Author + information
- James L. Ritchie, MD, FACC, Chair,
- Nora F. Goldschlager, MD, FACC,
- Ajay Labroo, MD, FACC,
- Michael R. Nagel, MD, MPA, FACC,
- W.Douglas Weaver, MD, FACC and
- Eric S. Williams, MD, FACC
Job satisfaction, an important ingredient of a healthy professional environment that encourages efficiency and teamwork, which can result in better outcomes. This working group focused on methods to enhance the process of matching cardiologists with job opportunities. The group included cardiologists from academic and private practice and a cardiologist who had recently completed training. We used data from the ACC Cardiology Workforce Study 2002 (hereafter ACC workforce survey) to inform our discussions and recommendations. This report focuses mainly on the job-matching process from the perspective of the job seeker. Although most individuals actively seeking jobs in cardiology are trainees, many experienced academic or practitioner cardiologists are seeking a different position. The report includes suggestions for various types of educational programs that would help to inform trainees about the current cardiology job market and ways to improve their chances of finding a position that matches their interests and needs. We also discuss ways that the ACC, because of its national scope, local chapters, and affiliates-in-training program, is well-positioned to facilitate the job-matching process.
Trainees completing their cardiology fellowships now have the good fortune of a very active job market that presents them with a wide range of options in terms of job content and location. The results of the ACC workforce survey sent to senior cardiology trainees, cardiology training program directors, and recruiting firms provide compelling evidence that many open positions exist in general clinical cardiology and its subspecialties (e.g., interventional cardiology and eletrophysiology). Bruno and Ridgway Research Associates assisted ACC leaders and staff in constructing and conducting the survey. Their detailed analysis of the survey results led them to conclude, “The data from these three important segments impacting cardiology workforce point to the inescapable conclusion that, while there is ample supply of cardiology and high and increasing demand for their services once graduated, there are not enough training slots to meet that demand. Also, the evidence is that the disparity of supply versus demand will continue since programs seemingly can only make modest increases evenif they had the resources.” The survey data also led these consultants to predict that “the job market will continue to be very favorable toward senior fellows, recruiting for their services will continue to be very competitive, and the current workforce will have to face an increased patient demand” (1). The ACC workforce survey revealed that 71% of senior cardiology trainees believed that their job search was relatively easy. When the survey was conducted in the summer of 2002, 74% of the senior fellows had already secured a post-training position. Those who had accepted a position received an average of five job offers; those who had not yet accepted a position received an average of four job offers. Importantly, a majority of those who had accepted a position were satisfied with it (Fig. 1).
The ACC workforce survey provided useful information about what factors senior cardiology trainees thought were most important as they considered different positions (Fig. 2). Our consultants explained, “An analysis of gaps between satisfaction with features of a first post-training position in a cardiology practice and importance of those same features reveals that there are hardly any gaps at all. It seems that each of the very important features on the senior fellow ‘wants and needs list’ has been satisfied” (2). Each cardiology trainee (with his or her spouse, partner, or family) must consider many things as they evaluate potential job opportunities. The ACC workforce survey provides a useful perspective on the relative importance of several aspects of finding an ideal position.
One of the biggest challenges facing our specialty and patients with cardiovascular disease is a continuing (and worsening) shortage of general clinical cardiologists. It is evident from the ACC workforce survey that currently only a small percentage of senior trainees are seeking this type of position. Figure 3provides a summary of the type of opportunities that senior fellows were seeking. Working Group 8 proposes an excellent model that would facilitate training more general clinical cardiologists.
The results of the ACC workforce survey suggest that most senior trainees are quite satisfied with the positions they have chosen or are considering. We believe, however, that the job-matching process could be enhanced by providing trainees and cardiology training program directors with more information about the job market and job seeking. We are unaware of recent published data that reveal how often cardiology training programs sponsor formal presentations or otherwise try to facilitate the job-search process in a structured way. It is our impression that most training programs do not address these topics. However, several recruiting firms focus on cardiology, and some of them sponsor seminars or otherwise provide job seekers with information about the market for cardiovascular specialists.
From the standpoint of the cardiologist looking for a position (and most will be senior cardiology trainees or recent graduates of training programs), the job-matching process consists of two distinct but complementary phases. The first phase relates to the general type of position the cardiologist is seeking (Table 1). The second phase consists of a candidate selecting a specific position from the opportunities offered to him or her. This important stage may take several months to complete, based on the cardiologist's interests and aspirations, the job market at the time, and the need to address the many professional and personal details involved in the decision to accept a position. The ACC workforce survey revealed that (of the respondents) 75% of the senior trainees were married, 82% were male, their median age was 34, and 53% had graduated from a U.S. medical school. The fact that three-quarters of trainees seeking a job are married emphasizes the fact that many of the decisions about where to locate are shared with a spouse (who will often have his or her own specific work or life goals).
The most popular private practice model for both ACC members and senior cardiology trainees is the single-specialty group. In cardiology there has been a steady trend away from solo or small group practice to large single-specialty group practice over the past quarter-century. The popularity of this practice model can be attributed to a combination of factors, including a greater degree of functional autonomy and a higher potential salary compared with private multispecialty groups. Academic positions are most closely related to the multispecialty group practice model, but full-time academic cardiologists practice in a teaching hospital and usually have a significant commitment to research and/or teaching in addition to patient care responsibilities.
As we considered how to enhance the job-matching process, we recognized that a significant number of recent cardiology trainees change jobs within five years of accepting their first position. It would be useful to gather data on this aspect of job-matching in order to reduce the number of unsatisfactory matches. Many factors enter into a trainee's decision to accept their first position, and many professional and personal factors contribute to his or her decision to leave that job for another position. In some instances the practice or institution decides not to keep the cardiologist as a member of their group or staff after an associate period of one or more years. We believe that better and more stable job matches will result from enhancing the original search and match process through education and by providing greater awareness of the number and types of positions that are available.
The training program director or another interested cardiology faculty member should discuss at an early stage of a fellow's training the type of career he or she is most likely to seek upon completion of their fellowship. Indeed, it is useful to discuss this with internal medicine residents if they express interest in cardiology or when they are interviewing for a cardiology fellowship position. Each training program should develop a formal system that encourages fellows to discuss their career goals at regular intervals either with the director of the program or another faculty member. Understandably, the career goals of a significant number of cardiology trainees change during their fellowship as they are exposed to various cardiology subspecialties and learn more about the various types of careers open to them. Working Group 8 describes the broad spectrum of careers that now exist in cardiology.
Many (probably most) trainees see academic and practitioner cardiologists mainly during busy inpatient clinical rotations or when they are “on call,” a time that can be especially hectic. These experiences present a distorted view of cardiology practice and surely discourage some highly qualified medical students and internal medicine residents from considering a career in the specialty. An effort should be made to provide trainees a more balanced view of the spectrum of cardiology opportunities. For example, it would be useful for internal medicine residents or cardiology fellows interested in private practice to have an opportunity to have one or more outpatient rotations in various types of practices. This would afford them an opportunity to explore and better understand the spectrum of clinical activities that take place outside a busy hospital inpatient service. It seems likely that some members of the part-time faculty affiliated with the academic medical center or cardiologists in nearby communities would welcome this opportunity, although the time pressures that practitioners face in all settings today may reduce their interest in taking on this added responsibility.
If a formal offsite outpatient cardiology rotation is not feasible, an informal arrangement during elective or vacation time might be possible. The local ACC chapter could help identify cardiology groups or individual cardiologists willing to serve as mentors. The practitioners who participate would in turn become acquainted with trainees considering private practice opportunities. Such a relationship might facilitate hiring one of these fellows in the future. Groups having difficulty recruiting might be willing to offer opportunities to trainees interested in seeing their practice firsthand. Working Groups 2 and 3 also emphasize the importance of mentoring in various contexts as we seek to attract the most qualified candidates to our specialty.
A similar mentoring experience could be arranged for trainees considering a career in academic medicine or industry. Ideally, in the academic setting, a full-time faculty member should be assigned to mentor a trainee who shares his or her professional interest. The mentor should meet regularly with the trainee to provide feedback and advice. This faculty member could also help the trainee identify open positions in other academic medical centers. Trainees seeking specific types of academic or private practice opportunities should also be encouraged to attend local, regional, and national cardiology continuing medical educational meetings and ACC chapter meetings. These meetings provide trainees an opportunity to meet formally or informally with a variety of individuals who can describe various professional opportunities.
The California chapter of the ACC developed a program that has been very successful in connecting trainees with academic and practitioner cardiologists. This model, which takes advantage of the ACC's network of 39 chapters, could be replicated throughout the country because most cardiology training programs are located in states with chapters. For several years the California ACC chapter has sponsored a popular one-half day program during its annual meeting that informs trainees about the academic and private practice job markets. Other chapters have incorporated similar programs into their meetings.
Ideally, senior trainees and recent cardiology graduates should participate in the planning of this type of local program. Many subjects might be included. For example, the program might include “case studies,” examples of job searches that went well or perhaps not so well. Some ACC chapters have sponsored a “job fair” that enables trainees seeking a specific type of position to meet with representatives of academic programs, private practices, and industries that are seeking cardiologists. (See Appendixfor the agenda of the California Chapter Fellows Session.) It would be useful if the didactic portions of some of these programs devoted to job-seeking could be recorded for distribution to interested trainees and training program directors.
Trainees considering an academic career should consider attending the conference “How to Become a Cardiovascular Investigator,” which addresses various aspects of academic cardiology positions, with emphasis on research. These conferences, held at the ACC's Heart House, have been sponsored jointly by the ACC, American Heart Association (AHA), and the National Institutes of Health (NIH). This one and one-half day session provides valuable insight into various aspects of beginning a career in academic medicine. Subjects discussed include: 1) the spectrum of clinical and research opportunities available in most academic centers, 2) writing grant applications, 3) choosing a research project, 4) writing scientific papers, and 5) job searches, among other topics. There is no registration fee for this program. Recordings of these conferences should be made available to training program directors. If there is sufficient interest, this program could be expanded to a second site, such as the West Coast, to facilitate access. Attendees have commented that the face-to-face interactions with faculty have been particularly valuable.
The 2004 ACC Scientific Sessions included a symposium dealing with job opportunities and job seeking. The topics included “Career Choices: How to Network, Identify the Decisions that Count, and Make it Happen” and “How a Fellow-in-Training Got Started in the Real World,” among others. This working group believes that programs such as these will continue to be popular among trainees and may encourage more of them to attend the ACC Annual Scientific Sessions.
Other topics of interest to job seekers that could be incorporated into the mentoring process at individual institutions or could be part of a structured program offered by the ACC, its chapters, or other organizations might include: 1) the role of professional recruiters, 2) the business aspects of private practice, 3) legal issues related to contracts of employment, 4) the most popular methods of compensation (including salary, bonuses, and benefits), 5) how to access published surveys that list starting and mean salaries for different types of cardiologists in various geographic locations and types of practice, and 6) how to evaluate the financial stability and physician turnover history of a practice, among other things.
The ACC also sponsors a “Computerized Placement Center” at the Annual Scientific Sessions. This includes a dedicated on-site facility with electronic access to the College's ACC Cardiology Careers (discussed in the subsequent text). The ACC staff members are available at the job-placement center during the annual meeting to assist trainees and cardiologists seeking positions to post their resumes that include their specific interests. The facility provides space for meetings and interviews between job seekers and individuals representing institutions or practices that are recruiting. Shortly, the College will begin to offer assistance to retired or semi-retired cardiologists seeking to return to practice on a part-time or full-time basis.
The ACC provides several services to facilitate job matching. One that has proved to be very popular is the Web-based ACC Cardiology Careers (http://www.acc.org/home_links/jobopport.htm, Accessed June 13, 2004). In June 2004 there were 577 cardiology jobs posted at this site, and several postings describe more than one open position. When initiating a job search, the fellow may submit his or her resume to ACC Cardiology Careers at http://www.acc.orgfor maximal exposure and to directly contact practices offering specific types of opportunities or in specific geographic areas. Once again, the ACC chapters should consider how they might better serve their members seeking partners and the affiliates-in-training in their state or region.
In summary, this is a time of great opportunity in cardiology, one of medicine's most interesting and dynamic specialties. Fellows completing their training are entering a job market that offers a wide range of positions in academic medical centers and in private practice. To enhance the job-matching process and to reduce the likelihood of dissatisfaction trainees should take advantage of the tools available to them (such as ACC Cardiology Careers) to be better informed about their options. Meanwhile, academic medical centers, the ACC, and local ACC chapters should continue to improve the process of matching the right person with the right position.
1. Each cardiology trainee should have a faculty mentor whose responsibilities include helping the fellow consider career options early in their training.
2. Opportunities for outpatient rotations in private practice settings should be made available to interested trainees.
3. ACC chapters should consider ways to facilitate job matching between their members and trainees in their state or region. Successful programs, such as the one conducted by the California chapter, can serve as models for other ACC chapters.
4. The special symposium on job hunting should be a standard part of the ACC Annual Scientific Sessions.
5. Formal national ACC or ACC chapter symposia dealing with job searching should be recorded and made available to all training program directors and interested trainees.
6. Trainees interested in an academic career should attend the Learning Center Program “How to be a Cardiovascular Investigator.”
7. The ACC Cardiology Careers Website and the onsite Computerized Placement Center at the ACC Annual Scientific Sessions should be given increased exposure to all trainees, faculty, and the membership at large.
- American College of Cardiology Foundation