The Journal of Emergency Medicine, Vol. -, No. -, pp. 1–7, 2013 Copyright Ó 2013 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter
http://dx.doi.org/10.1016/j.jemermed.2013.08.105
Administration of Emergency Medicine
A SURVEY OF ACADEMIC EMERGENCY MEDICINE DEPARTMENT CHAIRS ON HIRING NEW ATTENDING PHYSICIANS Ryan D. Aycock, MD, MS,* Moshe Weizberg, MD,* Barry Hahn, MD,* Kera F. Weiserbs, PHD,† and Brahim Ardolic, MD* *Department of Emergency Medicine, and †Department of Academic Affairs, Staten Island University Hospital, Staten Island, New York Reprint Address: Ryan D. Aycock, MD, MS, Department of Emergency Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305
, Keywords—job application; employment; internship and residency; personnel selection; organization and administration
, Abstract—Background: For graduating emergency medicine (EM) residents, little information exists as to what attributes department chairs are seeking in hiring new attendings. Study Objectives: To determine which qualities academic EM department chairs are looking for when hiring a new physician directly out of residency or fellowship. Methods: An anonymous 15-item Web-based survey was sent to the department chairs of all accredited civilian EM residency programs in March of 2011. The questions assessed the desirability of different candidate attributes and the difficulty in recruiting EM-trained physicians. Respondents were also asked to give the current number of available job openings. Results: Fifty-five percent of eligible department chairs responded. On a 5point scale, the most important parts of a candidate’s application were the interview (4.8 ± 0.4), another employee’s recommendation (4.7 ± 0.5), and the program director’s recommendation (4.5 ± 0.7). The single most important attribute possessed by a candidate was identified as ‘‘Ability to work in a team,’’ with 58% of respondents listing it as their top choice. Advanced training in ultrasound was listed as the most sought-after fellowship by 55% of the chairs. Overall, department chairs did not have a difficult time in recruiting EM-trained physicians, with 56% of respondents stating that they had no current job openings. Conclusion: How a physician relates to others was consistently rated as the most important part of the candidate’s application. However, finding a job in academic EM is difficult, with graduates having limited job prospects. Ó 2013 Elsevier Inc.
INTRODUCTION Several resources are currently available to guide applicants on how to gain acceptance into medical school and residency. To advise applicants seeking to match into emergency medicine (EM) residency programs, authors have interviewed program directors and faculty to determine which factors are most important in selecting new residents (1,2). Similar guides exist for program directors providing information on which candidate attributes correlate with successful choices (3,4). However, for graduating residents seeking a position as an attending physician, there is a paucity of information on what attributes emergency department (ED) chairs are seeking. A search strategy on PubMed using (‘‘emergency medicine’’ OR ‘‘emergency physician’’) AND (employment OR job OR hiring OR position) demonstrates that the only available literature consists of either interviews with single decision-makers regarding what characteristics they look for in selecting new candidates at a single institution, or personal narratives with unsubstantiated claims (5–7). This information may not be generalizable to other EDs or other geographic locations, leaving
RECEIVED: 5 March 2013; FINAL SUBMISSION RECEIVED: 7 August 2013; ACCEPTED: 18 August 2013 1
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graduating residents with insufficient guidance when applying for their first job after graduation. If graduating residents know what prospective employers are looking for in attending candidates, they will be able to more strategically plan their job search and application, and may be in a better position to decide whether or not to pursue a job in academics. In addition, this information would allow residency directors to design their programs to make their graduates more competitive in the marketplace. This study seeks to determine what criteria academic department chairs look for when hiring new attendings directly out of residency or fellowship. MATERIALS AND METHODS We conducted an anonymous, online survey of all academic EM department chairs in the United States (US) between March 1, 2011 and April 30, 2011. No incentives were offered. The Institutional Review Board of our hospital approved this study. All 153 accredited nonmilitary, US emergency medicine residency programs were identified using the American Medical Association’s FREIDA database (8). Our home institution was excluded from this study, as our chair is a co-author, leaving 152 eligible respondents. No power analysis was calculated, as the entire study population was included. FREIDA, the Association of Academic Chairs of Emergency Medicine, as well as individual department Web sites, were searched for e-mail addresses for all department chairs (9). Individualized e-mails were then sent to each chair in March of 2011, with a link to the Web site of the survey (www.surveymonkey.com). In cases where contact information could not be located, the residencies’ program coordinators were e-mailed and asked to forward the link to the department chair. A follow-up e-mail was sent in April to encourage chairpersons who had not replied to take the survey. This subsequent mailing included a prompt to prevent initial respondents from filling out the survey a second time. The survey was built for a larger project to assess the hiring landscape of all American EDs, both academic and community. It is a Web-based 15-item questionnaire that inquires about hospital demographics and factors that might influence hiring decisions. The survey was created by two emergency physicians (R.D.A. and M.W.) after identifying four domains that were perceived to be important during the hiring process: gathering information from the applicant (i.e., the interview), gathering information from others (e.g., recommendations), the location where the candidate trained, and the broad category of additional candidate attributes such as fellowship training, productivity, and personality. It was critically re-
viewed by a group of emergency physicians, including our institution’s department chair. Based on this initial assessment, further revisions and modifications were instituted. The candidate attributes section uses a 5-point Likert scale to determine which elements the respondent considers important when hiring a new attending physician. Chairs were also asked to give the current number of job openings, to rank candidate attributes, and to list sought-after fellowships. Free text responses were allowed for these last two questions. A list of all of the EM fellowships currently accredited by the Accreditation Council for Graduate Medical Education (ACGME) was listed for convenience. We also listed subspecialties that are currently on track to receive accreditation (e.g., emergency medical services). Although not accredited, ultrasound was included due to its high number of fellowships. The survey is included as an Appendix. Data were compiled and analyzed using Microsoft Excel 2007 (Microsoft, Inc., Redmond, WA). For items using a Likert scale, a weighted average was calculated, along with the standard deviation. RESULTS Surveys were sent to all of the nation’s 152 department chairs. We received 84 responses, giving a response rate of 55%. Table 1 shows how chairs ranked the importance of various elements of the application, where 1 represents ‘‘Not at all important’’ and 5 represents ‘‘Extremely important.’’ SDs are given to demonstrate consistency. When asked to rate the difficulty in hiring an EMtrained physician in their area on a scale from 1 to 5, the mean result was 2.5 6 1.3. Thirty-five chairpersons cited at least one job opening: two chairs noted that they had more than six positions available, four had three to six spots available, and 29 had one to two job openings. Forty-five respondents (56%) denied having any open positions. Four did not respond to this question. We asked, ‘‘What three attributes (in order) would you say are the most important qualities for a new hire to possess?’’ Respondents could choose from a list or write in an answer. Eighty-one responses were received. The results are ranked and listed in Figure 1. When asked to list any fellowships they seek when hiring new attending physicians, 67 (80%) of the chairs responded. More than one choice could be selected. The results are ranked and listed in Figure 2. DISCUSSION Our results suggest that EM department chairs consider subjective impressions of applicants as the most
Survey on Hiring New Attendings
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Table 1. Ranked Importance of Elements of the Application Application Element
Mean
SD
Range
Interview Recommendation from a current employee Program director’s recommendation Reputation of residency program Completing a 3- or 4-year program
4.79 4.70
0.41 0.52
4–5 3–5
4.54 3.80 2.78
0.67 0.71 1.46
1–5 1–5 1–5
SD = standard deviation. Key: 1 = Not at all important; 5 = Extremely important.
important features of a candidate’s application, with the interview, a current employee’s recommendation, and the program director’s recommendation averaging > 4.5 on a 5-point scale. These data are consistent with results obtained from other academic and business studies (1,10,11). The way a physician relates to others carries a tremendous impact on hireability. Indeed, department chairs ranked ‘‘Ability to work in a team’’ as the single most important attribute a candidate must possess, selecting it five times as often as ‘‘Clinical productivity’’ as their top choice. On the other hand, the residency program graduated from carries less weight. The program’s reputation was viewed with neutral importance, whereas completing a 3- vs. 4-year program was seen as not important. However, the question of a 3- vs. 4-year program had the largest SD, reflecting a wide variance in opinions. We did not ask respondents whether their program was 3 or 4 years, possibly affecting their response to this question. Beyond teamwork and clinical productivity, department chairs at academic facilities rated teaching, publishing, research, and fellowship training as important attributes for candidates to possess. These qualities fall in line with the goals of residency programs to train the next generation of emergency physicians (6).
Figure 1. The three most important attributes that a candidate must possess, as a percentage. Write-in responses included ‘‘Attitude’’ (n = 1), ‘‘Personality’’ (n = 1), ‘‘Emotional intelligence’’ (n = 1), ‘‘Commitment to an academic career’’ (n = 1), ‘‘Nonclinical productivity’’ (n = 1), clinical effectiveness (n = 2), and filling a niche (n = 2).
Figure 2. Preferred fellowships, as a percentage. Write-in responses included research (n = 7), administration (n = 1), evidence-based medicine (n = 1), education (n = 1), geriatrics (n = 1), ‘‘All’’ (n = 1), ‘‘None’’ (n = 1), and ‘‘It depends’’ (n = 8). EM = emergency medicine; EMS = emergency medical services.
In our study sample, academic programs did not report having difficulty in finding EM-trained physicians. The majority of respondents stated that they had no positions available. If the responses are considered similar across the country, several observations can be made about the competitiveness of securing an academic job after residency. The answer choices available for the number of job openings were 1–2, 3–6, and > 6. Given this range of choices, there would be 55–96 job openings among these 80 locations. If we extrapolate to the 152 civilian EM residency programs in the country, there would be 109–182 total available positions. The 2009 National Residency Match Program listed 1515 first-year positions in EM (12). Physicians entering residency in 2009 would have been starting their third year of training as the survey was completed and were gearing up for their first job. If there were only 109–182 academic job openings available, then only 6.9–12% of graduates in 2012 would have been able to secure one of these positions. Given that 26% of graduates in one recent survey mentioned a desire to stay in academics, the limited number of vacancies means that most of them would not have had a position available (13). Combined programs (e.g., emergency medicine-internal medicine) were excluded from these calculations. Ultrasound was the most popular fellowship choice among chairmen, consistent with the growing number of fellowship programs. The Web site Emergency Ultrasound Fellowships currently lists 87 programs that offer advanced training in this field (14). This amount is greater than the number of any ACGME-accredited EM fellowships (8). Sports medicine, hospice, and hyperbaric medicine were the least sought-after subspecialties. The number of free text responses that listed ‘‘research’’ totaled more than any of these. If research had been listed among the other fellowships with its own checkbox, it may have gathered more votes. As residency programs
4
are tasked with the responsibility of training future clinicians, an important aspect of that education includes guidance on evaluating the currently available literature. Further, the Residency Review Committee mandates that residents participate in a scholarly activity (15). Academic departments may benefit from a research-trained physician who can teach critical appraisal and research methodology (16).
R. D. Aycock et al.
preferences of many department chairs, graduates should pursue an academic career due to interest in a specific pursuit and not to satisfy the perceived preferences of department chairs. Any conclusions derived from this study should only reflect the hiring preferences of academic EDs and not community hospitals. CONCLUSIONS
Limitations This study has several limitations. It was not pilot tested due to the small population size. It was designed by the authors based on notions of important applicant attributes, and then edited after receiving feedback from our chairman and other emergency physicians not affiliated with this research project. Other readers of this article could argue to add or remove questions based upon their own specific desires to know what department chairs are looking for. Additionally, the survey was originally created for use as a larger research project on hiring first-time attending physicians among both community and academic hospitals. We decided to target the academic chairs first. The demographic information such as what percent of the hospitals are classified as residing in urban centers is not produced here, and may not be as useful to applicants as finding a teaching/research position. The two most desirable attributes for candidates were ‘‘Ability to work in a team’’ and ‘‘Clinical productivity,’’ which were also the first two menu items for the survey due to their alphabetical position. The frequency of citations may be due to coincidence of location instead of true desire, as no repeat questions (test-retest internal validity) were used in constructing this survey. Just over half of the eligible academic department chairs in the country responded, meaning that the results of the survey may not necessarily be generalizable to the other 45%. Further, all surveys are inherently prone to self-reporting bias. As the survey was anonymous, no attempts were made to validate the responses, such as number of job openings or ED size. Possible unmeasured confounders may have affected survey responses, such as chairs looking to fill particular demographic niches (female, minorities, junior vs. senior faculty, researchers vs. educators), the availability of job applicants who were not recent residency graduates, the size of each program’s faculty, the percentage of new hires from a programs’ own residency graduate pool, and whether respondents had three- or four-year residency programs. This survey did not look at job searches from the candidate’s point of view. We realize that there are many factors that determine whether a new attending is a good fit, such as location and departmental opportunities. Although the information presented here gives the hiring
Our study represents an investigation into hiring preferences using a large cohort of academic EM department chairs. The way the physician relates to others was consistently cited as the most important element of the application, as reflected in the high importance given to the interview, recommendations, and selecting ‘‘Ability to work in a team’’ as the single most important attribute. Other qualities important to academic programs related to teaching, research, and sub-specialty training. The job market in academics remains tight, with only 6–12% of graduating residents likely to obtain one of the few open positions. REFERENCES 1. Crane JT, Ferraro CM. Selection criteria for emergency medicine residency applicants. Acad Emerg Med 2000;7:54–60. 2. Blouin D, Dagnone JD. Performance criteria for emergency medicine residents: a job analysis. CJEM 2008;10:539–44. 3. Hayden SR, Hayden M, Gamst A. What characteristics of applicants to emergency medicine residency programs predict future success as an emergency medicine resident? Acad Emerg Med 2005; 12:206–10. 4. Thundiyil JG, Modica RF, Silvestri S, et al. Do United States Medical Licensing Examination (USMLE) scores predict in-training test performance for emergency medicine residents? J Emerg Med 2010;38:65–9. 5. Lee S. Finding a community job in emergency medicine: advice for residents. CAL/AAEM Newsletter 2010;11:3–4. 6. Stern S. Fellowship training: a necessity in today’s academic world. Acad Emerg Med 2002;9:713–6. 7. Simon HK, Linakis JG, Anderson AC, et al. Obtaining a faculty position in academic emergency medicine. Pediatr Emerg Care 1997;13:130–3. 8. American Medical Association (AMA). FREIDA Online. Available at: http://www.ama-assn.org/ama/pub/education-careers/graduatemedical-education/freida-online.page. Accessed March 1, 2011. 9. Society for Academic Emergency Medicine (SAEM). Association of Academic Chairs of Emergency Medicine. Available at: http:// www.saem.org/SAEMDNN/Default.aspx?tabid=560. Accessed March 1, 2011. 10. Blouin D. Reliability of a structured interview for admission to an emergency medicine residency program. Teach Learn Med 2010; 22:246–50. 11. Tolan T. First impressions matter especially in an interview. Six common mistakes hiring managers should avoid in their search for the best talent. Healthc Inform 2011;28:48. 12. The Match: National Resident Matching Program. Results and data: 2009 main residency match. Available at: http://www.nrmp.org/ data/resultsanddata2009.pdf. Accessed May 28, 2011. 13. Burkhardt J, Kowalenko T, Meurer W. Academic career selection in American emergency medicine residents. Acad Emerg Med 2011; 18(Suppl 2):S48–53.
Survey on Hiring New Attendings 14. EUS Fellowship Programs. Emergency ultrasound fellowships. Available at: http://www.eusfellowships.com/programs.php. Accessed July 21, 2013. 15. Accreditation Council for Graduate Medical Education (ACGME). ACGME program requirements for graduate medical education in emergency medicine. Available at: http://www.acgme.org/ acWebsite/downloads/RRC_progReq/ 110emergencymed07012007.pdf. Accessed June 21, 2011. 16. Blanda M, Gerson LW, Dunn K. Emergency medicine resident research requirements and director characteristics. Acad Emerg Med 1999;6:286–91.
APPENDIX: THE SURVEY This survey’s goal is to assess the attributes that emergency medicine department chairs and hiring managers are looking for when hiring new attendings directly from residency or fellowship. Please fill this survey out only if you are in a position to make hiring decisions. Is your emergency department an academic or community program?
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25 – 49 10 – 24 < 10 How many visits did your emergency department have in 2010?
$ 100,000 75,000 – 99,999 50,000 – 74,999 25,000 – 49,000 15,000 – 24,999 < 15,000
Thinking about potential hires that you do not know personally, what value do you place on the program director’s written or verbal recommendation?
Academic (i.e., supporting a residency program, either as primary site or rotation) Non-academic, community
How would you describe your group?
What value do you place on the interview?
> 6 sites 2-6 sites Solo site, democratic Solo site, non-democratic Hospital employee
How would you describe your hospital’s location? Urban Suburban Rural What is the population size of your hospital’s catchment area?
$ 1 million 500,000 – 999,999 200,000 – 499,999 < 200,000
How many total beds does your hospital have?
$ 750 500 – 749 250 – 499 100 – 249 < 100
How many beds does your emergency department have? Include an urgent care center or fast track if it is integrated into your triage. $ 75 50 – 74
Extremely important Somewhat important Neutral Not really important Not important at all
Extremely important Somewhat important Neutral Not really important Not important at all
What value do you place on your perceived reputation of the candidate’s residency program?
Extremely important Somewhat important Neutral Not really important Not important at all
What value do you place on a recommendation from one of your current employees?
Extremely important Somewhat important Neutral Not really important Not important at all
Does attending a 3- or 4-year program have an impact on your hiring decision?
Extremely important Somewhat important Neutral Not really important Not important at all
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In your area, how would you describe the difficulty in recruiting EM-trained physicians?
Extremely difficult Somewhat difficult Neutral Not really difficult Not difficult at all
How many job openings are there at your location?
$6 3-6 1-2 None
What three attributes (in order) would you say are the most important qualities for a new hire to possess? Ability to work in a team Clinical productivity Comfort with critical care
Comfort with pediatrics Fellowship-trained In-service exam scores Personally known to the chair or hiring manager Research potential Substantial publications Teaching potential Other: If there are any fellowships that you look particularly favorable upon when making hiring decisions, please select them below. Critical care Emergency Medical Services Hospice and Palliative Medicine Medical Toxicology Pediatric Emergency Medicine Sports Medicine Ultrasound Undersea and Hyperbaric Medicine Other:
Survey on Hiring New Attendings
ARTICLE SUMMARY 1. Why is this topic important? There is limited information available to graduating emergency medicine residents regarding what attributes department chairs are seeking in hiring new attendings. 2. What does this study attempt to show? If residents know what prospective employers are looking for, they will be able to more strategically plan their job search and application. 3. What are the key findings? How a physician relates to others is consistently seen as the most important part of the candidate’s application. In addition, 56% of department chairs mentioned that they had no current job openings, indicating that job prospects are limited in academics. 4. How is patient care impacted? Residents who desire to go into the competitive field of academics will be a better fit.
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http://dx.doi.org/10.1016/j.jemermed.2013.08.105
Administration of Emergency Medicine
A SURVEY OF ACADEMIC EMERGENCY MEDICINE DEPARTMENT CHAIRS ON HIRING NEW ATTENDING PHYSICIANS Ryan D. Aycock, MD, MS,* Moshe Weizberg, MD,* Barry Hahn, MD,* Kera F. Weiserbs, PHD,† and Brahim Ardolic, MD* *Department of Emergency Medicine, and †Department of Academic Affairs, Staten Island University Hospital, Staten Island, New York Reprint Address: Ryan D. Aycock, MD, MS, Department of Emergency Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305
, Keywords—job application; employment; internship and residency; personnel selection; organization and administration
, Abstract—Background: For graduating emergency medicine (EM) residents, little information exists as to what attributes department chairs are seeking in hiring new attendings. Study Objectives: To determine which qualities academic EM department chairs are looking for when hiring a new physician directly out of residency or fellowship. Methods: An anonymous 15-item Web-based survey was sent to the department chairs of all accredited civilian EM residency programs in March of 2011. The questions assessed the desirability of different candidate attributes and the difficulty in recruiting EM-trained physicians. Respondents were also asked to give the current number of available job openings. Results: Fifty-five percent of eligible department chairs responded. On a 5point scale, the most important parts of a candidate’s application were the interview (4.8 ± 0.4), another employee’s recommendation (4.7 ± 0.5), and the program director’s recommendation (4.5 ± 0.7). The single most important attribute possessed by a candidate was identified as ‘‘Ability to work in a team,’’ with 58% of respondents listing it as their top choice. Advanced training in ultrasound was listed as the most sought-after fellowship by 55% of the chairs. Overall, department chairs did not have a difficult time in recruiting EM-trained physicians, with 56% of respondents stating that they had no current job openings. Conclusion: How a physician relates to others was consistently rated as the most important part of the candidate’s application. However, finding a job in academic EM is difficult, with graduates having limited job prospects. Ó 2013 Elsevier Inc.
INTRODUCTION Several resources are currently available to guide applicants on how to gain acceptance into medical school and residency. To advise applicants seeking to match into emergency medicine (EM) residency programs, authors have interviewed program directors and faculty to determine which factors are most important in selecting new residents (1,2). Similar guides exist for program directors providing information on which candidate attributes correlate with successful choices (3,4). However, for graduating residents seeking a position as an attending physician, there is a paucity of information on what attributes emergency department (ED) chairs are seeking. A search strategy on PubMed using (‘‘emergency medicine’’ OR ‘‘emergency physician’’) AND (employment OR job OR hiring OR position) demonstrates that the only available literature consists of either interviews with single decision-makers regarding what characteristics they look for in selecting new candidates at a single institution, or personal narratives with unsubstantiated claims (5–7). This information may not be generalizable to other EDs or other geographic locations, leaving
RECEIVED: 5 March 2013; FINAL SUBMISSION RECEIVED: 7 August 2013; ACCEPTED: 18 August 2013 1
2
R. D. Aycock et al.
graduating residents with insufficient guidance when applying for their first job after graduation. If graduating residents know what prospective employers are looking for in attending candidates, they will be able to more strategically plan their job search and application, and may be in a better position to decide whether or not to pursue a job in academics. In addition, this information would allow residency directors to design their programs to make their graduates more competitive in the marketplace. This study seeks to determine what criteria academic department chairs look for when hiring new attendings directly out of residency or fellowship. MATERIALS AND METHODS We conducted an anonymous, online survey of all academic EM department chairs in the United States (US) between March 1, 2011 and April 30, 2011. No incentives were offered. The Institutional Review Board of our hospital approved this study. All 153 accredited nonmilitary, US emergency medicine residency programs were identified using the American Medical Association’s FREIDA database (8). Our home institution was excluded from this study, as our chair is a co-author, leaving 152 eligible respondents. No power analysis was calculated, as the entire study population was included. FREIDA, the Association of Academic Chairs of Emergency Medicine, as well as individual department Web sites, were searched for e-mail addresses for all department chairs (9). Individualized e-mails were then sent to each chair in March of 2011, with a link to the Web site of the survey (www.surveymonkey.com). In cases where contact information could not be located, the residencies’ program coordinators were e-mailed and asked to forward the link to the department chair. A follow-up e-mail was sent in April to encourage chairpersons who had not replied to take the survey. This subsequent mailing included a prompt to prevent initial respondents from filling out the survey a second time. The survey was built for a larger project to assess the hiring landscape of all American EDs, both academic and community. It is a Web-based 15-item questionnaire that inquires about hospital demographics and factors that might influence hiring decisions. The survey was created by two emergency physicians (R.D.A. and M.W.) after identifying four domains that were perceived to be important during the hiring process: gathering information from the applicant (i.e., the interview), gathering information from others (e.g., recommendations), the location where the candidate trained, and the broad category of additional candidate attributes such as fellowship training, productivity, and personality. It was critically re-
viewed by a group of emergency physicians, including our institution’s department chair. Based on this initial assessment, further revisions and modifications were instituted. The candidate attributes section uses a 5-point Likert scale to determine which elements the respondent considers important when hiring a new attending physician. Chairs were also asked to give the current number of job openings, to rank candidate attributes, and to list sought-after fellowships. Free text responses were allowed for these last two questions. A list of all of the EM fellowships currently accredited by the Accreditation Council for Graduate Medical Education (ACGME) was listed for convenience. We also listed subspecialties that are currently on track to receive accreditation (e.g., emergency medical services). Although not accredited, ultrasound was included due to its high number of fellowships. The survey is included as an Appendix. Data were compiled and analyzed using Microsoft Excel 2007 (Microsoft, Inc., Redmond, WA). For items using a Likert scale, a weighted average was calculated, along with the standard deviation. RESULTS Surveys were sent to all of the nation’s 152 department chairs. We received 84 responses, giving a response rate of 55%. Table 1 shows how chairs ranked the importance of various elements of the application, where 1 represents ‘‘Not at all important’’ and 5 represents ‘‘Extremely important.’’ SDs are given to demonstrate consistency. When asked to rate the difficulty in hiring an EMtrained physician in their area on a scale from 1 to 5, the mean result was 2.5 6 1.3. Thirty-five chairpersons cited at least one job opening: two chairs noted that they had more than six positions available, four had three to six spots available, and 29 had one to two job openings. Forty-five respondents (56%) denied having any open positions. Four did not respond to this question. We asked, ‘‘What three attributes (in order) would you say are the most important qualities for a new hire to possess?’’ Respondents could choose from a list or write in an answer. Eighty-one responses were received. The results are ranked and listed in Figure 1. When asked to list any fellowships they seek when hiring new attending physicians, 67 (80%) of the chairs responded. More than one choice could be selected. The results are ranked and listed in Figure 2. DISCUSSION Our results suggest that EM department chairs consider subjective impressions of applicants as the most
Survey on Hiring New Attendings
3
Table 1. Ranked Importance of Elements of the Application Application Element
Mean
SD
Range
Interview Recommendation from a current employee Program director’s recommendation Reputation of residency program Completing a 3- or 4-year program
4.79 4.70
0.41 0.52
4–5 3–5
4.54 3.80 2.78
0.67 0.71 1.46
1–5 1–5 1–5
SD = standard deviation. Key: 1 = Not at all important; 5 = Extremely important.
important features of a candidate’s application, with the interview, a current employee’s recommendation, and the program director’s recommendation averaging > 4.5 on a 5-point scale. These data are consistent with results obtained from other academic and business studies (1,10,11). The way a physician relates to others carries a tremendous impact on hireability. Indeed, department chairs ranked ‘‘Ability to work in a team’’ as the single most important attribute a candidate must possess, selecting it five times as often as ‘‘Clinical productivity’’ as their top choice. On the other hand, the residency program graduated from carries less weight. The program’s reputation was viewed with neutral importance, whereas completing a 3- vs. 4-year program was seen as not important. However, the question of a 3- vs. 4-year program had the largest SD, reflecting a wide variance in opinions. We did not ask respondents whether their program was 3 or 4 years, possibly affecting their response to this question. Beyond teamwork and clinical productivity, department chairs at academic facilities rated teaching, publishing, research, and fellowship training as important attributes for candidates to possess. These qualities fall in line with the goals of residency programs to train the next generation of emergency physicians (6).
Figure 1. The three most important attributes that a candidate must possess, as a percentage. Write-in responses included ‘‘Attitude’’ (n = 1), ‘‘Personality’’ (n = 1), ‘‘Emotional intelligence’’ (n = 1), ‘‘Commitment to an academic career’’ (n = 1), ‘‘Nonclinical productivity’’ (n = 1), clinical effectiveness (n = 2), and filling a niche (n = 2).
Figure 2. Preferred fellowships, as a percentage. Write-in responses included research (n = 7), administration (n = 1), evidence-based medicine (n = 1), education (n = 1), geriatrics (n = 1), ‘‘All’’ (n = 1), ‘‘None’’ (n = 1), and ‘‘It depends’’ (n = 8). EM = emergency medicine; EMS = emergency medical services.
In our study sample, academic programs did not report having difficulty in finding EM-trained physicians. The majority of respondents stated that they had no positions available. If the responses are considered similar across the country, several observations can be made about the competitiveness of securing an academic job after residency. The answer choices available for the number of job openings were 1–2, 3–6, and > 6. Given this range of choices, there would be 55–96 job openings among these 80 locations. If we extrapolate to the 152 civilian EM residency programs in the country, there would be 109–182 total available positions. The 2009 National Residency Match Program listed 1515 first-year positions in EM (12). Physicians entering residency in 2009 would have been starting their third year of training as the survey was completed and were gearing up for their first job. If there were only 109–182 academic job openings available, then only 6.9–12% of graduates in 2012 would have been able to secure one of these positions. Given that 26% of graduates in one recent survey mentioned a desire to stay in academics, the limited number of vacancies means that most of them would not have had a position available (13). Combined programs (e.g., emergency medicine-internal medicine) were excluded from these calculations. Ultrasound was the most popular fellowship choice among chairmen, consistent with the growing number of fellowship programs. The Web site Emergency Ultrasound Fellowships currently lists 87 programs that offer advanced training in this field (14). This amount is greater than the number of any ACGME-accredited EM fellowships (8). Sports medicine, hospice, and hyperbaric medicine were the least sought-after subspecialties. The number of free text responses that listed ‘‘research’’ totaled more than any of these. If research had been listed among the other fellowships with its own checkbox, it may have gathered more votes. As residency programs
4
are tasked with the responsibility of training future clinicians, an important aspect of that education includes guidance on evaluating the currently available literature. Further, the Residency Review Committee mandates that residents participate in a scholarly activity (15). Academic departments may benefit from a research-trained physician who can teach critical appraisal and research methodology (16).
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preferences of many department chairs, graduates should pursue an academic career due to interest in a specific pursuit and not to satisfy the perceived preferences of department chairs. Any conclusions derived from this study should only reflect the hiring preferences of academic EDs and not community hospitals. CONCLUSIONS
Limitations This study has several limitations. It was not pilot tested due to the small population size. It was designed by the authors based on notions of important applicant attributes, and then edited after receiving feedback from our chairman and other emergency physicians not affiliated with this research project. Other readers of this article could argue to add or remove questions based upon their own specific desires to know what department chairs are looking for. Additionally, the survey was originally created for use as a larger research project on hiring first-time attending physicians among both community and academic hospitals. We decided to target the academic chairs first. The demographic information such as what percent of the hospitals are classified as residing in urban centers is not produced here, and may not be as useful to applicants as finding a teaching/research position. The two most desirable attributes for candidates were ‘‘Ability to work in a team’’ and ‘‘Clinical productivity,’’ which were also the first two menu items for the survey due to their alphabetical position. The frequency of citations may be due to coincidence of location instead of true desire, as no repeat questions (test-retest internal validity) were used in constructing this survey. Just over half of the eligible academic department chairs in the country responded, meaning that the results of the survey may not necessarily be generalizable to the other 45%. Further, all surveys are inherently prone to self-reporting bias. As the survey was anonymous, no attempts were made to validate the responses, such as number of job openings or ED size. Possible unmeasured confounders may have affected survey responses, such as chairs looking to fill particular demographic niches (female, minorities, junior vs. senior faculty, researchers vs. educators), the availability of job applicants who were not recent residency graduates, the size of each program’s faculty, the percentage of new hires from a programs’ own residency graduate pool, and whether respondents had three- or four-year residency programs. This survey did not look at job searches from the candidate’s point of view. We realize that there are many factors that determine whether a new attending is a good fit, such as location and departmental opportunities. Although the information presented here gives the hiring
Our study represents an investigation into hiring preferences using a large cohort of academic EM department chairs. The way the physician relates to others was consistently cited as the most important element of the application, as reflected in the high importance given to the interview, recommendations, and selecting ‘‘Ability to work in a team’’ as the single most important attribute. Other qualities important to academic programs related to teaching, research, and sub-specialty training. The job market in academics remains tight, with only 6–12% of graduating residents likely to obtain one of the few open positions. REFERENCES 1. Crane JT, Ferraro CM. Selection criteria for emergency medicine residency applicants. Acad Emerg Med 2000;7:54–60. 2. Blouin D, Dagnone JD. Performance criteria for emergency medicine residents: a job analysis. CJEM 2008;10:539–44. 3. Hayden SR, Hayden M, Gamst A. What characteristics of applicants to emergency medicine residency programs predict future success as an emergency medicine resident? Acad Emerg Med 2005; 12:206–10. 4. Thundiyil JG, Modica RF, Silvestri S, et al. Do United States Medical Licensing Examination (USMLE) scores predict in-training test performance for emergency medicine residents? J Emerg Med 2010;38:65–9. 5. Lee S. Finding a community job in emergency medicine: advice for residents. CAL/AAEM Newsletter 2010;11:3–4. 6. Stern S. Fellowship training: a necessity in today’s academic world. Acad Emerg Med 2002;9:713–6. 7. Simon HK, Linakis JG, Anderson AC, et al. Obtaining a faculty position in academic emergency medicine. Pediatr Emerg Care 1997;13:130–3. 8. American Medical Association (AMA). FREIDA Online. Available at: http://www.ama-assn.org/ama/pub/education-careers/graduatemedical-education/freida-online.page. Accessed March 1, 2011. 9. Society for Academic Emergency Medicine (SAEM). Association of Academic Chairs of Emergency Medicine. Available at: http:// www.saem.org/SAEMDNN/Default.aspx?tabid=560. Accessed March 1, 2011. 10. Blouin D. Reliability of a structured interview for admission to an emergency medicine residency program. Teach Learn Med 2010; 22:246–50. 11. Tolan T. First impressions matter especially in an interview. Six common mistakes hiring managers should avoid in their search for the best talent. Healthc Inform 2011;28:48. 12. The Match: National Resident Matching Program. Results and data: 2009 main residency match. Available at: http://www.nrmp.org/ data/resultsanddata2009.pdf. Accessed May 28, 2011. 13. Burkhardt J, Kowalenko T, Meurer W. Academic career selection in American emergency medicine residents. Acad Emerg Med 2011; 18(Suppl 2):S48–53.
Survey on Hiring New Attendings 14. EUS Fellowship Programs. Emergency ultrasound fellowships. Available at: http://www.eusfellowships.com/programs.php. Accessed July 21, 2013. 15. Accreditation Council for Graduate Medical Education (ACGME). ACGME program requirements for graduate medical education in emergency medicine. Available at: http://www.acgme.org/ acWebsite/downloads/RRC_progReq/ 110emergencymed07012007.pdf. Accessed June 21, 2011. 16. Blanda M, Gerson LW, Dunn K. Emergency medicine resident research requirements and director characteristics. Acad Emerg Med 1999;6:286–91.
APPENDIX: THE SURVEY This survey’s goal is to assess the attributes that emergency medicine department chairs and hiring managers are looking for when hiring new attendings directly from residency or fellowship. Please fill this survey out only if you are in a position to make hiring decisions. Is your emergency department an academic or community program?
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25 – 49 10 – 24 < 10 How many visits did your emergency department have in 2010?
$ 100,000 75,000 – 99,999 50,000 – 74,999 25,000 – 49,000 15,000 – 24,999 < 15,000
Thinking about potential hires that you do not know personally, what value do you place on the program director’s written or verbal recommendation?
Academic (i.e., supporting a residency program, either as primary site or rotation) Non-academic, community
How would you describe your group?
What value do you place on the interview?
> 6 sites 2-6 sites Solo site, democratic Solo site, non-democratic Hospital employee
How would you describe your hospital’s location? Urban Suburban Rural What is the population size of your hospital’s catchment area?
$ 1 million 500,000 – 999,999 200,000 – 499,999 < 200,000
How many total beds does your hospital have?
$ 750 500 – 749 250 – 499 100 – 249 < 100
How many beds does your emergency department have? Include an urgent care center or fast track if it is integrated into your triage. $ 75 50 – 74
Extremely important Somewhat important Neutral Not really important Not important at all
Extremely important Somewhat important Neutral Not really important Not important at all
What value do you place on your perceived reputation of the candidate’s residency program?
Extremely important Somewhat important Neutral Not really important Not important at all
What value do you place on a recommendation from one of your current employees?
Extremely important Somewhat important Neutral Not really important Not important at all
Does attending a 3- or 4-year program have an impact on your hiring decision?
Extremely important Somewhat important Neutral Not really important Not important at all
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In your area, how would you describe the difficulty in recruiting EM-trained physicians?
Extremely difficult Somewhat difficult Neutral Not really difficult Not difficult at all
How many job openings are there at your location?
$6 3-6 1-2 None
What three attributes (in order) would you say are the most important qualities for a new hire to possess? Ability to work in a team Clinical productivity Comfort with critical care
Comfort with pediatrics Fellowship-trained In-service exam scores Personally known to the chair or hiring manager Research potential Substantial publications Teaching potential Other: If there are any fellowships that you look particularly favorable upon when making hiring decisions, please select them below. Critical care Emergency Medical Services Hospice and Palliative Medicine Medical Toxicology Pediatric Emergency Medicine Sports Medicine Ultrasound Undersea and Hyperbaric Medicine Other:
Survey on Hiring New Attendings
ARTICLE SUMMARY 1. Why is this topic important? There is limited information available to graduating emergency medicine residents regarding what attributes department chairs are seeking in hiring new attendings. 2. What does this study attempt to show? If residents know what prospective employers are looking for, they will be able to more strategically plan their job search and application. 3. What are the key findings? How a physician relates to others is consistently seen as the most important part of the candidate’s application. In addition, 56% of department chairs mentioned that they had no current job openings, indicating that job prospects are limited in academics. 4. How is patient care impacted? Residents who desire to go into the competitive field of academics will be a better fit.
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