Career Compass—December, 2021 by American Academy of Neurology

December 2021

What’s Inside Compensation in Times of Change . . . . . . . . . . 5 Rural Employment: Options for the Physician’s Spouse . . . . 13 Working in the United States: Resources for the International Neurologist . . . . 18

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Do your best work with us. At AHN, you can be part of a clinician-led system that values your experience and gives you the opportunity to be part of one of our specialized teams dedicated to treating headache, stroke, movement disorders, and epilepsy using the latest innovations.

Join us at ahn.org/neurocareers.

Mercy Health in Cincinnati, OH seeks a BC/BE General Neurologist to join successful existing practice with established physician referral base, EEG and EMG with a fully integrated EPIC EMR, 50/50 outpatient and inpatient, strong mid level support, and offers the ability to subspecialize portion of the time. This opportunity offers a competitive salary with up to a two year guarantee, comprehensive benefits including employer sponsored 457f, employer match 403b, signon bonus, and student loan assistance. Greater Cincinnati is home to over 2.1 million people offering a great lifestyle filled with events, recreation, arts, sports and culture. Cincinnati has three international airports within a two-hour drive and has a climate that's neither too hot nor too cold. Perfectly situated for a variety of recreational activities, the city claims one of the country's top park systems. Cincinnati boasts one the lowest unemployment rates in the Midwest making it an ideal place for you to practice. For further information or consideration send CV

to James Cook, JCook1@mercy.com

JOIN OUR NEUROSCIENCES TEAM

TRUE BLUE • EPILEPTOLOGY • MOVEMENT DISORDERS • VASCULAR NEUROLOGIST • GENERAL NEUROLOGY

EMPLOYED POSITION OFFERING: • Highly market competitive, non-academic compensation • Affiliated with University of Michigan • Program marketing • Full benefit package • Potential sign-on bonus • Potential student loan reimbursement • Health system employed medical group model • Extensive Primary Care referral network

University of Michigan Health-West is seeking full time, permanent Epileptologist, Vascular Neurologist, Neurologist and Movement Disorders physicians to join a growing, functional neurosciences program.

physicianservices@umhwest.org 616.252.4765

UofMHealthWest.org/recruiting/neurology

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Multiple faculty positions for clinicians and clinician scientists are available in a variety of Neurology subspecialties, with most having an established practice including: PEDIATRIC NEUROLOGY HEADACHE MEDICINE BEHAVIORAL NEUROLOGY MOVEMENT DISORDERS NEUROMUSCULAR DISORDERS GENERAL NEUROLOGY Assistant or Associate Professor Rank commensurate with experience. Applicants should be board eligible or board certified in Neurology, with fellowship training preferred for specialty positions.

The University of Toledo College of Medicine Department of Neurology is recruiting neurologists and subspecialists to join their expanding department in an exciting new educational affiliation with Promedica, a comprehensive health care network of specialized hospitals and outpatient facilities in Northwest Ohio and Southeast Michigan. Nationally recognized for excellence, the department has a 5-week required third year clerkship for medical students, a growing Neurology residency program and several competitive fellowship programs. The flagship academic medical center is a 794-bed hospital offering brand new state of the art inpatient facilities and is the largest acute care facility in the area. It has been named on of Healthgrades’ 100 Best Hospitals in America. Outpatient services are offered in the newly built Neurosciences Center, conveniently located across from the Toledo Hospital.

Candidates with interest in translational research and/ or independent research funding are strongly encouraged to apply. Joint appointment in Department of Neurosciences and protected time for research will be available based on track record and interest.

Please submit a letter of interest, CV, and references to:

Imran I. Ali, MD Professor and Clair Martig Endowed Chair Department of Neurology, University of Toledo 2130 W. Central Avenue, Suite 201, Toledo, OH 43606 Imran.ali@utoledo.edu or ann.murphy@utoledo.edu

Neurologists Needed in Central New York Bassett Healthcare Network in Cooperstown, New York is recruiting full-time General Neurologists with an opportunity for building a subspecialty practice. Department Highlights • Fully Epic EMR across the 10 county Network • H1b Visa support, Cap exempt

Outpatient Neurologist Interested in growing a patient-centered practice in the beautiful college town of Northampton, Massachusetts? Cooley Dickinson Health Care is currently seeking BC/BE outpatient neurologists to join our established, busy team. Send CV to: Logan Ebbets, CPRP, Senior Provider Recruiter recruitment@cooleydickinson.org | joincooleydickinson.org

ADVANCING CARE FOR OUR COMMUNITIES

• Call no more than 1 in 4 • Mostly outpatient with hospital consultations • Tele-Neurology support from University of Rochester • Working with Residents and Medical Students For confidential consideration, please contact: Amy S. Johnson, Medical Staff Recruitment ph: 607-547-6982 • email: amy.johnson@bassett.org or visit ExperienceBassett.org

Bassett Medical Center provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex (including pregnancy, childbirth, or related condition), age, national origin or ancestry, citizenship, disability, marital status, sexual orientation, gender identity or expression (including transgender status), genetic predisposition or carrier status, military or veteran status, familial status, status a victim of domestic violence, or any other status protected by law.

Compensation in Times of Change KEEPING UP WITH CHANGES IN PHYSICIAN PAY If you think the practice of medicine has been changing fast, that’s nothing compared to changes in compensation for the practice of medicine. It used to be, in the not-so-distant past, that physicians would receive a contract outlining an offer with such things as how much call they would take, their allotted vacation time and, yes, their salary. Negotiating, if the doctor chose to do it, was largely a matter of trying to improve the numbers on the contract.

Compensation models are changing The basics of this process haven’t changed— there’s still a contract, an offer, and items such as vacation and call to review before negotiating or

signing. But salary? According to Melissa Yu, MD, FAAN, that model of compensation may no longer dominate. As chair of the American Academy of Neurology subcommittee that oversees that group (the Practice Management and Technology Subcommittee) she has seen a wide variance in pay models other than just strict salary. To be sure, some of the variations in compensation methodology Yu experienced were tied to changes she initiated. For example, when Yu moved to academia after eight years in private practice, (she’s now an associate professor in Baylor College of Medicine’s Department of Neurology), she naturally entered into a different payment

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model for her work. Before making that switch in 2012, her compensation was frequently affected by adjustments in how Medicare payments were made. But even in the traditionally stable academic sector, Yu has seen changes. Indeed, her added administrative responsibilities have exposed her to the compensation planning process at her institution. Yu’s conclusion from all of these experiences, direct and indirect? “The age of the guaranteed, straight salary is decreasing,” she says. Replacing it? “We’re seeing more ties to metrics. Whether it’s clinical productivity, quality measures, or patient satisfaction, physicians in general are just being measured more.” In short, if you’re not already experiencing this, you can expect at least some of your compensation in the future to be tied to your performance metrics.

What do the salary surveys tell us? Like Yu, Brad Klein, MD, MBA, FAAN, has devoted significant attention to the topic of physician compensation. As chair of the Academy’s Medical Economics and Practice Committee and as a member of the AAN Board of Directors, his leadership roles have long been entwined with this issue. In particular, he says, he participated in designing some of the early benchmark compensation surveys conducted by AAN in 2013. Although he’s not part of the work committee charged with developing the upcoming biennial

survey, Klein says he can empathize with the challenge of revising the questions to match the rapidly evolving compensation picture currently being experienced by physicians. One thing he doesn’t worry about is the breadth of response. The last survey (published in early 2020, using 2019 data) captured information from more than 3,200 respondents, including 2,700 neurologists, 474 advanced practice professionals, and 71 practice managers. “It’s the largest neurology compensation benchmark available,” Klein notes. This robust response is important on several levels, not the least of which is simple volume. When more people participate, Klein says, “We can communicate with each other that you’re in the ballpark with what you’re earning or what you’re offering.” As chief operating officer of Abington Neurological Associates and medical director of Abington Headache Center in Pennsylvania, Klein relies on the AAN physician compensation survey to provide a reference point for his own work. “I’m in private practice, so I’m always intrigued to see how people are paying their physicians,” he says. “Just running a private practice, as I’ve done for over a decade now, it helps me to see where I’m doing a good job and where I’m not.” Klein explains that he was just as likely to reference the survey when he was an employee as he is now in his role as an employer.

Although questions and categories may shift as the current work committee completes the next survey, doctors who haven’t participated in past years might be surprised at the number and variety of compensation models presented for selection by respondents. In addition to the guaranteed salary that used to be more common, there are several options combining salary with a quality bonus or a production bonus, or both. Physicians can also indicate they are compensated based on productivity alone, or that they are paid an equal share of a practice’s compensation pool. Even with all of these options, the survey can’t possibly represent every compensation model used by employers in today’s complex market. Indeed, more than one process might exist within the same organization, depending on the level or type of work assigned to the physician. In his practice, Klein has developed three different contracts, reflecting varying scenarios as the individual potentially rises to the partner level. What ties the three contracts together, he says, is an underlying approach of productivity and communal compensation. As he explains, “We want to reward you for working hard—productivity—but we also want you to support each other, since different doctors practice different aspects of neurology and some fields pay more than

others.” In this system, Klein says, 60 percent of what a doctor generates goes to their productivity credit and 40 percent goes into the communal pot, to be divided among the doctors. While everyone gets paid a lower regular salary that accommodates the practice’s ups and downs, at the end of the year the productivity and communal amounts are calibrated for overhead and paid out appropriately to each doctor.

Advice for physicians, new and experienced It’s one thing to learn about compensation models, but something else entirely to make good use of the knowledge. For example, how might a doctor who prefers a guaranteed salary negotiate a hospital contract based on productivity? Since compensation structures represent complex organizational decisions in most cases, it’s not likely this candidate will influence a change in the model itself. But it may be possible to negotiate how some of the productivity is measured, or what percentage of the overall compensation will be based on the metrics. Another option? Klein notes that individuals who prefer a specific compensation method might find themselves better served by matching their preferred model to the type of position it’s likely to be found in. This strategy, he notes, can sometimes shift according to the stage someone is at in their career. As he explains, “If a guaranteed salary is important to you, that is more likely to happen in academia, but if you’re in a private practice, it’s more likely you’ll be offered salary plus a

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productivity bonus. Those who are younger may be less efficient in seeing patients and more worried about paying loans, starting a family, etc. may find higher base salaries more palatable. Whereas, if you are further along in your career, may be more financially stable, and can leverage your efficiencies to be more financially productive, the bonus model might work better. It’s not to say private practice can’t work for anyone, but it is important that the potential employee and employer talk candidly about their needs.” For the majority of neurologists who work in patient care, quality metrics are bound to play a role in compensation. As Klein puts it, “This is where it gets dicey. When their compensation is tied to quality, individuals need to understand how those measures are determined and that they are accurate.” He adds, “It can be a very challenging prospect to demonstrate quality in a meaningful way. Ideally, the employer is using AAN guidelines and can assess the individual neurologist. However, in some organizations, the neurologist may not have control

Dr. Yu also recommends that candidates take the time to assess their risk tolerance at different stages of their career. “Starting out,” she says, “you’re not going to be as productive, as efficient, so there’s risk in a productivity-based plan.” On the other hand, she warns against the lure of a high starting salary in the offer “because sometimes there’s a catch to that. If there was an income guarantee and you decided to leave, you may have to pay it back.” Like Klein, Yu also notes the challenge in being compensated according to metrics. In her role as a physician informaticist, she acts as an interpreter to the IT staff, helping them ask for the data in a way that honors the actual work being performed by the doctor. As she explains, it’s easier to report process measures—“Yes, I did this, I counseled the patient with epilepsy about this medication”—than it is to report outcome measures, such as less eye damage for a patient whose diabetes is under control. While doctors may not be able to control which measures are requested and compensated for,

If practice A is going to give you X dollars and practice B is offering 10 percent more but without the extra benefits, you can’t compare those as apples to apples. over quality metrics nor cost containment and their reimbursement may be impacted by work done by their primary care colleagues, hospital, or other care providers in the community.” To navigate a system in which the neurologist’s metrics might be enmeshed with those of other care providers, Klein recommends that candidates learn more about the department they’re planning to join. For example, how did the department or the average neurologist do in terms of quality metrics or bonuses in the past year? As he says, “At the two extremes: if the department is measured and doing well, and the last bonus reflects it, then that’s a good sign. If the bonus is low, or the department ‘s measures are poor, then that’s a bad sign. The gray area may be if the department is beholden to the system for their bonus, where there is less internal control. “That will give you a good sense. If everyone’s getting a 98 percent response and a 98 percent bonus, that’s a good sign. But if it’s spread out all over the place, that can be a bad sign.”

Yu advises they can educate themselves on how to bill and document appropriately, so that they are accurately claiming the measures they are achieving. “That’s not taught to a huge degree in residency,” she says, “but the AAN has lots of resources on that. You need to be sure that you’re capturing what you’re actually doing and billing to the most appropriate level that you can.”

It’s not all about the paycheck As a final piece of advice, Yu recommends a closer look at the overall contract before choosing one position over another. “Look at all the other, nonsalary ways you’re going to be compensated, such as CMEs, paid vacation, tuition reimbursement, insurance, health, and dental. If practice A is going to give you X dollars and practice B is offering 10 percent more but without the extra benefits, you can’t compare those as apples to apples.” Along the same lines, Klein advises tracking monthly expenses for the first year or two in a new job, to ensure financial viability. This exercise will

help sound the alarm if the income isn’t meeting expenses such as student loans. On the other hand, it may also demonstrate something unexpected—the ability to work fewer days, for example.

Trends and disrupters No matter what a physician may learn about compensation, or which models an organization may employ, something will always come along to upset the apple cart. Some disrupters happen in slow motion, while others—think COVID-19— strike like an out-of-the-blue lightning bolt. And sometimes a disrupting force will attach to a slowermoving trend. That’s the scenario playing out with telemedicine and the coronavirus pandemic. While neurologists and other health care providers have conducted remote health care services for decades, it has always been a small piece of the puzzle—and one that was difficult to monetize besides. Now, in a matter of only a few weeks, telemedicine has become a primary conduit for delivering neurologic health care—and those in charge of compensating for medical services are scrambling to keep pace.

issues, Klein is paying attention to a quickening change rooted in justice issues: parity in pay regardless of gender or race. As he notes, there is work to be done in both areas. “There is data that there is a gender differential in compensation,” he says. “Trying to understand that better is a critical detail that we have to address. We, as a society, haven’t done due diligence in racial bias and it’s way overdue to be looked at in compensation.” This short list undoubtedly doesn’t cover all of the changes bubbling just above or below the visible surface of compensation for neurologic care, but it does exemplify one point made by both Klein and Yu: health care and the way it’s compensated is undergoing rapid and constant change, making it critical that doctors maintain the ability to adjust to new realities. And, regardless of how a doctor is compensated, now or in the future, it seems clear that the days of simply negotiating a higher salary every year or two are long past. Paying attention to the organization’s bottom line and the market in general will have to become second nature as doctors build their careers in the years to come. n

Yu explains it this way: “Up until March 15 or so, in 2020, the use of telemedicine in outpatient neurology was pretty limited because of insurance rules and reimbursement models. Then it exploded in terms of temporary coverage by insurers when we wanted everybody to stay home. Now we’re all holding our breath to see what’s going to happen with that coverage.” While Yu feels certain that the coverage is here to stay (“I think the genie is out of the bottle on virtual services.”), Klein anticipates that the rate of reimbursement may drop in the future, which would affect the compensation received by neurologists.

NEUROLOGIST OPPORTUNITIES

In Virginia

Carilion Clinic is seeking BC/BE neurologists in several specialties to join our growing Department of Neurology. Based in Roanoke, Virginia, Carilion Clinic is an award-winning, community-based network of seven hospitals, over 220 primary and specialty physician practices and is affiliated with the Fralin Biomedical Research Institute at the Virginia Tech Carilion School of Medicine. All in the family-friendly, beautiful Blue Ridge region of Virginia.

Another compensation trend Yu has been tracking may be less affected by the pandemic, except that it may be slowed somewhat in developing. “We keep hearing that value-based care for different payment models may be coming, for the things that may not lend themselves to productivity compensation models. These would be like, ‘I kept the patient out of the hospital.’ That’s good, but now the neurohospitalist won’t see that patient. As those models become more prominent, we’re going to be looking again at compensation. How will the neurohospitalist be compensated if they don’t see the patient in the hospital?”

AVAILABLE OPPORTUNITIES: Epilepsy - MS - Movement Disorders General Neurology We offer a comprehensive benefits package with paid relocation, an employer-funded pension plan and up to $50K in sign-on bonus. CONTACT: Karyn Farrell, recruiter at kbfarrell@carilionclinic.org

While some trends and disrupters may be prompted by health care practices or broader compensation

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GENERAL NEUROLOGIST OPPORTUNITY Neurologists with clinical expertise in General Neurology are invited to apply for an open position at Penn State Health Holy Spirit located in Camp Hill, PA. Join our growing community practice now! This search represents part of a major institutional commitment to expansion of the neurosciences. This position is supported by one other Neurologists, in a patent-focused community practice setting. With NO ON CALL and an 8 am to 5 pm schedule the selected candidate will flourish in a supportive work life balance environment. Leadership opportunities are available to those with relevant experience. Ideal Candidates Will Have The Following: • Medical degree - MD, DO, or foreign equivalent • Completion of an accredited residency program • Excellent patient care abilities and interest in teaching As a member of the Department of Neurology you will be associated with: • An outstanding program with a national reputation • A highly collaborative culture • Cutting-edge basic and clinical neuroscience research and top-notch facilities at both the Hershey and the University Park campuses • Interaction with dynamic clinicians across all neuroscience-related departments and participation in innovative educational approaches Competitive compensation and generous benefits, including: • Penn State Tuition Discount • Relocation Assistance • Back-up Family Care • Medical, Dental, Vision • 401K, 403(b), 457(b) retirement plans FOR ADDITIONAL INFORMATION Anderson Smith, Physician Recruiter at asmith50@pennstatehealth.psu.edu Penn State Health is fundamentally committed to the diversity of our faculty and staff. We believe diversity is unapologetically expressing itself through every person’s perspectives and lived experiences. We are an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.

Assistant Professor, Associate Professor, or Professor of Neurology — Columbia University—New York, NY The Department of Neurology at Columbia University, nationally renowned for research, clinical care, and education, is seeking full-time neurologists at the assistant, associate, or professor level specialized in the area of Hospitalist Neurology. The Columbia Hospitalist Neurology program includes clinical responsibilities at New York Presbyterian Hospital – Columbia University Medical Center, a tertiary care hospital in Manhattan; New York Presbyterian – Allen Hospital, a community hospital in Manhattan; and New York Presbyterian – Lawrence Hospital, a community hospital in southern Westchester County, New York. Each successful applicant will have an academic appointment at the College of Physicians and Surgeons, Columbia University, and be eligible for all the Columbia University benefits available for the faculty appointment. Each Neurohospitalist recruited will attend on the Inpatient Neurology Services and the Neurology Consult Services, train residents and medical students, and develop and participate in Quality Improvement initiatives. These are full-time positions, which may combine Neurohospitalist and specialty neurology practice and research, based on the specialty training and research interests of applicants for the positions.

Qualified applicants are requested to apply for the position at the Columbia University Job website: http://apply.interfolio.com/93534 Qualified applicants may also email a letter of interest and CV to: Laura Lennihan, MD Professor of Neurology Vice Chairman of Neurology Director, Program in Hospitalist Neurology Columbia University Medical Center 177 Fort Washington Avenue Milstein Hospital, 8GS-300 New York, NY 10032 LL18@cumc.columbia.edu

Neurology Career Opportunities NORTON NEUROSCIENCE INSTITUTE is recruiting multiple board-certified or board-eligible physicians in Louisville, Kentucky. Our program offers multidisciplinary research pathways and expanding facilities, including a comprehensive neuroscience space set to open in summer 2021.

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The ideal candidates will have an opportunity to join a collaborative team of more than 110 subspecialty neuroscience providers with Norton Neuroscience Institute and Norton Children’s Neuroscience Institute, affiliated with the UofL School of Medicine. Career opportunities are available in the following programs:

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Neurologist Opportunities

Neurologists with expertise in General Neurology, Movement Disorder, and Stroke are invited to apply for open positions at Penn State Health Milton S. Hershey Medical Center, which is the academic medical center of The Penn State College of Medicine. This search represents part of a major institutional commitment to expansion of the neurosciences. The successful candidate will join the collegial faculty of Penn State Neurology, which is in an exciting period of growth under the leadership of the Chair, Krish Sathian, MBBS, PhD. Faculty rank will be commensurate with experience. Leadership opportunities are available to those with relevant experience.

FOR ADDITIONAL INFORMATION, PLEASE CONTACT: Anderson Smith, Physician Recruiter at asmith50@pennstatehealth.psu.edu

IDEAL CANDIDATES WILL HAVE THE FOLLOWING:

• Medical degree – MD, DO, or foreign equivalent • BC/BE in Neurology and relevant fellowship training or foreign equivalent • Relevant clinical interest and expertise • Excellent patient care abilities and interest in teaching WHAT ELSE CAN YOU EXPECT?

• Competitive compensation • Generous benefits, including relocation assistance

AS A MEMBER OF THE DEPARTMENT OF NEUROLOGY YOU WILL BE ASSOCIATED WITH:

• An outstanding Neurology program with a national reputation • A highly collaborative culture • Interaction with dynamic clinicians across all neuroscience-related departments and participation in innovative educational approaches

Penn State Health is fundamentally committed to the diversity of our faculty and staff. We believe diversity is unapologetically expressing itself through every person’s perspectives and lived experiences. We are an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.

If you’re a job-hunting neurologist, you may have noticed the preponderance of positions available in rural and underserved areas of the country. Tempted? You should be—these openings can present terrific opportunities to build your career while setting down roots for your family. Ah, the family…concern for your spouse might be one of the issues giving you pause. How will he or she find work? As it turns out, perhaps more easily now than ever before.

Rural Employment: Options for the Physician’s Spouse

There are many factors that might make a neurologist wary of rural work assignments, including worries about low pay, opportunities to work within a subspecialty, and lifestyle in general. As it turns out, these worries can be put to rest. The salary is generally greater than that offered in larger urban areas. Combined with a lower cost of living, lucrative hiring bonuses, and other incentives, many physicians find rural employment to be a financial windfall. Likewise, the chances of practicing a subspecialty can be better than in areas with more neurologists vying for the same opportunities. As for lifestyle, that’s a subjective measure but many physicians report being pleasantly surprised to find more cultural and recreational opportunities than expected, along with a more relaxed pace of life. Having crossed each of these issues off the checklist, the

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job-seeking neurologist might still be left with the question of opportunities for his or her spouse. Or, perhaps more troubling, opportunities for a spouse who is working now and would be uprooted by a move to the country. This phenomenon, often described as the “trailing spouse” issue by relocation specialists, has plagued two-career couples for decades. It’s been especially common for military spouses and those married to corporate executives, which are two employee groups that are frequently required to relocate for their work. In those cases, the uprooted spouse has most frequently been the wife, and she’s often been responsible for managing the move itself along with issues related to the kids, with her own career indeed trailing in last place for attention. That’s the history of the situation. But the current reality? Worker shortages plus remote work options equal unprecedented opportunity for the socalled trailing spouses of rural physicians. While both of these phenomena have been brewing for a while, the pandemic may have knocked down the final barrier in terms of employer resistance. Having now seen how many jobs can be performed in new ways, and having experienced nerve-wracking employee shortages, the nation’s employers are experiencing a twin burst of creativity and

tolerance when it comes to how they get their work done. This is all good news for the neurologist considering the impact on a spouse’s career when considering relocation to a rural area. If you are that neurologist, then read on. There are at least five ways your spouse can pursue a career if you decide to practice in rural America. 1. Work remotely for a current employer. If your spouse is currently employed, he or she

might be able to continue in the same role from a rural location. This is a strong option for any job that is conducted primarily from an office, but it can also work for professional service roles, including counseling, social work, law, training, and others where the interactions primarily

consist of conveying ideas and information. To explore these options, a little homework is needed. Before talking with his or her employer, the relocating spouse should do some brainstorming about how the current work or a variation of it (or a brand-new role) could be conducted remotely. Then, a brief cost/benefit analysis is needed. Nothing fancy, but it’s easy to anticipate the boss asking, “How much would this cost? How would our business benefit?” Being able to answer those questions will make for a better conversation when the time comes. 2. Obtain a new job that is remote. Again, if your spouse has skills that can be parlayed for remote work, he or she could be an excellent candidate for an entirely new job with a different employer, located anywhere in the country. Since many of the roles we never imagined being possible away from the workplace are now conducted partly or wholly online, the range of opportunities for remote work has expanded exponentially. If your spouse can’t or doesn’t want to take his or her job along to the new location, this is an excellent option. Online job boards are a good place to start when exploring this possibility. Many have filters that can be set for preferences such as “remote work” or “telework,” making the search easier to manage. Checking with specific employers within one’s industry to inquire about remote work opportunities is another pathway,

and one which can sometimes reveal positions that aren’t yet (or won’t be) advertised. 3. Find a local, hands-on job. No matter how rural the position you’re planning to take, there’s at least a medical center or clinic in the location, right? Right. Which means there are any number of local jobs that could appeal to your spouse. Identifying local organizations and potential employers may be something your recruiter can assist with. If not, there’s always the old-fashioned process of checking with the chamber of commerce or town council for a list of businesses to contact. If there’s a newspaper serving the area or even a phone book, your spouse can get a head start by getting copies to review prior to your move. 4. Work as an independent contractor. The concept of having a gig or side hustle is quite familiar by now and it may be that your spouse has already been operating as an independent contractor. Skills that work well for portable side hustles include writing, editing, software coding, managing projects, and more. Whatever skills are used, the work in this model is conducted on a contract or gig basis, rather than as an employee. Like any work structure, there are pluses and minuses to this option, but one of the major advantages for relocating spouses can be the flexibility of working only when it fits the schedule. Independent contractors often locate assignments on web sites specific to their profession, or on more general sites that broker introductions with companies or individuals needing certain tasks performed. These sites

can be convenient, but they can also drive down take-home pay through competitive bid processes. To maintain more control, your spouse may want to contact former employers to ask if they’d like any work conducted on a project basis. 5. Start a business. The side hustle from above could certainly be treated as a business, but there are other, more traditional models to consider as well. For example, rental space would be available in your new town to operate anything from a coffee shop to a boutique. One advantage of rural living can be the availability of affordable or unoccupied buildings that can be renovated for new purposes. Other options for business startup can be conducted without any external space, provided your new home can accommodate it. Or, your spouse might review ideas for buying into a franchise operation, where much of the setup is already in place. Like any business startup process, legwork is needed before diving in. Regulations governing home-based businesses, for example, or state and county business licensing would be good information to have. Luckily, there are quite a few web sites and governmentsponsored resources for business owners, so the research doesn’t need to be difficult. 6. Educational goals. Depending on where your spouse is in his or her career path, one of the best options might not involve work at all. If career improvement is important at this stage, now might be the time to start or complete a degree or certificate that will enhance future work opportunities. No matter how rural your new location, as long

as there’s broadband, there will be training options available. This may even be a benefit for you to negotiate on your spouse’s behalf, particularly if your new employer is a university that could sponsor tuition. 7. Getting creative. Your spouse may have creative talents, previously restricted by available time and space to explore. If their current career path is less than satisfying, is it time to explore a detour? Homes with studio or art space could well be an affordable option in your new community. Things like supplies, workshops, and distribution channels can be easily accessed online. Your spouse’s potential new career could emerge as that of a creative artisan or teacher given the slower pace of life, newly available time, and generous inhome workshop.

What not to do… Procrastinate! The sooner you and your partner get started on this transition, the more smoothly it will go for both of you. Even if you don’t yet know which town or state you’ll be working in, there are still steps that can be taken now. Internet research is key. Resumes and CVs should be up to date, LinkedIn profiles can be written, and voicemail can be programmed on your cell phones so recruiters know they’ve reached the right person with the next great job offer. Remember: While relocation will always bring challenges as well as adventure, with a little planning and creativity, it can also be a benefit for your spouse’s career. 

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Available Testing: Bon Secours Mercy Health is seeking a talented Neurologist to join their busy and established team of providers in Richmond, Virginia.

Successful candidate will become part of our comprehensive neuroscience program which includes:

• A full continuum of care from diagnostics and treatment to physical therapy.

• Specialized, Joint Commission certified Primary Stroke Centers and Acute Stroke Ready Center. • Emergency Room teleneurology for rapid and efficient acute stroke treatment.

• Dedicated inpatient acute care and intensive care neuroscience units -- one for stroke and neurology and another for neurosurgery -- with specialized nurses and clinical staff.

• Spine treatments and procedures that use the latest technological advancements.

• Collaboration with the fully accredited Bon Secours Sleep Center staffed by neurologists who are board certified in sleep medicine.

• Long-term video-EEG monitoring to help diagnose and treat seizure disorders such as epilepsy.

• Electroencephalograms (EEG) • Nerve conductions (NCV) • Electromyography (EMG)

• Videonystagmography Testing (VNG) • Evoked Potentials (EP)

Treatments offered:

• Image-guided neurosurgery

• Endoscopic brain tumor surgery • Stroke Prevention • Support Groups

• Balance and Fall Prevention • Concussion Management • Vestibular Rehabilitation

• Endoscopic brain tumor surgery • Image-guided neurosurgery

Contact: Stacey B. Ellis | Stacey_ellis@bshsi.org | www.bsmhealth.org Physician and APC Recruiter Specialty Services | Bon Secours Mercy Health

• MRI guided laser brain surgery • Vascular brain tumor surgery

Now Hiring: Board Certified/ Board Eligible Neurologist Neurology Specialists seeks to add third physician to our medical team in 2020.

Build Practice Around Preferred Sub-specialty

Position Benefits:

• • • • •

Competitive salary Rewarding incentive structure Malpractice Coverage

in Beautiful Sun City, Arizona

We are looking for specialists that also want to

Full benefits package, 401K and profit sharing also included NO call, nights or weekend work

retain their general neurology skills while building a practice around their preferred sub-specialty. ideal sub-specialty interests are neurophysiologist experienced in EEG/EMG, movement disorders

Practice Overview:

•

• • • • • •

Dedicated Neurology clinic within 20,000 square foot healthcare complex NEW state-of-the-art Neurology clinic opening 2021

specialist, epileptologist, migraine/ headache specialist and dementia/memory disorders specialist.

On-site Infusion Suites, Procedure Suites, EEG and EMG

Dedicated resource staff to handle administration, referrals, billing, marketing and practice management

AZ Integrated is a great place to expand your professional career, and Arizona is an ideal place to live and raise a family. If you or someone you know is interested in learning more about this opportunity please contact us at mmadueno@azintegrated.com.

Interested physicians should send CV and available start date to info@neurologycharleston.com

Please email your CV to Mari Madueno, mmadueno@azintegrated.com if interested.

On-site 1.5T MRI Fully integrated EMR Well-established referral network

*This position does not qualify for J-1 Visa Waivers*

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Working in the United States: Resources for the International Neurologist

barriers. And nearly always, there’s a series of steps to obtain visas or waivers that provide eligibility for employment. While many foreign-born neurologists first arrive in the US on a J-1 visa to complete a residency or fellowship, they soon find the process for remaining here as practicing physicians to be more complex. If this describes you, the good news is that there are multiple ways to become approved to work in the United States. But every path takes patience and attention to detail. Read on for more information and check out the glossary to learn more about the terms you’ll want to understand.

More than one way to work in the US Secondary school…post-secondary school…medical school and licensing…internships…residencies and fellowships―nothing about the neurologist’s journey from training to practice is easy, but for the immigrant physician wishing to work in the United States, there are even more challenges. Sometimes, there’s a repetition of training or licensing to meet US criteria; often, there are language or cultural

When someone talks about getting permission to stay on in the United States, they may be thinking in generic terms or they may be thinking about just one process they’ve heard about. In truth, there are several ways for foreign-born physicians to work in the country, each requiring its own strategy and process. The following three options are perhaps the most common:

J-1 Visa Waiver. Neurology fellows and residents using a J-1 visa to complete their studies in the United States are required to return to their home countries for two years when the visa expires, before applying to re-enter the United States. To set aside this requirement (allowing them to continue directly to employment without returning home), they need a waiver or, more specifically, what’s known as the Conrad 30 J-1 visa waiver. This particular section of the waiver program provides 30 slots per state specifically for physicians. To receive one of these slots, the physician’s potential employer makes application to the state’s department of health requesting the two-year home residency be waived in return for the physician providing three years of health care in a medically underserved area. H-1B Visa. Since H-1B visas don’t include a specific program for physicians, approximately 85,000 annual slots are shared among all professions, attracting around 200,000 applicants. Universities and training programs are usually exempt from the cap, meaning foreign-born physicians in training don’t need to compete for limited slots―until they finish training, that is. At that point, they will either need to enter the broader pool, or focus on employment with exempt training institutions. In both cases, employer sponsorship will be required for the visa to be approved. Unlike the Conrad J-1 visa waiver, the H-1B visa does not require employment in a medically-underserved area. Permanent residency/US citizenship. For physicians who want to live and work permanently in the United States, the most secure route will be through permanent residency, leading to citizenship. In this case, residency, often called Green Card status, would be achieved through an employersponsorship process. After three or five years of permanent residency, the physician would be eligible to apply for what is called “naturalization”―the term for becoming a citizen of the United States. If all of this sounds overwhelming, take heart. Ann Massey Badmus, principle attorney with Badmus & Associates in Dallas, has some good news: In her practice specializing in immigration issues, she says, “I talk to two or three hundred physicians a year and I would say 90 percent or higher would get approved.” Badmus identifies three keys for success in the process: Understand the type of visa you’re seeking and what it requires; start as early as possible mapping out your strategy; and speak with an immigration attorney as early in your career as

possible, to provide guidance. Read on for more on each of these points.

Timing is important―steps to take Whatever you’ve heard in the past about how long a visa approval might take, it would be smart to extend that timeline by several months or more. For numerous reasons, ranging from backlogs to rule changes to staffing shortages and an increase in applications across all programs, governmentbased visa processes are running much slower than in years past. Badmus recommends starting the process at least one year, and more likely two years in advance of when the physician would want to be employed. That means a doctor starting a two-year fellowship now should also immediately initiate the process to secure a visa for later employment. As Badmus notes, “The earlier you start, the better your options” of finding work you want in a region you want to live in. Since both J-1 visa waivers and H-1B visas require employer sponsorship, it’s logical to start the process with a job search. But that’s actually the second step, at least in the case of the Conrad 30 program. Because each state has 30 slots for physicians seeking a J-1 waiver, Badmus advises a look at the program requirements and deadlines for the states you’d most want to work in. With that knowledge in hand, you’ll be better able to gauge which employers to contact and how quickly. (See the resources list below for a link to a list of each state and its requirements.) Ideally, Badmus says, a physician would be through interviewing and have an employment contract before starting the last year of fellowship “because you’re going to need that last year to work through the J-1 visa waiver process.” The contract itself will be similar to any other employment contract with the exception that three years will be stipulated. Depending on the state, the contract may also leave out the standard non-compete clause, as states providing the J-1 waiver would prefer doctors are able to continue working in the underserved area if they choose.

Strategies to employ While it’s natural to begin your search where you’d most like to live, that might not be the most strategic path. For J-1 visa waivers, remember that highly popular and densely populated states such as California and New York have the same 30 slots as states such as North Dakota and Idaho―so it’s

Careers.AAN.com 19

easy to guess which spots might be the most or least competitive. If your choices lead you to more competitive locations, you might need additional strategies, such as a willingness to be a generalist or work in a different kind of practice than you’d envisioned. The key, Badmus says, is to study the needs of your target states as well as their requirements and process, then adjust your own process and expectations accordingly. And, if you get turned down in the first state you try, Badmus advises applying in other states. For those seeking H-1B visas, similar cautions apply. Employers in very popular parts of the country may be flooded with applicants seeking visa-sponsored positions, while those in rural or under-served areas may have far fewer applicants. For both types of visas, the success strategies for any job search would apply: Identify the employers you would like to work for, send your CV to their recruiters or practice managers, request a meeting or interview, etc. The difference for a candidate seeking a visa sponsorship, however, is critical: Since you are asking the employer to take an extra step on your behalf, you need to be prepared for that part of the conversation. As Amy Schoch, senior manager of AAN Career Services, notes, “You can’t wait for the employer to do the work for you. If you want your first choice for employment, you’ll need to do some of the steps yourself.” That could mean supplying information and contacts for the visa program, completing some of the forms in advance, arranging a conversation with your attorney to answer questions, or anything else that makes the process of hiring you less intimidating for the employer. What if you can’t secure employment before your training ends, despite your best efforts? Two of the most common choices are to continue with another training program or return home to work for two years before attempting re-entry to the United States. You might also double down on efforts to identify cap-exempt employers (usually training institutions) for the H-1B process, although timing might not be on your side. Even when these options are exhausted, it’s possible that other pathways could be available, depending on your specific circumstances. This is one of many reasons to work with an experienced immigration attorney, to reduce the chances of missing an opportunity.

Don’t go it alone―you need a team It’s probably clear by now that immigration processes and visa applications are not simple procedures. This is a situation that calls for a team of experts, not a solo effort. In addition to mentors, advisors, and others who might assist, your team needs two key people: An attorney and a recruiter. The recruiter slot can perhaps be filled by a rotating set of professionals you contact in each hospital or practice you want to work at. Or, you might focus on a recruiting firm specializing in physicians or neurologists for the expertise you need. In either case, the recruiter is key to helping you understand the needs of different employers and strategies for approaching them. By contrast, your attorney would ideally be someone you choose early in this process, who continues to serve you throughout your career. Because visas are federal, it won’t matter which state your attorney is licensed in. But it does matter that he or she specializes in immigration and, most importantly in immigration for physicians. This is the person who can advise you not only on the appropriate steps to take, but on the terms of your contract and other details relating to your employment. It’s common for attorneys to meet briefly at no charge, but then the services will be billable, either by the hour or per service. Given the high stakes involved, this is a cost most physicians consider to be part of the investment they’ve already made in their training. For further information, check out the glossary and resources list below. Then get started! Time will slip past before you know it, and this is a process you want to tackle as early as you can.

UNDERSTANDING THE OPTIONS―A GLOSSARY OF TERMS The first step for candidates is to gain a basic understanding of the options available to foreignborn physicians who want to work in the US. While each situation is different and needs its own solution (best identified by a qualified attorney), these are the relevant visa options both candidates and employers should know about: F-1 visas are used by foreign nationals who come to the United States for enrollment in medical school or other full-time education. J-1 visas are used by foreign-born physicians (or other professionals) who attained their medical degrees in their home countries before coming

to the United States to complete residency or fellowship training. J-1 visa waivers are needed for foreign nationals to stay on in the United States to apply for work. The Conrad 30 waiver is the specific J-1 visa waiver for J-1 foreign medical graduates (FMGs). Without the waiver, the candidate must return to his or her home country for two years before being eligible to come back to the US. H-1B visas are the most common work visas used by foreign-born physicians (and others with bachelor’s degrees or higher) who seek employment in the United States. These visas must be sponsored by employers, and the physician must be licensed as well as degreed. Additional visas, such as O-1, TN or E-2 visas, may also be applicable in more extraordinary situations to foreign-born physicians seeking work in the United States. All visas noted above are temporary work or education visas and must be renewed according to their specific criteria. Permanent residency (“Green Card” status) can be gained through several pathways, including employment. In this circumstance, the process must be sponsored by an employer.

US citizenship normally requires a period of three or five years of permanent residency before one is eligible to apply for naturalization as a United States citizen.

ADDITIONAL RESOURCES Government resources and websites: In addition to webinars, the website for Badmus & Associates includes a helpful list of immigration-related websites leading to government resources and case-status sites. Check it out at badmuslaw.com/ resources/helpful-links/. State-by-state Conrad J-1 visa waiver timelines: To help you track the deadlines and steps for the Conrad J-1 visa waivers specific to foreign-trained medical professionals, the Ford Murray Law firm has created a state-by-state reference on its website. Visit it at fordmurraylaw.com/must-knowdeadlines-conrad-30-j-1-visa-waiver/. Books and articles: Numerous law firms and attorneys have written helpful guides on immigration steps for physicians and others, including Ann Badmus. Her book, The Immigration Prescription: The Practical Guide to US Immigration for Foreign-born Physicians, can be purchased in print or as a Kindle ebook. 

Careers.AAN.com 21

GENERAL NEUROLOGIST OPPORTUNITY Penn State Health St. Joseph in Berks County, Pennsylvania is seeking a general neurologist to join our existing practice. The selected candidate will have both inpatient and outpatient responsibilities. This is an excellent opportunity for a neurologist who wishes to enjoy a high-quality of life while providing care within a community of approximately 400,000. What We’re Seeking • Medical degree – MD, DO • BC/BE in Neurology • Candidates with subspecialty training encouraged to apply What We’re Offering: • A competitive salary and generous benefits • Outstanding program and highly collaborative culture • Interaction with dynamic clinicians • Routinely ranked among the Top 50 Heart Hospitals in the country in quality metrics • Nationally certified as a Center of Excellence in Chest Pain, Stroke and Heart Failure • Nursing care that has also earned the distinction as a “Pathways to Excellence” accredited facility

FOR ADDITIONAL INFORMATION, PLEASE CONTACT: Anderson Smith, Physician Recruiter asmith50@pennstatehealth.psu.edu or 717-531-4703

MEMPHIS ELECTROMYOGRAPHER NEEDED Practice limited to outpatient electromyography

No Call • No Weekends • No Hospitals • Attractive pay • 3,4 or 5 days a week (your choice) Experienced & certified techologists • Modern space & equipment Friendly atmosphere • No treatment. Only testing.

Bingham Nerve & Muscle has been providing EMG/NCS studies since 1989. We currently have 4 physicians and are interested in adding 1-2 more. We prefer a special interest in electromyography + ABEM or neurophysiology boards. If you have interest, please contact:

Ron Bingham, MD RB@NERVEANDMUSCLE.COM CareerCenter: 20 NCC Ad, halfpage Placed in AANnews, Brain&Life 8.25 x 5.25 +0.125 bleed, 4C

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Careers.AAN.com 23

Lancaster Medical Center

GENERAL NEUROLOGIST OPPORTUNITY Penn State Health Lancaster Medical Center is seeking a General Neurologist for our brand-new state-of-the-art Lancaster Medical Center. The new facility located in Lancaster, PA and set to open summer 2022. Neurologists with clinical expertise in general neurology are invited to apply for an open position at Penn State Health Lancaster Medical Center. You will flourish in a supportive work/life balance environment. Leadership opportunities are available to those with relevant experience. What we’re seeking: • We are seeking someone trained in general neurology • MD, DO, or foreign equivalent Opportunity highlights: • Competitive salary and benefits • Sign-on bonus and relocation assistance • CME time and fund

• Ability to acquire a license to practice in the state of Pennsylvania • Completion of an accredited residency program • LTD and life insurance • Penn State University tuition discount for employees and dependents

Area highlights: • Lancaster Medical Center will enhance an already vibrant network of primary and specialty care providers across Lancaster County, including practice sites of the former Physicians’ Alliance Ltd. that joined Penn State Health in 2017 and the Lime Spring Outpatient Center that opened in East Hempfield Township in January 2019. • The Lancaster Medical Center will create new clinical and research opportunities for learners and investigators at Penn State College of Medicine, both during construction and after the hospital opens. • The new hospital will feature all private inpatient beds, an emergency department, physician offices, various specialty inpatient services, an imaging lab, and complete medical and surgical capabilities. INTERESTED APPLICANTS, SEND CV AND COVER LETTER TO Anderson Smith, Physician Recruiter at asmith50@pennstatehealth.psu.edu Penn State Health is fundamentally committed to the diversity of our faculty and staff. We believe diversity is unapologetically expressing itself through every person’s perspectives and lived experiences. We are an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.

Career Compass—December, 2021

Articles inside

Rural Employment: Options for the Physician’s Spouse

Working in the United States: Resources for the International Neurologist

Compensation in Times of Change