I am a family physician who has made a few, shall we say, less-than-optimal job choices in the past. I've also made my share of mistakes dealing with recruiters. Most of what I now know about finding a job I learned by trial and error. By sharing some of the pearls I have gathered along the way, I hope you'll be better equipped to find a position that matches your values and expectations the next time (or the first time) you're in the job market.

Identify what you want

The first and perhaps most important step in the job search process is also one of the most difficult: identifying what you want in a new position. Like most people, I was tempted to skip this part, assuring myself that I knew exactly what I wanted. But dissatisfaction with a current job persuaded me to sit down for a few minutes of brainstorming, which proved to be quite illuminating. Here's a framework to help guide your thinking:

List likes and dislikes. What aspects of your current position really bother you? Jot down anything you can think of: messy charts, poor quality signouts, partners who do not share the workload, demanding patients, inequitable pay, managed care hassles, administrative issues, difficulties with referrals or problems with support staff. Then list what you most enjoy: a busy day, a good nurse, inpatient or outpatient medicine, procedures or ICU/CCU work, delivering babies or treating children or elderly patients.

Define your work style. Do you like socializing at the office, leaving on time, or both? Are you a turtle or a rabbit, and which do you prefer to work with? [For more about work style, see “Turtles and Rabbits: Family Physicians Under Time Pressures,” FPM, April 1999, and “Nine Ways of Living With Time,” FPM, January 1997, page 61.]

Identify your “ideal.” In what type of environment would you most like to work? Family practice residents and new physicians without much experience in the job market may find the AAFP's “Residency to Reality” series of monographs helpful for learning about and assessing different practice opportunities.

Determine personal and family needs. How far away from your current home or your hometown are you willing to move? What are your family's needs in terms of school, employment and recreation?

Once you've finished this step, combine your lists into one master list (see my example). You'll want to refer to this list again after you've searched for leads and decided which opportunities you want to pursue further.

Look for leads

Family physicians are still very much in demand, which makes locating quality leads one of the easiest aspects of the job search. You can look for leads on your own, work with a physician recruiter or opt to do both. Using recruiters can save you time, but keep in mind that they represent the employer and have specific financial incentives (generally a lump sum payment) to place you in the job they represent, not the job at which you'll be happiest. Recruiters who are salaried to represent a specific medical corporation may be more motivated to place you in a “good fit,” knowing they may have to replace you if you leave. I generally find my own leads using medical journals, the Internet and the telephone book.

Medical journal ads. Most medical journals have classified ad departments that list job openings. These can range from descriptions of a specific job by a prospective employer to general invitations to contact an organization to marketing by recruiting firms. Beware of the bait-and-switch tactics of some recruiters; they may advertise a certain position (e.g. “Mid-western town, $170,000 starting guarantee, no call”) just to get you to contact them. When you do, don't be surprised to hear that the position they advertised has been filled but other, less attractive alternatives are still open. If you prefer to deal directly with employers, read the ads carefully. The same name or telephone number listed in multiple ads is a tip-off that the ad was placed by a recruiter. If you prefer not to deal directly with recruiters, think twice before calling. If you do call, beware of the bait-and-switch and ask for more specifics on which jobs they're actually offering.

Online. The Internet is practically bursting with Web sites for the job seeker. Many health care Web sites have pages where you can search for jobs or post your curriculum vitae (CV) (e.g., Medscape offers www.medscape.com/home/jobcenter/jobcenter.html). If you're hesitant to post your CV online because of concerns about confidentiality, choose a site where access is available on a subscriber-only basis. Organizations such as the Medical Group Management Association (www.mgma.com), the AAFP (www.aafp.org/careers) and the American College of Physicians – American Society of Internal Medicine (www.acponline.org/jobs) offer placement services online. Other sites, such as MDdirect (www.mddirect.com), Medimorphus.com (www.medimorphus.com) and HealthSearch USA (www.healthsearchusa.com) are devoted entirely to physician placement.

Telephone books. If you've already targeted a particular locale where you want to practice, your best bet may be an old-fashioned search of that area's telephone book. This way, you can contact individual practices or prospective hospitals in the area directly. Local libraries often have phone books for other cities, or you can use the Web. Try searching by the town's name and follow the leads to hospitals/health care. Many hospitals maintain Web sites that list local physicians and group practices; some even indicate which groups are hiring.

Finally, if you are seeking a faculty position with a residency program, the Society of Teachers of Family Medicine lists openings online at www.stfm.org.

Pare down your list

Once you've gathered a healthy group of leads, use a short “triage” list to help narrow your search. My triage list includes all the criteria a job must offer for me to seriously consider applying for it. Your triage list may be longer than mine. Include anything that you feel you cannot live (or at least be content) without, and continue to update your list as needed during the search. I've revised mine several times.

My husband is an academic, so proximity to a college is a must for us. I also really like a four-season climate, so I look for a practice north of the Mason-Dixon line. I also enjoy obstetrics and am not willing to give it up as part of my practice. These are non-negotiable terms of employment for me. I can usually determine whether the job meets them by reading the information in the ad; sometimes, however, I do need to make a telephone call to get my questions answered.

Do your homework

Once you've sufficiently narrowed your leads, gather as much information as possible about the prospective employer prior to your first telephone interview. Many organizations will send written information (and videos) on request, from glossy promotional brochures to annual financial statements to benefits details. If all you receive is the promotional brochure, call back and ask for something more substantive. Do look closely at the information you receive; I once had an organization send me financial information showing a $200 million deficit in the prior fiscal year. They seemed surprised that I had noticed.

You can also gather information during the telephone interview itself. Referring to your brainstorming list and a list of questions will help keep you focused.

Don't get overwhelmed

Searching for a new position is stressful, but you can limit your stress by being organized, setting some limits, being honest and having a fall-back plan.

Be organized. It's likely that you'll speak with so many people during your job search that you'll lose track of anything you don't write down. It's a good idea to keep an index card for each recruiter or employer you're working with, listing the recruiter's name, organization and telephone number, and the leads they've presented to you.

You will need good, old-fashioned file folders for the information you accumulate and a personal commitment to stay organized. As you interview, summarize each substantive conversation soon after you have it, fill in answers on your checklists and place the information in a file folder designated for that particular lead. Otherwise, you may have only some illegible scrawls and a vague recollection of the conversations you've had.

You should also keep a running list of leads and their status: yes, no, or not sure. If you are working with recruiters, this will enable you to keep them organized, so they don't present your CV to the same leads more than once, or call you multiple times to tell you about them.

You'll definitely think of more questions as you interview. Keep updating your list. Asking one more key question may make a difference to your long-term satisfaction.

Set limits. The most important limit to set during the job search process is when and where you will accept calls from recruiters and prospective employers. Unless your office staff and administration are aware that you are looking for a new position, you should ask not to be called at work. You may also want to limit the hours you will accept telephone calls at home. This can range from “nothing after 10 p.m.” to “Tuesdays and Thursdays from 6 p.m. to 9 p.m. only.” Although you don't want to miss the ideal lead, you and your family deserve to have some uninterrupted time. You can also ask recruiters and potential employers to contact you via e-mail or to leave messages on your home answering machine during the day. Both options allow you to choose when to respond.

You should set some additional limits with recruiters. You don't need to tell recruiters what other search firms you're working with, what other leads you're pursuing or what firms have presented you with leads. You are definitely not obligated to answer personal questions. If you feel uncomfortable, do not answer. Responses like “I'm sorry, but I do not feel that information is necessary for us to work together,” or “I'm sorry, but I do not feel comfortable answering that question” usually work. Occasionally, recruiters may be persistent. (Were they pharmaceutical representatives in their previous lives?) I've occasionally had to resort to “No, thanks.” For example, “How many children do you have?” “No, thanks.”

You may also want to limit the number of recruiters you use. As a general rule, if they push me beyond the “No, thanks” point, I do without them. You may also encounter a recruiter who calls repeatedly, disregards your search parameters, calls you at work or during times other than those you've specified. If a recruiter becomes a burden, ask that he or she stop calling you.

Finally, consider limiting the number of jobs you interview for. These are expensive to the employer in terms of travel, lodging and meals, and to you in terms of time away from work, home and, for some, family. If I have significant reservations about a position, I don't interview for it, or I postpone the interview and gather more information. Recruiters and prospective employers are happy to cooperate if you state that you are interested but have more questions. If they are unwilling to give you more information, you should be cautious about interviewing or accepting a position.

Be honest. Whenever it is practical, tell people the truth. Let potential employers know if you are interviewing elsewhere. If you decide against an opportunity at any stage in the process, call the recruiter or employer to tell them. If possible, give a polite, brief summary of why you made this decision. “Not a good fit” can serve, if needed, as an acceptable euphemism for “That job stinks” or “Those guys are real jerks.”

Have a fall-back plan. If you are just completing residency, ask your program director about temporary jobs, such as working at a local urgent-care center. You may also want to consider locum tenens work. It can provide you with an income, give you valuable experience and buy you time to keep searching for a position that's right for you. Plus, if you fall in love with a temporary assignment, most locum tenens agencies will be happy to help place you there permanently. In fact, many have recruiting interests and can simultaneously serve your short- and long-term needs. Some locum tenens agencies may ask you to sign a standard no-compete clause, but if you're up front with them they should be willing to make line-item exceptions.

Next steps

If you've done your brainstorming to identify what you must have in terms of a job, narrowed your list of possibilities and done your research, you should feel organized and confident to begin interviewing in person. In an upcoming article, I'll explain how you can use face-to-face interviews to gather even more information (much of which is virtually impossible to acquire by phone) to help you determine whether the position you're interviewing for is truly the right one for you.