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Finding Your First Job in EP
Finding Your First Job in EP
Finding Your First Job in EP
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Video Transcription
There we go. So everyone can hear me right now, now that I've unmuted? Yes. So as I said, my name is Eric Grubman. I think that a couple of things I would echo that Fred said, it's a tiny community. When I started in practice, and I think a little bit of my background is helpful for this. I joined a private practice group. It was my first job at a fellowship in New Haven. And I had a joint appointment with Yale University because I was terrified to be on my own. And that lasted for like a year. And then I was on my own in this private practice, sort of been practicing in the shadow of Yale. I ran into a patient with VT that I tried to ablate and I couldn't get it. And there wasn't really anyone at Yale who was doing that at the time. It was sort of early. So I called Bill Stevenson up on the phone. I had no idea who he was. And I ran the case by him. I was terrified. I didn't think he could just call somebody. And he was extraordinarily nice. He told me what to do. He helped me do it. And you really can call any of us and we're all happy to help. I mean, that's part of the reason we're here. What I wanna talk about is, I think this may be my second slide. Doesn't matter. It's how to find a job. So the first thing I'll start by saying is the current US unemployment rate is 4.6%. That says October. It's the most recent data we have. The graduating EP fellow unemployment rate is as best I can tell, zero, okay? So everybody gets a job. Everyone's very nervous about it. And you're nervous about it for a number of really good reasons. But what I think we can sort of go over is some of the strategies to find a job. And hopefully that'll help keep your nerves at bay. Remember that this is gonna be your first job. For me, I'm on my probably fourth iteration of my first job. I never moved from this house that I'm sitting in. Right here, it's not actually this road. But I've transitioned. I had that initial job that I worked some days for Yale University and some days for my group to working for my group to more of a joint thing. And now I was hired, our entire group was bought up by Yale like eight years ago. And I've been a full-time academic practice physician since then. So I really do have a good understanding of all the kinds of jobs, what's important and what's not in each of them. Also, and this is gonna sound funny, but geography and money are important and we'll discuss money in a way that probably none of your fellowships ever talked about. But a job that fits what you and your family wanna do is always gonna be the best job. I would urge you not to take a job just because it pays the most. Take a job that's something you and your family would rather do. Where's my, it's not advancing. Oh, it is. So it's time for you guys to start to shift gears. In your training, this was the gear you were in. You all focused or most of you focused on getting yourself into the optimal EP training program that you could find. The other factors that we talk about when getting a job, the geography of where you are, family considerations may be secondary, the work atmosphere. Sometimes you took a fellowship even though one of the faculty member might not have the reputation of always being the friendliest. Those are all secondary. Certainly financial considerations are almost non-existent when you're looking at fellowship. So that's sort of where you are now. When you go to your first job, it's a total shift. You first have to decide what kind of a practice setting you wanna be in. Do you wanna be in an academic position? Do you wanna work in a big university setting where you're gonna be writing grants and doing research? Do you wanna be in private practice where you're sort of, and we'll go over the differences where you're calling the shots a little bit more? Or do you wanna be an employed physician which sort of is almost a hybrid model? And are these jobs available? Your family considerations certainly become more relevant whether your spouse wants to be somewhere or you wanna be somewhere getting jobs that the both of you are happy, your kids. The work atmosphere is really important. You're gonna spend more time with your partners than anyone in your life other than your spouse. And so it's important to pick people that you're gonna like to work with. And there are ways to find out whether you're gonna like to work with people before you actually start. They may not be your best friends although you will find a few best friends in the people you work with, but you really need to be able to tolerate working with them. There are geographic considerations. I like boating in the water. So I was hopeful that I could find a job near an ocean or some big body of water. You're not gonna be able to find everything for every job. If you find a job, I wouldn't have not taken a job in Kansas City because I needed to be near the water. That was certainly a draw for me, but you have to make your list of the things you really want and financial considerations are in there and not in the way you guys think. It's not like which job pays me the most is the job I'm gonna take, but we'll go over how financial considerations may play into it. So these are the different kinds of practices that are available. And I stole this slide obviously, but on the left is the academic practices. And that's the one you guys are all most familiar with. Most of the faculty that you work with are in these sorts of situations, right? I'm in one of these situations. I work for Yale University. If you're gonna take a job like that because you're interested in doing research or you're interested in an education, understand the criteria for promotion. The only way you're gonna get a raise in an academic center by and large is to get promoted. So understand how people get promoted, all right? There'll be plenty of opportunities for research. You'll work with trainees. And so you have to be sure that you're comfortable working with trainees. And I know you guys are all trainees, but it's something you have to love, okay? If all I wanted to do is put pacemakers in, I can put a pacemaker in by myself in 25 minutes. So you have to love the fact that you're teaching people every July, how to put in pacemakers or do ablations. The base salaries may be on the lower end. It's made up by other parts of the job. Private practice is a diminishing piece of EP. It was really big when I came out of training, but it's not really big now. It's nice because physicians have full autonomy. You run the show. If you like to be the boss, this is a great job. You can engage in other things besides EP, IT, human resources, marketing, contracts, and running a small business or mid-sized business. When we joined Yale, my practice that I ran had a hundred employees. So it was, I guess, a mid-sized business, and that was fun. If you're gonna join that, you have to understand the partnership structure, how you become a partner, who becomes a partner, and your base salary may be lower. There are, again, other ways that we make money in private practice, but the base salary may not be as high as you would think. On the other end, or the final end is the hospital-employed physicians, which is becoming a larger and larger chunk. All administrative duties, all the HR stuff, the marketing is delegated to other employees. Your base salary may be a bit higher, and you have to understand what the opportunities for career growth are in those jobs. So they may not be so easy to advance, and the compensation models vary, and we'll talk about that as we talk about finances. You can do clinical research in any of these. When I was in private practice, I certainly wasn't writing grants or coming up with independent research projects, but I contributed mightily to large research studies and authorships in major journals. So you can do research in any of that, okay? Why is it not advancing? I'm hitting all the buttons. So this is where EP is currently. There's only about a little less than 20% of electrophysiologists are in private practice, and the remaining are in some sort of integrated, either academic or hospital-based practices, but all these practices still do exist, all right? So when we talk about geographic and family and work atmosphere, think about the, I always divide these into the at-work factors and the at-home factors. The at-work factors would be based largely on the reimbursement structure, okay? There is a shared reimbursement where every partner in a private practice shares the money, right? Everybody gets the same. I used to joke that when I put a pacemaker in at three in the morning, and someone had a heart block, I made $8 because I had to share it with all of my partners, all of whom were asleep. There are other, it creates a certain group, camaraderie between the partners. The downside is that at two in the morning, when you're putting a pacemaker in and everyone else is sleeping, you can build up a little bit of resentment if you feel your other partners are not working as hard. The other structure is an eat what you kill model is commonly called, where if I put a pacemaker in at three in the morning, I would get the, anyone know how much you get for putting a dual chamber pacemaker in more or less? Yeah, it's about $800. So I would get the $800 all for myself. That has its, certainly financially, it's a lot easier. You can decide when you wanna work, when you don't wanna work. The problem is that you're not competing with your partners for work, and that can be a difficult situation as well. So understand how that works in the group you join. If it's an academic thing, again, it's a totally different setup. And understand the partnership structure, right? One of the important questions to ask if you're gonna join a private practice is how many of the partners, how many of the employees made it to partner and how many partners have left over the years? Those are very important questions. And you wanna generally get in touch with people who have left, maybe not telling the people who you're interviewing with to find out what happened to those people. Why'd they leave? All right, then there are the at-home factors, right? Which is something you haven't really thought about. Would you like to be close to your family? Would you like to be close to other support systems? Is this a nice place to live? If you have a family, is this gonna be a great place to raise kids? Is your spouse gonna like it? These are things that become more important and things you need to think about as you're looking at jobs, all right? So how do you find the job, right? And that's sort of the main thing. So now is the time to start. When I got my first job, literally there was an ad in the New England Journal and I called and they called me back and the next thing I know, I had the job. Most jobs are not advertised. And the other jobs I had offers that I had along the way were never advertised, especially academic ones. What you would do is, what you should do is call me or the equivalent of me in your institution, okay? There are people in every institution that know the landscape, have plenty of friends, know who works where, and are able to make the connections to help you get a job. So that's an important thing. Also industry, I don't know if anyone ever tells you this, but the device companies, Medtronic Boston and St. Jude have people whose job it is to help you find jobs, right? It's obviously in their interest to find you a job. And so if you speak to the reps from the various companies, they can put you in touch with those people that will help. They'll call the rep if you wanna be in St. Louis, they'll call the rep in St. Louis who will find out if there's a job and get you hunting down that. Also understand there are no perfect jobs, all right? When I was in private practice and I was running that 100 employee group, 90% of the time it was amazing, 10% of the time I used to joke I was yelling at people. It was 90% good, 10% bad. Now that I'm in a full-time academic practice, I can tell you it's different people I'm yelling at about different things, but 90% of it is amazing and 10% of it is bad. So you have to know none of them are gonna be perfect, okay? You have to decide what's important to you, where that, you know, what, whether you wanna be in a certain location, you wanna be in a certain kind of practice, what it is. And then again, rely on people, your mentors, industry, and us to help you get those jobs so you can get where you're going.
Video Summary
In this video, Dr. Eric Grubman discusses strategies for finding a job in the field of electrophysiology (EP). He emphasizes the importance of considering factors such as practice setting (academic, private practice, or hospital-employed), geographic location, family considerations, and work atmosphere when looking for a job. Dr. Grubman also explains the different reimbursement structures within EP practices and advises new graduates to seek advice from mentors and industry professionals in order to navigate the job search process effectively. Overall, he highlights the need to prioritize personal and professional goals when choosing a job in EP.
Keywords
electrophysiology
job search
practice setting
reimbursement structures
personal and professional goals
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