Pediatric Residency Program > Career Planning

Career Planning

The following information was compiled to assist pediatric residents in making career choices. The discussion will include items to be considered in choosing careers in practice, pediatric subspecialties, or other areas. Sources of information, including links to internet sources, are also presented and will be periodically updated.

When to start planning

Career planning should begin in the PL-1 year as each rotation is checked for "goodness of fit" with one's personal goals and aspirations. The problem, of course, is that the PL-1 year begins with insecurity about basic knowledge and performance, demands a steep learning curve related to new responsibilities and environments, and requires an exploration of new relationships with fellow interns and other residents. Sleep deprivation, post-call challenges, and the overwhelming desire to avoid an onerous mistake leave little time for introspection and testing of training experiences. This is unfortunate, since half the year may go by before a new PL-1 feels comfortable enough to really explore her/his future plans, and significantly more time may transpire before anyone else begins to ask if career plans have been considered.

It is the responsibility of the training program to initiate career-planning discussions for each of its trainees. This process should begin during the PL-1 year and continue through the PL-3 year. There are numerous of ways that planning can be fostered (e.g., in semi-annual meetings with the program director to review the trainee's progress, in regular meetings with a faculty advisor, in house staff meetings that are focused on career planning, and by meetings with the Department Chair).

Making personal choices about career directions is difficult. Many residents express that they "always wanted to be a doctor" and that they "love children." There may also be siblings or parents who are physicians, making the choice of a career in medicine almost inevitable. Now, however, the individual must come to grips with the reality of exploring her/his own career direction within medicine and pediatrics. It is very important to emphasize that the individual must take control of this process. Well meaning friends, colleagues, parents, and program directors will often make suggestions about career directions that they believe are "perfect" for an individual, but which may, in fact, have nothing to do with the individual's own goals or dreams. Even though some individuals would like to see divine intervention direct them toward a specific career, they ultimately have to decide what is in their best interest, not what someone else thinks is the right thing for them to do.

Post-pediatric residency careers can take many different directions. Some of the most popular options include private practice (in all varieties from solo practice through large HMOs or other managed care organizations), further training in general academic pediatrics, Robert Wood Johnson fellowship training, pediatric subspecialty training, basic science training, Epidemic Intelligence Service, Public Health Service, Indian Health Service, advanced degrees such as a Masters of Public Health (MPH), and other specialty activities such as neurology, psychiatry, pediatric anesthesiology, radiology, and NIH fellowships.

Pediatric Practice

The American Academy of Pediatrics has excellent and diverse information about pediatric careers. This site should be consulted as an essential part of career planning. It can be accessed at http://www.aap.org/profed/career.htm and http://www.aap.org/profed/gmepw.

Since the majority of pediatric residents enter practice, this will be the first area of discussion. The following data are from a random sample of 497 third-year pediatric residents completing categorical programs in 1999 (AAP News, March 2000).

"For 92% of those entering a general pediatric practice position and for 89% of those entering a subspecialty fellowship, the resident's new position was his/her first choice. The majority (59%) of those entering general pediatric practice were heading to a solo or pediatric group practice. Residents entering general pediatric practice estimated they would see 32 patients per day, and they anticipated a starting salary of $93,238. Of those entering a subspecialty, 21% chose neonatology, 13% chose hematology/oncology, and 11% chose infectious diseases. Less than 1% of residents were entering a non-pediatric fellowship."

"Residents also were asked what information or services they found helpful in their job searches. A total of 35% of residents reported that contacts they or their family had made were the most useful sources of information in their job search. An additional 18% said a residency faculty member was most useful, 14% said a peer was most useful, and 13% said direct contact from a practice was most useful. When residents were asked about other information or services that would have been helpful for their job or fellowship search, a central listing of job/fellowship opportunities was rated the highest."

See below for practical points about searching for jobs.

Residents' Post-Residency Position % of Residents
General pediatric practice 52%
Pediatric subspecialty fellowship 22%
No job or position at this time 12%
Chief residency 9%
Other position 4%
Non-pediatric residency or fellowship 1%

Most Useful Source of Information For
Learning about Positions		 % of Residents
Contacts made by self or family 35%
Residency faculty member 18%
Peer Direct contact by practice 14%
Direct contact by practice 13%
Physician placement service 7%
Other 7%
Advertisement in journal 6%

Practice opportunities are multi-faceted and range from solo practice through partnership or group practice to HMOs (staff model or group/IPA model) or various PPO arrangements. There are also additional options such as hospitalists and locum tenens arrangements. Practice environments range from the inner city to neighborhood health centers, suburban practices, and rural locations. Part-time and shared practice opportunities are often available, as well as practice in night or after-hours clinics. Issues to consider when exploring possible positions include office hours, on-call schedules and coverage, hospital responsibility for inpatients, opportunities to recruit new patients (e.g., through nursery coverage), salary, benefits, vacation and CME allowances, office management philosophy, parental leave and other special needs, licensure, cost of buy-in, partnership requirements, dissolution buy-out or restrictive clauses, and the specific expectations and philosophy of the practice. If it is a group practice, assess the stability of the group. If some physicians have left the group, find out why. It is also a good idea to spend a day or two with the practitioners at a site of interest to better understand their specific interaction, communication, and practitioner styles.

It is useful for both you and prospective employers to have a curriculum vitae or resume. In addition to the demographic material, it is particularly helpful to have a personal statement that describes your strengths and defines the kind of practice you would like to join. In describing your strengths, you will also help define the value you bring to the practice. Characterizing the kind of practice opportunity you desire will help crystallize these issues and make you more comfortable with your decisions.

There are a number of resources to use as one begins to look for private practice opportunities, including the classified advertisements in pediatric journals (like Pediatrics and Journal of Pediatrics, The New England Journal of Medicine and the Journal of the American Medical Association), postings at the various meetings sponsored by the American Academy of Pediatrics, and Web sites such as:

http://www.pediatricjobs.com/
http://www.practiceline.com/
http://www.medscape.com/
http://www.medbulletin.com/
http://www.nehealthsearch.com/
www.yahoo.com
www.nejm.org/
http://www.pediatrics.org/

and many other sites related directly to regions of the country, schools, etc. There are many good "pediatric" sites to visit for a wide variety of information, including job opportunities. They include:

www.aap.org (many links to other organizations)
www.ambpeds.org
www.medscape.com/Home/Topics/pediatrics/pediatrics.html
www.pedinfo.org
www.med.jhu.edu/peds/neonatology/organ.html#Organizations
www.upstate.edu/peds/
www.medmatrix.org/
PedJobs - Pediatric Employment Network: http://pedjobs.org/pedjobs/
American College of Physicians: http://www.acponline.org/careers/?hpnav
Comp Health: http://www.mycomphealth-online.com/
I Hire Physicians: http://www.ihirephysicians.com/default.asp?campaign=goto
Medical Search Online: http://www.pediatricjobs.com/
Pediatrics: Job Postings, Salary Information, and Job Search Tips: http://resumegenie.com/jobs.asp?job=Pediatrics
DocJob: http://www.docjob.com/
Action Medical Search: http://www.americanmedicaljobs.com
Beansprout: http://www.beansprout.net
Career Magazine: http://www.careermag.com/
Doc On The Web: http://www.webdoc.com/
EmployMED: http://www.employmed.com/
Physician Recruiter: http://www.therecruiter.com/
Health Care Recruitment Online: http://www.healthcareers-online.com/
Health Care Jobs Online: http://www.hcjobsonline.com/
Health Network USA: http://www.hnusa.com/
Health Opps: http://www.headhunter.net/JobSeeker/Jobs/jobfindhc.asp?siteid=healthoppscom&ch=hc
Job-Source, Inc.: http://www.job-source.com
Job Span: http://ww1.jobspan.com
Medical Ad-Mart: http://www.medical-admart.com/
MedSearch-Healthcare Careers (Monster.com): http://www.medsearch.com/
MedZilla.com: http://www.medzilla.com/
NationJob Network: http://www.nationjob.com//medical/
Physician Employment: http://www.physemp.com/
Physician’s Guide to the Internet http://www.physiciansguide.com/jobboard.html

Women In Medicine:

To address the importance of women's issues in pediatrics the following web sites may be helpful:

Associations

  • American Medical Woman’s Association:
    Organization of women physicians and medical students dedicated to serving as a unique voice for women's health and the advancement of women in medicine. They have worked to improve including smoking prevention and cessation, osteoporosis, violence against women, heart disease, gender equity, breast cancer, and reproductive health.
    http://www.amwa-doc.org/
  • National Asian Woman’s Health Organization:
    Established to eliminate health disparities for Asian women and their families.

Bibliography

Jobs

  • Empowering Women In Medicine:
    Includes strategies and resources for women. After registering, job listings are included.
    http://www.feminist.org/
  • International Woman’s Health Coalition
    Working to generate health & population policies, programs and funding that promote & protect the rights and health of girl's and women worldwide, particularly in Africa, Asia, and Latin America. A job site is included.
    http://www.iwhc.org/
  • MomMD
    A community for women in the medical community. Providing resources, information, inspiration, support, and advice for women, particularly mothers in medicine. Resources for physicians, medical students and premeds.
    http://www.mommd.com/
  • National Black Women's Health Project
    Seeking to improve the health of black women by providing wellness education and services, health information and advocacy. A job Fair site is included.
    http://www.blackwomenshealth.org/site/PageServer
  • Women in Neuroscience
    An international organization promoting the advancement of women neuroscientists at all career levels.
    http://beemnet.org/win/

Volunteer

  • The American Cancer Society: http://www.cancer.org/docroot/home/index.asp
  • Coalition of Community Foundations for Yourth (CCFY): http://www.ccfy.org/
  • Amazon-Africa Aid Organization (3AO):
    The Amazon African Aid Organization supports a health clinic run by the Funadacao Esperanca, a non profit Brazilian health and education organization which has been providing health care along the Brazilian Amazon for over 30 years. The health clinic depends on volunteer dentists and physicians to provide care for the needy people of the Amazon.
    http://www.amazonafrica.org/
  • Interplast:
    Interplast;s medical volunteers and colleagues in developing nations have provided reconstructive surgeries for needy children and adults with cleft lip, cleft palate, severe burns, and other crippling injuries.
    http://www.interplast.org/
  • Doctors On Call (D.O.C.):
    D.O.C., Organization Incorporated, also known as Doctors On Call, is the first independent international surgical outreach organization to focus on surgical outreach exclusively to Caribbean.
    http://www.doc-online.org/
  • Jewish Healthcare Foundation:
    Tzedakah is a word that turns up frequently in the reports and other publications of the Jewish Healthcare Foundation. Tzedakah, the Foundation explains, is a Hebrew word that roughly translates as social justice––the deep moral obligation that the more fortunate have to reach out and help those who are less fortunate. And Tzedakah is a key to the Foundation's past, present, and future.
    http://www.milbank.org/nf/jewish.html
  • The Humana Foundation:
    The Humana Foundation is the philantrhropic arm of Humana Inc. Established in 1981, The Humana Foundation is dedicated to improving the health and well being of communities throughout the USA and abroad. The Foundation supports charitable organizations and institutions that promote education, health and human services, community development and the arts.
    http://www.humanafoundation.org/
  • Illinois Department of Public Health: http://www.idph.state.il.us/
    and then under the IDPH is:
    SWICAT:
    SWICAT is a newly-formed volunteer group in our area that has made a commitment to, "Promote a Tobacco Free Society Through a Network of Community Resources." A variety of health care professionals, organizations, health departments, hospitals, and schools are currently members of SWICAT. The purpose of this site is to raise awareness of tobacco prevention and control in southwesteren Illinois
    http://www.siue.edu/
  • Foundation for Women's Health, Research and Development
    FORWARD is an international non-governmental organization dedicated to improving the health and well-being of African women and girls wherever they reside. FORWARD promotes action to stop harmful traditional practices such as female genital mutilation (FGM) and early and forced marriages, which violate the human rights of women and girls and adversely affects their health and well-being. http://www.forward.dircon.co.uk/
  • Planned Parenthood
    The world's largest and most trusted reproductive health care organization. Founded by Margaret Sanger in 1916 as America's first birth control clinic, Planned Parenthood believes in everyone's right to choose when or whether to have a child, that every child should be wanted and loved, and that women should be in charge of their own destinies.
    http://www.plannedparenthood.org/
  • Women In Medicine
    Woman Can Do
    Helping to educate women about the importance of participating in medical research. The past exclusion of women from clinical trials has limited knowledge of how diseases and conditions and their treatment affect women differently.
    http://www.womancando.org/
  • Miscellaneous:
    International Medical Graduate Information
    The Chicago Medical Society (http://www.cmsdocs.org/) provides information for International Medical Graduates: http://www.cmsdocs.org/links/html/links_set.html
  • BioMed
    Scientist Jobs: An international recruitment websites for Life Science and Medical professionals.
    Find jobs that are suitable by carrying out a quick search or use an advanced search to refine results against a range of factors.
    http://www.biomedscientistjobs.com/program/defaultindex.cfm?CFID=706572&CFTOKEN=5165126
  • http://www.ramana.com/locum.htm
  • Other medical job web pages (Lists of web sites)
    Jobs In Health Care: http://www.oingo.com/topic/8/8497.html
    Science and Medicine Jobs: http://jobsearchtech.tqn.com/cs/sciencejobs/
    Pharmaceutical Careers Inc.(All positions requiring an MD): http://www.pharmaceuticalcareers.com/Positions/main_md.html
  • "Head hunters" or hospital recruiters are usually seeking to fill specific positions, but these individuals may also have knowledge of other openings. Some pediatric programs may maintain a list of practice jobs in their area. Prior graduates of programs should also be contacted, as they may have additional information about openings.

Practical Points:

How to find a job after leaving residency:

Look for the type of practice you might be interested in. This includes Private practice, academic practice, hospital based and military based practice. The military practice is usually time repaid for financial support given by the government for Medical school. The employment contract is predetermined and non-negotiable by the MD. The Hospital based practice includes hospital or health system; and contracts the doctor for specific clinical responsibilities such as Medical directorships, pathology radiology or pharmacy services or Hospitalist programs.

The academic physician is hired by the medical school to provide education, conduct research and participate in scholarly activities as determined by the Dean and Department Chair. Also the physician is expected to practice medicine. Many academic centers have divided the patient care part of the business by creating separate and independent practice organizations. Education and teaching stipends are determined by academic rank, specialty and are negotiable. Other revenue may be generated by private, intramural or government grants. All inpatient and outpatient activities are charged accordingly. Some academic centers are now charging doctors for practice expenses such as: rent of space, supplies, practice overhead (which includes beepers, answering service, and secretarial support), and malpractice coverage. Doctors in academic practice have an income which is usually below private market levels.

There are several options for doctors interested in private practice. One can join a group practice, multidisciplinary practice or start a solo practice. Solo practices are becoming rare in today’s environment due to revenue reductions and significant increases in expenses. In group practices, members are usually of the same medicine specialty, practicing as a single corporate entity, with revenue as well as expense sharing. Multispeciality groups consist of different specialists practicing as a single corporate entity, sharing expenses but not necessarily revenues. Some careful planning should go into starting a private practice. The factors one should consider are geographic location, selection of the locale, office space, office furniture and equipment, office personnel, and ancillary staff, and a billing system. Other planning includes hospital privileges, insurance and cash flow. When planning the location of a pediatric practice, look for a young population with potential for growth, and hospital facilities. When considering the local factor, figure in how much space you need and the rental contracts for office space. Usually contracts are for 5 year terms, with a sliding scale of rental increase per year, plus added property taxes on a per year basis. Build out costs are shared by landlord up to a maximum per square foot allowance. The office space must meet OSHA standards in regards to sinks, disposal of body fluids, needle disposal, diapers and ADA. The office equipment supplies include furniture, examination tables, otoscopes, scales, chairs and filing cabinets. Other office equipment includes computer systems and software, telephone system and fax machines, and paper supplies, including letterheads. The personnel in a private practice which needs to covered are a secretary, nurse, an answering service, a billing service and a cleaning service. Other expenses will include malpractice insurance, liability insurance, workmen’s comp and state employment security insurance. In a group practice the doctor starts out as an employee and the contract is usually renewed in 1-2 years. Partnership is usually offered in year 2-4 of employment. The partnership must be bought. The price of a partnership should be determined by a written buy-sell agreement with the following considerations: valuation, and stock purchase. When looking at an employment contracts, compensation and benefits have to be spelled out. Benefits include health insurance, disability insurance, life insurance and CME.

From a resident’s perspective, advice to the question,
What Should I do To Prepare for Life After Residency?

During the PL2 year:

  • Apply for and take USMLE Step 3
  • Decide if you want to do fellowship or primary care
  • Apply for fellowship positions during summer of PL2 year
  • Undecided on a fellowship?
    Talk with Department Chairman and sub-specialists about your interest in sub-specialty.


    • Discuss different fellowship programs
    • Discuss personal/professional goals
    • Ask when applications will be available/are due
    • Ask about interview schedule
    • Ask about Match Day for specific specialty
  • Make a list of programs where you would like to apply for fellowship

August/September of PL2 year:

  • Call fellowship programs for applications
  • Write personal statement
  • Prepare CV
  • Obtain medical school transcripts
  • Obtain Dean’s letter from medical school

September of PL2 year:

  • Mail applications
  • Ask for recommendation letters

During PL3 year:
Timeline for primary care or fellowship:

  • Apply for State Licensure—the earlier the better!
    May require fee, depending on state
  • Apply for medical staff privileges at appropriate hospitals
  • Apply for DEA number
    Some states require state and national applications
  • Apply for pediatric boards
    Usually take these the October after you graduate from residency

During PL3 year:
If looking for a job out in the real world:
Things to consider in looking for in a practice:

  • Setting: academic/private practice/community practice
  • Socioeconomic status of patient population
  • Nursery coverage, ER coverage, hospital rounding/admitting
  • Multispeciality clinic vs. pediatrics only
  • Why is the practice hiring someone new?
  • Call schedule? Shared coverage? Overflow patients?
  • How many patients are seen per day?

Helpful hints:

  • START EARLY!!
  • Look around for cities/communities where you would like to work and live
  • Start early with credential/licensure process! Some states take up to six months!
  • Contact university hospital programs within the area
  • Think about a recruiting service
    May charge a fee to the hiring practice
    Also may know about contacts you could not otherwise find
  • Get contacts through various sources
  • Introduce yourself to practices with a cover letter and CV
  • Have an attorney look through your contract before you sign it
  • If signing more than one contract (i.e., Hospital and practice having separate contracts), do not sign until you have seen and evaluated BOTH contracts
  • Negotiate for things you want such as maternity leave, CME time

FELLOWSHIP

The focus of the next discussion will be post-residency fellowship positions. Many of the pertinent issues are identical to those for private practice, but additional considerations include:

How does one select a fellowship area?

Who does one talk to?

When does one start the process?

What materials are available?

Is there a computerized matching process?

How does one arrange interviews and time off from one’s resident duties?

How does one evaluate a program?

What is an appropriate salary/benefits package?

What are the critical things to evaluate before making a decision?

How is an offer tendered, and what does one need to do to accept?

Are there policy and procedure issues that one should know about?

How does one select a fellowship area? The basic premise here is no different than with private practice: The individual must assess his/her own interests, goals and aspirations and consider current and future needs as well as his/her own skills. A great deal of input from others, as well as introspection, is required, but it is essential to select an area that satisfies one’s own needs, not the well-meaning but perhaps misguided recommendations of colleagues. That is not to say that input from other residents, attendings, advisors, mentors, spouses, and friends is not important, but ultimately these decisions should be very personal, private choices since the individual will keep and live with them. What about fads or the current "hot" areas? Should one take the leap? The answer really depends on whether an area fulfills the criteria set by the individual to attain future goals.

Should one even consider a fellowship, given the fact that the major emphasis at present is on primary care? The answer is unequivocally "yes" if that is the direction of one’s career interests and aspirations. Despite dire predictions, pediatric subspecialties are not dead or dying and, in fact, will probably make a resurgence in the near future according to the recent report "The Future of Pediatric Education II: Organizing Pediatric Education to Meet the Needs of Infants, Children, Adolescents, and Young Adults in the 21st Century" (January 2000, supplement to Pediatrics and at http://www.aap.org/profed/fope1.htm). Most things in life have a cycle and rhythm, and career pathways are not an exception. The pendulum has swung hard toward primary care in the past few years, but the opportunities for well-trained pediatric subspecialists are many and varied. There is clearly a shortage of pediatric subspecialists in pulmonology, endocrinology, neurology, rheumatology, adolescent medicine, emergency medicine, gastroenterology, and probably other areas as well. There is never a shortage of positions for subspecialists who are well trained in investigation, whether basic science or clinically oriented. There has also never been a time when more funding opportunities were available to new investigators.

Selecting a fellowship area really begins with a resident "testing" each area he/she encounters during training. If an area is under serious consideration, it is important to arrange one’s schedule to do a rotation (or elective) in that area early on, in the PL-1 year or the beginning of the PL-2 year. Questions to be considered should include: What are my strengths and do they match the subspecialty? Are these the kind of patients I want to take care of? Can I deal with chronic aspects of disease? Can I deal with the fact that my patients may die? Do I enjoy providing support and guidance to patients and families? Is the application of high technology advances critical to my practice style? Do I want to focus my practice on a particular area? Often, a particular individual in a subspecialty or area of interest stands out as a role model or valued mentor. It must be recognized, however, that it may be difficult to separate the appreciation of a role model’s practice from the desire to actually pursue further training in that field. Experiences with a patient or patients may also affect an individual to the point of influencing one’s future course. Sometimes lifestyle issues predominate and thereby dictate decisions.

Who does one talk to? Everyone! Input should be gathered from fellow residents, attendings, advisors, program directors, and individuals within subspecialties of interest. All of this background and advice should serve as the foundation for making decisions. Discuss your interests with more than one member of the subspecialty faculty. Seek the input of your program director and faculty advisor/mentor. If suitable, talk with your department chair. All may have suggestions about specific programs, and they may be able to contact the programs and lobby in your interest.

When does one start the process? This should be done as early as possible, since at least half of the first year is spent garnering basic skills and gaining confidence about abilities and decision making. Aside from the few programs for which one almost has to apply shortly after birth, no program decisions need be made in the first year.

What materials are available? The Graduate Medical Education Directory, published by the Accreditation Council for Medical Education (ACGME), which can be found in medical school libraries and most specialty departments, lists all accredited subspecialty training programs and contact information. The Directory also contains the educational requirements for specialty and subspecialty training as written by the specialty Residency Review Committees and the eligibility criteria for certification of the specialty boards. Each year the January issue of the Journal of Pediatrics lists fellowship programs, program directors, application deadlines, start dates, duration of appointment, and minimal requirements for application. This list, although it may not be complete, is an excellent place to begin the search of programs. However, the list does not provide any way to differentiate program quality. Some programs have developed well-deserved reputations over the years, but that is hardly a quantitative approach to program selection. Specialty and subspecialty programs are listed in FREIDA (Fellowship and Residency Electronic Interactive Database Access) Online on the AMA Web site (http://www.ama-assn.org/). FREIDA Online provides internet access to extensive information on ACGME-accredited residency programs and combined specialty programs. FREIDA Online (http://www.ama-assn.org/) allows users to search all ACGME-accredited programs by program identifier, specialty/subspecialty, state/region, program size, and educational requirements, among other variables. All program listings include program director name, address, and phone number, as well as program length and number of positions offered. In addition, 85% of programs listed include expanded variables, such as program benefits (including compensation), resident-to-faculty ratio, work schedules, policies, and educational environment.

The Pediatric Infectious Diseases Society has an excellent web site, http://www.pids.org/Fellowship%20Training.htm, that provides extensive information about available fellowship programs. Many programs now list their faculty, program philosophy, and research activities on the internet. It is important, therefore, to make the internet an early reference and resource for program characteristics.

It might also be useful to look at abstracts submitted to the Society for Pediatric Research in one’s area of interest to identify individuals and programs whose focus of activity matches one’s own. The abstracts are published each year in Pediatric Research.

Is there a computerized matching process? At the present time, four pediatric subspecialties have a computerized matching process: Emergency Medicine, Cardiology, Hematology-Oncology, and Critical Care Medicine. Neonatal-Perinatal Medicine is weighing the merits of using a computerized match. With the high likelihood of couples’ involvement in subspecialty training and the interest of subspecialties in computerized matches, it will be important that the match date be synchronized in the future. Information regarding the match in Pediatric Emergency Medicine can be found in the April issue of Journal of Pediatric Emergency Care, which also lists all active Pediatric Emergency Medicine subspecialty programs. The National Resident Matching Program, Washington, D.C., provides match deadline dates to programs and candidates (202/828-0676 & http://nrmp.aamc.org).

How does one arrange interviews and time off from resident duties? This can be a sensitive issue, especially when a cross-covering resident is not actively looking for positions. The first rule should be that the traveling individual "pays back" those who cover while he/she is away. It is the resident’s responsibility to arrange coverage, and this should be carefully coordinated with the chief residents and the program director. Colleagues understand the importance of interview trips, but they should not be left with extra duty.

How does one evaluate a program? Many issues come into play here. Does the program have a balance of strong clinical experiences and research opportunities? How many subspecialty residents has the program trained in the last five years? How many subspecialty residents are currently in the program? How are they funded, especially for the second and third year that generally include fewer clinical duties? What do subspecialty residents do after they have completed the program? What is the board pass rate of graduates of the program? How successful is the program’s research efforts? Do they have NIH funded grants? Do they have an NIH funded training grant? How many faculty members are there and are they available? What is the faculty’s bibliography over the last five years? Are all faculty subspecialty board certified? Do the research training opportunities coincide with your own needs and aspirations (e.g., are there both clinical research and basic research opportunities)? How much time is available for the resident to do research? Is research available in blocks of time or is it interspersed in short segments throughout the program (which would not be desirable)? What is the call schedule, and how much call is taken during research time? What is the prevailing philosophy of the program toward its trainees?

As with any new situation, it is imperative to evaluate the environment, the facilities, and the individuals with whom you will be interacting. What is the "human chemistry?" Did you like the faculty? Do you have the sense that one or more of the faculty members would be a good mentor?

It is also important to assess the resources in other subspecialty areas and in other departments at each location. You may find that your clinical training will be completed in the cognate specialty area, but your research will take place with someone in a quite different area. It is therefore of crucial importance to understand the overall research programs and whether you will have the opportunity to go outside the subspecialty area for training if that is appropriate.

Ultimately, the question of whether a program is "right" is a decision with both tangible and intangible elements. Location, access to outside activities of interest, spousal interests (most important!), etc all play an important part in the decision.

What is an appropriate salary/benefits package? Most individuals will enter subspecialty resident training in their fourth post-graduate year (R-4) and should be paid at that level in accordance with the salary scale at the individual institution. During the second and third years of subspecialty training, the individual should be paid as an R-5 and an R-6. NIH stipends may pay at a different rate, and residents should be aware that this could affect their salary. Benefits should include malpractice insurance, health insurance, HIV benefits, some life insurance, and an option to buy long-term disability insurance. One should also inquire about the ability to defer loans while in fellowship.

What are the critical things to evaluate before making a decision? The answer to this involves a review of the points discussed earlier regarding program evaluation. When families or significant others are involved, they must be a critical factor in making any decision. What kind of housing is available and at what distance from the workplace? Commuting always comes out of home time, not out of work time. How about schools for children, both in quality and location, as well as public vs. private? What is the proximity to friends and family? Is the associated life style compatible with your current arrangements?

How is an offer tendered, and what does one need to do to accept? This process varies widely at the present time, since some areas have a computerized match and others a much more informal process. In the matching process, like the intern matching process, one signs a contract to go to the highest matched program. Similarly, when one has either verbally or in writing accepted a position in a program outside the match, this is a contract that must be honored. The importance of careful deliberation and "being sure" before signing the contract must be emphasized, realizing, of course, that any contract can be broken. Don’t start a career off on the wrong foot, either in private practice or in any other venue by defaulting on a contractual obligation.

Once a contract has been signed (or the match completed), it is time to consider all of the other issues associated with job changes. If it is in a new city, matters of transportation, living arrangements, packing and moving, changing addresses, opening new bank accounts, and all the myriad of other details must be addressed. If a spouse or significant other is in the picture, his/her needs will also need to be considered. Failure to pay particular attention to the needs of a spouse, children, or significant other is a recipe for unhappiness and potential disaster.

Are there policy and procedural issues that one should know about? Staff privileges and licensure are important issues to deal with early. Be sure to check with each program to see if you will need an unrestricted medical license or whether you will receive an educational/training license. Some states take up to three months to process license applications. It is best to start these proceedings as early as possible. Sick leave, medical leave, and family leave policies should be in place, and there should be a formal grievance procedure available.

Other Training Directions

  • Information on the Centers for Disease Control and Prevention can be found at http://www.cdc.gov/.
  • Indian Health Service information is at http://www.ihs.gov/
  • International Opportunities:
    Doctors without borders: www.dwb.org
    WHO: www.who.int
    HOPE: www.projhope.org
    Child Family Health International: www.cfhi.org
    Child Health Research Project: http://www.childhealthresearch.org/
    Surgical Opportunities: Operation Smile: http://operationsmile.org/wjoh/, Rotaplast: www.rotaplast.org, Interplast: www.interplast.org
    Official Job Listing of the Canadian Society of Biochemistry and Molecular & Cellular Biologists (CSBMCB):
    http://www.medcor.mcgill.ca/EXPMED/DOCS/index.html
    United Nations Employment Opportunities: http://www.unicef.org/employ/Intern.html
  • Pediatric Scientist Development Program: A national program designed to provide training in basic science and basic health services research and career development opportunities for young pediatricians who are committed to academic research careers. Prior research experience is not required. Pediatric residents with M.D., or M.D./Ph.D. degrees in their third (PL-3) or chief residency (PL-4) years who are prepared to spend at least two years in fundamental research training to acquire strong research skills are encouraged to apply, as are candidates who seek training in statistics, epidemiology, informatics, or health policy. Candidates may not apply after clinical fellowship training has begun. Nominations must originate from chairs of medical school departments who are committed to providing continued career development support for the candidate. Applicants must be US citizens, permanent residents of the US, or Canadian citizens. February 1, 2001, is the deadline for application for research training to begin July 1, 2002. For additional information: http://info.med.yale.edu/pediat/pedsci.htm
  • Robert Wood Johnson Clinical Scholars Program: This program is designed to allow young physicians committed to clinical medicine to acquire new skills and training in the non-biological sciences important to medical care systems. The program offers two years of graduate-level study and research as part of a university-based, post-residency training program in priority areas designated by participating institutions. The program is open to US citizens training in any of the medical/surgical specialty fields, including psychiatry, pediatrics, obstetrics-gynecology, and family medicine. Contact Web site: http://www.rwjf.org/
  • Time Line:
    1. "Test" each rotation ®
    2. Begin regular meetings with faculty advisors, program director, chairperson, etc. ®
    3. Read this web site ®
    4. Plan fellowship areas of interest early in the PL-2 year ®
    5. Request application materials and submit before the end of the calendar year ®
    6. Arrange interviews for second half of PL-2 year ®
    7. Contact NRMP about Match dates ®
    8. Begin practice interviews ®
    Graduate
    PL-1 PL-2 PL-3 JOB
  • Subspecialty Information Access:
    General: FREIDA (Fellowship and Residency Electronic Interactive Database Access) Online on the AMA Web site. FREIDA Online provides internet access to extensive information on ACGME-accredited residency programs and combined specialty programs. FREIDA Online allows users to search all ACGME-accredited programs by program identifier, specialty/subspecialty, state/region, program size, and educational requirements, among other variables. All program listings include program director name, address, and phone number, as well as program length and number of positions offered. In addition, 85% of programs listed include expanded variables, such as program benefits (including compensation), resident-to-faculty ratio, work schedules, policies, and educational environment. http://www.ama-assn.org
  • Academic Physician and Scientists
    Science Careers: http://recruit.sciencemag.org
    The National Academies (Fellowship and Postdoc Opportunities): http://www.nationalacademies.org/opportunities
  • Administrative Medicine and/or Government/Military Opportunities
    The American College of Physician Executives: http://www.acpe.org
    U.S. Department of Health and Human Services Opportunities: http://www.hhs.gov/opportune.html
    Armed Forces Careers. Com: http://www.armedforcescareers.com/
    National Institute of Health: http://www.acponline.org/careers/?hpnav
  • Anesthesia
    http://www.pedsanesthesia.org/
  • Hematology/Oncology
    Bloodline: The online resource for Hematology Education and News: Grants and Fellowships: http://www.bloodline.net/grant/index
    Journal of Pediatrics: the January issue annually provides a listing of pediatric subspecialty programs. For subspecialties not listed below, the Journal and FREIDA offer listings of training programs.
  • General Academic Pediatrics: Residents who desire further training in general academic pediatrics should consider funding through individual National Research Service Awards (NRSAs) from the National Institutes of Health. http://www.grants.nih.gov/training/nrsa.htm
  • Genetics: For training in Genetics see the American Board of Medical Genetics, www.faseb.org/genetics/abmg/abmgmenu.htm
  • Cardiology: Annual listing of programs: Journal of the American College of Cardiology. Fellowship match established. Contact NRMP. http://nrmp.org
  • Critical Care Medicine: Fellowship match for 2001. Contact NRMP. http://nrmp.org
  • Emergency Medicine: The April issue of Journal of Pediatric Emergency Care lists all active Pediatric Emergency Medicine subspecialty programs. Fellowship match for over 10 years. Contact NRMP. http://nrmp.org
  • EMSC: Emergency Medical Services For Children: http://www.ems-c.org
    Brown University Program In Emergency Medicine: Fellowships:
    http://www.brown.edu/Administration/Emergency_Medicine/emr/pages/fellowships.htm and
    http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
  • Infectious Diseases: Excellent Web site provides extensive information about available fellowship programs. http://www.pids.org/Fellowship%20Training.htm
  • Pulmonology: Annual listing of programs: American Journal of Respiratory and Critical Care Medicine.
  • Asthma, Allergy and Immunology information can be accessed at The American Board of Allergy and Immunology, http://www.abai.org/ (interviewing for positions in Asthma, Allergy and Immunology may start earlier than for other fellowships, and it is recommended that you begin during the first part of the second year).
  • Public Health and Public Policy
    Association of Schools of Public Health: http://www.asph.org/
    Public Policy and International Affairs: Fellowship Program: http://www.aed.org/ppia/
    Public Policy Office: http://www.apa.org/ppo/
    The National Academies (Fellowship Programs unit Policy and Global Affairs [PGA]): http://www4.nas.edu/osep/fo.nsf
    Health Hippo: Health Jobs (This is quite possibly the coolest web site around – and not just for jobs!): http://hippo.findlaw.com/hippojobs.html
  • Religious Organizations (Please note: A few of these jobs could have volunteer or employment opportunities connected to the organization.)
    Food For The Hungry: http://www.fh.org/
    American Jewish World Service: http://www.ajws.org
    Catholic Medical Mission Board: http://www.cmmb.org/
    Catholic Network of Volunteer Service: http://www.cnvs.org/
    International Orthodox Christian Charities (IOCC): http://www.iocc.org/
    Lutheran World Relief: http://www.lwr.org/involved/openings/volun.html
    MAP International: http://www.map.org/
    United Methodist Committee on Relief (General Board of Global Ministries): http://gbgm-umc.org/umcor/jobs.stm
    Christian Medical & Dental Associations: http://www.cmds.org/?BISKIT=658782877
    The Christian & Missionary Alliance: http://www.cmalliance.org/
  • Volunteer (Please note: A few of these jobs could have employment opportunities connected to the volunteer counterpart. The majority of these organizations are for volunteer positions.)
    The American Red Cross: http://www.redcross.org/
    International Federation of Red Cross and Red Crescent Societies: http://www.ifrc.org/jobs/field.asp
    Children’s Defense Fund: http://www.childrensdefense.org/
    Direct Relief International: http://www.directrelief.org/
    International Medical Corps: http://www.imc-la.com/
    International Rescue Committee: http://www.intrescom.org/index.cfm
    Flying Doctors of America: http://www.fdoamerica.org/pages/overview.html
    Mercy Corps: http://www.mercycorps.org/
  • Careers as Hospitalists have become more attractive in the last few years as hospitals search for better ways to provide better inpatient services. See the AAP Web site at http://www.aap.org/ and http://www.hospitalist.net/
  • This information was compiled by: Herbert T. Abelson, M.D., Laurel Blewett, Walter W. Tunnessen, Jr.
  • Any comments for changes/additions/etc should be directed to Herb Abelson