Landing Your Ideal First Job

The transition from stroke fellow to attending physician is an exciting time, filled with new responsibilities and challenges. Although you have accumulated multiple interviewing experiences at various stages of your medical training, interviewing for your first neurology job is different. Consider using several strategies outlined below to guide your process.

Know Your Strengths and Weaknesses

As you approach this critical juncture, you should consider the type of career you envision for yourself based on your strengths and weaknesses. Neurologists can be clinicians, researchers, educators, hospital administrators, public health advocates, or any combination of these. However, not all jobs will be suitable for everyone since each requires different skill sets. For stroke specialists, in particular, part of the decision-making process involves choosing whether administration of a stroke center is a desired part of the job. For example, a position as a Stroke Center director may require administrative expertise and time that will limit your clinical and research time, but offers alternative professional benefits. For those who prefer managing inpatient neurological disorders, becoming a neurohospitalist is another option. Compared with stroke neurologists, neurohospitalists see not just stroke but also other neurological disorders.

As new healthcare delivery models emerged to address unmet patient needs, new career opportunities also appeared. For example, services such as concierge and direct-care medicine provide enhanced medical care by offering patients personalized services and continuous access to neurologists. Additionally, within the past 20 years, telestroke made timely stroke care possible for patients otherwise limited by geographic constraints. Recent emphasis on patient outcomes in medicine have also led to the creation of hospital experience officers who evaluate and improve inpatient experiences.

Traditionally, 2 major career decisions exist: (1) academia versus private practice and (2) the proportion of research time desired. While an academic clinician-researcher position may be the perfect job for some, others may prefer private practice. Academic settings themselves range from smaller hospitals affiliated with medical schools to large academic centers. Private practice can range from solo to larger group practices to health maintenance organizations. Research, particularly clinical trials, can be performed even in private practice, though the type of research may differ from that performed in larger centers. Compared with private practice, academic positions often include teaching responsibilities and administrative duties, as well as lower initial salaries. Making the right decision will save time in your search and future unhappiness in an unsuitable position.

Start Writing Your Curriculum VitaeEarly

Early and careful preparation of your cover letter and curriculum vitae (CV) is a crucial first step of the job search. Department chairs, division chiefs, and recruiters make an initial assessment based on your cover letter and CV. An attractive, professional cover letter and CV will increase your chances of obtaining an interview. The American Academy of Neurology offers junior members complimentary CV reviews. In particular, the American Academy of Neurology Neurology Career Center contains useful articles about how to generate a stellar CV. Asking your fellowship program director or mentors for guidance on your CV is an alternative approach. Sending in your National Institutes of Health biosketch in place of a traditional CV is optional. Attaching a professional photo should be avoided to circumvent any unconscious bias. Your cover letter should include a brief introduction, the position you are applying for, and a summary of how your clinical and research skills match the job description. Common sections of a well-crafted CV contain information about your education, professional employment, research experiences, American Board of Psychiatry and Neurology status, medical licensure, professional associations, peer-reviewed publications, book chapters, conference presentations, awards and honors, and related professional experiences. All contents must be listed in chronological order. Do not include other personal information such as your social security number, birthdate, or marital status. To capture the attention of your readers, you may include a brief opening paragraph to highlight training, research experiences, and personal traits that make you stand out.

It is usually not necessary to include letters of recommendation with your CV but requirements vary by institution. It is advisable to ask for recommendation letters 1 month in advance to give letter writers enough time to generate one. At least 1 letter should come from your division chief or stroke fellowship director and another from your clinical or research mentor. You could also include a third letter from your residency program director.

Be Resourceful in Locating Job Openings

The job hunt typically begins about 9 to 12 months before your projected start date. This time frame provides the necessary time to explore different institutions, programs, and cities. If you are limited geographically, you may want to start the process even earlier. Attending annual meetings of the American Academy of Neurology, American Neurological Association, or the International Stroke Conference and other vascular neurology conferences the year before your last year of fellowship is a fantastic way to network with peers, past mentors, and new colleagues to learn about openings. The American Academy of Neurology (https://careers.aan.com)¹ and American Neurological Association (https://myana.org/careers)² websites host job sections for both academic and private practice positions. Online search sites are typically grouped by job title, job type, and location. However, it is recommended that you always inquire if a given position is still available. Fellowship directors are great resources since they frequently receive emails about recently opened positions. Former colleagues from residency and fellowship can also provide invaluable advice from their own experiences. Another approach is to send your CV and cover letter unsolicited to division chiefs. Your cover letter typically contains a brief introduction, type of position sought, and why you are interested in that position. If you do not receive a response within 1 month, you could send a follow-up email.

Create Your Job Talk for a Targeted Audience

For those seeking academic research positions, it is never too early to start preparing a research presentation since you may be asked to give a talk during an initial or second interview. These job talks are typically about 1 hour in duration, including 10 to 15 minutes allotted at the end for questions. The purpose of the presentation is for future colleagues to learn about you and your research interests, showcase your teaching skills, determine how well you fit, and set up potential research mentors and collaborators. Bear in mind that your presentation should be different from most Grand Rounds or lab meeting presentations. You should, for instance, feel free to incorporate personal stories illustrating your medical journey and why you decided to pursue a particular research field. If a job contains teaching responsibilities, then highlight the achievements of your trainees. Before finishing your presentation, be cognizant of your audience. If there are medical students, residents, fellows, or nonspecialists in attendance, you should carefully explain any jargon. Rehearse your presentation with your division chief, program director, research mentors, or cofellows within your current institution. Questions generated from your rehearsal may be similar to those asked on interview day.

Prepare for Interview Day Weeks in Advance

Your first interview may be by phone, videoconference, or onsite. Weeks prior, you should generate a list of possible questions you may be asked. Responses should incorporate key strengths that make you suitable for the position. Practice rehearsing answers with your peers. Once you receive your interview schedule, familiarize yourself with faculty on the list, especially key publications and how their research may relate to yours. If there is someone with shared research interests not on your proposed schedule, email the interview coordinator to see if time can be carved out to meet with a potential mentor.

On interview day, you will likely meet the chair of the neurology department, division chief, other faculty members within your division, current fellows, clinical staff, and research assistants. The day may also include a tour of the inpatient and outpatient neurology areas, administrative offices, and clinical research center. Most meetings are one-to-one and last about 30 to 60 minutes. Whether your initial interview is by phone, videoconference, or in-person, approach it with enthusiasm and confidence. Now is the time to showcase yourself and your research. Typical topics discussed include: job specifications (including amount of clinical and teaching responsibilities), protected research time, ultrasound interpretation requirements, clinical and research interests, your career plans 5 and 10 years on, and your ability to relocate to a different city, if applicable. This is your opportunity to ask about your title, inpatient service time, administrative duties, size of the division and neurology department, ancillary research or coordinator support, available research facilities, and specifics of the promotions or tenure pathway.

Interview day may also include meetings with human resources officers to review benefits, vacation time, sick leave, maternity leave, and retirement plans. Salary is a sensitive topic and is usually not discussed in the initial interview but reserved for a subsequent interview.

Second interviews provide an opportunity to meet key faculty members missed during the initial interview. Travel and lodging expenses to the interview site are usually reimbursed but vary depending on the institution. You may be invited for lunch or dinner with the division chief and other faculty members to see how you fit with the group. If free time remains, you could explore neighborhoods within the city or neighboring towns to scout potential living areas. You should thank everyone personally on interview day and always follow-up with thank-you emails or letters immediately afterwards. Be aware that your goal during your first in-person interview is to be invited back for a second interview and eventually obtain an offer letter.

Negotiating Your Offer

Once you have completed all your interviews and have settled on a particular employer, you will likely receive an outline of the offer letter from the neurology chair. After receiving the outline, you should first read the entire document in its entirety. Most importantly, you should express gratitude to the chairperson for sending you the offer. If there are parts of the outline that require negotiation or clarification, you can discuss them with the chair by phone or via email. Basic components of any offer letter will include your job description (clinical duties, academic responsibilities, research endeavors), your qualifications for the job (ie, board certification, state licensure, hospital privileges), salary, access to clinical and research resources, fringe benefits, bonuses, professional liability insurance, noncompete clauses, and terms and termination of the offer. Your clinical and research time and salary may be potentially negotiable items but can vary on a case-by-case basis. After all negotiations are complete, the chair will send you the contract for you to review and sign.

Make a Decision Suitable to Your Interests/Needs

Once you are finished with interviews, if there is continued mutual interest between you and a prospective employer, you will need to make a personal decision about where to go. Your choice depends on how your personality and research interests match those of your prospective employer. How do you fit into the neurology department and subspecialty? Can you see yourself working alongside your new colleagues? Do you have supportive mentors and a neurology chair who will rally for your success and help propel your career forward? Your impressions from your onsite visit(s) will greatly impact your decision, along with other personal considerations for your family if you are relocating. Can you imagine yourself and your family living in a particular city or town? Where will you live and how will you commute to/from work? You should consider all aspects of a particular job before making your decision (Table).

Conclusions

Congratulations on reaching this exciting time of your career: the transition from stroke fellow to attending neurologist. Before starting your job search, think about what type of job is most suitable for you. Searching for your first job requires patience since the process is a months-long marathon, not a sprint. If you prepare your CV and research presentation early and carefully, are resourceful in your job search, prepare for all interviews thoroughly, and consider all aspects of a job before making a decision, then you will be in a great position to capture your ideal first job.

Footnotes