There's no denying today's brutal radiology job market, which can seem especially cruel for radiology fellows, who won't be certified for long after their fourth year of residency under the new certification regime. But despite the dismal market, understanding the rules of the road can help beginning radiologists land a good job in an institution that supports their career goals.
At a career mentoring session at RSNA 2012, Dr. Jocelyn Chertoff, vice chair of radiology at Dartmouth-Hitchcock Medical Center in Lebanon, NH, spelled out the formula for succeeding in a very tough market.
"I think we all know that the job market is dreadful right now -- take that as a given and move forward," she said. And before you get down to the specifics of applying for any job, you must take the time to understand yourself and your life goals, she added.
"Set your priorities and make a list of what you want in a job; note them in order of priority," she said. Job seekers should make some preliminary decisions about acceptable and unacceptable work scenarios right from the start.
The time to start looking is in residency -- fellowship is too late. "But if you didn't start early, start now," Chertoff said.
It's worth remembering that every day of your residency is, at its core, a job interview, she said. Making a good impression in your first institution means showing up every day during your residency. It means being helpful and working hard. Smart is good, but smart is expected, she said. "CRAFT," which stands for collegial, reliable, affable, flexible, and tactful, nicely sums up the qualities you'll need to demonstrate.
"These are the kinds of skills people want as residents," she said. "They have to understand they're being evaluated all the time. When they get to work, they have to put their game face on and they have to be working, showing what they can do. As a program director, I am going to say I'll do the best I can for you, but I'm never going to lie for you. I'm not going to say you're the best in the program if you aren't. You have to make a good first impression, and you have to continue to make a good impression in the workplace."
Optimizing your candidacy also means understanding the job market and yourself, Chertoff said. As you explore different jobs, keep going back to your life priority list.
"Don't go where the jobs are if you hate the region," she said. "If there are jobs in the Midwest but you hate the Midwest, don't go there. ... If you hate the beach, don't go there." The same principle applies to the type of radiology being practiced: If you hate it, don't get involved in it. However, it is important to keep an open mind about the kinds of positions and locations where you could potentially be happy.
When fellows start looking for their first positions, they aren't just job hunting, they're designing their lives, Chertoff said, citing a formula from Nigel Leeming from his upcoming book Cocktail Napkin Happiness. Leeming advises his readers to create their own "Iron Triangle of Happiness," a three-pillared formula where happiness comes from balancing talents and skills on one point of the triangle, home and family on the second point, and community and friends on the third. If you ignore any part of the triangle, you won't be happy in your new career, no matter how good the job.
Networking is a crucial part of the job search, she said. Talk to friends -- and friends of friends. Also look at ads in journals, the American College of Radiology (ACR) Career Center, RSNA Career Connect, and the American Roentgen Ray Society (ARRS) Career Center. If that doesn't work, use a headhunter.
"I've talked to people who have gotten jobs through headhunters and to others who say that's not a good way," Chertoff said. "I think if you're not finding a job, you go to a headhunter -- you do what you have to do."
When the job search isn't producing great success, doing a fellowship, even a second one, can help you avoid a gap on the CV, Chertoff said. Fellows should also make an effort to maintain a broad skill set.
Fellows often ask why a potential employer would even consider hiring them when they're often competing against board-certified radiologists for the same position.
"Employers know you're not board-certified yet, but they're very interested in knowing what you can do," she said. So focus on what you do well, creating a compelling narrative about your qualities in the workplace, and putting them together in a way that maximizes your chances for success. Maybe you're comfortable doing biopsies under CT and ultrasound or trained in obstetrical ultrasound, or you're mammography-ready or nuclear-medicine-authorized. Remember that your first job need not fulfill all of your career goals, she noted.
"You have to be prepared to grow into the job you want," Chertoff said. "The job you take is not going to be the same job you're doing five years later."
Also keep in mind that this isn't the first job downturn, and it won't be the last, Chertoff said. With the rise of health maintenance organizations in the 1990s came fears of decreased reimbursement and reduced utilization. When Hillary (Clinton) Care was being debated by Congress, providers began preparing for sharply reduced reimbursement and decreasing utilization. And now, with the dawn of the Patient Protection and Affordable Care Act (PPACA, aka Obamacare), providers believe that accountable care organizations will bundle payments enabling better primary care, which may or may not decrease utilization.
"We actually don't know if the ACA is going to help or hurt radiology, but it's incredibly important for all of us to get involved and advocate for our profession," she said. Residents "need to understand that somebody else isn't going to take care of this for them. They need to be involved."
Screening the employer
At some point, when you've identified an employer that interests you, it's time to see what they have to offer. Survey the physical space where you would be working, Chertoff said. Look at the equipment, the support staff, and the IT infrastructure, and make sure it will support your goals.
"Think about the future," she said. "Are they likely to continue to upgrade? IT infrastructure is important; if it isn't good, you can't do your job. ... And don't forget to look at the images." Talk to someone who's left the organization and ask them what happened. Maybe they'll warn you about a snake in the grass of the organization, and even if you decide to take the job anyway, you'll be forewarned, Chertoff said.
Dress for success in your interview, and be polite and respectful, she said. Also be clear about what you want, ask for what you need, and be ready to negotiate the details. Take notes during your discussions, and sign and date them. What's the best interview question?
"I know you're a great radiologist, and you know you're a great radiologist," she said. "How are you going to convince clinicians that come to you for help that you're a great radiologist?" The answer speaks to your job, and how well you're doing it, she said.
Remember also that the job interview is often less about you and more about what the practice needs, she said. Start by saying you'll do whatever needs to be done, but that you're also interested in developing your work in an area where you are highly expert, which will benefit your employer. During your interview, plant the seed that you're a team player who will do what the practice needs.
To keep the job you've worked so hard to land, keep reading and keep learning, she said. Ask for help when you need it, and be helpful when someone else needs it.
Another idea from the business literature is "managing up," Chertoff said. The term refers to building a successful working relationship with superiors, managers, and employers. On one level it means staying clear of big surprises.
"If you want to talk to the chairman, don't make an appointment and sit down and spring it on him," she said. "Because his first answer is going to be 'no.' What you do [instead] is send an email and say, 'I'd like to talk to you about this idea I have.' So by the time you get to the office, he has really passed 'no' and is starting to see how that [idea] might be good for him. It's kind of common sense, but residents and fellows may not have experienced it yet."
Other tips for managing up include offering solutions, not problems; being honest and loyal; understanding your boss' perspective and preferences, as well as your own style; depending on your boss' strengths, but recognizing his or her weaknesses; and recognizing -- and not pushing -- hot-button issues. Finally, ask for feedback, and don't go over your boss' head.
Saying goodbye
If the time comes when you feel you must leave a job, this is not the right time for absolute honesty, Chertoff said.
"Don't say, 'I'm leaving because you're a micromanager and you're driving me crazy,' " Chertoff advised. "You want to give them a graceful way of describing why you've left."
Create a script that passes the sniff test for believability, allowing everyone to leave as friends with a nice handshake, she said. For example, perhaps your spouse needs to move for a new job opportunity, or maybe you need to be closer to your family.
"In my hospital, I've always said, 'Isn't it odd how people are always leaving to be closer to family?" Chertoff added. "Wasn't their family in the same location when they arrived? But that's fine. You have to allow the department to save face, you have to leave gracefully and professionally, and they may want to come back. You may get out there and discover that job was pretty good."
Last but not least, she said, "Remember that even in a very tight job market when there aren't a lot of jobs -- you only need one job."
