• LecturehallLIFE SKILLS: How to Conduct an Effective First Podiatric Job Search
  • Lecture Transcript
  • TAPE STARTS – [00:00]

    Male Speaker: Next speaker, I've had the pleasure of knowing since he was a student at Temple, Dr. Christopher Hood, Jr., graduated from TUSPM, 2012. He completed the podiatric medicine surgical residency at Crozer-Chester, then joined prominent orthopedic group in the Malvern area, Pennsylvania at Premier Orthopedics. He is a rising star here at Present in the field of podiatry. In general, he has published many journal articles, blogs for Podiatry Today. He has lectured in multiple podiatric state meetings. So please welcome Dr. Christopher Hood, who is going to speak on job searches.

    Dr. Christopher Hood: Alright, do we have any residents here? Too many. Alright, so, I tried to put this together in thinking how many people are going to be here, how to conduct the first job search for the residents. I think a lot of tools that I tried to use in trying to find the first job that I had. I've actually used several times because I'm -- whatever three years and two months into my practice but I've probably done about three or four job searches in that short time coming out of residency, then fellowship researching for jobs again. I just recently moved into Nashville. So all the tips and tricks I kind of figured out in the internet. I've just been reusing multiple times. So I think anyone going through their career can possibly learn from this. So it doesn't just have to be your first job search. So I have no disclosures. Most of the stuff in here is either my opinion or something that I found online. So the objective is just to understand for residents but for everyone how to perform a job search, where to look for jobs and then a lot of the different parts of the job search interviews, contracts. We just had a great lecture on contracts, so l will skip through some of that stuff just because it's redundant, maybe just comment on a few things from my experience.


    So I love Legends of the Hidden Temple back when I was a kid, so I kind of have something throughout the presentation stuff that's either repeated, stuff that's my opinion and some shameless plug stuff. So I know this is a Present lecture. I also have my own website. It's foot and ankle resource.com. It's on the last page here. I kind of just created it when I was going through the process trying to put all this different information that I found into one location, partially for myself, partially for other people to use. And so anywhere you kind of see the green or the silver snake, that stuff will be linked on my website so you can find it there too. So with a random fact of the day, just moved to Nashville, Tennessee a year ago. A couple of weeks ago, my wife and I went to the Jack Daniels whiskey distillery which our first fun fact is that it's in Moore County which is a dry county. So it's the only place in the county where you can actually buy whiskey. So if you want to drink in Moore County, you're drinking Jack Daniels. The other fun thing is in the middle picture is the picture of a safe that was in Jack Daniel's office. The rumor story is that one day he forgot the combination, kicked the safe, got a toe infection resulted in multiple amputation, sepsis and that's how he died. So it was kind of interesting. So on the brighter note, the future for podiatry is pretty bright. These US job news report survey just came out a couple of months ago, all pretty high scores, all the top jobs were all the different medical professions, podiatry kind of being right in there. Bureau labor statistics staying there will be about 10% employment growth already started over the next couple years with -- they are just saying a thousand jobs opening up but we know it's going to be more than that when we're graduating 300, 400 hundreds residents a year and pretty much everyone is finding employment, so we're all doing a good job.


    So the roadmap is just we're going to go through different subcategories of how to go through the job process. So I think the biggest key is staying organized and staying ahead and we have talked about that with the fellowship talk where you want to start the job search or the fellowship search early because a lot of these jobs are getting locked up ahead of time. I think the whole of point of being a podiatrist and going to residency is ultimately getting a job, so we should be starting early, trying to figure out all the different components of what that job is going to entail, so when it really comes time about 18 months out when you should be really looking for that job, you're already ready to go. So practice links to good website that you guys can go to which has a lot of information about jobs, job searches, contracts, etc, and this is their kind of playlist of how you should go through everything and a lot of it's commonsense; figuring out where you want to live, writing your CV, getting your references, defining the goals, what are your desires and the job that you want, start to look for the job and then start actually preparing your resume and cover letter, prepping for interviews, having a good interview and then signing the contract. They also put a checklist together, so you can actually find this through their website if you just search for that when and what to do in your job search and the ultimate job search guide. There are two PDFs that you can go through, has a lot of these points described in more details and then also the job list. So what to do as a resident? So pretty much you want to start looking and figuring out earlier than later as we kind of talked about what the contract stuff. So usually, the recommendation is about 18 months out, trying to figure out where you want to go and so forth. So the real big question you get to ask is like how do I know where to go? Well, it's going to be up to you to decide that. Do you want the best job? What does that mean to you? Is it the highest salary? Is it an orthopedic group? Is it a hospital? Is there some specific things you desiring in your career or is it the location? I think more often than not and we have kind of hit this throughout the few of the presentation this weekend. We had the malpractice talk the other.

    The guy was speaking about the different malpractice rate, so maybe you want to figure out a location where the malpractice is cheaper, especially if you're going to be opening up your own practice. Is it somewhere where you're near family, where there is good resources? Maybe it's an underserved area where there is a good opportunity for you. So location I think is probably the most important one and we will hit that a few times throughout the presentation. And then again, do you want a fellowship or not and we just had a nice long presentation about that kind of discussing all the ins and outs. Other stuff you can do as a resident is pretty much everything. You want to be involved, you want to do research, you want to scrub as many cases as you can. You want to get into the office. You want to do research. You want to attend conferences. You want to network. I hate networking but you will have to do it. It's the only way you're going to make connections. You never know if that one connection is going to be the one that leads to a job either directly or indirectly. And then the other big thing is you're going to want to learn the office side of podiatry and again we have hit on that with a few of different presentations. Billing, practice management. I was on a job interview six, eight months ago and one of the first question I got asked is how do you feel about being a business owner, i.e., discussing about partnership. They didn't care about my background. They didn't care about the surgeries I did. They wanted to know how I felt about being part of a business. So again, resident life, once you're getting into that 18 month barrier type, try to figure out the intensity of the job you want the type of job, all the different scenario, the geography and then possibly a fellowship. So this was in medical economics which I think is a good website to check out every so often or follow in social media because they put out good articles. Back in May of 19, where they interviewed and sent a survey out to 2019 graduating residents and they got about 400 replies throughout their survey. In green, I hit kind of main points and main take-homes for you guys, the number one thing that residents cared about was the location and then pay and then work life balance. So again, location is going to be really important because that's going to dictate possibly your pay and definitely your work life balance and how you're going to enjoy that area and your longevity and staying in there because take it for me, it stinks starting over a few times in such a short period.


    Some of the other stuff getting to the business side of things, the second green bullet points, so how prepared the residents are feeling on "business side of things." 8% survey that they said they are very prepared, 54 somewhat and 38 unprepared. And with over 50% of those respondents saying that they received no sort of formal business training in medical school. And again just some quotes at the bottom regarding their greatest concerns. Good income, debt, free time and again insufficient practice management knowledge. So the fellowship route, what we went through this already. I think the big things to consider is figuring out what each program has to offer, network at conferences. If you're thinking about a fellowship, I think you should really figure it out by the end of the first year or attend ACFS conferences since they have the most fellowships. I will kind of go in that direction. They usually do a breakfast luncheon where most of the programs will be there. They will give a five or ten minute spiel about the program. The fellows are usually going to be there, so you can talk to either current past fellows and figure out what are they doing there, is it something that you're interested in taking part of? One of the big things about staying ahead as I remember was kind of disheartening. When I went to it at the first time as a second year that one of the fellows programs got up there and said they already knew they are fellow for the next two years. So that's where you really need to get ahead, especially if it's one that you want to possibly have a chance at. And then also continue the fellowship and your job search at the [indecipherable] [0:09:32] time because neither one is guaranteed, specifically the fellowship and most of the determinations are going to be made through the fall into the winter of your third year and so you can still be concurrently searching for jobs and if the fellowship doesn't work out, you're not six, eight months behind in the job search. So the basics, all the different kinds of job that exist, probably most of us are going to end up in the top four of those whether it's solo practitioners, small group or contracted employer for solo practitioner. General practice podiatry own, general practice either multispecialty group or orthopedic and then hospital employed.


    So preparing yourself, the big one and two were going to be your big points and then three are little things that I kind of think are important on the secondary side of things. So obviously, cover letter, letter of intent, CV resume and having your professional references all set, your logs updated and your licenses set. So remember, your cover letter is going to be the first impression that a job is going to see of you. So you want to make sure that you may be the best person, the coolest guy, the coolest girl, the most qualified, but if your organization in your cover letter, your resume isn't good, your grammar is not good, it doesn't make sense, it looks poor, it's already setting off the interview process, so to speak on a bad foot. Dr. Wilde just right around the corner 2016 posted a blog talking about how residencies are preparing doctors for the real world and these are just direct quotes taken from the article that he wrote and I think the second one is probably the most important. "With the amount of online resources to help guide creation of all these important documents that are the first look into a person, it's surprising how many resumes, CVs are poorly constructed, difficult to read, poorly formatted, not updated, incomplete and just look bad." So he is telling you what he is wanting. He is someone who does a lot of hiring, it's a very wealthy, very -- what do you want to call it -- very prominent practice and they are telling you, use resources online, this is where I got all my information to do my job search, personalize it a lot, that's another big one. So how do you do this? So the cover letter. I kind of thought about having two or three different cover letters and each cover letter I had had some generic points and some specific points. So all the generic stuff, the introduction, the educations, all the awards, all the stuff that you want to kind of promote about yourself. And then the specific stuff was the next few paragraphs. Who are you applying for? You don't write dear podiatry practice, dear practice manager. It's dear Dr. Wilde, dear Dr. Smith, dear Wilde foot and ankle. You want to make it personal.


    Are you applying to a podiatry practice and ortho practice? Is it private practice? Is it academic? Is it hospital? You can then talk about some of the specific things that practice may be looking for and how you can fit in to that situation. Figuring out who that job's patient target population is and how you can help that situation and then what can you offer the practice. Is the practice have people just doing forefoot, just doing rearfoot, just doing wound care, do you offer something different? It shows that you did some research in other practice and are trying to actively see how you can fit in with that group. It may spark something in that job's eyes and say, hey, I never thought about -- I sent out a lot of my rearfoot, maybe we can hire someone who can do that and we can keep all that revenue within the practice. And then a little folder on the bottom was just an example where my last job search around I had 20 different cover letters because I applied to 20 different jobs. So each one is specific. If you're not sure how to do a cover letter, there is a lot of examples online. This is just one taken from a consulting group, Alpha Medical where they help you do job searches. So the resume, the whole point is to sell and brag about yourself with achievements that are relevant to, I think, podiatry and medical field. Make sure again that it's organized, that it's formatted correctly, that it's uniform, updated every couple months. As a starting resident, you should already have a resume but you should start then every couple of months updating it and again it should match your online profile if you do anything on LinkedIn, any social media things to make sure everything kind of look all the same. And it should also match your skill-set, your comfort level and what your kind of surgical or practice desires in the future. So the resume, I modeled mine after this Dr. Adam Perler who is someone I met on the fellowship interview, his website adamperler.com, very easy to find. His resume is very daunting. I think it's about 20 pages but I think the organization of how it's all put together made a lot of sense to me and so on my website, I have a link to his resume.


    My resume is on there. You can see and just kind of how we organized it. So obviously, you're going to have your name, address, personal or work email. I think you should have a personal work email address, so if your email is something from 20 or 10 years ago, cool college guy, 26. It should be something that's little bit more appropriate because again, that's going to be your representation of you as you're applying for the job. Use your home address. Don't use your work address. Make sure that it's something that any information is going to get back to you. Employment, don't be afraid if your employment is blank. Some of you may have had jobs that have really nothing related to the medical field prior to this and that's okay because I don't think many people were expecting that when you're coming in to your first podiatric job when you have been basically school for the last 20 years or so. Talking about your education, undergrad, anything secondary and then your podiatry school, residency training with maybe a couple of bulleted points discussing some of the keys that you want to highlight. If you did any fellowship training, any sort of licensure that you have is important to put on there. And then what I called the hands-on or the hands-off activities, so any advanced training workshops that you've been to whether it's something that's come through your residency program or some sort of course that you went to or something like this what we call professional development showing that you've been active in the community going to conferences. Any sort of research, abstract publication that you've done and then some of the miscellaneous points. So I think the next couple of things are extra things that you can do but it's definitely going to be that whole stay organized, stay ahead side of things. So you should have your personal references already set by the time you send out your first resume. You can do this one of two ways and kind of thinking about it, I think that 1B is going to be a better point. So you should have all set but hold on sending it out to anyone until they ask for it. So usually at the bottom of my cover letter or my resume, I put something along the lines of professional references available upon request. You want to make sure that it is available because you have no idea if someone gets your resume and wants it the next day or three weeks later.

    So you want to first consider who you're going to use for your professional references. It can be your residency director, any attending that you're closed with, any outside podiatry physician, some family medicine and internal medicine and orthopedic doctor you worked well with, possibly any old job that you had in the medical field. Maybe you did a master, you did research somewhere at a lab, using them. Maybe, a co-resident, probably someone who is above you just not someone your peer, equal level or below and obviously not family. The three big things; ask for person who you're using it if it's okay so they are aware that they are your reference. You want to make a sheet that has all of their information on there. So you have your two or three references so that you have your reference list available at the drop of the hat if someone asks for it. And that's why I think that 1B is going to be more important by putting that available upon request because if a job comes back to you and says, hey, I like your references. You can, A, have this list available to send out immediately and then B, you can inform those references that, hey, I applied to this job you should be hearing from them maybe in the next week or so whether it's by email, by fax, by phone calls because these jobs will reach out in all different ways to try to talk to the references to get ahold of you. So it sort of prompts that attending to say, hey, look out for that call or it will prompt them to maybe a put a letter of recommendation together for you knowing that they are going to be called upon in a short period. So this is just an example of what mine look like. I had probably about seven or eight references that I had as my main form and depending on what job I was applying to, I'd pick and choose the two or three as appropriate. So again, it's all just the basic information and addresses, who they were in my life; residency director, fellowship director, attending and so forth. You want to stay up on your logs. I know this could be daunting as a resident, but I'd try to log all your cases at least once a week so that it's all on there because if you've to go and do it three, six months later, it's A, really annoying to do and B you may be needing them sooner and then you sort of rushing around you're losing cases and so forth.


    So make sure you know the cases that you have done. Make sure that it's a reflection upon what kind of practice you want to do if you're wanting to join an orthopedic group, just as an example they are looking for someone who is doing a lot of hind foot and most of your cases are rear foot, you haven't done anything hindfoot yet, it may not be the best fit for you because they are going to be expecting that sort of stuff. The state license again is important to get. I know we just talked about the fellowship that they were talking about in Duke where you need to get your license a couple of years ahead of time in order to be able to do the fellowship there. It's the same thing for the job. So every states is going to have different rules. Some of them you just pace them on, you fill out some forms, have the school send your transcripts and you get a license in a couple of months. Some of them, you have to take a test, maybe a two-part test. Sometimes you've to do it two years in advance. So lot of my residents who went to North Carolina and had a bunch of them, the beginning of their second year, they are already applying for their license. They haven't even applied for the job yet, but they had to get the license first because it takes so long so that it shows the job that you're serious about coming to North Carolina and then you can start also right as you graduate from residency. So you want to try to figure out again location because location may dictate how soon you need to start some of these processes. And then again, some of the states will have you enrolled in just like college application, they will have a rolling, acceptance whereas the applicants are coming in, they will review them and grant license or they schedule it couple of times a year. So if you miss a date and the next date isn't until six months later, you may be six months behind the ball. So even more stuff, I think these are a couple of random things that you can possibly do especially for networking. So this is an example of a business card that a first-year resident gave me once when I was somewhere. So it's the first-year resident with their own business card linking to all their information about them. So I'm going to a conference, I'm cleaning up, I get home, I put on my stuff where I pulled a card out, hey, maybe I go look at that and check that person out. You may want to have your own website again sort of going off the business card which is going to link maybe just as a website that has your resume on it so someone can easily access that information.

    Make sure whatever you do, it's reviewed by multiple people again having good punctuation, good grammar and that sort of stuff. Making sure you update all your stuff every couple of months. And then this is one thing where I thought I had a really great idea what I called having your resume quote "email prep". So anytime you go to a conference, you want to have -- I do, I have in my draft box in my Gmail, I have my resume and my CV just sitting as a draft. So if I'm talking to someone I don't have a card on me. They give me their information. I can sit right then at that moment and email them my resume so they have it on the spot. And then I was looking as I was doing some research for this project and New England Journal Medicine career center actually said that they recommend the same thing. So I'm doing pretty good, I think. So where to look for job. Websites is probably going to be a big thing. All the different societies usually will have some sort of classified section that talks about different jobs APMA, ACFAS, AOFAS, JAPMA. Dot's Café is pretty good website that has a lot of different jobs on there for podiatrist and for foot and ankle orthopedist where if you go into the foot ankle orthopedist section, you will find some jobs that are actually looking for podiatrist. Recruiters are good thing to use where they can kind of maybe find some jobs for you. They are doing a little bit of ground work. Some of the general websites, Monsters, Indeed and so forth. School website, I know TUSPM has a bunch of jobs listed on there. Usually, the school ones are going to be a bit more local. Word of mouth, so lot of people will also get jobs from either their attending who maybe know a graduate that's hiring, one of their friends that's hiring and so forth. Any sort of mentor's family, friend. I think the Vice reps can be a good help for a couple of reason. When I was in Philadelphia and moving to Nashville, one of the first thing I did was reach out to my Stryker rep who put in hold of the local Nashville rep who was able to tell me about the scene there about the different practices that exist who may be looking for what I'm looking for.

    They also have a good idea about the practices to kind of see if you would or wouldn't be a good fit. And then conferences, going to the conferences. Usually, they will have some classified bullets and boards there. They will do some sort of job careers stuff. So just looked at this about a month ago. These are just all the different jobs that are out there on the different websites. It's probably a lot of duplicates. So I think word of mouth really comes in to play in trying to find a job and making your own job because if you count all this up here, there is probably not more than 100 to 150 jobs out there that are actually listed, but again, there is 300 to 400 residents graduating every year and everyone for the most part getting jobs. And then again somebody's website, you can actually upload your resume to it like, Pod Exchange, the APMA and then Dot's Café. So I have my resume on Dot's Café and MD job site. I'm not applying for jobs but every so often I get a random phone calls or email asking if I'm interested in a job. This is one that I think is helpful too, especially if you're trying to create your own job. So what I'd do is I'd go on Google maps of the town or the area that I'm interested and just start using different search terms, podiatry, foot and ankle, orthopedics, multispecialty and then see what pops up. So I did Nashville podiatry, so these are all the different practices. I searched foot and ankle, different practices popped up. So that's why you want to use those search terms. Orthopedics, different practices popped up. And then hospitals because maybe you want to try to see if hospital is interested in hiring a podiatrist. So really crazy. So from there, I made a large excel spreadsheet where I have the practice, I have all the information about them. Is it an orthopedic, is it podiatry, how many podiatrist are in the practice, is it orthopedic, do they have any foot ankle MDs, do they have any podiatrist in the group? All the information and then as I contacted them, I'd just keep track of who replied and who didn't reply. So you kind of keep everything it in nice, uniform way and it keeps you very organized as you're trying to go through the job search.


    So as you're applying for the jobs, you will first likely have a phone interview just to kind of prescreen and may talk -- someone from the practice may talk to you, maybe set up more formal secondary interview with either a partner or have you come out to the practice, do a face-to-face meeting. Obviously, we talked about sending thank you messages after that and then the contract. So the interview obviously starts when you apply, so that's why you want to put everything as a good foot forward with your resume, your cover letter and all that sort of stuff as a representation of you. So interview prep, you want to review the company, you want to review the people you're interviewing, you want to know about them. This is just like going through residency interviews all over again. You want to figure out, is this place for you or is the location for you. You want to make sure you've reviewed your cover letter, CV, your logs, all that sort of stuff because they are going to be sitting with that pile of paper in front of you and you're not and they are going to be looking through it and start asking you stuff about it. So you want to make sure you know how you're representing yourself. Obviously, you want to dress business in some way and then come with questions because they are going to ask you a bunch. So they are going to want to know about you, your education, your experiences, maybe about your family, what you can offer to the practice. They may ask you some billing scenarios. that Wilde article I mentioned earlier. They will ask you how to bill a bunion, how to code stuff in the office during their interview. So if you don't understand billing and coding and at least the basics of it, maybe not the code specifically that may not go well for you. They might offer you surgical cases. I was on an interview a year ago for a practice and I sat there and went through a 20-minute PowerPoint of multiple choice, rapid fire and questions. So it does still happen in the job world. Remember that they are judging you all the time. Make sure you kind of know what's going on in the real world. There is some sort of sports happening going on, something to talk about current events without staying political, just having stuff to talk about, so there is not dead space. And then the biggest thing is to be truthful of the employer and yourself. You don't want to lie to them. You want to represent yourself well. You want to represent your background, your residency and so forth because maybe you won't take that job that someone from your program or someone you know will later and it's a small community.

    So we talked about contract stuff in the last presentation. Lot of this is the same. If you Google physician employment contract guide, you will find a PDF by the American College of Physicians or Colombian Med and it kind of goes through a lot of the details but again just Googling this you're going to find a lot of information online about it. So I will kind of skip that one. Again, I already talked about it. I really don't have to do this section. Remember, you're the doctor. You treat foot and ankle stuff but you're not a lawyer. So lawyers, if contracts are confusing, the language is different, they do this for living. You may know someone who can read the contract for you but I think it's important to pay someone to look at the contract. The daunting thing about it is as you get the contract, they are going to look at it and then they are going to rip it apart and it's going to look like that first college essay that you submitted with more red on it than black ink, but you're paying them to do that. That was kind of thing that I learned. They are going to rip it apart, to point all the different stuff out. They've looked at this contacts a lot. They know kind of what they are looking for and sort of looking out for your best interest but just also doing their job. And then you have to consider again, what's important to you for negotiating purposes. When you get a lawyer, you can have them done in a couple of different ways. You can either pay them as a fee for service. So when I have my contracts reviewed, my lawyer does a $500 just flat fee and it also does one secondary review of the contract. Some lawyers will just do the charges by the hour. So you just have to figure out because it can get expensive especially if you're doing a fee for service that only does one review or you're doing it hourly and if you want to nit-pick a contract, you're going to go back and forth with the employer two or three times. Every time you go back and forth that's more fee for service, that's more hours that you're accumulating and the lawyer doesn't care. They will review the contract a million times for you. But ultimately, you will have to decide what you are or are not comfortable for it because the attorney gives you the advice but you make the final decisions on what you want the contract to look like.


    So salary, we kind of mention that already. It's all over the place. I'd say that most of the numbers I found were anywhere between low 100's and high 100's, 100,000 rate, not really stating is it new practitioner or people who have been 5, 10 years but the contracts of the salary and how it all sort of pans out with bonuses and so forth. Lot of the hospital employee jobs will go off the MGMA data which is just the big medical resource for salary, base salary, how may RVUS you hit, how many RVUs you need to hit in order to bonus and what that RVU values is going to be afterwards. Then you can find all that stuff online if you just Google search MGMA compensation data. So this was in that US jobs news report from the first slide where they are saying the median income is about 130,000. What I've heard -- I've reviewed a lot of contracts as well from the past residency program that I have worked for and these are just a bunch of different examples. In the last talk, we kind of discussed the contract and how it sort of works for you. Given a base salary, usually you're going to have to produce or net collect for the group anywhere between two or three times that amount. Above that, you're going to get anywhere between, I've heard, 20% to 40% of that extra income. What people kind of tell me when I was going to the job process is that you should kind of expect somewhere around $100,000 of base and then 30% over 300,000 and that seemed to be pretty true across a lot of the job that I found. And then again, the hospital job, you have to really look out for just because they may offer you these big base salaries to begin with, possibly a bonus structure but if you're not getting your RVU target when they redo that contract the following year or after your two years of guarantee, they can actually reduce your salary. The other big I think to think about is the big picture. So one of my mentors in residency told me you should expect to gross for the practice or net collect for the practice about 300,000 to 350,000 your first year.

    So you want to kind of run the numbers in the different scenarios when you're discussing a contract. So I used the example here if you net collect $350,000 for the practice, you may think an $80,000 salary with that three times 30% is a low offer but you're ending up with a $113, 000 in the grand scheme of things where if you do $100,000 base with the same contract or $120,000, in the grand scheme of things, you're really off a couple of thousand dollars. So if you kind of live on that 80, maybe it's going to work the contract out better for you in terms of trying to negotiate that point as much or if the jobs is not going to buzz on it, just kind of doing the math, asking them or what does a new associate typically collect and sort of just run in the numbers. So really just like residency when you go to interviews, you want to compare all the different jobs, think about them individually, do some digging around, do some internet researches about the practice. Whenever I apply for a job, I'm going online. I'm looking up the reviews for the practice, reviews for the doctors, trying to get a sense of them as much as I can. Discuss it with family, discuss it with friends, figure out, is the job the right fit for you. 46% of physicians leave a job within the first three years and usually it's because it's not a good fit between the two. And again, where you're living is going to be really important. So how is the community, how is the location, is there family nearby or not, are you 30 and single, are you 35 with four kids because you're going to be looking for different things. So once you get the contract, sign on the dotted line, you want to try to secure job hopefully within three to six months of graduating because there is a lot of extra stuff that you and that job are going to need to put together, getting you on the insurances, having the practice setup for you. They need a couple of months to prepare just for you coming, so you don't want to be signing on the dotted line right at the end of the residency. So you have a job, you made it to the top of the mountain, so you can either have the dream or possibly the reality.


    So I have a blog that I did for podiatry today right when I came out of residency talking about the different stuff that you could be doing during those last few months leading into the job or when you start the job to try to promote the business, promote the job, promote yourself. So you can check that online and that could be another talk for another day. The wrong job, you may get the job, you may be there six months a year. It may not be the right one for you. The medium average years people are working their first job in our age group is about three years or so. You can always quit, be honest with the practice, be honest with yourself and just do it respectfully. I [indecipherable] [0:32:36] residents who graduated from my program and it just kind of all over the place. You get some people with the job after the first year, two and three years, on two and three years. So it happens. You don't expect it to happen. I thought the job that I had in Philadelphia I was going to be at forever. My wife gets a fellowship in Nashville and now I'm in Nashville. So kind of stuff in life happens. Try to take each interview as its own. Think about how that job fits for you and try not to pit them all against each other because there is all going to be stuff at each one that you like, you're not going to like, but ultimately, you have to figure out which one's going to be the best for you. I will skip that. And then the billing thing. I think this is pretty key because when you get into the job, you need to make them money and so the last couple of months of your residency if you haven't done it already, try to go to some of the billing conferences, try to figure out someone in your residency who is an attending, who is really good at billing, who could teach you get into the office because again as we talked about in the last presentation, the office is where you're making a lot of money not the surgery. We all know how to do surgery but if you can't bill, you can't make money. That's it. Kind of go quick. So I'm all done. Thank you.


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