Dr. Kylie Jungles (Host 1): Welcome to the special episode of Allergy Talk, a podcast by the American College of Allergy, Asthma and Immunology. Today's episode is a FIT podcast, a space created for Allergy and immunology fellows in training by fellows in training. This is a first podcast in a series about topics important to FITs. So, stay tuned for more content to come.

I'm Kylie Jungles, one of your co-hosts today. I'm currently the national Senior FIT Representative for the college and the head of the FIT Committee. As a soon-to-be fellowship graduate, I was in your shoes not too long ago as I was beginning the job search. After finishing up my fellowship at Rush University Medical Center in Chicago. I'll be joining a private practice in upstate New York, joining an attending that I actually met initially at the college meeting. So, I'm happy to further discuss the job search process with you all today.

Dr. Amber Hardeman (Host 2): And I'm Amber Hardeman, the National Junior Fit Representative for the college. I'm finishing my first year of fellowship and currently right in the middle of the interview process with practices that I actually found through the college career fair. So, this is all very close to me. Thanks for joining us. Whether you're just starting to think about your post-fellowship plans or in the thick of interviews, today's episode is packed with practical tips to help you confidently navigate the job search process.

Host 1: We're so excited to welcome our expert guest, Dr. Melinda Rathkopf. She's a nationally respected leader in our field with extensive experience mentoring early career allergists, and a rockstar when it comes to helping FITs think strategically about their first job.

Host 2: Dr. Rathkopf, thank you so much for being here. Can you tell our listeners a little bit more about your background and your current work?

Dr. Melinda Rathkopf: Thanks, Amber and Kylie. I'm thrilled to be here today and please call me Melinda. So, I went to medical school at Emory, but was on an Air Force scholarship. So after finishing medical school, I went on active duty. I completed my Pediatric residency and subsequently Allergy fellowship in the Air Force. I had the privilege to stay on as an attending at the Air Force Fellowship Program in San Antonio. And then, when I separated from the Air Force, I actually moved to Alaska.

In Alaska, I was part of a private practice. We were a single specialty group in Anchorage. I started out as an employed physician and then became a partner and, eventually, the medical director. I actually was in Alaska for over 16 years. But about two years ago, I switched gears and returned home to Atlanta. I'm currently an associate professor at Emory University School of Medicine. I'm the Medical Director of the Allergy Clinic here at Children's Healthcare of Atlanta, and I'm core faculty for our Allergy and Immunology Fellowship Training Program. I've been involved with the college for many years in leadership programs, mentoring programs, Board of Regents, and my two passions, the Practice Management Committee and Advocacy Council.

I'm passionate about helping young FITs understand the business side of medicine because we just don't get enough of that in medical school, and helping them launch their hopefully very rewarding careers.

Host 1: Thank you so much for sharing your story. We're really excited to have you here today. So, let's start with the very beginning, before you even send out a CV, Melinda, what do you think are the first steps a fellows should follow when starting their job search?

Dr. Melinda Rathkopf: I love this question because the first step is really about you. You need to start with self-reflection, so start with you. Determine what you want to do, determine how you want to do it, and determine where you want to do it. You really need to think about what are your personal values, your career goals, and what kind of lifestyle do you want? Are you someone that thrives on autonomy and you would do better in solo practice? Or do you like having someone around the office to bounce your thoughts off of? Do you want academic involvement with opportunities to teach and do research? Are you seeking a specific geographic area? All of these questions will help you focus your search.

The college has some really great resources to help you get started. I'm excited that on the Practice Management Committee, we recently put together a FIT and new allergist toolkit and are constantly updating it. The first section of this toolkit is devoted to choosing a practice environment that matches your priorities. It includes links to the American Medical Association module of what to do first in your next practice, in your next job. So, I encourage all FITs to work through this module as you're getting started on your career search.

Host 2: Wow, that's great perspective. It also sounds like those really are some great resources we'll have to check out. And, Melinda, once fellows have a sense of their goals, what should they be preparing? A CV, a cover letter. Anything else?

Dr. Melinda Rathkopf: You know, an up-to-date polished CV is something you're going to need for the rest of your career. So, it's worth the time and the effort to build a strong CV. And regardless of what stage of career planning you're in, always set aside some time to update it. I actually have it on my monthly checklist to look over my CV, add any recent talks, any publications, and make sure it's as up to date. That way, you have it ready to whip out as soon as you need it. So, just start that habit now. You could also write a pretty flexible cover letter, and then you can tailor it to more specific jobs. If you have this basic letter already written and you're CV up to date, it's a great headstart. I also recommend writing a brief career mission statement, having that in mind. It'll help you communicate your goals clearly when you're networking or interviewing with prospective future employers.

Host 1: That sounds great. So now once we have our cv, the next step is often, "Where do we want to work?" And these days, it seems like there are a lot of different options. We have private practice, academic, hospital, employed, and also pharmaceutical options.

Host 2: Or maybe even hybrid. Sometimes people want to do multiple things. I feel like there's so many options and each of them have pros and cons. Melinda, how should FITs start to navigate this type of decision?

Dr. Melinda Rathkopf: You know, the key here is to truly understand what each model looks like and how that matches with your profile. What kind of employment model would you prefer? Again, do you want to go solo? Do you want to be employed? Do you want to have a potential for partnership? If so, look at private practice settings.

Even within private practice, you're going to have that opportunity to be solo or group employed or a partnership. Private practice generally offers more autonomy, but it often comes with more responsibility for managing the business and the day-to-day operations. When I became a partner, you know, I never thought about the fact that I'm now a small business owner responsible for running a business and responsible for employees. Whereas academics can offer you teaching and research, but it may come with more administrative tasks. Employee-based practices may mean more infrastructure's already in place and you get less autonomy, and someone else runs the business. So, it could mean more flexibility for you as the physician. So, it's really about kind of, again, going back to that step one looking inward and self-reflecting on exactly what type of employment model you're looking for.

Host 1: Sure. That sounds great. And with many of us in academic settings for training, how do you suggest that fellows explore these options while they're still in their fellowship training?

Dr. Melinda Rathkopf: If you have elective time, really take advantage of electives, do electives outside of where you are currently in fellowship so you can see something different. If you can do shadowing opportunities in locations and settings you're interested in, maybe there are formal mentoring programs or even informal conversations with mentors in different settings. Even if all you had was vacation time to go and spend a few days, it would be worth doing that. As both of you mentioned, you made connections at the college meetings, so attend national meetings and ask people about their work lives. Ask your mentors, ask colleagues, reach out. The toolkit mentioned previously also includes a webinar from new allergist to FITs on what they wish they had known prior to graduation.

Host 2: Wow. It seems like there's so many different options of the types of locations and settings that we can have. How about a pro tip moment, Melinda? What's one green flag and what's one red flag that you feel like we should look out for?

Dr. Melinda Rathkopf: Yeah, green flag. I think the practice culture needs to match the values you hold. Again, going back to that, figuring out your own values first so you can make sure it matches. Are you feeling like it's a collaborative place? Is it patient-centered care? Is there mentorship available? Some red flags would be: is there a high turnover at the practice? Poor communication with you or vague answers about your compensation structure or your work-life balance? Those would all be some red flags. If you're noticing anything that just doesn't seem right or feels uncomfortable, or these red flags when you're just in these initial stages, they're unlikely to change and may potentially get worse.

Host 1: Those are some great tips. Thank you so much for sharing. So now we've done the prep, the next question that most people are wondering is how do we actually find a job? There's no match for becoming an attending.

Dr. Melinda Rathkopf: No. And it's hard, right? Because you need to start early. Some would say you need to start 12 to 18 months before graduation. And that can be very overwhelming, right? Because that's six to 12 months into your fellowship. You're already thinking about the end of your fellowship. So when you're starting to think about your future job, word of mouth is gold. You know, talk to mentors. Ask your program director. Look at where prior graduates of your program have gone. Look at networking at the conferences. There's a more formal checklist in the toolkit and it includes things like reviewing the college career center. The New England Journal of Medicine also has a career center. The college has an annual meeting job fair you can attend. You can consult your state and regional allergy societies for open positions and for networking with colleagues. You can go into the colleges, find an allergist tool that's up on the top right hand side on the website, and see where allergists are in the area you want to go to. You can look in the member directory if you're a member of the college, and you can send out letters of interest to allergists in your preferred area. That can be really helpful if you're kind of tied to a specific geographical area but don't already have a connection there, is using those options. You could consider a recruiter or a medical headhunter service. You can review job listing in the Annals and in JACI: In Practice, and you can also review the career center at the academy and their virtual job fair.

Host 2: Great. So, these are all actually a lot more options than I think a lot of us might even be aware out here. So while we're looking through the different types of career centers and sometimes the journals, what should FITs make sure we have ready to go to best present ourselves?

Dr. Melinda Rathkopf: Have your CV ready to go. Have a template cover letter and have a list of references. You know, I mentioned your cover letter and CV, but also talk to potential references. Be sure to ask them ahead of time. You don't want to put someone on your reference list if they don't feel they can give you a good reference. And there's nothing wrong with coming right out and asking that, saying, you know, "Do you feel you could give me a good reference if I listed you as a reference"" And only do so, obviously, if they say yes.

You need to get yourself organized too. You know, there's a lot of organizational tools, whether they're handwritten, if you're old school, whether they're digital, but make a spreadsheet. Have some type of documentation where you can track the applications, who your contact is there, when you last contacted them, possible interview dates, follow up. It's easy to lose track of the details. I kind of think of it like if you've ever been house hunting after you've looked at a few, they all kind of start running together and the details can get muddled in your head. So, just be sure to get yourself organized from day one. If you have those template cover letters, your CV ready to go and you've got your tracking all down, you'll be prepared, which will be impressive to your future employer.

Host 1: That definitely gives us a great starting point. I feel like there's so many things that we need to remember to have on hand, and it's a good way to get us kind of going here. You had mentioned that headhunters or recruiters could play a role. How do they factor into this?

Dr. Melinda Rathkopf: They could be very helpful, especially if you're tied to a specific area or may not have very much flexibility in what type of job you're looking for. Recruiters can be helpful. But remember, the recruiter typically works for the employer, not for you. So, make sure the job aligns with your values and goal and realize where they're coming from. Don't feel pressured to accept something just because it came through a recruiter. But you can also hire your own headhunter or recruiter on your side, again, especially if there's a critical location and you're struggling to find what you want.

Host 2: That all sounds like really excellent information. Let's kind of switch gears. What about after we break the glass and we've started to get interview invites? Let's talk about how we move further with those. We know that interviews can be very nerve-wracking. But with preparation, they can also be energizing.

Host 1: Definitely. I think, you know, we've all done interviews for fellowship and residency, but job interviews are a little bit different. So Melinda, what are the most common questions fellows should be ready to answer when it comes to interviewing at practices?

Dr. Melinda Rathkopf: Be prepared for the classic questions: "Tell me a little bit about yourself." Have a concise summary of your training, your interest, and your goals. But don't make it so long that you don't give the person a chance to interact with you. Make it conversational. Also expect "Why are you specifically interested in this practice?" So, do a little research on the practice if you're able to. Be prepared to answer "What's something you feel you can bring to our practice? What would make you a better hire than another applicant?" And then, have some idea of your long-term plans. Don't make up something. If you're not sure, say you're not sure. But if you have some general idea, be prepared to answer that.

One tool that might be really helpful is actually use AI to help you interview. You can ask ChatGPT to give you interview questions, as if you're applying for a new job. You can even put in details of the practice and have it correspond with you. So, that could be a good way to practice some interviewing skills using AI.

Host 2: Oh, wow. I never really thought about using AI for that. That's great. So, what about for us, the FIT side? What kind of questions should we be asking the different practices?

Dr. Melinda Rathkopf: You know, I think, what's important is looking at the patient mix. Do you want to see adults and kids equally, more adults, more kids? How is that going to be handled in the clinic? What is the clinic flow like? How many patients are you going to be expected to see? Are you going to have any administrative time? Is there any flexibility if you have a family that you also need to adjust to their schedules? You know, if you have to deal with taking your child to school or daycare, is that something your clinic will help accommodate? What's the ratio of support staff to physicians? Are there mentorship opportunities? Are some of the more senior members of the physician staff willing to be mentors to you? And how do they onboard new physicians? Unless you're only the second person ever added, there should be some type of process on how they onboard.

I would ask about technology utilized. I think now, you know, in fellowship training, pretty much everyone is using electronic medical records, but you'd be surprised at practices out there that may still be on paper. Do they do allergy-specific immunotherapy software? If they have an infusion clinic, do they use software specific for infusions? What is the use of AI in the practice? Are you allowed to use AI? Are there other supportive tools like a patient portal, online check-in? Ask about those. If you're used to technology augmenting your workflow and suddenly you didn't have those tools, that could be a big deal.

If it's important to you, ask about what teaching and research opportunities may be available. Many private practices have these. In my prior private practice, we had medical students, we had residents, and we had fellows coming through. We participated both in pharmaceutical research and in research through the American Academy of Pediatrics.

Ask about your compensation structure. You know, we'll talk a little bit more about that later, but how RVUs or bonuses are calculated. Ask about employment tracks versus partnership opportunities and how that's structured. Is a partnership guaranteed if you sign on initially? Is it eventually required? What if you didn't want to become a partner? If it is available, what is the buy-in structure?

Host 1: That's great. You gave us a lot of important information to really consider and a lot of things that we haven't had to consider, looking at residencies and fellowships. It's definitely a different perspective now that we're becoming attendings and having our first real job. With that being said, I know that the interview days can be stressful, overwhelming. At the end of my interviews, I felt like the day was a blur, but are there any red or green flags that we should look for during the interview day ourselves?

Dr. Melinda Rathkopf: A red flag would be if they seem very vague or defensive when you ask specific questions. You know, I wouldn't expect them to open up their books and give you details of their finances, but they should answer some general questions about their compensation process, their ranges, their structure.

And a green flag would be that they're transparent, if they involve multiple team members in your interviewing process. It shows that you're worth the investment, and they feel it's worth the investment of finding the right fit. You could consider asking if you can record the interview. Definitely don't record it if they're not comfortable with you doing that. But you could ask if you know they mind, so you could refer back to it later. If they start to talk more details or finances, offer to turn the recording off though.

Host 2: And also, don't forget to follow up. It's always important to send a thank you note. It's a small touch that can leave a really strong impression, especially if it's someone that you've felt like you've had great interactions with.

Dr. Melinda Rathkopf: I agree with that completely, Amber. You know, that always shows you were raised right, right? Always say thank you and follow it up with a note, because that mail's going to come to whoever's in the mail room and then maybe the practice manager so they can be your champion also. So, you know, be kind to everyone you meet along the way. If you're going in person for the interview, be kind to the person that meets you at the front desk, the person that sets you back in the conference room. They're all part, and I guarantee you their opinion matters to the physicians in that group.

Host 1: Definitely. That's a great tip. I think, people really appreciate it when they know that you're not just there to show face. You're kind of being kind to everyone and that's your personality. So, thank you so much for all of this great advice. We've covered a lot in this segment, but we'd like to end with a favorite question. Melinda, what's the best piece of advice you'd give to a fellow about to enter the job market?

Dr. Melinda Rathkopf: This will probably count as a couple of pieces of advice, but the first is just to surround yourself with good people. This has always served me well. You know, I was in the Air Force and I had some assignments that if I told you the locations might not have seemed ideal, but I knew I was going to be working with people that were good people that I could work with, and it paid off.

The most important thing, again, with that is to trust your gut. If something feels off, it probably is, and don't rush the process. You've got the rest of your life or the majority of it to work. So, the important thing is to find the right fit. The right opportunity is out there. It's worth taking the time to find a job that supports you, your growth, and your wellbeing.

The other thing I would add to that is you can start a job and it not be the right fit. So, don't feel like you have this pressure to accept a job right now that's going to be the right job for the rest of your life. You heard my story, and I've worked in multiple different career options, but still gave them all very long dedicated spans of my life and did my best while I was there. But there became times in my life where it wasn't the right fit and I needed to pivot. So, as you may have heard me say in other lectures and stuff, don't be afraid to pivot. You're never stuck on your first choice.

Host 2: I think that's such a powerful note to end on, especially because we're all used to going through the match multiple times. And this is really the first opportunity we have to look at a bunch of places and choose directly which one we want rather than being put into a place. Melinda, thank you so much for sharing your time and your insights with us and our FIT community.

Host 1: And if you guys are looking for more information on job searching, don't fret. We'll be back with part two of the series soon where we'll do a deeper dive into contract negotiation and compensation models. So, be assured not to miss it. Keep a lookout for it on the second segment of the FIT version of the Allergy Watch Podcast.

Host 2: And as always, thanks for listening. Be sure to subscribe, leave ratings, share this episode with your co-fellows. It's definitely important. Also, if you're interested in joining the FIT Committee and getting more involved, look out for the application to join FIT Committee as a national or regional representative. You can also reach out to Anna Nagle at annanagle@acaai.org.

Dr. Melinda Rathkopf: And I also recommend you check out that New Allergist and FIT toolkit on the college website. It's in the toolkits under the Practice Management section of the website.

Host 1: Thanks, everyone.