OnCall Advisors, LLC

6. Is call being handled as communicated in my contract? When tracking your financial plan, be sure to consider the following questions: 1. 2. 3. 4. 5. Are my investments performing as expected? Is my net worth moving in a positive direction? Is my debt reduction strategy on schedule? Am I living within and following my budget? Am I closer to reaching my goals?

The most important aspect of monitoring both our contract and financial plan is making sure that you do so regularly. In most cases, physicians do not do this on their own and greatly benefit from having a professional physician contract attorney and financial planner to remind them and perform the reviews.

Most transitions in life are difficult and reward those who prepare ahead of time. For physicians, the transition from training to practice is the same. Many of the mistakes made by previous generations of physicians can be avoided, mitigated, or significantly lessened by simply following the time-tested path outlined in this guide. For those desiring a less stressful, more successful transition into practice please feel free to use this guide and let us know if we can help consult with you further in any of these matters.

What to Do Next?
For assistance or questions regarding the guide or other physician financial topics, please contact us at 888-848-0786 or click the link below: Contact Our Transition Specialists To Create Your Transition Plan Today!

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1. 2.

Merritt Hawkins, A New, Hospital-Specific Model for Assessing Physician Staff Requirements, 2012, 2013

Securities offered through Securities America, Inc., member FINRA/SIPC. Advisory services offered through Securities America Advisors, Inc. OnCall Advisors and Securities America are unaffiliated.

2013 OnCall Advisors, LLC