Desperately seeking a job isn’t a position in which most otolaryngology residency graduates ever expected to find themselves. Pre-COVID-19, jobs were plentiful for otolaryngologists, some of the most-sought-after medical specialists.
Explore This IssueSeptember 2020
“We saw residents waiting until the very end, sometimes until the second half of their last semester, to choose the opportunity they wanted,” said Travis Singleton, executive vice president of Merritt Hawkins/AMN Leadership Solutions, a physician search and consulting firm. “I get why that happened: They were in a 10-year strong market where there were always jobs. It was just about which one. You wanted to wait until the very end. You were the No. 1 draft pick a week before the draft.”
This isn’t the case for many otolaryngologists completing residency or switching jobs right now, said Singleton, who has helped clients hire physicians for the past 15 years.
“We’re seeing a lot of offers rescinded, especially for those coming out of residency who thought they had something lined up. Frankly, because groups aren’t growing anymore and are not seeing more patients, they can’t justify bringing in more payroll,” he said.
Merritt Hawkins/AMN Healthcare reports that search requests for healthcare providers have decreased by more than 30% since March 31, 2020. “It’s a reversal of a market that we haven’t seen in 50 years, since they invented Medicare. Words like ‘layoffs’ and ‘furloughs’ have never been associated with the physician occupation,” Singleton said.
By many accounts, things do appear grim. The U.S. Bureau of Labor Statistics reports the healthcare sector lost 1.5 million jobs between February and April (although it has been adding jobs ever since). The financial impact of the pandemic seems to have cut across practice environments. Of the medical practices surveyed by the Medical Group Management Association in April, 97% say they have experienced a negative financial impact. The same survey reports that medical practices across the United States have lost more than half of their normal revenue and patient volume. Meanwhile, the American Hospital Association reports that hospitals and health systems lost $200 billion in the first quarter of this year.
But amidst all this bad news are some hopeful accounts. ENTtoday spoke with four otolaryngologists who have found opportunities despite these challenging times.
Life doesn’t always go as expected. And when it doesn’t, you have to be able to adapt. … But above all, stay positive and make the most out of your situation. Things will all work out in the end, perhaps even better than you had originally planned. —Blake Raggio, MD
Word of Mouth Works
Sandra Ho, MD, had a job lined up before her training was scheduled to end. But in mid-April, the practice where she had planned to work shuttered. This happened two months before she was expected to finish her otolaryngology residency at SUNY Downstate Health Sciences University in Brooklyn, N.Y. Dr. Ho applied to locum tenens jobs all over the country, only to find out after much back and forth with recruiters that most of the positions were no longer available.
“When they did tell me that something had opened, they said I would have to take a competitive rate because there were 16 other applicants,” she said.
Dr. Ho also applied for permanent jobs in New York City, where she hoped to stay, as well as for positions as far away as Hawaii. She was frustrated to submit applications, only to find out later that the employers had initiated hiring freezes or weren’t looking to bring in anyone new for another six to eight months. Dr. Ho let her mentors and fellow residents know she was in need of a job—soon. Good old word of mouth paid off when a fellow resident landed a job at a practice in Queens, N.Y., and told her about another opening in the same group. She’s now one of four physicians at a general otolaryngology practice, working for a salary she considers to be competitive for her geographic area.
Her advice? Apply widely and don’t be picky. “You may need to sacrifice pay and location. I consider myself lucky to have a job,” she said.
A Layoff Leads to Independence
This may seem like the worst time to launch a practice, but, in some ways, Samantha J. Hauff, MD, had no choice. Dr. Hauff was laid off from a small otolaryngology practice in San Diego at which she had been employed since early 2019. She had considered opening her own practice in the past but felt she needed to save more capital to put toward starting her own business. When the pandemic lockdown forced the practice to temporarily close, its owners could no longer afford Dr. Hauff’s position, she said. Leaving the area wasn’t an option because her husband is a military physician stationed in San Diego. Dr. Hauff also didn’t want her insurance credentials to expire. Suddenly, this seemed like the moment to make a bold move.
Dr. Hauff went from losing her job on April 3 to opening her own practice on July 27. “I did everything on a shoestring budget and essentially by myself,” she said.
The most important step was finding a commercial space, because she needed an address for insurance contracting. Luckily, she found a landlord willing to negotiate quickly and secured a site within a few weeks of looking.
“I basically tried to start it all on a very small, five-figure budget. I don’t think it has to be as expensive as one would think. You can use pre-owned equipment and keep personnel costs down initially by doing more yourself,” she said.
Dr. Hauff has since hired a medical assistant who helps with administrative work but chose to forgo paying for an insurance contracting consultant. “Some people pay thousands upfront for insurance contracting. It isn’t that complicated; you can do it on your own if you’re willing to put in the time,” she said.
With help from the Scripps Mercy Physician Partners, Dr. Hauff created a business plan. To be profitable, she needed 10 patients in the first month of opening and needs to add 10 patients per month every month thereafter until she reaches full capacity. At the time of this writing, she’s expecting to see 20 patients in her first month. Although Dr. Hauff faces pandemic-related challenges like securing enough personal protective equipment and ensuring social distancing in the clinic, she’s glad she didn’t let the crisis deter her dreams.
“It’s a big project, but you can break it down into a thousand small steps and get through them one by one,” she said. “I think that, even though I won’t make much money in my first year, over the long term it will be a set-up that will make me happy. Having control over my own schedule and managing the day-to-day operations is the way I’ve always wanted to run my practice.”
After a Rescinded Offer, a Dream Job
Blake Raggio, MD, understands all too well the old adage about the best-laid plans. Dr. Raggio had locked down a job offer last September, long before his American Academy of Facial Plastic and Reconstructive Surgery fellowship with the University of Toronto would end this summer. He was all set to start a position with a private practice in Dallas that was going to be funded for the first year by an academic medical center with which the group had contracted. The hospital saw revenue drop because of COVID-19 and abruptly rescinded the position in April. With only two months of his fellowship left, a family to support, and debt to pay off, Dr. Raggio frantically researched opportunities far and wide.
“For two weeks, I had recruiters on speed dial,” he said. “I could tell you about every otolaryngology job opportunity in North America.”
Dr. Raggio’s dream was to raise his 3-year-old and 1-year-old daughters in the Dallas/Fort Worth area in Texas, but ultimately was open to other locations. When a recruiter told him a hospitalist-owned otolaryngology and facial plastic surgery group in Montgomery, Ala., was looking to replace a physician who was retiring, he was interested. Being a New Orleans native, he loved the idea of living in a Southern city.
Two weeks after losing the job in Dallas and many virtual interviews later, Dr. Raggio signed a contract for the position in Montgomery, which he said afforded him a more promising opportunity than the position he originally had in Dallas. Shortly thereafter, Dr. Raggio bought a house, enrolled his daughters in school, and moved his family from Canada to Alabama, where he started the new job Aug. 1.
Dr. Raggio recommends that residents start their search early but warns them to be prepared for anything. “Life doesn’t always go as expected. And when it doesn’t, you have to be able to adapt,” he said. “Cast a wide net. Spend a few hours a day contacting recruiters, searching every job search site, and calling resources—anyone you think can help. But above all, stay positive and make the most out of your situation. Things will all work out in the end, perhaps even better than you had originally planned.”
I basically tried to start it all on a very small, five-figure budget. I don’t think it has to be as expensive as one would think. You can use pre-owned equipment and keep personnel costs down initially by doing more yourself. —Samantha J. Hauff, MD
An Early Search Spells Success
Terrell Bibb, MD, chief resident at the University of Arkansas in Fayetteville, started looking for a job halfway through his third year of residency. That’s much earlier than most residents begin their job search, but he was intent on moving back to West Texas, where he and his wife grew up. “There aren’t many people wanting to go back to that area, so it isn’t competitive, but there also aren’t a whole lot of job opportunities,” he said.
For four months, Dr. Bibb called practices, spoke with recruiters, and searched through job sites. He heard about the best opportunity from a fellow resident, who forwarded him a job listing. He applied and ended up signing a contract in December with a general otolaryngology practice in Wichita Falls, Texas.
“It’s important to reach out to people who aren’t necessarily advertising that they have open positions,” he said. “A lot of it is word of mouth or knowing someone who knows someone.”
Job Search Tips
To land a job right now, Singleton of Merritt Hawkins/AMN Leadership Solutions said otolaryngologists need to be flexible. “Maybe you didn’t want to go to Arizona, but you’re looking into it now,” he said. “Or maybe you didn’t want to work for a hospital, but the starting salary is more than what you thought you could get.”
Singleton said he predicts the job market will normalize by the second quarter of 2021, if the COVID-19 outbreak is under control and patients return for elective procedures. “Until you can run normal operations, patients won’t come back to you,” he said.
Liz Mahan, a physician recruitment advisor with the Association for Advancing Physician and Provider Recruitment, said many of her organization’s members are seeing an increase in the number of candidates looking for jobs. “Someone who really wanted to be in private practice or in a specific area may have to think about opening up the search to being in an employed practice, at least for the interim, or considering another location,” she said.
Stephanie Cajigal is a freelance writer based in Los Angeles.