Fellows Survival Guide

Finding and Landing a Job
  1. Types of jobs
    Your job search will mostly depend on the career path you decide to follow. Whether it is academic medicine that you decide to pursue, or private sector, industry or public health, know the “market” and the need so that you know your strengths and what you can bring to the table. Talk with your mentor(s) about what qualifications are needed for your ideal job and what training and experience during your fellowship will contribute to your success. Discuss where to find opportunities that might not be widely posted or that you may have missed on a first pass. Reach out to division chiefs with your CV and cover letter at institutions you are highly interested in, even if there is not a posted position – they will be happy to hear from you. 

    Know your goals! Be strict about what you are looking for in a job. Write a mission statement for yourself that describes what your ideal career would look like, including long-term. This will be incredibly helpful during the interview process, when you are asked where you see yourself in 5 and/or 10 years from now. Know your strengths and skills.
  2. CV, cover letter, biosketch
    Get in the habit of updating your CV early in fellowship; follow your institution’s standard format (Appendix I is an example of a CV format). Also prepare your NIH Biosketch, and write a cover letter prior to starting your application process. We have included an example of a cover letter (Appendix II) along with a sample email that would accompany it (Appendix III).
  3. When to start and typical timeline 
    Start thinking about your job early in your second year and start browsing websites and developing connections during this time. At the latest, you should begin seriously investigating job opportunities around the beginning of your third year. This includes reviewing online sources (see below), exploring opportunities at your current institution, and reaching out to other institutions of interest. ID Week in October and the St. Jude/PIDS Pediatric Infectious Diseases Research Conference in the spring are excellent opportunities to ask your mentors to introduce you to people and to begin seriously networking for jobs. While there is no defined interview season, the most common time for interviews is late fall through early spring. Keep in mind that once you have accepted a position, the credentialing and licensing process takes at least a few months, and often longer.
    If you have visa limitations (such as needing a waiver for a J1 visa), you should start this process even earlier, as many states close their applications in the fall of the year preceding your start date. Likewise, if you have other restrictions (e.g., geographic), it would be good to start this process early. It never hurts for an institution to know that you are interested; hiring situations often change and the more you make yourself available, the more likely you are to be in “the right place at the right time.”
    Throughout this process, try not to put all of your eggs in one basket, and continue to apply for and pursue positions even if things look promising with a specific job. Until you have been offered a position, there is always a risk that something may significantly change. Plus, it doesn’t hurt to have more than one option when negotiating your contract.
  4. Where to search
    “Look everywhere and talk to everyone” was common advice given by recent job seekers. Unfortunately, jobs are not all listed in the same place, and some jobs may never be posted. The PIDS website is an excellent place to start, especially if you are searching for an academic job. Other organizations and websites advertising jobs include: IDSA website, LinkedIn, Doximity, PhysiciansJobsPlus, indeed, Job Search Engine | Simply Hired, practicelink, CareerMD, pedjobs, NEJM Career center, and the JPIDS classifieds (check CID and JID, too), in addition to known search engines.
    Industry jobs may be posted on monster.com, pharmaceutical company websites, LinkedIn, or Doximity. CDC jobs are posted at usajobs.gov. NIH jobs are posted on their website as well as their clinical center website. The FDA posts job listings on its website.
    Contacting a recruiter may also be useful.
    Often, word of mouth may be your key: ask around, check with your program director and division chief, reach out to programs about potential jobs, and meet potential employers and colleagues during meetings such as IDWeek, PAS and PIDS/St Jude. If you are interested in a particular hospital or region, talk with faculty at your current institution to identify contacts at hospitals of interest. You can contact them directly with a CV and cover letter expressing your interest, but it also helps to have a faculty member facilitate the conversation.
  5. Interview
    The interview process depends on the institution at which you are interviewing. Some places conduct a phone interview first. Most academic centers will invite you for the first interview where you will get a big picture view of how they work, and then, if you are a good match with their program, invite you for a second interview where you can discuss details. If there is someone in particular, you’d like to meet (such as the microbiology director or a particular scientist you may collaborate with etc.), ask for it. It shows them you know what you want, and it lets you learn more about the institution and your interest. During the interview, be yourself, ask about what interests you, how you would fit into the institution’s goals, and how they can fit into your career goals. This is a huge step, so don’t be nervous about asking questions.

    At some point in the process, often during the second interview, you may be asked to give a 30-45-minute talk about your research or area of interest or demonstrate your teaching skills by giving a talk to residents or medical students. Begin preparing for this as you begin applying for jobs.
  6. Negotiating the contract
    Remember: everything is negotiable!

    In general, institutions follow national averages to make a salary offer, considering their location, cost of living, and your experience. The AAMC publishes an annual Faculty Salary Report and while free access is restricted, most institutions subscribe to this service and you should consider asking your Program Director or Division Chief if they can share this information with you. When institutions make their offer, they usually expect you to negotiate. However, many mentors recommend not placing so much emphasis on the salary, especially at first, but making sure the contract terms fit well into your career path and the quality of life you are looking for. You can start by negotiating other important factors such as FTE (full-time equivalent), wRVU (discussed below), call hours, and a clear promotion/advancement track.

    FTE refers to the way your time will be allocated. If you are interested in pursuing a career in Infection Prevention, this cannot be realistically achieved if you’re only allocated 20% of your time for this task. This applies to any area of focus you decide to enter. Address these issues early on! Remember to include teaching in your FTE allocation if you’re in an academic setting.

    Negotiating lab space and material, startup costs, and initial financial support is extremely important if you’ll be following a research track. You should understand the timeline when you’re expected to bring in independent grant funding and what metrics will be used to evaluate your academic success. Consult with your mentor to assist in making sure you are starting in the best possible position for success along a research track.

    Almost all of us, regardless of which track we choose will participate in clinical care of patients. Some institutions use the work RVU as a standard to the expectations for every physician. The wRVU is directly derived from your billing! Know what the RVU expectations are (for the first 3 years, as those may be low in your first year but increase with time) and see if they are reasonable for your FTE allocated for clinical work. Make sure you understand billing systems and regulations.

    Consult with your mentors regarding appropriate FTE allotments, startup packages, and RVU expectations. Employers know that you are new to this process and will not be surprised that you need to consult your colleagues. Doing research shows that you are informed and puts you in a better position to negotiate.

    Ask a lawyer to look at your contract since most are written in technical language and are not easy to understand. Two very important clauses you need to review are the non-compete clause (which would prohibit you from working within a certain mileage radius if you decide to leave the institution) and the malpractice tail insurance (which will cover any malpractice suits that may be filed years after your leave the practice). Remember to check benefit packages, including life insurance, long-term disability insurance, and retirement plans. Also, ask about relocation and loan repayment packages, and signing bonuses as many institutions offer these benefits.
  7. Finding a Job for International Medical Graduates
    Jobs outside of the United States and Canada may be very different than they are here, especially if pediatric infectious diseases is not an established career path in your home country. When you are looking for a job, make sure you understand exactly what the position entails (work location, responsibilities, support, salary). Pediatric infectious diseases practitioners may be clinicians, educators, microbiologists and/or scientists; you may need to focus your training in one or more of these areas before the end of your fellowship to ensure you are prepared for your new job.

    Some fellows may choose to try and work or extend their training in the United States. IMGs who are training on an H1-B visa can transfer their visa to a new employer or apply for an immigrant visa (“green card” or permanent residency). Those training on a J-1 visa must, in general, return to their home country for 2 years before applying for another visa to work in or immigrate to the United States. The only exception to this requirement is to receive a J-1 visa waiver.

    J-1 waivers may be possible if:
    • applicants demonstrate they will suffer from persecution in their home country (“Persecution waiver”)
    • fulfilling the 2-year home residency requirement would bring exceptional hardship to the applicant’s spouse and/or children who are U.S. citizens or permanent residents (“Hardship waiver”)
    • the applicant has extraordinary ability in the field of science
    • the applicant is sponsored by an “Interested Government Agency” (such as Conrad-30, Appalachian Regional Commission, the Delta Regional Authority) that supports the applicant’s continued presence in the United States; for example:
      • state departments of health and regional authorities may sponsor J-1 waivers to physicians in return for providing care for a minimum of 3 year in medically underserved communities, after which they are eligible to apply for a work or immigrant visa
      • positions in underserved areas are often in primary care, but some may be earmarked for subspecialists
      • Notes:
        • Conrad-30 allocates each state (including territories such as D.C. and Puerto Rico) with 30 waivers annually. While most waivers are designated for primary care positions, states are allowed up to 10 ‘flex’ positions that can be used for subspecialists. Only one state Conrad-30 waiver application can be processed at one time. The timeline to submit a Conrad-30 waiver depends on the state but generally starts in the fall prior to starting employment. Many states accept waiver applications on a rolling basis and certain states (such as California) are extremely competitive while other states often do not use all 30 spots annually. Some states publish and regularly update the number of available Conrad-30 spots on their website. Applicants should check the applicant timeline and requirements with their specific state department of health.
        • Other waivers have different timelines (for example, persecution and hardship waivers are generally only filed after receiving your last DS-2019). A no-objection waiver is not eligible for J-1 visas for physician training.

Once a J-1 waiver is obtained, applicants can change their immigration status and receive an H1-B or immigrant visa without restriction. Be mindful that the process for obtaining an H1-B and immigrant visa itself can be lengthy and complicated.

The process for visa transfers and waivers is complex and applications are time sensitive. Begin your job search early to identify a position, ensure the institution has willingness and experience in sponsoring visa transfers or waivers, and pay close attention to deadlines. Discussing your visa needs upfront with division directors is critical. It is best to seek legal advice early in the process to identify your best options. Make sure to have a backup plan if your approval is delayed or disallowed.

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