Hi everyone, it’s Medicine Mondays again. Today I’m going to attempt to recreate my “Experience Matters” post that I lost a few weeks ago.

Stock Photo from: Pixabay

Experience Matters? Well of course it does!

Well, you may not be thinking of it in the same way I am. Obviously, a novice just starting his trade will not nearly be as confident or have the technical skill as a master who has been doing it for years. This is of course probably similar for a young attending fresh out of fellowship versus a battle-hardened attending with 10 years experience.

You would be right if you considered the above. However, that is not the kind of experience I am talking about today.

What do you mean?

I’m talking about a different kind of experience, in the context of being a fresh young attending. The best way to explain this is an example:

The year is 2013, young Sensei is a bright-eyed neuroradiology fellow looking for a new job for when he finishes fellowship in July. For those who don’t know, the radiology job market has been pretty tight the last 6 or 7 years, from around 2010-2016 or so. This pushed many radiology residents to do fellowships in order to “buy time” before venturing out into their first job.

I gave a lot of thought as to why this happened. I think a lot of things factored into the tight job market. The stock market crash of 2008 made many radiology attendings on the verge of retirement “hang on” for a few more years so their retirement nest eggs could recover. This closure of potential openings created downward pressure on the job market. There was less job openings which allowed recruiters/employers to be more picky with regards to candidates. This hit the residents/fellows especially hard, forcing some into fellowships (or even 2nd/3rd fellowships) in hopes that the job market would get better.

For me, it’s 2013, right in the middle of this time.

Even after applying to virtually all the job posts on the ACR Career Center, job interviews had been hard to come by and pickings had been slim. It was extremely difficult and I was very lucky to land my first job at a nice little private practice group in Rhode Island. Some of my other friends did not fair as well as me. Some were forced to take less than optimal jobs (night jobs with poor pay, no stability, poor benefits, and high burnout).

So I started my first job and everything was great. I went to work everyday and worked hard. I developed good rapport with the other clinicians and ancillary staff. All in all, I felt that I was well-liked by everyone and I’d be up for partnership without a problem soon enough.  Unfortunately, that was not to be. My little community hospital merged (read: was bought out) by a larger hospital group. This hospital group already had its own (larger) radiology group which covered them. This would effectively displace my radiology group (read: we’re out of a job).

Wow.

I started the job in July and this news came in September. I remember that it was a Monday. My last day would be the end of March. So, I came home and brushed off my still relatively updated CV, added my work experience from July until September and hit the ACR Career Center again. After my experience the prior year I was expecting more of the same. The possibility of not having another job lined up after my last day at my current job weighed heavily on my mind.

So what happened?

I got interviews.

I mean, it wasn’t like a ton, but it was significantly more than when I was a fellow.

Why? What had changed?

Experience.

What!!? Your 2 months of experience mattered?

Yup.

I’ve thought about this a lot, so let me try to explain a bit more.

When I was a fellow, I had essentially the same credentials as every other fellow coming out. The other thing that was slightly different was that I will have completed a neuroradiology fellowship. Ahead of me there was a lot of other radiologists who already had experience. They had worked nighthawk, or been with another private practice group, or hospital system or whatever.

So for me, and the other fellows, our professional references look like this:

• John Smith, MD –  Fellowship Director of Ivory Tower University
• Jane Jones, MD – Program Director of Big Name University
• Paul Shoemaker, MD – Neuroradiology Attending of Ivory Tower University

While that may seem nice to us fellows, to the people in the real world, this reads as one thing. This person has NO WORK EXPERIENCE.

Your work experience and recommendations are derived from your professional references. The most important thing on your CV when looking for your job are your professional references. When it comes down to it, after the schooling and tests and the paperwork, everyone applying for a job has an MD, DO, or MBBS or whatever behind their name and graduated from some residency/fellowship. As an aside, if you are going into academics, then of course, your prior research will matter. However, for the most part, what distinguishes you from the rest are your professional references. 

It means something.

If you list me as a professional reference then that means I will vouch for you. I am putting my reputation on the line to say that John Smith or Jane Jones, or whoever is a good doctor, good radiologist — good person. This is not something I do for everyone because my reputation is at stake.

If I was to recommend someone, and on my recommendation, was hired, then I’m responsible for that hire. Not legally responsible, but you know what I mean. Let’s say I recommend Jack Smith, MD and he gets the job. Then for some reason, he has to leave that group unexpectedly on bad terms. 

Will my recommendation mean anything to this group anymore? Probably not.

This is an important point. When you list someone as your professional reference, you have a duty to them as well. You shouldn’t burn your bridges, even if to you it’s only a Temporary First Job. A job is still a job, even if it was temporary to you. You should always keep the well-being of your colleagues in mind.

As a physician, “two weeks notice” doesn’t exist. You should do your best to give your employer time to hire (and credential) your replacement.

Wait a second… didn’t you have professional references from your residency/fellowship?

Yes, they looked like that list up there. However, it’s not the same.

References from your residency and fellowship don’t carry the same clout as ones from work experience.

The reason for this is pretty simple. Your attendings as a fellow or a resident don’t work with you side by side everyday. Even if they do spend a lot of time with you, it is more of a mentor/protegé relationship rather than a colleague relationship.

You need to trade on your own name.

^ Just like Linus needs to trade on his.

This happens as soon as you start your first real job. As soon as you step foot into your first job, you are trading on your own name. You are now on a different playing field than all the other residents/fellows in the world. The professional references you have from this job are important.

More so than that, your co-residents and co-fellows will also have moved on in the world, into their first jobs. They are also now important professional references to you. As a resident/fellow, their references didn’t mean anything. However, as soon as they stepped foot into their first jobs, they are legitimate professional references as well.

But I thought you said professional references from residency/fellowship don’t mean anything?

No, I said, the ones from your attendings during residency/fellowship don’t carry the same clout.

Once you leave residency/fellowship, your prior co-residents and co-fellows are now your colleagues, who have worked alongside you before, and are now working as attending themselves.

They mean something.

Why is it so different?

Well, the best way I can explain it is using the title of a book:

Your first job after finishing residency/fellowship is like going from Zero to One. The idea is that going from training to your first job is creating something. You are going from Zero Experience to Some (One) Experience. The difference of Zero to One is infinite, going from nothing to something, it’s like trying to do the impossible.

On the other hand, going from 1 to x is significantly easier. You are going from something to something else.

So, in this analogy:

Zero to One is me finding my first job during fellowship.

1 to x is me finding my second job after my first job.

By the way, it’s a great book about startups from Peter Thiel. It’s easy to read and I’d recommend everyone read it:

Well, what about now?

Well. Now I’m at my 2nd job and I’m a little more than three years in. I really like my job and don’t see myself going anywhere.

In the unlikely event that I need to change jobs, I do have pretty significant work experience now. Also, I have professional references all around the United States from my old co-residents/co-fellows/colleagues. Additionally, the job market itself seems to be doing better than it was. I still talk to some of my younger co-residents and so I have a pretty good idea of how things are going.

Here’s the latest Merritt Hawkins survey (A recruiting agency). Scroll down to page 7 and you’ll see a trend toward increasing recruitment for radiologists. While not definitive, this correlates with my own feeling that the radiology job market is getting better. Also read page 30 about “Radiology Continues Its Comeback”. This piece seems a kind of “fluffy” for me, but I agree, for the most part.

However, one thing that has not changed is that smaller groups (<10 people) are still at risk for being swallowed up bigger groups (>40) and hospital systems. Be careful out there.

Click to Enlarge

TL;DR

Experience Matters… but maybe not in the way you’re thinking.

You need to trade on your own name – Like Linus.

Your professional references are your work experience, treat them as such.

Anyone you list as a professional reference is staking their reputation on you.

You have a duty to them as well to make sure you don’t leave a job on bad terms.

Zero to One is an infinite difference. 1 to x, while potentially large, is still finite.

Radiology’s job market is doing better.

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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