By Philip Salen, MD

After spending four years in medical school and two years training as emergency physicians, residents entering the final year of training have to think about their future.

The job search process is stressful, exhausting and expensive. Careful planning and appropriate prioritization can make this process tolerable and also markedly increase the likelihood of possessing a satisfying emergency medicine position when residency ends.

Getting Ready for the Job Hunt

Getting ready for the job hunt should start prior to the beginning of the final year of your residency. When you are choosing your schedule for your final year, select your electives based on when you want to visit and interview for prospective jobs.

It is especially important to start the preparatory process early if you want to work in a geographically distant area from your residency, a highly competitive area of the country or an academic setting.

In the past, graduating EM residents have benefited from the dearth of trained emergency physicians, but with more than 1,000 EM residents graduating every year, starting early and being organized is crucial.

Getting ready for the job hunt entails preparing several key documents: a curriculum vitae, a personal statement and recommendations. Your curriculum vitae is a crucial document and should be updated throughout the academic year with your new accomplishments.

ED directors will use the CV when deciding whether to invite you for an interview, so your advisers should review it for appearance and content. Because of the high quality of trainees in emergency medicine, many graduating residents have excellent backgrounds and clinical skills to offer their prospective employers.

For highly competitive positions, a personal statement can help distinguish you from other equally qualified candidates. And request recommendations early to ensure they will be ready by interview time.

In addition to references from your residency director and attendings with whom you have a good working relationship, consider having an emergency department nurse manager also write a reference. It will help document that you not only work well with your peers, but other medical staff as well.

Prioritizing of Your Goals

Throughout your residency, reflect on what is most important to you as an emergency physician and what you desire most in your practice. Prioritizing your goals early in the search may save you months of frustration because once you know what you want, you won't waste your time interviewing for jobs that don't offer it.

Take time to talk to your significant other and make sure you know his or her geographic preferences and career needs.

Choosing an emergency medicine position revolves around several key issues: geography, compensation, clinical hours and ED practice.

The best emergency medicine positions is at a place where you will be happy living. Target an area where you would like to live, and chances are you will also enjoy and be happy working there.

Most residents take positions geographically close to where they have trained. If you are looking to relocate to a part of the country that you are not familiar with, plan on job hunting earlier to ensure that you are truly interested in working and living in this particular area.

Since many career opportunities are not advertised, it is wise to contact all the emergency departments in the geographic regions that interest you. This information is available from the American Hospital Association's Guide to the Health Care Field and lists information on every hospital in the United States.

Compensation and clinical hours are integrally related. Academic positions and those in geographically competitive areas offer lower salaries because there are so many applicants for each available position. Salaries tend to be higher in the Midwest and South and lower in the Northeast and the West.

If compensation is important, make sure prospective jobs offer the ability to pick up extra shifts. If you are more concerned about the time spent outside your job, do no accept a position that requires more than 2,000 clinical hours per year or extra shifts during understaffed times.

However, certain positions will pay a premium or require fewer clinical hours if you work extra night shifts or exclusively overnight.

Emergency Departments — Finding the Right Practice

Finding the emergency department practice that best suits your needs revolves around many different issues: academic vs. community practice, urban vs. suburban vs. rural practice, the hospital's financial well being, daily census of patients, level of trauma care and an independent hospital based group vs. a large multi-hospital group.

Academic positions offer fewer clinical hours but require teaching responsibilities and possibly an active commitment to research. Community emergency medicine practices will require more clinical hours but fewer non-clinical responsibilities and better financial packages.

In this era of managed care, hospitals — particularly those in urban and small rural settings — are under tremendous financial pressures that could affect the staffing of emergency departments. In addition, the availability of "back up" to the emergency physician is another crucial issue to consider. This is especially important if the emergency department provides care to a significant number of trauma patients.

Finally, while some emergency physicians may like the freedom to focus solely on patient care issues that is offered by working for large multi-hospitals groups, others may want more control over administrative decisions offered by independent hospital-based groups regardless of the extra non-clinical time commitments.

Important Resources

The most important resource for residents from the onset of their job search is also the one most easily available: advice from attendings and recently graduated residents.

Job listings are posted in major emergency medicine journals, such as Annals of Emergency Medicine, and organizational newsletters such as EMRA's EM Resident and SAEM's Newsletter, which posts many academic job offerings.

EMRA's Job Catalog and Fellowship Listing is an excellent resource which posts many private practice listings and all emergency medicine fellowship positions.

Gus Garmels' Career Planning Guide for Emergency Medicine, available from EMRA (1125 Executive Circle, Irving, TX 75038-2522) is a well-written booklet, which covers the gamut from searching for an emergency medicine position to signing a contract.

ACEP's Scientific Assembly is also an excellent resource to start looking for jobs and provides an opportunity for networking. At Scientific Assembly, EMRA has several excellent presentations for residents beginning their searches, such as a Job Reception, a Job and Computer Job Bank and a Career Development Workshop.

Additionally, many individuals representing hospital emergency departments, emergency medicine groups and professional placement services are present solely to recruit new physicians.

Plan to spend the proper amount of thought, time and effort in your search for the emergency medicine position best suited to your needs in order to make your efforts completing medical school and residency even more worthwhile.

After all, you are the one who put in the effort to complete medical school and residency. Now it's time to make sure you get the position that's right for you.