Introduction
PM&R is a uniquely diverse field with an overwhelming amount of career options. Graduates can choose between academic versus private, inpatient versus outpatient, primary versus consultant based work or any combination of the above. Many clinicians end up choosing a mix of practice settings to accommodate their goals and ideal physiatry model.
Initiating the job search process can seem like a daunting process. This guide is intended to be an overview of important considerations and helpful pearls to assist with navigating this process. It is not an exhaustive document and each individual’s experience will differ, but this will provide a reference from which residents can begin to feel more confident about finding and landing their first PM&R position in the “real world.”
Looking Ahead During Residency
Practice Setting
Although you should think about your preferred clinical settings throughout residency, serious considerations should begin by your fourth year.
Some practice options to consider are:
- Inpatient vs. outpatient
- Census / patient load
- Opportunities to teach medical students vs. residents vs. fellows
- Commitment to teach didactics vs. clinical based teaching
- Opportunities for procedures (ultrasound, EMG, intrathecal baclofen pump program)
- Availability of support staff
- Research opportunities and expectations and the support system available, including protected time
- Full time vs. part time
- Need for fellowship training
- Small vs. large practice
- Single specialty vs. multispecialty centers
- Free standing rehabilitation hospital vs. within an acute hospital
- Government hospital setting (veteran population, access to resources not always available to civilian population)
- Flexibility to mold your practice
Prepare
Prepare your cover letter, CV and interviewing skills. A formal cover letter is a must when you are initially inquiring about a position. This can be included in the body of an email or as a separate attachment with your CV. Include about three short paragraphs indicating your interest in the position and a little about yourself and your practice interests (i.e., Neuro-rehab, MSK, pain, inpatient/outpatient, etc.). it should be clear, concise and fit on 1 page.
Prepare your CV.
Creating a professional and thorough CV is of utmost importance, as this is the employer’s first look at you and your accomplishments. 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. CVs can be annotated to provide brief explanations of committee positions, awards, research). Have several people (i.e., attendings, chiefs, or program director) review your CV prior to sending it out. The document is best saved and sent as a PDF file to avoid accidental changes when the file is opened by the recipient(s). You can read more about CV preparation here.
Prepare for the interview. Everyone will be nervous for the interview season. Even if you are applying to different practice settings, most of the questions will cross over. In addition, practice answering unexpected questions. This will help your interview go smoothly.
Some of the questions you may want to ask include:
- “Who would I work with?”
- Practice setting questions
- Are there early supervision/mentorship available?
- Questions about the community/living area
Face-to-face interviews are probably not the time to bring up specifics about compensation/benefits, etc. unless the interviewers address it first. You can read more about interview preparation here.
Additional Resource on the Online Learning Portal:
Job Search and Networking
Starting early will allow plenty of time for networking, talking to recent graduates and attendings, negotiating contracts, and considering family obligations. Networking is key! Reach out to your attendings, program director, and mentors and ask them if they are aware of any open positions. If they are available, ask them to introduce you to the lead hiring physician.
Attend conferences such as AAPM&R, AAP, or other sub-specialty-specific conferences. AAPM&R’s annual conference (the Annual Assembly), held in October or November, is prime time to network. These conferences are designed for continuing education but also host networking events. Attend each conference with an updated CV and business cards at your disposal. The Job and Fellowship Fair at the Annual Assembly is a great starting point for many residents. It is not uncommon for job interviews to take place during the week’s conference. Even if you do not land a job interview subsequent to the conference, the contacts you make can easily lead you to an interview.
Browse PM&R job resources:
*Use with caution as it is not always clear where information is disseminated.
If you do not have a connection to the facility, cold call or email the facility. There is no harm in trying to connect with people. Institutions/clinics may not publically advertise or recruit for a position because this also expends resources, thus it is worth contacting practices you are interested in even if no position is advertised. The contact person is usually an HR representative, physician recruiter, practice manager or PM&R department administrator.
Interview
You will likely meet with many people in the department during the day, which may include the physicians in the practice, nurses, administrators, basic science researchers. This is the best opportunity to get a good sense of the culture and personality of the practice and the environment that you would be working in.
Contract
Be open minded and flexible. Just because a job offer has 1 or 2 unappealing aspects, does not mean the offer should be disregarded. Employers are willing to negotiate just as much as the resident.
Sometimes, employers will provide a Letter of Intent and you may be required to sign the offer. Often the Letter of Intent is simply a showing of good faith rather than a binding contract but ask the employer before signing it.
Besides the scope of practice, some areas to consider in your contract include:
- Moving expenses
- Signing bonus
- Advancement track (clinical educator vs. research vs. clinical scholar)
- Student loan repayment
- CME reimbursement/time-off
- Licensing reimbursement
- Vacation and sick days
- Parental leave
- Non-compete clause (duration, location, scope of practice)
- Salary vs. productivity based pay
Approximate Timeline
PGY3
Determine whether or not to pursue a fellowship. For more information about the fellowship process, see the AAPM&R Fellowship Training Advice and Resources page.
PGY4: The Early Months
1. Consider scope of practice.
2. Consider practice setting:
- Academic vs. Private vs. Veteran’s Administration
- Urban vs. Rural
- Single vs. Multispecialty
3. Consider geographic location, budget, standard of living expectations, family desires, spouse’s career, and dependent’s education.
4. Network! AAPM&R provides many opportunities, through the Physiatrist in Training (PHiT) Council, Member Communities, Annual Assembly, PhyzForum, etc.
5. Regularly check job postings on the AAPM&R Job and Fellowship Board. Employers submit postings frequently and the Job and Fellowship Board is constantly updated.
PGY4: The Middle
1. Follow up with employers; politely inquire as to what they desire in an applicant and provide any updated CV information.
2. Start arranging time off to attend interviews with your program coordinator. Programs are supportive of their seniors and want them to succeed and will attempt to accommodate your requests. Conversely, be respectful when arranging time off for interviews.
3. Consider scheduling interviews within a 2-month period in the fall/winter of PGY-4. This way, any job offers that are made will be within a few-week window, giving you the chance to compare and negotiate accordingly.
4. Practice interview questions with your co-residents.
5. By this point, you should have some interviews scheduled. If you are struggling in this area, discuss your CV and networking strategy with your faculty advisor or program director. They will be able to provide insight from their own experience and point you in the right direction.
6. Discuss your interview offers with recent graduates. There is a good chance they will have some insight on your potential employer from their recent interview trail.
PGY4: The Later Months
1. Narrow down offers to 1-2 places. Discuss the offer with family, significant other, and faculty advisors.
2. If you are struggling between 2 offers, tactfully ask one employer if they would be willing to negotiate on the smaller items such as CME reimbursement or licensing fees if the other employer is offering it. It is okay to call the employer with follow up questions or concerns as you will be signing a contract for the next 2-5 years.
3. When you are in the stages of contract negotiation, consider hiring a healthcare attorney to review the document. Ask your department, recent graduates, or attendings for a recommendation on an attorney that has experience with physician contracts. Even if nothing appears to be out of place, it is worthwhile to have an expert review this binding document.
Last, but not least, be sure to maintain your AAPM&R membership throughout your residency and beyond!