Rough Timeline
- PGY2 Year: Congratulations! You survived your intern year. Take advantage of the opportunities provided to you by your PM&R residency program, including mentorship if the opportunity is available to you. If you do not have a mentor that fits your interest, there is a AAPM&R Mentorship Program that can match you with someone who can help guide you. If you don't have one already, create a draft of your CV.
- First Half of PGY3 Year: Decide whether you want to pursue a fellowship. At this point, you will often have narrowed it down to a couple of options. Approach each rotation and experience with an open mind.
- Second Half of PGY3 Year: Regardless of whether you decide to pursue a fellowship or not, start to consider the type of job you would prefer. This includes deciding whether you prefer inpatient vs. outpatient vs. a combination of the two. Also consider the type of setting you want to work in, i.e., academic vs. community vs. private practice. Start networking as early as possible and attend career fairs that are available to you like the AAPM&R Early Career Course. Another available resource to PM&R Residents is the AAPM&R Job and Fellowship Board.
- Fall/Winter of PGY4 Year: Job interviews are often scheduled during the fall and winter of the PGY4 year. Job offers and negotiations will often begin during this time period as well.
- Spring of PGY4 Year: Job offers continue to be made and contract negotiations occur. Use your advisors as a resource when navigating this.
TIP: Most academic programs use the job fair at the AAPM&R Annual Assembly as the beginning of recruitment season.
Determining Job Preferences
The first step when entering the job market after completing residency or a fellowship is determining what type of job you wish to pursue. This is an intimidating task; however, it is paramount that you use the experiences you gained throughout your residency and fellowship to guide you. It may be beneficial to make a list of the things you absolutely want and do not want from your future job.
Below you will find some of the key factors one must consider when choosing their career path:
- In what setting do you want to work?
- Academic — research requirements and/or teaching responsibilities, working with medical students/residents, patient population (often referral centers/specialty care)
- Private — group vs. individual practice, association with other departments (e.g., ortho, neurosurgery, etc.)
- Government hospital setting — veteran population, access to resources not always available to the civilian population
- Small vs. large practice
- Single specialty vs. multispecialty centers
- Free standing rehabilitation hospital vs. inpatient hospital vs. outpatient hospital/clinic vs. combination
- What do you want to do in your clinical practice?
- Inpatient vs. outpatient
- General, MSK, Neuro, SCI, Spine/Interventional, Workers Compensation, etc.
- Procedures
- Electrodiagnostics
- Do you have a preference on patient population?
- Underserved communities, inner-city population, elderly, complex patients at referral centers, etc.
- Consider payer sources (e.g., commercial, Medicare, Medicaid)
- Is location a priority?
- Geography — West Coast, East Coast, Midwest, South, etc.
- Region — urban, suburban, rural
- Climate
- Cost of living — real estate, taxes, daily living
- Population growth trends
- Does the region have a high demand for PM&R physicians?
- Additional Resources:
- Will the position successfully address the needs of a family or significant other?
- Employment opportunities for a spouse or significant other
- Children (e.g., daycare, schooling)
- When do you want to start working?
- This is often outside of your control and determined by your future employer. However, it is important to consider things that may limit your ability to accept a position, including requiring time off after graduation for personal obligations or board exam preparation.
- Are you interested in working call? If so, how often?
- Full-time vs. part-time vs. locums tenens?
- How does salary impact your decision?
- Salaried vs. productivity-based pay
- Loan forgiveness is offered through some institutions and areas
- Expected expenses and budget based on the cost of living
- 1099 (Contractor) vs. W2 (Salaried, typically with benefits and PTO)
TIP: A key resource available to AAPM&R Members is the AAPM&R Career Path Podcast Series where physiatrists who successfully found a job of their choice discuss their decision making process.
Financial Considerations
Depending on where you practice, the reimbursement structure and rates may vary.
Reimbursement Structures
- Guaranteed Salary: A guaranteed base pay that may have a productivity bonus for what you earn above the determined salary
- Academic settings are more likely to have salary-based pay.
- Some private practices will offer a 1- to 2-year guaranteed salary, taking into consideration that a new physician may have a smaller patient volume as they begin their practice. This "guaranteed salary" may be considered a loan of a "debt" of what you did not earn to meet that salary. This may be tabulated during those years and then gradually forgiven over a period of time (e.g., over the subsequent 2 years, 1/24th of the debt is forgiven each month). If you leave the practice before this debt has been fully forgiven, you may be required to repay the practice.
- Productivity-based Salary: Reimbursement is based on what you earn and ultimately bill. This is a common model in private practice.
Reimbursement Rates
This varies considerably by region of the country. Private practices typically have higher reimbursement rates than academic settings. Based on the current healthcare reimbursement structure, procedural based practices have higher reimbursement. Inpatient care and consult services often provide higher revenue than clinic visits.
Most practices determine salaries and reimbursement rates based on fair market values. Based on the AAPM&R 2017 PM&R Physician Compensation Survey Report, the median compensation for a physiatrist was $300,000, which indicated a 5.7% annual growth rate. The Medscape Physiatrist Compensation Report for 2020 indicated the average salary for a PM&R physician is $308,000.
Additional Resources
TIP: Reimbursement rates are typically higher if you are willing to work in a more rural or underserved setting.
Polishing Your CV
Your curriculum vitae or CV is often your first introduction to a potential employer. Creating a thorough and intriguing CV that reflects your unique strengths and accomplishments is essential. This is what can help you get your foot in the door.
TIP: It is extremely important that you update your CV on a regular basis. This will ensure that you are not scrambling to prepare your CV or sending an outdated CV.
- Categories to include:
- Contact information — Make sure to use an email or mailing address that you will still have access to once you complete your training. You will often lose access to your residency or fellowship email addresses once you transition to the next step in your career
- Educational background in reverse chronological order — including medical school, graduate school, undergraduate school, post-graduate training (e.g., internship, residency), fellowship(s)
- Previous employment in reverse chronological order
- Licensure — including certifications and specialty boards
- Research, presentations and publications
- Awards and honors
- Membership in professional organizations
- Leadership experiences — including committee participation and teaching experiences
CV TIPS
- Be consistent with your format. If you abbreviate something, abbreviate it throughout. When adopting the reverse chronological order format, continue to do so throughout the CV.
- The first person to read your CV may not be from a medical background. Make sure that your CV is approachable and understandable to the layperson who may be screening your CV. In addition to having mentors, faculty or your program director review your CV, be sure to have someone from a nonmedical background review it.
- If you are applying for an academic position, be sure to highlight educational, leadership and research experiences, i.e., adjust the order of categories on the CV.
- The document is best saved and sent as a PDF file to avoid accidental changes when the file is opened by the recipient(s).
- Update your CV monthly and consider including a "date last updated" in the CV.
Below you will find guides for how to prepare your CV:
- Sample CVs: (1, 2)
- Guidelines for creating a medical CV:
Writing a Cover Letter
This is used to express interest in a position. It can initially be drafted as a general letter and adjustments can be made depending on the specific institution to which it is being sent.
A formal cover letter is a must when you are initially inquiring about a position opening. This can be included in the body of an email or as a separate attachment with your CV.
Components
- Typically, three (3) concise paragraphs
- Tell a little bit about yourself. Focus on the things that make you stand out.
- Express your interest in the position. This can be adjusted for each position you apply for.
- Indicate your practice interests (e.g., neuro-rehab, musculoskeletal, pain, electrodiagnostics, inpatient/outpatient, etc.)
Additional Resources:
TIP: Try to limit the letter to one page. Make it memorable.
Gathering References and Letters of Recommendation
Potential employers will typically request at least two to three references that they will contact to ask about you. They may or may not request formal letters of recommendation.
TIP: Give your references advance notice that they may be contacted by particular practices and the position for which you are applying.
- One reference is usually written by your Residency Program Director.
- Choose faculty, mentors and/or advisors with whom you have worked closely and can give an accurate and thorough description of your capabilities as a physician and colleague.
- Provide a copy of your CV to your references and letter writers.
TIP: Plan ahead when asking for formal letters of recommendation. Always make sure you give letter writers adequate notice to allow them to compose a thoughtful letter. This means that you should ask for the letters early, ensuring that you give them weeks to months to write the letter.
The Job Search: Building a Network
Start gathering information regarding job availability near the end of your PGY3 to early PGY4 year. If you have completed a fellowship, your job search will typically occur during the course of your fellowship year.
TIP: Create a spreadsheet with specific information regarding each position you are interested in to simplify the comparison process. This should include contact information to make it easier to express interest and ask questions should they arise.
Here are places you can start to build your network:
- Job Fairs: an opportunity to network with multiple institutions in one setting. A job fair will often be your first impression for a potential employer. Make sure you act and dress professionally. Use job fairs as a place to practice for more formal interviews. That being said, meetings at a job fair may serve as the formal interview for a position. The AAPM&R Annual Assembly hosts a Job and Fellowship Fair that includes most major academic institutions that are and will be recruiting.
TIP: The bottom line is to always act professionally because your interaction with people at job fairs may serve as your first impression.
- State PM&R Society Meetings: another setting to allow you to meet and network with the PM&R community in your area.
- Physician Recruiters: If you take time in your PGY3, PGY4 and fellowship year to do your research, this may not be necessary. Physician recruiters also may not be aware of positions that are not openly advertised. That being said, they are often an invaluable resource in helpig you navigate the job market. Do not let a fee deter you if you feel you need their assistance.
- Alumni Associations: a good resource for talking with recent graduates about their job search.
- TIP: The alumni reception at the AAPM&R Annual Assembly is a great networking opportunity.
Additional Resources:
- PM&R Job Resources
- Physician Job Database Resources
- Online resources, i.e., PracticeMatch, CareerMD
- Representatives may call or page you and request information
- You can post a profile, CV and job preferences online
- Use with caution — it is not always clear to whom or where this information is being sent
- Online Professional Networks
- i.e., LinkedIn
- TIP: Be sure to keep your information and network up-to-date
The Job Search: Applying and Interviewing for Positions
Inquiring about a position
This can be in response to a posting of as a "cold call" to an institution or clinic to see if they are anticipating any openings in the upcoming 6 to 12 months. The appropriate person to contact is often the Human Resources representative, physician recruiter, practice manager or PM&R department administrator. It is reasonable to express interest in a position as much as 12 to 14 months prior to completing your training.
TIP: Contact practices you are interested in even if no position is being publicly advertised. Advertising available positions expends resources and thus a position may still be available despite them not actively trying to recruit someone.
Scheduling Interviews
- Be sure to budget both time and money for traveling for interviews. Some expenses may be covered by the hiring institutions and clinics.
- It would be ideal to schedule your interviews within a two-month period in the fall and winter of your PGY4 year. This would give you an extended time period to compare, negotiate and make an educated decision.
TIP: Keep your job search in mind when planning your PGY4 schedule and vacations. Be sure to give attendings adequate notice should a job interview arise.
Interview Day
The interview day itself can be daunting. You will meet a variety of people throughout the course of the day, including other physicians in the practice, nurses, therapy staff and administrators. Use the opportunity to get a sense of the culture and the atmosphere within the practice. This is your chance to understand the environment you could potentially be working in.
What information should be presented and if not, what questions should you ask?
- Who will I work with?
- Job specifics —
Is there any flexibility to develop clinics that focus on personal interest areas? Inpatient vs. outpatient vs. a combination of both? What are the call responsibilities?
- Note: the physician hiring staff may have a different point of view compared to the practicing physicians regarding the medical practice, i.e., call schedule, hours, patient load.
- What special expertise do the current physicians bring to the practice?
- Is early supervision and/or mentorship available?
- Are there any unique or special services/resources available to patients through the institution? (i.e., telehealth services, support groups, interdisciplinary "one-stop-shop" clinics)
- Are affiliated therapy services housed in the same clinic or at a nearby center or hospital?
- How many physicians have left the practice in the past three (3) years?
- What information is available about the community/living area?
- Review MGMA data in advance to determine an approximate salary range for a physician with your skill set.
TIP: Face-to-face interviews are probably not the time to bring up specifics about compensation and benefits unless the interviewers address it first.
Additional Resources and Interviewing Tips
After the Interview
Take time to write down your thoughts and experiences throughout the day
TIP: When you return home from your interview day, write down pros and cons for the potential site. Make sure to note down any red flags.
If time allows, explore the city for a day or two following the interview. This is where you could potentially be living — make sure it is a place that you can enjoy, unwind and thrive in. Who knows, this may be the home of your future permanent job! The practice may connect you with a local realtor.
Make sure to thank your interviewers They are extremely busy and they have taken the time from their schedules to meet with you. Send thank you notes as soon as possible to important people from the interview day.
Contract Negotiation
This can be an intimidating process, but it is paramount to get fair compensation and satisfaction with your position. At this point, the employer has already selected you as someone to join their team. This is your opportunity to make your needs and expectations known. Make a list of your priorities, including what you need, what you want and what you are comfortable compromising on.
An available resource to AAPM&R members are the resident-directed lectures about contract negotiation and related topics at the AAPM&R Annual Assembly Career Corner.
TIP: Do not be afraid to negotiate. It is expected that there will be some degree of negotiations. Know that some items will be non-negotiable.
When negotiating your contract...
- Make sure you understand all the terms and conditions of the contract before beginning negotiations.
- Negotiations may be done by email, phone or in-person.
- It may be helpful to create a script for yourself for verbal negotiations.
- It may be helpful to know the pay in the neighboring hospital, if the information is available.
- Be confident without being arrogant.
- Be respectful and realistic with your requests.
- Be timely in your communication.
The following may be negotiable...
- base salary (to an extent)
- signing bonus
- resident stipends
- loan forgiveness
- moving expenses
- CME funds
- state date
- work schedule (i.e., 4-day work week as full-time)
When offered a contract, carefully review the employment agreement for...
- a detailed job description
- salary — guaranteed or productivity-based? Inquire how long a salary is guaranteed. How does the salary change after that time period?
- length of contract agreement
- contract renewal procedure
- notification time if your contract is to be terminated
- restrictive covenant clause — this is a non-compete clause that typically includes a time period and geographic radius that you would be unable to work in if you were to leave the job. These are very common.
- the opportunity to become a partner in the practice — how long does it take? is everyone offered the opportunity? what is the buy-in structure?
- benefits — medical and dental insurance; disability insurance; life insurance; moving expenses; vacation time; CME time and funds; funding for licensure, academic fees, membership dues; retirement plans; malpractice coverage, does it include tail coverage? (see "common pitfalls")
Hiring a contract attorney
- It may be beneficial to hire an attorney to review a contract. Look for a qualified lawyer who is familiar with contract law and/or health law.
- The range for an approximate fee for an attorney to review a contract is between $300 to $1000 per contract. It will be more expensive if an attorney were to negotiate and review the contract for you.
TIP: Ensure that your contract is written properly because this is what will define your livelihood. Attorneys may offer a discounted rate for residents.
Common Pitfalls in Contract Negotiations
Not getting a tail policy.
- Tail policies refer to additional malpractice coverage for litigations that may come up beyond one's termination date.
- Know who pays for this — it could be you, your current employer, or your future employer.
Not having an exit strategy.
- Sure, everything looks great now, but we cannot predict the future. Be prepared if things don't work out.
- Review the restrictive covenants/non-compete clauses to make sure they are reasonable and precisely defined.
Verbal agreements.
- You may discuss details of your work hours, call frequency, etc. in your verbal negotiations, but it is not official until it is on paper. Recap conversations at least in email to keep an adequate paper trail.
Not understanding the compensation formula and method.
- Ask for a sample calculation of compensation. Ensure it is worded the same way in your contract.
- Clarify if your compensation is salaried or productivity-based. It may be a good idea to establish a base salary as you work to build your practice.
- Determine the payment formula, payer pool and collection rate.
Not discussing dispute resolution and what policy is in place.
Waiving your right to appeal should you have termination of medical staff privileges.
Once negotiations are over, you are satisfied with the job that has been offered to you and have signed your contract, celebrate! You have survived your residency (and possibly fellowship) journey. Congratulations, you have earned the title of attending!
Wishing you the best of luck in your future careers!
Sincerely,
Erin Grimsby, MD, PGY4—Medical College of Wisconsin
and the 2013 Resident Physician Council Board
Updated 2017 by Christina Klein, MD; Ashley Wong, DO; and Claire Finkel, MD
Updated 2021 by Neha Dhadwal, DO