I am a second-year fellow in rheumatology, and I want to share my personal experience of my job-hunting quest.
Know Yourself
One of the most challenging parts of entering the job marketplace is self-assessment. There is no training for that. Looking at yourself is not as easy as it sounds. We are trained to be humble and cannot always see where we shine.
Think about what skill sets you have to offer, and write them down.
You want to show what makes you unique and convey that during your interviews. For example, are you good with musculoskeletal ultrasound and have the training and/or certification to use in the clinic? Do you have what it takes to build a subspecialty or procedural clinic? It doesn’t matter if you are going into an academic setting or private practice; the other side always wants to know.
Click to enlarge.
You should also consider whether you need a work visa after fellowship because it will be relevant to the following steps. You may need an immigration lawyer to assist you during the path (see Figure 1).
Career Pathway
Have you thought about what path you want to take? Do you want research to play an important role in your career? Or do you want to prioritize clinical experiences, such as taking care of patients daily?
Most private practices are known for flexible schedules with a “choose your own adventure” style. They want you to be happy in the practice and to consider long-term commitment, so let them know your preferences.
If research, teaching and education are must-haves, then consider academic positions (although private practices may have incorporated some degree of research nowadays, it may not be the same as in academic centers). In the academic positions I have interviewed for, I did notice more flexibility in the schedule. Nothing is written in stone, but you have to advocate for yourself—for the type of work and schedule you want.
Do you get excited with complex patients in the hospital? What cases make you feel you are making a difference? Most academic positions have inpatient work, which is not necessarily true for private practices. You should consider private practice if outpatient is your priority.
After almost a year of fellowship, you have already noticed your preferences between inpatient, outpatient or a combination of both. Consider the path that best suits you.
Geography
Like matching to fellowship, you are already debating where to live in the mid- to long term post-fellowship. You may already have engaged with a recruiter from a particular practice you are interested in. This is a good start.
Look around, but remember your first job may not necessarily be your last job. You can always change to another position. At the same time, choose a position you know you would be comfortable with for at least three years (preferably even longer).
Most employers, whether academic centers or private practice, have non-compete clauses, and some may suggest that you won’t be able to work in the same city for a certain amount of time (usually one or two years) after you leave a position. This fact will force you to move to another city or region. So think carefully before choosing a position. Although the Federal Trade Commission (FTC) issued a sweeping ban on non-compete agreements in 2024, the measure has yet to take effect; a nationwide injunction has stalled its implementation, casting uncertainty on its validity. You may want to talk to a lawyer before signing a non-compete.
Where to Look
If you are interested in academic positions, email the department you are curious about. If they have openings, the coordinator will forward your email to the hiring department, and they will invite you for an interview. Remember that most interviews are online or over the phone. This gives you the flexibility to schedule them one after the other. Some other interviews may be over dinner.
If you are interested in private practice jobs, check out website listings on the ACR’s CareerConnection, Health Careers, JAMA’s Career Center or Jackson Physician Search.
Those websites have recruiters nationwide to help you connect to different practices and businesses. I am not affiliated with any of them, and I have used them successfully. Don’t be disappointed by job ads that don’t suit you at first glance because they could still be a good learning experience. If I had it to do over, I would have started looking in the first year of my fellowship.
For networking opportunities with rheumatologists from around the country (and the world), attend national meetings, such as ACR Convergence, the ACR’s State-of-the-Art Clinical Symposium and the meeting of the Coalition of State Rheumatology Organizations (CSRO).
The Interview
The best place to start is the ACR career fair, which includes representatives from academia and private practices who are looking for suitable candidates. You can participate in the career fair at the end of your first year of fellowship. In 2024, a mix of phone and Zoom meetings occurred with fellows. The contacts you make give you good places to start your job search and give you a broad idea of the job market. You should ask about:
- Working environment: The city and population characteristics, how the practice is run, ancillary staff, who is responsible for prior authorizations. Know the place where you will be working for the following years.
- Your duties: How many patients are you expected to see every day? How many clinics do you have in a week? Will you supervise fellows or residents? Do you have inpatient duties, and if so, what’s the workflow?
- Benefits: In addition to the usual dental, vision, health and malpractice insurance, you should ask about tail coverage, 401(k) matching or any other type of retirement plan. You may think, “I’m young and won’t stay in the position for the long term,” but you may find you like it and stay 10 years. Don’t get caught out by not reading the retirement plan details.
4. Salary: This is a tough one. Some people don’t like to ask about compensation during the first meeting. There is no right and wrong here. If you feel more comfortable asking about compensation in subsequent meetings, that is fine. At one point, you will ask about the salary if it hasn’t been disclosed already. I recommend reviewing the regional and national numbers in MGMA.
The Contract
You like the place and are interested in the position. You have discussed it with them multiple times and negotiated an excellent salary and benefits. Now comes the real deal—they offer you a contract. You are asking yourself what these strange sentences are in the contract. My recommendation is to ask for help. Start with senior fellows, then attendings, and consider hiring a lawyer. A lawyer can help immensely in understanding the details of a contract. Consider that the legal fees may cost much less than a surprise in the future. Also, everything discussed verbally with your potential employer should be written in your contract to avoid misunderstandings in the future.
Conclusion
Once you sign, you know when and where you are going for the following years. Celebrate all your hard work! You deserve it. Remember: There is a and many of them are retiring. Every place is looking to hire new rheumatologists. The demand is high, but the supply is low because there are few rheumatology graduates.
Finally, recognize that you have the power to decide what kind of place you want to work. You are always in charge.
Chen Chao, MD, MBA, is a second-year fellow at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. He is a member of the ACR, ACP, MSSNY and NYSRS.
