As a fellow about to embark on your career, the job search process can be time consuming and confusing. If you are uncertain about your career path, plunging into the job market makes little sense. Interviewers quickly eliminate candidates who are unsure of their direction. Self-assessment is the first and most important step in any job search. Selfknowledge allows you to match your interests, skills, goals, values, and potential with a future career. After your training, you should be cognizant of your key competencies as well as your personal concerns including family needs, community needs, education, and finally salary. These are the exact things the people who will be looking to hire you are evaluating.

WHAT TO EXPECT

Telephone Interview

Most practices will have a brief telephone interview before having you visit. Telephone screening offers an introduction and gives some level of assurance that you are appropriate for the opportunity. This is also an opportunity to assess what the job entails and what the expectations from the employer will be. For instance, an academic institution looking to fulfill a space at the VA can quickly be eliminated if one has no interest in working at a VA.

Site Interview

Expect that the interview will last 1.5 to 2 days. Scheduling these interviews can be difficult because coordination of multiple schedules is required. Flexibility in your schedule will be necessary. The employer typically pays all costs of the trip, and they will attempt to coordinate everyone's schedule. Just remember to keep track of all expenses and receipts because they will be reimbursed. If traveling from out of town the night before the interview, the lead person in the group may meet you that evening; if arriving late, expect to meet in the morning. It is important to rest the night before because the interview process can be long, with few breaks in between interviews.

Come prepared to the interview. The more prepared you are, the easier it will be for you to stand out against the competition. You should dress professionally and wear a conservative suit with a neat and well-groomed appearance. Be on time; a prompt arrival indicates your interest in the opportunity. Concentrate on selling yourself and determining if this position is for you. You should remember that there is no such thing as a perfect opportunity. If you look for everything on your wish list, you may miss the best opportunity by searching for something that doesn't exist.

BE YOURSELF

It is important to be yourself. Be courteous and polite to all physicians as well as the ancillary employees. Often, the ancillary staff is a good judge of character, and the physicians will listen to and want their opinion. Be flexible by showing there is more than one way to handle a given situation. In some instances, interviewers try to trap the candidate into agreeing with a senseless observation or opinion. If you are pressed for answers on a subject on which you may disagree with the interviewer, be honest but not argumentative.

Do not be too brief with answers to questions regarding hobbies, family, and spare time activities. These questions can be an essential way for the interviewer to see your humanity and the real you. Remember, you are competing with people whose qualifications and accomplishments are very similar to yours. The interviewers will want to know that you fit in with the culture of the organization.

In order for them to get to know you, you will need to stress your accomplishments. You need to distinguish yourself from the competition. When asked about your accomplishments, be prepared. Develop a list naming the most important first. You will want to let them know how you can benefit their practice. You need to convey your skill level, the number and types of cases that you performed, your specific interests, and how you will develop those into a successful practice. It is just as important to determine if the opportunity fits your needs and to ask specific questions regarding caseload. For example, if your interest lies in aortic surgery, and the group that you are interviewing with has a large dialysis and venous practice, it is important to determine this during the interview process. You will need to market yourself by appearing competent without being too modest or arrogant. Using case examples of straightforward and challenging cases that you have managed is helpful in this regard.

References

The interviewers will want to know that you are both safe and effective as a physician. Your personal references will often convey this message as well. Whether coming out of training as a vascular surgeon, a cardiologist, a radiologist, or a cardiothoracic surgeon, your personal references will be called, and they will be asked the typical questions (see Questions Your References May Be Asked sidebar; see also Questions You May Be Asked sidebar).

WHAT YOU NEED TO LEARN ABOUT THE PRACTICE

In general, what you need to determine is what type of practice it is, whether it has any academic affiliations, what the philosophy of the group is, and what the shortand long-range goals are for the practice and for your position. During the interview process, it is helpful to learn as much about each individual in the group as possible because these will be the people that you will be spending a significant amount of time with during the day. You need to determine if the group is cohesive, what their practice styles are, and what their workload is. It is important for you to determine if your personalities are well matched. Are there any specific personality conflicts within the group, and if so, how are these managed? What are the practice's weaknesses and strengths? Why are they looking for another partner? Has someone or is someone leaving? If so, why? Is someone retiring? If so, when? Or, is the practice just so busy that another body is needed, and, if this is the case, what is the type of caseload that it is trying to fill?

To establish whether you are able to work with the other physicians, find out about their backgrounds. It is of utmost importance to determine their practice style and if they tend to be more progressive or conservative in their management style as it relates to patient management. Conflicting types of patient management can become difficult to manage with competing partners if there is a specific philosophical difference unless the group is trying to expand its practice.

It is essential to determine how you will build and maintain a practice. First find out if there is a genuine need for another physician within the group. How does the group obtain their referrals, and what are the plans to market you as a new member of the group? Attempt to determine if there are enough primary care physicians to keep you busy. Is there a genuine need for another of your specialty within the city, and what is the surrounding competition of other physicians? It is also important to ask what the average waiting time for a new patient appointment is to assess how busy the practice is currently. And finally, are there future plans for continued growth after you're hired?

Educational Benefits

Educational benefits of the practice are important as well. Are there seminars or journal clubs conducted within the group to fulfill CME requirements? Does the group allow and encourage attendance at annual specialty conferences and activity within medical societies? Also, remember that each state requires its own medical license, and it is important to establish if there are any special requirements to obtaining and maintaining a medical license.

Finances and Billing

It is also good to understand the finances and billing within the group. Understanding and knowing the payor mix including Medicare, Medicaid, and private insurance as well as noninsured patients is important to knowing what types of patients you will be treating. Does the practice use an automated or manual system for scheduling, billing, and/or insurance filing? The use of electronic medical records is beneficial to everyone but is associated with a cost to institute to the system.

Your Time in Practice

Your own personal well-being as well as that of the group is vital. It is important to determine how scheduling of clinics and cases, both in the OR and in the interventional suite, is obtained. Remember that you will not have any patients unless you are taking over an existing practice, and OR time and interventional time may be difficult to come by. As you become more established with a practice, this time will become more available to you, and you will have scheduled OR time. It is important to know how busy the current OR and interventional suite are and at what capacity they are operating.

Ask how much day and night call you will take and how many weekends you will be on call. Early in your career, taking call is a nice way to meet other physicians and help to establish a practice. However, it is important to have a certain balance in one's own life, and call for the most part should be evenly distributed. It is appropriate to ask about your daily responsibilities as well as any administrative or managerial duties that may be asked of you.

Practice Setting

It is important to get a sense of the office and the locations. You will want to know how many there are and to make sure the location is convenient for both the doctors and the patients. Ask if you will be expected to work out of more than one office. Travel between multiple offices can often become inefficient, and one can lose valuable time during the day even if the offices are close. Attempt to define this during the interview process so that you understand your responsibilities to the practice. It is also important to take time to research the area where you are applying (see Considerations for Your Potential New Locale sidebar).

SALARY

Finally, as with any job, you will have to approach your potential employer about pay if it has not yet been discussed with you; it is generally easier if the employer first brings up the subject. Salary is rarely discussed during the first interview, especially if the position is in an academic setting. The main goals during the first interview are for both sides to see if they are an adequate fit for each other. If they approach the subject with you, then certainly it becomes a fair question for you to follow up. Those in private practice are often quicker to discuss salary during the first interview. If asked what kind of offer you are looking for, your response should be, “I will consider your strongest offer.” Your goal in any interview is to obtain an offer.

This topic during your first job after fellowship can be somewhat intimidating because you need to determine what your worth is and the appropriate pay for an individual coming out of practice. It is perfectly reasonable to ask how much you will be paid in the first year and subsequently. For instance, if the first 1 or 2 years' salaries are fixed and the compensation moves to a productivity basis, you will want to know how the transition is handled and how the other partners have fared during this time. Also, you will want to know how overhead expenses are allocated. Frequently during the first and or second years, you will defer the overhead costs. Depending on how large the group is, the expenses can equal up to half of the group's revenue, and this becomes a significant consideration. It is key to get to know the income-distribution methodology for the group and individuals within the group. Lastly, it is important to understand what the buy-in is and how it works, including how many years it may take to become a partner because this can range from 2 to 5 years.

CONCLUSION

It is important for you to gain as much information as possible during the interview process to ensure that the opportunity fits your needs and expectations. It is also important to remember that it is your first job and that you will have additional opportunities to interview in the future, and the limitations of your first interview and job are tools to learn from for the next time.

Frank R. Arko, MD, is Chief of Endovascular Surgery and Associate Professor of Surgery at the University of Texas Southwestern Medical Center in Dallas, Texas. He has disclosed that he holds no financial interest related to this article. Dr. Arko may be reached at (214) 645-0533; frank.arko@utsouthwestern.edu.