Pathway to Partnership

Exploring post-training opportunities while still in Fellowship can feel particularly daunting. However, a mix of modern tech and classic introductions will put you on the path to finding your ideal opportunity.

If you are a first-year Fellow, it might even seem incredibly premature to start thinking about your first post-training job. We say, it’s never too early! Here are a few low risk, low maintenance tasks to kick off your search.

• Draft or update your CV (here are some hints)
• Establish a presence on professional networking sites like LinkedIn (and follow Allergy Partners as well as our VP, Physician Recruiting if you’re so inclined!)
• Join local, regional and national associations
• Attend conferences
• Connect with industry and thought leaders at every opportunity
• Start thinking about where you’d like your practice to take you and your family, and look into local allergy groups that you might want to join.
• Talk to your program directors and colleagues, and ask them for advice and introductions.

We are open to speaking with allergists at any stage of their career that are looking for a new opportunity. Feel free to reach out to our VP, Physician Recruiting to explore a Pathway to Partnership with us. Send your CV and areas of interest to begin a conversation.

With a little planning, you can make the most of the time between completing Fellowship and starting your first job.

Many graduating Fellows are surprised to learn that there is often a waiting period just after training and before jumping into work.

Credentialing for allergy/immunology physicians coming out of fellowship cannot begin until training is complete (usually July 1) and may be contingent upon the receipt of Board results. That means new Fellows will likely not be able to start full-time positions as allergists until the fall. Besides studying for and taking board exams, there are other activities that can fit nicely into this transitional time.

Board Prep

After the brief relief of completing Fellowship, there is still the specter of board examinations for most new allergists. Since exams are usually scheduled in September or October, post-Fellowship months are a great opportunity to hit the books without the added pressure of clinical rotations.

Job Search

Though most practices know there are more new allergists entering the job market in the fall, they are likely hiring year-round. It’s never too late to reach out to practices in the area(s) in which you’d like to live and work. If you are already in negotiations or under contract, make sure you are on track to be credentialed by your start date by staying in close contact with your new employer.

Temporary Employment

You may be able to find temporary work as a locum tenens physician while you’re waiting for board certification and eventual credentialing with a new employer. If you are under contract (or soon to be), be sure to disclose your intention to work as a fill-in physician. Your new employer might have non-compete restrictions that must be observed.

Relocation

If moving to another city or state is part of your plan, the time between training and starting a new position can be an opportunity to work out the details of that major transition.

• Tour different neighborhoods in your new city and find housing
• Check out schools, daycare or other resources for your family
• Explore employment for a spouse or partner

Maybe most importantly, take some time to recognize and appreciate the commitment and time that you’ve invested in your career. Completing Fellowship may feel like something is ending, but it’s really just the beginning.

If you’ve received offers from several practices, it can be a little like comparing apples to oranges. Some may offer a higher, yet short-term, base salary while others reward entrepreneurship by basing compensation, wholly or in part, on productivity. But if long-term investment (and ultimately, a potential nest egg at retirement) are important for you and your family, practices that offer a partnership track can be a good fit.

All physicians must of course consider the financial necessity of their monthly paycheck. But it’s important to also be mindful of long-term wealth-building strategies that can position you and your family securely in the future.

Pathway to Partnership 

Surveys have shown that a wide majority of graduating Fellows desire to become a partner in their next position, yet many are not sure if that is even on the table for them. It’s important to have partnership conversations early on in negotiating a new position so you know exactly what the opportunity looks like for you. Ask for timelines, models, and a sample contract that explains the process in transparent detail. Talk to other physicians in the practice that have reached partner to hear about their experience.

Thinking Beyond the W-2

Though structures vary, the ultimate goal for most partnership tracks is some level of company ownership. This is generally an ownership stake in a profit-generating entity of the practice that is distinct from one’s individual compensation. Therefore, there is both short-term (annual) and long-term (retirement or buy out) compensation to consider in any opportunity.

• Ask about share values and projections for growth (or growth over the last few years). What are the parameters for the company to buy back your shares at retirement (or other separation from the company)?
• Find out if the company pays dividends to shareholders.
• Learn more about other financial opportunities that might be available to physicians once they make partner.

Shared Interest, Shared Goals

As a shareholder in a group practice, physicians share the risks and rewards of company ownership. Though you might not work in the same location, as shareholders in the same company you and your colleagues are working toward a common goal – the success of the larger entity. This shared interest can unite a geographically diverse practice in activities that explore innovations in the field, elevate the company brand by delivering expertise on a larger platform, and ultimately contribute to a reputation that fosters growth. In other words, a high tide raises all ships.

This shared commitment to growth not only contributes to your nest egg down the road, patients benefit from the care provided by a growing practice in new communities.

Have an ideal practice location in mind? Set an intention and start putting out feelers for your next big move.

If there’s anything the pandemic years taught us, it’s that a major world event causes a lot of people to re-assess their current lifestyle. According to a report by Definitive Healthcare, The Great Realignment resulted in nearly 117,000 physicians leaving the workforce entirely in 2021. For those remaining in practice, this trend of work-life evaluation has continued, with tens of thousands of physicians deciding that there’s no time like the present to make a big move.

Whether motivated by professional goals or a desire to move closer to family, for example, it can be frustrating when that dream location doesn’t pop up on the job boards. There are steps you can take, however, so that if a practice’s plans align with yours, you’ll be among the first to know.

Reach out directly to local practices.

If you have a specific city in mind, you can always reach out directly to the local practices after having done some initial research online.

• Send your CV with your first email.
• Let them know your ideal timeline.

Contact large, growing practices.

If you don’t find (or click with) a local practice in your area of interest, reach out to a growth-minded practice with national presence. Often, these larger practices have planned growth initiatives that might align with your desired geography.

• Make connections with former colleagues or co-fellows who work for the organization.
• Visit their exhibitor booth at conferences.
• Participate in job fairs.
• Check out their recruitment information online for specific details and contact information.

If it’s a large practice, getting in touch with their in-house recruiter will be the best assurance you will get a follow up. You can even provide a few areas of interest, rather than just one.

At Allergy Partners, our recruiting team keeps a database of all past, current and future candidate interest. In fact, we welcome inquiries from candidates as early as their first year of residency. When an opportunity comes up, we already have a list of people to tell about it.

If you don’t see your particular area of interest on our list of current opportunities, we’d still like to hear from you. Send us your CV and tell us where you’d like to practice (and when). You never know when our growth initiatives will take us all exactly where you want to be.

While there are myriad ways to begin practicing in a new market, one consistent theme is the importance of getting to know your audiences. 

From patients to colleagues, a big part of having a thriving business is making (and nurturing) connections with the people you serve, and the colleagues with whom you serve them. The challenges may be different in each market, but the solution is the same (and the effort is on-going.)

Read More>>

Patient Relationships

For physicians, the beginning and end of most discussions is patient care. Fortunately, providing quality care and an excellent experience is not only good for patients, it’s good for business. 

• Make sure your entire team prioritizes patient experience at every touch point. 
• Provide days and hours of operation that work for your patients.
• Educate and communicate clearly in the exam room.
• Listen and respond to patient feedback.
• Provide meaningful and compliant outreach, marketing and social media posts.
• Prioritize review sites and make sure local listings are accurate.
• Unified branding and materials convey competence and confidence.

Referral Relationships

Some of the most important professional relationships you will have are with providers (and their staff) that will refer their patients to you for specialty care. Realize that long-standing referral patterns can be ingrained in the processes of those offices, and it can take extraordinary measures to change those patterns. The first step is to let referring offices know who you are and what you do.

• Schedule in-person meet-and-greets with potential referring offices and their staff. It’s important to meet not only the physician, but the referral coordinator if they have one, and the front desk specialists that are making the calls. These can be quick, informal introductions.
• Reach out to providers you know (or would like to know) with a handwritten note.
• Prepare and distribute materials written for a physician audience. Provide information on your scope of practice, including patient ages that are treated in your office, and conditions for which providers should refer.
• Consider offering educational presentations for larger offices.
• Respond quickly to referrals that your office receives, and implement a workflow to insure this always happens.
• Provide timely consultation and reports to referring providers, as appropriate.

If you are joining a group or taking over the panel of a retiring physician, don’t rest on your laurels. The referral relationships that an existing physician had are theirs, not yours. An ideal scenario would be a warm introduction from the provider that’s leaving, communicating his or her confidence in the continuation of care.

Institutional Relationships

It varies by location, but consulting or call affiliations with local hospitals can help introduce new providers to the medical community and open up referral channels. Hospitals often have advisory groups or committees that allow participation by adjunct staff, and this can be a great way to make professional connections. If your practice is near a teaching facility, having medical students, residents or fellows rotate through your practice can provide future leads for staffing.

Team and Industry Relationships

Even in a group practice, physicians can sometimes feel like they’re on a virtual island. It takes time and effort, but it’s good practice to regularly connect with other physicians (in your specialty or otherwise) to talk shop. College and Academy meetings are a great way to connect with colleagues on a national scale, and regional association meetings can connect providers to discuss issues and policies closer to home. In any of these settings, you can meet physicians with similar geography or areas of focus. 

If you practice with other physicians, make an effort to connect both inside and outside the office.

• Start a journal club to compare and discuss relevant publications. Take turns choosing articles and meet informally to talk about them (you could even do this by Zoom or email if time is tight!)
• Research HIPAA-compliant platforms to share and discuss cases
• Make a physicians-only email distribution list to share business discussions
• Meet socially!

The personal and professional relationships that you create, if well-maintained, can sustain your practice for many years, and introduce generations of patients seeking allergy care in your community.

Taking stock of what matters most to you, personally and professionally, will help you hone in on key points.

At first glance, reviewing a multi-page employment agreement can be daunting. While most of the language is generally boilerplate for the practice you’re joining, there are a few key points that are worth special attention – and perhaps, negotiation.

Most career transitions are prompted by the desire to improve one’s lifestyle, and that means different things to everyone. Making an inventory of the things that matter most to you in choosing a new position will help inform where to focus your negotiating energy.

Most practices have a standard employment agreement for physicians and advanced practice providers, and that is usually the first one with which you will be presented. While not every item in a contract is up for negotiation, there are a few that often spring to the top of the list.

Start Date and Term of Contract

A start date is usually mutually agreed upon, giving a physician enough time to relocate or give notice at a previous position. It’s also dependent on the practice’s ability to significantly credential a physician on payor panels, and this may be indicated as a caveat to the starting date in your agreement. Confirm whether the contract is open-ended or for a fixed period of time.

Hours, Locations

Make sure that you understand the number of hours you’re expected to spend in a patient-facing environment and how many hours per week the practice considers full-time. Ask the practice manager or other physicians how much time they spend outside of the clinic managing other tasks. Also, if a practice has several locations, make sure it’s clear in which offices you’ll be working and how often.

Reimbursements, Allowances, and Time Off

Most practices have standard amounts for CME and equipment reimbursements or allowances but may be willing to negotiate. Time off is often negotiable but may be regulated by HR policies, the state, or other entities.

Non-Compete and Non-Solicitation

A non-competition clause protects a practice if a physician leaves, disallowing the provider from opening a competing practice within a geographic range, advertising to patients, or recruiting staff. Practices often have different ranges depending on whether a location is in a metro or more rural setting. Mileage and timeframes may be regulated by the state or other agencies but can sometimes be negotiated. A practice will consider competition in the area and other factors before reducing these restrictions and may hold firm.

Compensation and Partnership Opportunities

Generally, compensation and partnership opportunities are discussed well before a contract is presented. Make sure that the contract language represents the discussions you’ve already had. If you wish to negotiate your compensation, now’s the time to do it.

As with any contract, it’s good practice to have it reviewed by an attorney who specializes in employment law or has specific experience in physician contracts. The American Medical Association, and in many cases, state medical associations, can provide a list of lawyers specializing in this area. Most practices will expect (and even appreciate) this level of diligence, so don’t hesitate to ask for time to review any agreement with your counsel of choice. 

As an interviewee, you may feel like the focus of conversations, but the recruiting process is just as much about getting to know your future business partners.

Researching, interviewing for, and selecting a new position can be a daunting process, especially when it requires relocation of one’s family and livelihood. Though Zoom meetings and emails may make you feel like you’re in the hot seat, it’s important to remember that you are also interviewing future business partners for compatibility.

The process of joining a new practice can take up to 12 months, which provides ample opportunity for all parties to get to know one another, online and in person. You should expect to meet practice representatives from the leadership team as well as from the local clinic, all of whom will provide an important peek into the company culture.

Ask around.

The allergy community is a small one, and it’s likely that you know someone who knows someone in the practice you’re researching. Talk to co-fellows and colleagues for references on the individual physicians as well as the company’s reputation.

Meet the leadership team.

Since company culture begins at the top, meeting senior leaders such as the CEO or operations team will let you know who sets the tone in the local clinics. Take note of transparency (or lack of) in these discussions.

Speak directly with physicians in the practice.

Getting to know the physicians you’ll be practicing with is paramount in accepting any position. Talk with them, both in the clinic and in a social setting, if possible, about their practice philosophy and style. Don’t be afraid to ask them what they like and dislike about the practice.

Spend time with the practice manager.

The practice manager will be able to provide operational details such as schedule, market data, and technology used. You can also get into the proverbial financial weeds to discuss historical overhead, reimbursements, and other business data.

Job shadow.

It’s important to spend some time within the walls of the practice, especially during clinic hours. Whether it’s a half or full day, observe how the office functions when there is a full schedule. Pay close attention to how the team interacts with patients and with each other.

Learn more about the community.

If you are moving to a new city or state, the physicians and team in the local practice are good resources to learn about neighborhoods, commute, schools, and recreation in the area. They may even be able to provide recommendations for realtors and relocation experts with whom they’ve worked personally. Even if the practice feels like a good fit, one key to career longevity is making sure you land in a community that clicks.

Ask questions.

It can take a while for a new practice to ramp up, and success is hastened by setting realistic expectations. A robust onboarding can also put providers in the best position to hit the ground running. Be sure to ask any questions, big or small that will make you comfortable in your decision-making.

• What EMR is used?
• What does the technology training program look like?
• How many patients will you see in a day?
• How much time do physicians spend on tasks outside of clinic hours?
• Will you be required to supervise advanced practice providers?
• Are weekends or evenings required?

Financial matters aside, joining a like-minded team just may be the most important factor in professional fulfillment.

A well-constructed CV displays your attention to detail and lays plain your professional accomplishments.

Whether it’s your first one out of school, or needs to be refreshed for a new job search, your CV is a potential employer’s first look at your qualifications. Keeping it clear and organized will not only make a great first impression, it will also assist other departments in their work once you’re hired.

There’s a lot more to your CV than a list of training, employment and publications. During a job search, it will be referenced by a number of in-house teams that will focus on different information along the way. From recruiters, to hiring committees and credentialing teams, your CV is the go-to document as you move through the stages of hiring so it’s important that it is accurate and up-to-date.

Title and Contact Info

• List your full name and credentials as you would have them appear on a business card or employment contract
• Include your home address and cell phone number
• Use your personal email address (and remember to check it often)

Training

• List your medical training in reverse date order, beginning with Fellowship
• Include the institution, location and degree received
• If you are an international medical graduate, indicate if you have obtained ECFMG Certification
• Format dates as MM/YY (the credentialing department will thank you for it!)
• If you are still in Fellowship training, include start date and expected graduation date

Certifications

• Include all board certifications (i.e. pediatrics or internal medicine) and active dates
• If you are not yet board-certified in allergy/immunology, indicate if you are board-eligible

Employment

• List your related employment in reverse date order, beginning with the most recent
• Include name of institution, location and title if applicable (i.e. Department Head)
• This is an appropriate section to include military service as well

Awards and Honors

• Grants and awards
• Special military recognition

Memberships and Affiliations

• Memberships in local, state or national professional associations (including AAAAI and ACAAI)
• Include committee participation or offices held

Languages Spoken

If you speak languages other than the one in which you are interviewing, be sure to include that as well. Speaking additional languages can be very attractive to employers in many regions of the country (and may even be required for some positions.)

Publications and Research

For some, this section can be quite lengthy! One option is to only include the last ten years of items, with a “full list of publications available on request.”

A good CV can provide a solid foundation document for years to come, and needs only to be updated annually or as necessary. There are a number of free templates online for a good head start. Remember to keep it clear, concise, and under four pages if possible. Run it through spell check, and pay special attention to email addresses and phone numbers that might be transposed. It will save recruiters and on-boarding teams major delays if your CV is accurate and up-to-date when you apply for a new position.

Having the necessary documents ready puts you in the best position for a timely career move.

Many physicians are surprised to learn that credentialing with payors for a new position can take 90-120 days.

Unlike most other professions, doctors are subject to several timelines that determine when they can begin seeing patients in a new job. Licensing and credentialing processes are determined by states and payors and can add months of lead time to starting a new position.

The credentialing process can often feel like getting a mortgage in that there’s always just one more piece of information that you’re asked for. Having all the necessary documents ready to go will put you on the best track to a target start date.

Know the Timelines

• Application for and receipt of a state medical license can take 4-6 weeks.
• Credentialing with commercial payors can take 90-120 days and cannot commence until state licensure is received.
• Credentialing for physicians coming out of fellowship cannot start until July 1, following completion of their training, and may be contingent upon the receipt of board results. That means new fellows will likely not be able to start new positions until the fall.

That last point comes as a big surprise to many new fellows when they learn they will be benched for a few months following graduation. This is a good stretch of time that can be best used to make geographical moves and get families settled.

Gather Passwords

Depending on the size of the practice you’re joining, you may be working with an in-house credentialing team or an outside vendor to walk through the process. They will request access to some of your dashboards, so have your credentials ready to go when they ask.

• NPPES/PECOS (NPI/Medicare) ID, Login, and Password
• CAQH Provider ID, Login, and Password

Update your CV

It may seem like a fine point, but payors prefer to have CVs formatted in a specific fashion. You can save time by updating your CV to list the dates of employment and education in MM/YYYY format. If you’ve signed a contract with an employer, they may ask you to add your new position as well.

Scan Your Documents

Payors will require a variety of documents that confirm educational accomplishments and citizenship. Make sure they are scanned in color and that the file names include your name and a reference to the document type so they are easy for the credentialing team to reference.

• Driver’s license or passport
• Social security card
• Proof of citizenship if born outside the United States
• State medical licenses (current and former)
• Federal DEA certificate
• State CDS certificate
• Malpractice insurance certificate for last 10 years (current/former employers)
• Medical school diploma
• Residency diploma
• Fellowship diploma
• American Board of Allergy & Immunology certificate
• Educational Commission for Foreign Medical Graduates certificate, if applicable
• Other Documents and Applications

You will also likely be asked to complete applications specific to the practice you are joining, which may include supplying additional information for background checks and medical malpractice coverage.

• MedPro application
• Hospital privileges application

Whether you are joining a practice as a new physician or aligning your practice with a larger company through acquisition, the credentialing team will need every item on their checklist in order to proceed. Having all documents and passwords pulled together will put you in the best position to be fully credentialed by your start date.

Allergy practices commonly plan for new providers at least a year in advance. Making inquiries early gives both parties ample opportunity to make a good match.

Most physicians, as they work through residency and fellowship, have a good idea about where they would like to build their careers. Whether it’s a hometown or favorite destination, the magic happens when that desire aligns with market factors and, ideally, a practice looking to add a physician to your timeline. Many practices have 3-5 year plans that identify key growth markets, as well as locations where a new physician should be added to keep up with demand or to replace physicians planning to retire.

In other words, your post-fellowship job might already be out there.

Start Looking for Allergy and Immunology Jobs

Ideally, you should begin reaching out in your first year or second year of fellowship, although there’s no harm in starting to form relationships with your target practices even earlier.

• Start the conversation by attending Academy and College meetings and stopping by booths on the exhibitor floor. Practice representatives will be able to share early growth plans in the areas in which you’re interested and can even put you in touch with physician ambassadors already in practice there.
• Attend virtual and in-person career fairs specific to allergists.
• Keep an eye on the Academy and College job boards and set alerts for your favorite locations.
• Search the internet and bookmark target practices.
• Follow practices on LinkedIn and other social media platforms.
• Reach out to physicians that you know and ask them about their experience with their practice. Would they recommend it?
• Introduce yourself to physicians in your target area and ask if they’d let you shadow. Tell them your plans and ask for their advice. They might have plans to add a physician that matches your timeline.

Know the Timelines

The interview, negotiation, and contracting timeline varies by practice, but most would agree that a compact and meaningful process is best for all parties. You should expect a timely response from a practice with which you’re interviewing but understand that the complexities of a larger practice might add to the turnaround time.

If you are applying for a job that has already been identified by the practice, the entire process should take about 8-12 weeks from the first conversation to a fully executed contract. Salary and other negotiations will add to this timeline. If you are reaching out to a practice early in your fellowship, you should expect to be in conversation with them for a year or more. However, once an opportunity has been identified, a practice may be comfortable signing a contract a year in advance of your start date. You can then focus solely on your studies for the remainder of your program.

Licensing and credentialing add a few months to the post-contract process. It’s a good idea to apply for your state license while you’re still in early conversation with a practice because credentialing with payors cannot begin until a state license is received and can commence only after July 1 following completion of your fellowship. From that point, the process takes 90-120 days to be fully credentialed with payors. That puts most physicians coming out of fellowship on track to start seeing patients about October.

Keeping in Touch

Larger practices will have a system of tracking candidate interest, but don’t be afraid to check in periodically. If you’re early in a search and your plans change, let practices with whom you’ve been in contact know that you are looking at different options or locations. They will appreciate the communication.

At Allergy Partners, our director of recruiting maintains a database that cross-references candidate interest with our growing footprint. We love to speak with Fellows early in their program so that we can identify and align potential synergies between candidates and our growth initiatives. In many situations, we’re able to complete the interview process well in advance of graduation (as much as a year) so that you can focus your attention on your training, knowing you have a job waiting for you.