《Life After Residency（住院医师之后的职业规划）》读书笔记

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因为最近在接受为期十天的高强度培训，我每天从早上七点一直忙到晚上十二点，所以读书笔记的更新有些耽搁，向大家说声抱歉。

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1  Finding the Right Fit 寻找最适合你的
  

• CHOOSING THE RIGHT LOCATION 选择工作的城市
  

For those residents who are married, the primary driver of location seems to be family.  已婚及已育的住院医师选择工作地点时，主要要考虑家庭因素，例如需要父母帮忙照看小孩、配偶的工作非常好。至于没那么多牵挂的住院医师，考虑的因素就多样些。
  
This is the best chance to ask yourself: ‘‘Where do I really want to live for the next 30 years?’’  You’ll need to be somewhere you can pursue your passions outside of medicine. 你要问问自己这个问题：“我想在哪里渡过接下来的30年？” 这个地方最好能满足你工作之外的爱好，如航海、爬山、滑雪、高尔夫之类的。
  
Another key factor that influences location choices is the cost of living.  另一个重要因素是当地的消费水平。
  
There are several resources to turn to when trying to assess the best or most desirable location for your future practice.  了解一个地方的渠道，原文中推荐的是一些（美国）城市排行榜杂志，例如Money Magazine（annual survey）
  
Another source of objective information which may help you choose a location for your subsequent practice is to choose the state with the highest performing health systems. 另外也可以选择医疗系统表现最佳的地区。
  

• PRACTICE ‘‘FIT’’ 选择工作的医院/诊所
  

Practices recruiting physicians are now focusing more on selecting physicians with professional and personal interests similar to that of existing members. 医院/诊所越来越倾向于招聘与现有员工的专业和个人兴趣相近的新人。很大一部分人跳槽去其他医院的原因是poor ‘‘cultural fit（文化契合度）’’。

• PRACTICE TYPES 执业地点的种类
  

Government Practice 主要介绍了军队医院、军队相关医院和公立医院，有稳定、清闲、退休后福利好等特点。大多数患者是慢性病。

University Academic Practices 大学学术医院，急重症患者比例较高，分科精细化，有更多的时间进行研究。你的研究成果和论文发布很重要。

Prepaid Group Practice 预付费联合开业

Private Practice Options 私营医院/诊所

• WHAT CAN I EXPECT AS A SALARY? 关于工资
  

One of the best resources is the Medical Group Management Association (MGMA), which publishes a yearly review of specialty-specific salary data, by region, by group type, by city size and other parameters. 通过医疗集团管理协会（MGMA）公布的年总结了解工资情况。

  
There are several other factors that might influence the salary you’ll be paid. 还有几个影响工资高低的因素——性别、付款方、职业补贴。  

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2  Getting Ready for the Job Search 做好找工作的准备

  

You’ve spent some time thinking about what your ideal job would be andnow it is time to find it. Depending on your specialty, you will start lookinganywhere from 6 to 18 months ahead of time. In a tight market, you might bestarting to express interest as early as 2 years ahead of time.  知道了你的理想职业是什么就是时候开始找这样的工作了。要提前6至18个月开始找。如果人才市场饱和，那就提前两年开始找。

  

Two essential items for preparing for your job search are yourcurriculum vitae (CV) and cover letter. 简历和求职信。

When reading a CV, on average, a prospective employer decides in 2minutes whether or not to pursue a candidate.This will be the first contact you’ll have with a prospective employer; makesure you make the most of this first impression or else it may also be the last contact with them. 雇主读简历时，平均两分钟就会做出是否雇用的决定。通过简历给雇主留下好的第一印象很重要。

  

WHY A CURRICULUM VITAE?

  

Starting with a good basefor your CV now will serve you well in the future. 好简历带来好未来。

  

WHAT’S IN A CV?

  

Sample CV
Name 姓名
Contact information 联系信息
  Address 地址
  Telephone 座机号码
  Cell Phone 手机号码
  E-mail 电子邮箱
Personal information (optional) 个人信息（选填）
  Date of Birth 出生日期
  Citizenship 国籍
  Visa Status 签证情况
Board Certification
Medical License 行医许可证明
Post-graduate Training 继续教育经历
Education 教育经历
  Graduate/Medical School 研究生/医学院校
  Undergraduate 本科
Professional Experience (Chronological order) 专业经验（按时间顺序前后排列）
  Work History 工作经历
  Academic Positions 院校职位
  Include position details and dates 包括职位细节和时间
Professional Societies 专业社团
Awards Received 所获奖励
Publications 发表论文
Outside Interests (Optional) 兴趣爱好（选填）

& Keep it short and relevant; usuallytwo to three pages maximum. 简短切题，一般最多两三页。
& Keep it generic: same CV for alljobs. 普适：一份简历适用所有职位。

& Always spell check and proof read;get someone else to read it to catch those last couple of oops. 检查拼写错误，让别人读一下看能不能发现错误。
& Write everything out, minimizeabbreviations. 尽量少用缩写。
& If sending your CV via email, it isrecommended to also send a hard copy unless specified otherwise. Email may disruptthe formatting on your electronic file, and you want it to look good! 如果是用电子邮箱发简历，建议使用pdf格式，以免发生文本文件文字格式出错。
& Hard copies should be printed ongood quality paper. 用好纸打印简历。

  

Potential employers will be scanning your CV for gaps in your trainingand employment. You should account for your time on a continuous basis. If youtook a year off to trek in the Himalayas, list it in some way under specialinterests as traveling or exploring other cultures. Spin it in a positive fashionrather than letting one assume you ‘‘dropped out’’ for a year. 如果你的教育或工作经历之间有较长的时间间隔，例如你去长途旅行了，就把这个经历写进兴趣一栏里。从积极的角度描述间隔时间，不要让你未来的雇主以为你那段时间“放弃退出”了。

  

& Professional qualifications includeboard certifications. Upon completion of residency, most of you will be board eligible(BE) and not board certified (BC). It is useful to list any portion of yourcertification process that you have completed at the time of applying, e.g.written boards (7/07). List all the states in which you have current or priormedical licenses. If you did not renew a license, list why (e.g. moved out ofstate).
& Post-graduate Training: Thisincludes your residency and any fellowship training that you have completed.Each line should start with the dates of training (e.g. July 2003–June 2005:Stanford University Hospital Department of anesthesia residency). If you functionedas a chief resident, list that year out on a separate line for added emphasis.
& Professional Experience: Many ofyou have worked for some period of time prior to your medical school ofresidency. List any such work in detail. You may have had a transitional job ormoonlighted during training. List the dates and job title. You won’t need tolist employment in High School unless it is somewhat relevant to the job you’reapplying for.
& Publications: Unless you areapplying for an academic job or other position for which prior researchexperience is directly relevant or have done specialty-specific research duringtraining, having a publication list available on request will usually suffice.

  

THE COVER LETTER 求职信

  

Your cover letter is more personal – it is the opportunity for you toexplain why you feel that a specific practice is a mutual good fit. 通过求职信解释你为什么适合这个职位。

  

& Date of completion of residency anddate of availability for employment. It is OK to have a specific start date requestbut if you can be flexible, be sure to convey that information.
& Any specialty skills from residencyor fellowship: do you have a certain niche that is marketable? E.g. You spent 6months on the cardiac rotation.
& Type of practice you are interestedin. There may be certain specialty areas where you feel you possess special expertiseand could add extra value to the practice.
& If a job is of particular interestto you because of geography, personal or professional ties, you may choose to mentionthis. Employers are looking for potential employees who have staying power sohaving a tie to the practice can be a bonus.
& Name Drop: If someone in thepractice knows someone from your residency program, it is a sure thing thatthey will contact them before they contact you. If you have a known connectionand that person will be your advocate, it is reasonable to mention it in thecover letter.

  

LETTERS OF REFERENCE 推荐信

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3 Identifying Practice Opportunities 识别工作机会

  

As a general rule of thumb, the better jobs are usually notadvertised. 好的工作机会一般不会出现在广告上。

  

POPULAR RESOURCES FOR JOB SEARCHES 流行的求职资源

  

Alumni Networks 校友

Plan to attend alumni reunions at association meetings. Alumni oftenuse these reunions as a recruiting tool themselves; so be prepared foron-the-spot interviews, e.g., have a business card or other contact info ready.Also be ready to say what makes you worth hiring. Have a few key sentencesprepared about yourself. Dress well. 参加校友聚会。

  

Association Meetings 学会

Whether it is the annual association meeting or a smaller regionalconference, these are great opportunities to network and gather information onjob opportunities. 参加学会是获得工作机会信息的大好机会。

  

If you are planning on attending a regional meeting, considergoing to one in the geographic area you would like to end up in, not just near whereyou are doing residency. 去参加你想去工作的地区办的年会。

  

Residency Program Faculty 科室间

Many jobs are ‘‘advertised’’ by word of mouth, and not formallyposted. Discuss your job search with your department faculty. One phone callfrom a well-connected faculty can make the difference between a ‘‘job’’ and‘‘no job.’’ 有些工作机会的信息是口头传播的，有时通过关系好的科室的一个电话，“没工作”就会变成“有工作”。

  

Online Postings 求职招聘网站

  

Professional Publications 专业期刊

Check the advertisements in your professional society’spublications. The jobs posted tend to be academic postings or harder-to-fillprivate sector jobs. 专业期刊上发的招聘广告一般是学术类职位或很不太尽人意的职位。

  

Recruiters 招聘人员

If you are interested in exploring a particular geographicregion or different practices, locums tenens work might be for you. Recruitersare often the best resource for establishing locums tenens work. Recruiters alsocan post an ad on your behalf if there is not a job posting immediately available.

  

Regional Hospitals and Clinics 地区医院或诊所

  

Co-residents 住院医师同事

  

THE COLD CALL 自我推销

Be prepared. Do your homework. Know something about the groupyou are interested in and have a ‘‘script’’ prepared in your mind. 做好准备，将自我介绍铭记于心。

  

Things to Do 需做之事

& Get comfortable: You want to come across ascompetent and friendly. In a live interview, there are many different ways ofdelivering this impression. In a phone interview, all you have is what you say(or don’t say) and how you say it. If you are not relaxed, this will comeacross in the conversation. Take your shoes off and hop in that big,overstuffed chair in the living room. Speak slowly and clearly. Keep a glass ofwater nearby for the inevitable dry mouth. 放松。
& Leave yourself enough time to have anon-the-spot interview. Your future employer needs to believe you want this job.If, after ten minutes, you ask if you can call them back, you will give theimpression that something else is more important than securing this job. Leaveat least 30 minutes for each phone call. 电话面试时留够时间（至少半小时）不被打扰，让对方觉得你重视这个工作机会。
& Go some place quiet where you can hear and beheard without difficulty. Don’t call from Starbuck’s or your local gym. Again,a noisy background gives the impression that you are not focusing on the phonecall and this job. 在安静的地方打电话。
& If you call from a cell phone, make sure youare someplace where you have good reception and will continue to have goodreception. Even though it isn’t your fault, repeatedly saying ‘‘Can you hear menow?’’ doesn’t instill confidence. 在信号好的地方打电话。
& Call during reasonable business hours and becognizant of different time zones. You may be asked to call back duringnon-business hours so your employer has some time to chat but the initialcall/page should be between 8 am and 5 pm. 在对方上班时间打电话，并留意是否在不同时区。
& Take notes as you go. This shows you werepaying attention and allows you to have a more effective interview. 做笔记。
& Respond to any requests they might have in atimely fashion. If they would like to see a copy of your CV, get it in the mailthe next day (or at least within 1 week). 尽快回应对方的要求。如对方叫你寄份简历，你第二天就寄（至少在一周内寄）。

  

Things Not to Do During the Cold Call 不要做的事

& If this practice doesn’t have an opening, donot ask if they know of any openings in the area. 如果这个医院/诊所没有职位空缺，不要问他们那个地区其他医院/诊所有没有职位空缺。
& Don’t multi-task. Yes, multi-tasking is anecessary skill to master if you are to get through residency. We have all workedout, talked on the phone, watched a movie and made dinner at the same time.That said, the phone interview is not the time to show off this skill. If youare doing other things while speaking on the phone with your prospectiveemployer, it gives the impression that your other activity is more importantthan this job. Don’t do laundry, microwave dinner, watch TV, use the restroom,etc. during the phone call. 打电话时不要做其他事。
& Don’t interrupt your interviewer. Use properphone manners. 不要打断对方的话。

  

TIMING YOUR JOB SEARCH 做好时间规划

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4 The Interview 面试

  

& Look like you want the job: You may live yourprofessional life in scrubs, but now is the time to break out the executivewear (or perhaps your cleaned and pressed residency interview suit if it stillfits!). 表现出你想要这份工作。
& Be prepared: Find out as much as you can aboutthe practice before you interview. If it is a hospital-based practice, much ofthe information is available online. Also, do research about the geographicarea. You are interviewing them as much as they are interviewing you(hopefully!). Being prepared shows you are serious about the potential job and reflectswell on your overall decision-making process. 面试前尽量多地了解准备应聘的医院/诊所。对医院所在地区也要有所调查。做好准备表明你对于这份工作机会很认真，并表现出优异的决策能力。
& Know your strengths: Be prepared to sellyourself to the practice. Invariably, your potential future employer will asksomething like ‘‘Why should we hire you when candidate X has equally impressivecredentials?’’ The middle of the interview is not thetime to search for an answer. Be prepared to effectively communicate yourstrengths. Most likely, during residency you have not needed to ‘‘sell yourself.’’So spend sometime thinking about the following questions: What do yourcolleagues, patients, coworkers compliment you on? Read your residencyevaluations; what do you receive higher marks on? What is unique about yourexperiences? What can you bring to that practice that someone else cannot? Doyou have a language skill, subspecialty training, or experience that the groupcould benefit from? It may not be just what you have done but what you wouldlike to do in the future that might be your strongest selling point. Do youhave professional interests that you would like to cultivate that could benefitthe group? 知道你的优点。多想想这些问题：你的同事、患者怎么评价你？读读你的住院医师评估，你在哪方面的评价更高？你有什么特殊经验？你可以给医院/诊所带来什么别人代替不了的好处？你有没有外语技能、亚专业培训经历或其他有利于医院/诊所的经验？你有没有感兴趣想培养的并对医院/诊所有益的专业？
& Know the exact time and place for theinterview, how long it takes to get there, where to park, etc. Arrive at least 10minutes early. 确认面试准确时间、地点、多久能到那里、哪里停车等等。至少提前10分钟赶到。
& Have an idea of questions that you want to ask.Even though it may be a key factor in your ultimate decision, do not start with‘‘What would my salary be?’’ 准备点你想提的问题，但最好不要以“工资多少”开始。
& Mind your manners: Sit still in your seat.. . don’t FIDGET! Make and maintain eye contact. Shake hands at the beginningand end of your interview.  注意你的举止：坐直，保持眼神交流，开始前和结束后握手。
& Be concise in your answers to questions. Askfor clarification if you don’t understand a question. 回答要简单明了。
& Be polite to everyone you meet during theinterview process. Potential employers need you to fit in with everyone involvedin their practice from the security guards to office assistants to otherphysicians. 礼貌对待面试过程中的每个人。
& Be sure to turn your cell phone off. If youabsolutely have to leave it on, put it on vibrate and apologize to yourinterviewer that you need to be available for emergency calls. 手机关机或设为静音。

What you don’t do or say could be even moreimportant than what you do do or sayduring the first interview. Here are a few things to remember to notdo during your interview. 面试中不要说/做什么可能比要说/做什么更重要。
& Don’t focus conversation on the financialcompensation or time off. 别让对话聚焦在津贴和休假上。
& Don’t look or act unprofessional. 不要表现得不专业。
& Don’t argue with your interviewer. Avoidcontroversial topics even if you are ‘‘just making small talk.’’ 不要与面试官争论。避免聊有争议的话题。
& Don’t lie. Invariably, the lie will revealitself. Being unethical buys you a one-way ticket to the bottom of theapplicant pool. 别说谎。

  

HANDLING DIFFICULT QUESTIONS 应对难题

  

Your potentialemployer will undoubtedly ask a question that will force you to discuss apotential weakness. These potential weaknesses fall into two broad categories:weaknesses resulting from past issues and weaknesses resulting from recurrentissues. A past issue might include a year off during medical school for mentalhealth needs, a prior DUI, failed boards exams that are now passed, ortermination from a job. When queried about the extra year during medical school,‘‘I took some time off for personal reasons,’’ should be an adequate answer.You are being honest but not giving any information that might be viewed asnegative by your potential employer. There is a chance the interviewer might needmore reassurance that this ‘‘issue’’ will not impact the ability for you toperform your job. If the line of questioning continues, ‘‘it is a private issuethat I would rather not discuss but, it is no longer an issue,’’ is areasonable response. You are being honest but also refocusing the discussionaway from the potential negative to a reassuring positive note. 提问你的弱点，分为两类，一类是过去发生的，一类是还会发生的。对于过去发生的弱点（例如毕业后一年内没有去工作、有过考试不及格、工作中止等等），面试官是想确认这个弱点对你的工作能力没有什么消极影响。  
In contrast to a past issue, answering questions about a recurrent issue istricky. A recurrent issue is something that has happened in the past and mightoccur again; a recurrence will potentially have an impact on your futureprofessional abilities. Your employer will want reassurance that you are capableof doing the job described but you cannot do that. You cannot guarantee thatthere will not be a disruption in your ability to perform your job. A recurrentissue might include a chronic illness, e.g. lupus, HIV, schizophrenia, beingthe primary care provider for an ill, loved one. It is difficult to know howbest to answer questions about a recurrent issue. Even though your honestymight be appreciated, discussing the issue in full detail and providing fulldisclosure will undoubtedly be viewed as a net negative by your future employer.It’s human nature. You are going to buy the car that has not been in anaccident rather than the one that has, even if it has been repaired and seemsjust as good as the other car. An alternative approach is to just not answerthe question. Not answering the question leaves a blank in the interviewer’s mind.This blank will be filled in with the worst case scenario answer. If yourpotential employer sees past this, you will be setting yourself up for potential problems in the future. Not acknowledging theissue will only cause problems when the issue does recur; not mentioning ahistory of debilitating lupus flares only to have to take time off 3 monthsinto a new job will be a source of tensions in your new group. If at allpossible, try to answer the question with a balance between full disclosure and‘‘none of your business.’’ Be truthful but guarded in your answer and focus onwhat you have done to minimize the weakness and its impact on your professionalabilities. E.g. ‘‘I have had to take time off to care for my child but myhusband and I have developed a schedule to minimize any impact on our jobs’’‘‘I had to take some time off for a personal health issue but it seems to be incheck.’’ In summary, be honest but succinct. Acknowledge the negative and re-focuson the positive. 对于还会发生的弱点，曾经发生过，但是还会反复发生，例如患有慢性疾病，很可能会对你将来的工作能力有影响。试着诚实回答这类问题，不要太详细也不要什么也不说，要寻求一种平衡。重点放在你为了把这个弱点对你工作能力的消极影响最小化做了些什么。
  
There are also questions that interviewers are not supposed to ask but may;e.g. ‘‘Are you planning on having children soon?’’ to the 30-something femalecandidate. A ‘‘none of-your business’’ doesn’t usually go over very well nordoes ‘‘I am planning on getting pregnant as soon as I sign the contract here soI can take advantage of the maternity leave policy.’’ This is a situation whereless is the better answer: ‘‘I am planning a family someday but have noimmediate plans.’’ If, however, you are already pregnant, a more specificanswer is necessary. 还有些可能会问到但其实不应该问的问题，例如问一个30岁左右的女性面试者“会不会很快要孩子”，比较好的回答是：“有将来要孩子的想法，但短期内没有这个计划。”
  

PREPARING FOR A VARIETY OF QUESTIONS 准备应对各种问题
  
Spend some time thinking through your answers and, maybe, even do a practice interview with a friend. It is important to be genuine and sincere in your answers. And remember to be honest. There are no right or wrong answers. Just like a personal relationship, a job might be a good fit for one candidate but not another. You are interviewing them as much as they are interviewing you. 花时间准备一下如何回答问题，可以让你的朋友帮你演练。回答问题时要真实、诚恳、诚实。答案没有对错之分。工作就像一段关系，可能适合一个人而不适合另一个人。你在被面试时，同时也是你在面试他们。

General questions you can expect to be asked include: 一般可能会问到的问题：
& What are your long-term goals? 你的长期目标？
& Why did you go into this specialty? 为什么选择这个专业？
& What interests you about this job? 是什么让你对这个工作感兴趣？
& What are your strengths and weaknesses? 你的优势和弱点是什么？
& Describe a situation when you had to work with a difficult person. 当你不得不和一个难相处的人共事，你会怎么办？
& What two or three accomplishments are you most proud of? 让你最骄傲的两个或三个成就是什么？
& How can you make this practice more successful? 你如何能让这个医院/诊所更成功？
& What is it about this particular group that interests you? 是什么让你对这个特定团体感兴趣？
& What made you decide to choose a small private group versus a large group practice? 是什么让你决定选择小团体而不是大团体？
& What are your professional goals? 你的专业目标？
& Do you speak any other languages? 你会什么外语吗？
& Do you plan to take time off between residency and your new job? 你计划在住院医师实习期和新工作之间休息一段时间吗？
& Do you have support/family/friend ties in the area? 你在这个地区有家人/亲戚/朋友吗？
& Are you familiar with the group’s call schedule? 你熟悉这个团体的调用时间表吗？
& Are you planning on working full time or part time? 你打算全职还是兼职做这份工作？
& What type of things do you like to do during your free time? 你在自由时间喜欢做什么？
& Why would you like to work in this area? 你为什么想在这个地区工作？
  
Academic practice questions you can expect to be asked include: 学术类面试问题
& What are your research goals? 你的研究目标？
& What are your academic goals? 你的学术目标？
& Have you prepared a grant application before? 你以前准备过经费申请吗？
& Have you received grant funding before? 你以前得到过经费资助吗？
  
At some point during the interview you will be asked if you have any questions. Do your homework and prepare a list of your questions ahead of time. Not only does this provide a better first impression, it also results in a more productive interview for you. Start with ‘‘bigger picture’’ issues first before getting down to the details. Also, there are questions that will be more specialty specific. 有时在面试中，会问你有什么想问的问题。事先做一下这方面的准备。从全局相关问题开始，然后再细化到特定专业。

Some bigger picture questions you will want to ask include: 你可能想问的全局类问题
& Describe a typical ‘‘day in the life’’ in your practice. 描述一下你在这个医院/诊所的一天。
& What does your ideal candidate for this job look like? 对于这个职位，你理想的候选人是什么样的？
& What are your plans for the future of the practice? 对于这个医院/诊所，你们未来有什么计划？
& What is the management structure of the practice? 这个医院/诊所的管理结构是什么样的？
& Are group members willing to mentor new hires? 有人指导新人吗？
& Why did the last (two) group members leave? 为什么上一个团队离开了？


Some more detailed general questions you might want to ask include: 你可能想问的细节问题
& How frequently are you on call? 值班或被呼叫来加班的频率？
& How easy is it to pick up extra work? 接额外的工作有多容易？
& How long is the average workday? Hours per week? 平均工作日时长？每周工作时长？
& Does everyone have equal access to work? 每个人都有平等的工作机会吗？
& How many years before partnership or shareholder position? 工作多久能成为合伙人或股东？
& What is the call schedule like? 调用时间表？
& Is there a jeopardy call schedule? 是否有危重症呼叫时间表？
& Are there CME lectures readily available? 是否有继续教育课程？
& What are the conditions for leaving the group? 离开团队有什么条件？
& How much advance notice is required for leaving? 离开前需要提前多久通知？
& Is there a buyout program? 有收购计划吗？
& Is it possible to take patients with you to a new practice? 可以把我的患者带到新工作单位吗？
& Is there a geographic non-compete clause? 有地域不竞争条款吗？
& Can partners be asked or forced to leave the group? If so, what are the conditions that might lead to such an event? 合伙人会被强制要求离开团体吗？如果是的话，什么样的情况会导致这样的结果？
& How do the partners get along? 合伙人们如何相处？
& Do partners tend to work together on issues that affect the whole practice? 合伙人会齐力应对影响工作单位的问题吗？
& Do partners tend to function more like individuals sharing space? 合作人是否更像共享空间的个人？
& What staff resources will be available/provided to support the practice? 将提供哪些人力资源来支持这个工作单位？
  
General compensation questions to ask include: 你可能想问的薪酬类问题
& How is compensation determined? 薪酬是如何决定的？
& What retirement benefits are offered? 退休后福利是什么？
& Are you RVU (relative value unit) based? 基于相对价值单位吗？
& Who determines bonuses? 谁决定奖金？
& Could your pay go down if the practice goes down and vice-versa? 如果工作单位下跌，薪酬是否也会降低？反之亦然？
& When do you make partner and how does your compensation change? 什么时候能成为合伙人？如何改变薪酬？
& Who pays for your insurance? Does it cover dental, disability and long-term disability? Does it change going from employed doc to partner? 谁交保险？如果成为合伙人后会改变吗？
& Are they going to start using pay for performance measures (P4P) to determine salary? Are they capturing P4P measures and trying to improve them? If not, again a big warning, you are entering a dinosaur practice. 是否根据工作表现决定薪酬？是否在改善考核标准？如果不是的话，警告你一下，你进入了一个过时的工作单位。
& What weight does the subspecialty practice have in the group? Do the specialists make much more than you? 亚专业在这个团体有多重的份量？专家是否赚得远比你多？
& Do they have a good 401 K plan that lets you max out? Typically 42 K?
& Can you moonlight outside the group? Are there urgent care or hospital moonlighting options? 可以做团队外的兼职吗？
& Do they pay for licenses, DEA, medical societies, CMEs, etc.? 单位会为执照、医学会、继续教育掏钱吗？


General malpractice and professional affairs questions to ask include: 你可能想问的医法相关问题
& Do you have your own malpractice lawyer on retainer? 单位有医法律师或顾问吗？
& Are you self-insured or do you have malpractice insurance? 有医疗事故保险吗？
& What is the coverage like? 医疗事故保险的覆盖范围？
& If you have a company, do you have to report all claims to the medical board? (If you are self-insured, you do not have to but insurance companies routinely pass the info on). 必须要把所有投诉报告给董事会吗？
& Who defends you against a claim by the medical board? 在董事会谁将为你辩护？
& How are patient complaints handled? Is there an ombudsman to deal with them? 患者的投诉是如何处理的？有没有专员负责？
& Who evaluates you for partnership? With what criteria? i.e. productivity, collegiality, competence, sobriety? 谁评估合伙人资质？有什么评估标准？
& Who makes the decision to hire and also to become a partner? Who gets to fire someone, and is it a group decision, majority or 2/3s? 谁决定雇用或成为合伙人？谁决定解雇？集体决议？多数人决定？2/3的人决定？
& Do they pay your tail insurance if you leave? What happens if the group folds about malpractice claims and insurance?
& If the group goes under, how much would you financially be responsible for? 如果团体效益下跌，你会因此在财政上付多少责任？
& Is anyone in the group doing anything on the margin of medical care – botox injections, crazy plastic surgery, workman’s comp fraud, etc.? 团体内有没有人做医保外的医疗服务，例如美容整形？
& If you have a complaint about another physician, who do you bring it up with? 如果你不满另一个医生，你向谁报告？
& Are there any inter-physician conflicts that might affect you? Surgeons vs. meds, this department head vs. that one, two queen bees in one office, etc. 是否有可能影响到你的医生内部矛盾？如内外科之间、科主任之间、科室内两个领导之间。
  
Certain jobs, like those in academics, will come with additional issues. Pertinent questions to ask include:
& What is required for promotion? 晋升的要求是什么？
& Average number of articles, lectures expected each year. 年均论文、专著要求数量？
& Initial funding or grant options. 科研基金或经费。
& How much time will be allocated to clinical work vs. research time? 临床和学术的时间如何分配？
& Is there flexibility in this as time goes by?
& What support will be provided for research activity? 有什么支持研究的措施？
& Is there available lab space if needed? 有没有实验室可用？
& Is there lab staff available? 有没有实验室工作人员可用？
& Is there staff support for administrative activities associated with research? 是否有工作人员支持与研究有关的行政活动？
& Are others in the department doing similar research? 部门内有其他人做类似的研究吗？
& Are there opportunities for collaboration? 有合作机会吗？
  
Anesthesiology 麻醉
Questions to ask include:
& How many hours worked: billable and non-billable hours? 工作几小时？是否按时收费？
& How are cases assigned? 如何分配病例？
& Relationship with surgeons. 与手术医生关系。
& Are you assigned to cases day after call (DAC) or do you receive a DAC? 值完班后第二天还会分配病例吗？或需要值班吗？
& How often called in the middle of the night? 半夜会有多少急诊手术？
& Do new hires get the same call schedule? 新人按常规安排值班吗？
& Are you working with cRNAs? 持证注册麻醉护士一起工作吗？
& Is there a pre-op clinic? 有术前评估门诊吗？
& Are patients usually adequately evaluated prior to day of surgery? 患者一般在术前前一天接受详尽的评估吗？
& Are you expected to call the patients the night before?
& Is there a call-relief system for cases that run late?
& What are the different locations that the group covers, e.g. hospital, surgery center, office-based practice?
& Availability of ample ancillary services, e.g. anesthesia techs, PACU nurses. 是否有麻醉附属服务，如麻醉技术人员、麻醉恢复室护士。
& Who assigns the cases? 谁分配病例？
& Who makes the call schedule? 谁安排值班表？
& How do surgeons respond when you cancel or postpone a case? 取消或推迟手术的话，手术医生会有什么反应？
& Does your group allow surgeons to ‘‘anesthesiologist shop’’ within your group?
Questions you will be asked include: 你会被问到的问题
& Comfort level for ASA 3, 4 cases. 你能处理ASA 3、4级的病例吗？
& Are you comfortable covering OB, peds, cardiac cases? 你能处理妇产、小儿、心血管疾病病例吗？
& Are you comfortable performing regional blocks? 你善于实施区域阻滞吗？


Pediatrics 儿科
Questions to ask include:
& What are the routine ages for regular well child exams? 定期儿童健康检查的年龄范围？
& Is there an advice nurse? If so, what hours does the advice nurse work?
& Where do the kids go after hours? Is there an urgent care?
& Is there a weekend clinic? 有周末门诊吗？
& Where is the closest hospital? 最近的医院在哪儿？
& Are there a certain number of hospital inpatient beds that are reserved for our patients? 有足够的住院病床吗？
& Who rounds on newborns in the hospital? 医院里谁负责新生儿？
& Do the OBs or Pediatricians perform the circumcisions?
& How many patients do the physicians typically see per day? 一般每天看多少患者？
& Are there standardized handouts that are given to the patient families for classic childhood illnesses? 有没有给患者家属发放常见小儿疾病的宣传册？
& Can the pediatricians determine which patients get longer times allotted for the visit? 儿科医生可以决定哪个患儿可以有更长的门诊看病时间吗？
& If a pediatric specialty referral is necessary, is the group contracted with any particular organization(s)?
& Who administers the vaccines? Nurses, MAs, or MDs? 谁给打疫苗？
& How well is the clinic prepared for asthma exacerbations and anaphylaxis? 诊所对于应对哮喘发作和过敏的准备措施是否够好？
& Will the nurses or MAs perform catheterizations? 谁给患儿插管？
& What procedures are typically performed in the clinic? 诊所的常规操作有哪些？
& Does the clinic typically follow the regular immunization schedule? 诊所能很好地依据时间表给小儿免疫吗？
& Do the pediatricians in the group conform to a set of standards (e.g. starting Vitamin D or fluoride at a certain age, screening for anemia, checking screening urinalysis)? 团队内的儿科医生需要达到什么样的标准？
& Do locums help out when pediatricians take their vacation? 儿科医师度假时，有没有临时代理医生？
& What is the admitting policy? Do the MDs follow patients in the hospital, or do hospitalists take care of the children? 入院政策？
& Do you have the equipment necessary for sedation, intravenous fluids, laceration repair, splinting? 是否有镇静、输液、缝合、夹板等操作的必需品？
& Are there laboratory facilities readily available? And how quickly are the labs resulted? 化验科设备是否随时可用？多快能拿到化验结果？
& Is radiology readily available? And how quickly are the films resulted? Can the physicians see the films online? 放射科是否随时可拍片？多快能得出结果？是否可以通过网络阅片？
& Is there a radiologist in-house?
& How many male and female pediatricians are there in the group? 儿科团队里有多少男医生和女医生？
& Do the pediatricians dictate their notes or are they hand written? 儿科医生口述医嘱还是要写下来？
& Are prescriptions faxed directly from the computers? 处方是否通过电脑直接传真？
& Do you use an electronic medical record? Can the physicians access this at home? 是否是电子病历？医生可以在家中获取电子病历吗？
& Can the families access their children’s medical records online? 患者家属是否可以通过网络获得患儿的电子病例？
Questions you will be asked include:
& What made you choose general pediatrics? 是什么让你选择了儿科学专业？
& How did you hear about this pediatric practice? 你对这个儿科单位有什么了解？
& What made you decide to choose an office-based practice versus a hospital-based one? 是什么让你选择了门诊而非医院？
& How do you think your pediatric residency prepared you for this type of practice? 你的儿科住院医师实习期经历对你对这份儿科职业的准备有什么帮助？
& Why do you think this pediatric practice will suit you? 为什么你觉得这个职位适合你？
& Are you familiar with the patient population?
& Do you think that you will still have interest in academic training? 你觉得你还对学术培训感兴趣吗？
& Do you have a particular interest or niche in pediatrics? 你对儿科有什么特别的兴趣吗？
& Would you feel comfortable performing procedures in clinic? Various practices differ, but these can include circumcisions, splinting, suturing lacerations, frenectomy, injections, incision/drainage, urine catheterization, lumbar puncture, venupuncture. 你能适应在门诊进行各种操作吗？
& For CME workshops, which pediatric topics would interest you the most? 对于儿科的医学教育，你最感兴趣的主题是？


Internal Medicine 内科
General questions to ask include:
& Are you inheriting an existing practice that may have specific characteristics (e.g. elderly patients, medicare patients)?
& How are new patients recruited? Do you get the problem patients nobody else wants? If you are the only female or of a particular ethnic background in the group, are you going to be ‘‘pigeon-holed’’ into a certain practice, e.g. only female urologist, so you get all the female patients. 你会不会被分配给没人想要的问题病人？会不会只让你操作一种特定的操作？
& What is the panel size of a normal practice?
& Over what time period are you expected to fill up your panel?
& Do you need to recruit in the community or with other doctors to get patients? 是否需要去社区招收病人？
& Does the practice have advanced access? (i.e. no backlog for appointments). If not, why? Every reasonable practice should have advanced access.
& Are there opportunities to practice share in the future? Very popular with women with kids who want to practice long term. If they do not have this option, it is a warning bell that you might not get supported during maternity leave, sick kids, etc.
& Are there big competitors in the area for patients? Are there any big changes, mergers, etc. foreseeable in the next 3–5 years? 这个地区有大的病源竞争对手吗？接下来的3-5年有什么可预见的大的变化、合并之类的吗？
& What is the general Medi-cal (or Medicaid) Medicare, non-insured, HMO mix of the general population?
& What is the relationship like with the Managed Care part of the organization? Do you have problems getting tests and consults approved and do you spend a lot of time with paperwork with this? How quickly do they deny or approve? Can you appeal?
& How good is billing? What % do they collect?
& Do you cover concierge practice patients or any other needy type patients?
& How long are patients waiting to see specialists? Are the specialists in the group or outside? Are they good about communication with you? 患者等多久能见到专家？专家在团队内还是团队外？他们善于交流吗？
Hospital-related questions to ask include:
& Do you work with hospitalists? Are they part of the practice or do they work for the hospital?
& What is the reputation of the hospitalists and do they contact you with admissions, DC, and need for follow-up tests?
& Are you expected to work in the hospital at all? 你必须在院内工作吗？
& Is it easy to get consults even on uninsured patients?
& Are the consultants set up to help out with procedures?
& Is the ICU covered by an intensivist 24/7 or is it you 24/7?
& How many hospitals will you cover? Are they far apart? Could you be required to be in two places at the same time?
& Are the surgeons supportive? Or do they want you to admit all their patients? Do they come in the middle of the night or expect you to do it?
& Will the ED write orders on patients for you and send them to the floor?
& What is the relationship like with hospital administration and other practices? Friendly vs. adversarial.
& Is there good parking at the hospital? Call-room, if you need to spend the night? Doctors’ lounge? 医院是否有好的停车场、值班室、医生休息室？
& Who has to cover holidays and weekends? New guy often gets this job. 谁在假日和周末值班？
& Is credentialing difficult at the hospitals?
Electronic medical records and work flow questions to ask include:
& Do they have one or are planning to get one? Is it any good?
& How much time do they spend answering the electronic medical records in-box lab results, calls? Do medical assistants cover the most or are doctors dealing with it?
& Can patients e-mail directly? How quickly do you need to respond to their questions?
& Does someone cover your inbox on weekends, holidays, vacations, your day off during the week? Are you expected to cover someone else?
& How are lab results dealt with? One person covers the whole department or individual docs get their own results? By fax or in an EMR?
& Do MA’s (medical assistant) take patient calls? 医助负责接患者电话吗？
Office-related questions to ask include:
& Do you get your own office space or do you need to share with someone? 你有自己的办公室还是集体办公室？
& How many rooms will you have to see patients? 你必须看几个病房的患者？
& Will you be in the main clinic space near other doctors or somewhere off site? Will other internal medicine doctors be available for curbside consults or are you on your own?
& Is there an urgent care on site or nearby?
& What do you do with sick patients? Is there a code team for the clinic? How far away is the hospital? How responsive is EMS?
& Do you have your own MA or nurse or do you share? Do you get to choose your own MA?
& Do the MA’s work hard? Who is in charge of them? What do you do if it is not working out with your MA?
& Do the nurses or MAs leave at 5 p.m. and you get to close down the office?
& How quickly can you get stat labs and x-rays? Is there a radiologist available to read films? Can you get CT scans during the day?
& Are you scheduled at 15 minutes or 20 minutes per patient? Huge quality of life issue for new docs.
& Are your patients scheduled such that you get breaks in your schedule to catch up, time to eat lunch, etc.?
& If in a joint practice, how is scheduling arranged for the last patient of the day?
& Do you dictate or type into EMR? Are templates available to make it more efficient?
& Is lab available on premises?
& Are the exam rooms nice and fully stocked? Who makes sure they are kept clean and fully stocked? Hopefully, not you! 检查室是否设备齐全？谁负责打扫和补充检查室？希望不是你！
& Are the receptionists nice and professional? How long do patients usually wait? Is there a mechanism if they are waiting too long? 前台接待员是否专业周到？病人一般得等多久？
& Is the office management good? Does the staff have a good relationship with management? What is the usual turnover? (Should be less than 20%). 行政管理部门怎么样？员工与管理部门的关系好吗？
& How are medication refill requests handled?
Questions you will be asked include: 你可能会被问到的问题
& What made you choose internal medicine? 是什么让你选择了内科？
& How did you hear about this practice? 你怎么知道这个单位的？
& What made you decide to choose an office-based practice versus a hospital-based one?
& How do you think your residency prepared you for this type of practice?
& Why do you think this practice will suit you?
& Are you familiar with the patient population?
& Do you have a particular interest or niche in internal medicine? Often, group practices have established different physicians as the ‘‘go to’’ person for particular conditions, e.g. geriatric medicine, orthopedics, allergy, etc. & For CME workshops, which internal medicine topics would interest you the most?


Surgery 外科
(See Internal Medicine section for questions on office-based practices)
Questions to ask include:
& How is OR time allocated?
& Will I be given block time?
& When would block time be allocated (i.e. would it be allocated prior to full partnership)?
& Where are the operating room facilities?
& Are they hospital based? Is there a surgery center?
& Are the OR’s office based?
& How will surgical cases be distributed to surgeons in the group?
& Will it be on a ‘‘next available surgeon’’ basis?
& Is their a system of distributing cases based on seniority?
Questions you will be asked include:
& Comfort level in performing specific types of cases.
& Long-term goals for practice, e.g. specific niche.


AFTER THE INTERVIEW
It is always a good idea to jot down personal information about the people you meet (e.g. Dr. Smith’s daughter enjoys ballet). Referring back to this during subsequent conversations, adds a nice personal touch; this calculated ‘‘schmoosing’’ needs to be balanced with genuine sincerity. 面试后记下你的面试官的个人信息，下次见面可能用得上。
After returning home from an interview, take a few minutes to write a personal note (by hand, not by computer or email) to the person or people who interviewed you, thanking him or her for their time and for the information about their practice you gained from the interview. If you came away with an interest to learn more, and continue as a candidate, say so. If you have no interest in continuing your discussions with the practice, say so, but in a nice
way. You are interviewing the group as well as the group interviewing you. Most medical communities are relatively small; think 6 degrees of separation may actually be more like 2 or 3. You don’t want to make any enemies at this point in your career. 面试后向面试官表示感谢。很多医生圈很小，你不会希望在找工作的这个节骨眼树敌。

nonoknows

5 Evaluating the Offer 评估工作机遇

EVALUATING THE GROUP 评估团队

Perhaps the most important one is the group’s reputation in themedical community and the reputations of its members. 可能最重要的是团队集体和个人在医疗圈的声誉。

BUY-IN 将来是否能成为团队的合伙人之一。

COMPENSATION SYSTEMS 薪酬机制

BENEFITS 福利

EMPLOYMENT CONTRACTS AND OTHER DOCUMENTS 雇用合同和其他文件

nonoknows

6 Medical Staff Credentialing and Privileges 证书和权利

7 Obtaining and Maintaining Your MedicalLicense许可证

8 Malpractice Insurance 医疗事故保险

9 Financial Planning for the New Practitioner 财务计划

这几章的内容讲的都是美国的情况，如果哪位有去美国发展的想法的话，可以找这本书看看，我就略过这些内容了。

nonoknows

10 Careers Outside of Clinical Medicine 转行

Do remember that it is not a good idea to run from a bad experienceto an unknown one unless, of course, you are forced to? If you can change most,if not all, of your concerns, then you will most likely choose to stay withinclinical medicine. Remember also that although the grass may look greener, oftenit is not true and a true Utopia is probably impossible to find. You shouldalso be introspective about the potential that your need to leave medicinemight contain an internal need unmet and that a job change may not resolve theissue. 除非是不得已，从不好的经历跑入一个未知的领域并不是个好主意。如果你能解决大部分问题的话，你也就不用转行了。要记住特别绿的草可能不是真草，真正的理想职业是几乎不可能找到的。你也要内省转行的原因，转行不一定能解决问题。

Remember, you have achieved something great by just having theopportunity to practice medicine; if, in the end, it is not for you, that doesnot mean you are a failure. The same work ethic and mental prowess that allowedyou to get into medical school and complete residency will carry you towards successin many areas of interest that you decide to pursue. 要记住，你能有机会行医就已经做得很不错了。就算最后你没成为医生，并不意味着你失败了。从医学校毕业、完成住院医师实习期的这种实力能使你在你决定从事的行业中取得成功。

How Do You Find Something Else to Do Outside of ClinicalMedicine? 转行能转到什么职业？
& Work at a hospital as a medicaladministrator. 在医院的行政管理部门工作。
& Remain in the medical field and useyour knowledge in research. 在医学领域从事研究工作。
& Find a home in business within theindustry of medicine. 医药企业。
   Medical devices and supplies. 医疗器械
   Capital equipment. 重要设备

  Pharmacology. 药品
& Move outside of medical fieldaltogether. 与医药无关的工作
& Get creative, invent something,perhaps, related to the medical industry. 投资，例如医药产业。

PART TIMING IT （院内/院外）兼职

Participating in other activities outside of your practice is hardwork. Chances are you will work more hours than fulltime practice, as, at leastearly on, most of these jobs are additive to your other responsibilities.You’ll need to get more education, something that isn’t easy to do in a busy practice.Along the way, you may make less money rather than more, if you substitutevolunteer or lesser-paid activities for patient care. 在院外从事其他兼职不是一件易事。你可能会工作更长时间。你需要接受更多的教育，如果你的本职工作很忙就有些难办了。如果你从事志愿者工作，你可能反而钱赚得更少。

MEDICAL ADMINISTRATOR 医疗机构行政管理者

On-the-job training is essential, but additional education is amust if you want to advance through the hospital ranks. A master’s level degreein business or healthcare administration is a logical choice if you have thetime or energy to complete one. There are numerous ‘‘executive’’ M.B.A.programs available through colleges and universities in all major cities. Thereare also numerous educational opportunities that incorporate generous amountsof home study, keeping time away from home to a minimum. Some programs allowyou to get credit towards a degree for individual classes taken in a conference-likesetting or online. 有机会成为院领导，如果想向上层发展、学有余力的话，可以考虑考个MBA。

INDUSTRY 企业

A technical sales representative position can get you necessaryface time with many physicians across the country and show your level ofintellect to many parties within the company. Soon, you will become the ‘‘goto’’ person for training and advice. Once you have established your value tothe company, look towards improving the company and realize that you may be theonly person in the company that really knows what you’re talking about. Keepyour focus on future perspectives for the company; feel confident in yourknowledge and assert yourself where you feel confident in your decisions. Therest of the company has far too much focus on the next quarter. But when theylook back, they will recognize that you either warned them of issues orprovided them with answers many months or years ahead of the rest of theworkforce. This can be great fun as you sell the vision of what the company canachieve for the future, and you can become rather personally invested in thesolutions that you are set out to create. 当医药器械代表的优势。在公司建立你的威信，体现你的价值。

RESEARCH 研究

OUTSIDE OF MEDICINE ALTOGETHER 医药之外的职业

  

If you know both what you want to do and the location you wantto work in, then it can be easy. However, always check your facts. Is this areal job, does it pay, what about housing and schooling, what are the localslike, etc.? 如果你知道在哪儿做什么工作，那就好办了。但还是要做好调查。

  

If you know what you want to do but are uncertain as to thelocation, then it can potentially become more difficult. It is imperative thatyou search the location thoroughly prior to committing yourself. Comparingplaces is imperative. 如果你知道你要做什么，但不知道去什么地方，那就有点难了。比较各个不同的地方很重要。

  

If you don’t know what to do but the most important thing foryou is the region that you want to live in, then this can also turn out to bepotentially big problem. It is imperative that you go there for a visit. Stayin a bed and breakfast for 2–3 weeks. Read the local newspaper to find out whois who in the place and peruse the job section. It is advisable to speak to asmany people as you can (in coffee shops, etc.). Survey the real estate market,visit local municipality (looking at house zoning, etc.), schools, supermarketsand museums. All this will give you a flavor of the place. 如果你不知道做什么，但你很想去一个地方生活，那可能会是个大问题。在那个你想生活的地方待两到三周。读当地报纸了解知名人物和招聘信息。建议跟尽量多的当地人聊天。调查当地房地产市场，访问当地政府部门、学校、超市、博物馆等等。所有这些都是让你了解这个地方。

  

If you don’t know what do to and the region you want to settlein is also immaterial, then you have an even bigger problem. There are manypublications that may guide you towards a successful non-medical career. Youcan also get career counseling from specialists in the field, governmentagencies, or contact a recruiter. 你如果不知道想去什么地方，也不知道想从事什么职业，那你就有更大的问题了。可以阅读介绍医生成功转行的指导书籍。你也可以向专家、政府专员、招聘人员咨询。

GET CREATIVE, BE AN ENTREPRENEUR 当企业家