Will They Pull a Faculty Position Offer?

For anyone applying for a faculty position, this is probably the nightmare scenario: you interviewed, you like the position, they liked you, they offer you the position, you begin negotiating, and then they pull the offer.  What the hell just happened? This topic is difficult for me to discuss because it is so thoroughly beyond-the-pale unprofessional and unacceptable for institutions to pull an offer that I can barely wrap my head around it.  Nonetheless, it does happen in veterinary medicine, and I have personally seen it twice.

The first I heard second-hand about but did not participate in.  The small, private institution had offered a candidate the position and the candidate came back with requests.  The problem is, one of those requests was absolutely impossible for the institution. The applicant felt strongly about it, though, so contemplated it for a long time and came back with another possible solution.  There was at least one other back-and-forth like this. The candidate came back with another possible solution, and the hiring manager at the institution became frustrated and said, “Forget it.”

The second happened to a friend of mine.  They received an offer for a faculty position at an off-campus research center affiliated with a large state school.  My friend came back with a request for flexibility to allow remote work from an office on-campus (4 hours away from the research center) 4-6 days per month because of a personal family situation.  The institution pulled the offer without further negotiation or explanation.

Let me be clear: this is the fault of the institution, NOT the applicant.  I told my friend that it was probably for the best: any organization which would pull an offer during negotiations is not one you want to work for.  This happens only because individuals at the organization get ego and emotion involved, which you SHOULD NOT do during negotiations. Here’s how negotiations are supposed to work:

The institution extends an offer.  You respond with what you would like in order to accept it.  The institution responds. They may give you everything, they may give you something, or they may give you nothing of what you ask for.  If they give you everything, great, you accept the offer. If they give you something, you may be able to reply asking for a different something.  The second-to-last step in any negotiation is the institution saying: this is our final offer, take it or leave it, and we need a decision by this date.  It is then up to the candidate to decide if that is acceptable to them or not.

I can’t imagine why an institution would rescind an offer unless it is due to ego or emotion.  I have heard administrators say during a negotiation, “Well, they aren’t appreciative enough of our offer,” or “What they are asking for is unreasonable.”  The first reflects a ridiculous premise- of COURSE they appreciate the offer, but they want to do the best thing for themselves, their colleagues, and the institution.  The second is irrelevant- if the institution believes it is unreasonable, they can reply with, “We cannot do that.” That’s how negotiations work!

If you are applying for faculty positions and are concerned about the pulled offer, my advice is: Do not be concerned.  First, they are vanishingly rare. I have a personal sample of probably 50 negotiations of which I am aware enough to know if this happened. The fact that this happened in only two cases indicates a 4% incidence rate. In fact, the rate is very likely much lower than that, as there are hundreds more negotiations I do not know of that did not result in a pulled offer. Second, it is a GOOD thing if an institution pulls an offer to you.  This indicates they are immature and unprofessional and don’t know how to conduct a negotiation. You don’t want to work at an institution like that. Of the two cases I described, I believe both candidates dodged a bullet.

Any competent administrator, if faced with a situation where they can’t give a candidate what the candidate is asking for, will say so, “This is the best we can do.  Let us know by this date if you will accept or not.” When negotiating, you need to ask for what you NEED and what you WANT and offer reasonable explanations for your requests.  Don’t accept any less because you are afraid of the pulled offer. The reasonable institution will give you what they can and negotiate in good faith.

NB: All of this assume YOU dealt with the institution in good faith. If you withheld something (pending license investigation, legal trouble, accusations of academic malfeasance, etc.), you should absolutely expect this will be discovered and, no matter where you are in the process, the offer will probably be rescinded. But you wouldn’t do anything like that, would you? So does not apply to you.

Making the Most of a Residency Interview

The Vetducator - residency interview image.

Your application is compelling enough for a program to spend the time interviewing you- congratulations!  Many residency programs conduct interviews, and it can be a significant variable in the decision making. Sometimes these are by phone, sometimes by video, and sometimes in person.  Obviously, you should follow the general guidelines for each of those interview types as well as prepare so you can present your best self. More specifically, here’s how to make the most of your residency interview experience.

This is not only a chance for them to learn about you but for you to learn about them.  If you get matched for a program but will be miserable, you may not finish. Every year there are residents who drop out of their long-dreamed-of specialty because the program wasn’t a good fit for them.  You need to make sure this is somewhere you can be happy for three or four years. Here are some questions to ask the program directors or existing residents to help you decide:

Both program directors and existing residents:

  • What’s it like to live here?  What do you like about it? What do you dislike about it?
  • What are the students/interns like?  What are the interaction with them and the residents?
  • What are the responsibilities of the residents?  Do they do general ER duties or call or only do specialty emergency duties?
  • What is the interaction with other specialties like?
  • What is the strategy for ensuring residents successfully complete a research project?  Are there opportunities to do more than the required project?
  • Are there opportunities or requirements to teach in lab or classroom or rounds room?  What kind of support is available to help nurture resident teaching skills?
  • If you could change anything about the program, what would it be?

Program directors:

  • What do you do to ensure resident success?
  • What are the plans for program improvements?
  • What have you learned from previous residents that has caused you to change the program?

Existing residents:

  • What have been your challenges with this program?  What did you like about it?
  • Would you have chosen this program if you knew then what you knew now?
  • What would you change about this program?

Asking incisive questions will ensure that the program knows you are serious and engaged.  What else can you do to impress them during your short interview time? Remember, their goal is to determine if you will be successful in their program.  You want to assure them you are competent, dedicated, and enthusiastic.

You need to have examples from your experience that demonstrate your best characteristics.  Are you willing to come in odd hours- tell a story during your clinical year or internship when you did and had a great time.  One of my best days in vet school was 22 hours long and started with a hemilaminectomy and ended with a GDV. The resident on duty said excitedly, “Well, what else would we be doing on a Friday night?” and I was in enthusiastic agreement.  Just saying, “Yes I work hard and I would love to be your resident” is not enough. Demonstrate you have those characteristics with stories.

Each residency program is different, but characteristics that are generally looked for include (in no particular order): curiosity, willingness to work hard and long hours (no laziness or cutting corners), detail oriented, compassionate, humble, teachable and willing to accept and use feedback/criticism, able to handle setbacks, good at managing stress, pleasant to work with/positive, ethical, good critical thinking skills, knowledgeable, effective at communication, enthusiastic, dedicated, and cooperative and helpful.

The residency interview is a difficult experience to navigate.  You need to get information to make sure you would be happy there while assuring them you would be happy there and a great catch for them in a very short amount of time.  Have a plan ahead of time. If you fumble asking questions or coming up with examples of how you’re awesome, you’re sunk. It’s a fairly high stakes experience. You spent undergrad, vet school, and maybe an internship to get here.  You can’t just hope it will work out. You must prepare.

How to Be Successful: Show Up

The Vetducator - success by opening doors by showing up.

Show up.  That’s it.  End of blog post.  You can believe me and stop reading or you can read on if you need more convincing.

Living in the South is strange in so many ways.  One which you would not expect is the approach service workers (plumbers, electricians, roofers, contractors, etc.) take to showing up.  That is, maybe they will and maybe they won’t. Not just being late- that’s any service worker. You make an appointment, and they never show or call to reschedule.  This is distinctly different than in other parts of the country in my experience. It seems like a simple arrangement- you show up to do a job, I give you money. Don’t you like money?  Apparently, laborers in the South do not. Every now and then you find one who actually shows up, and they get all my business and my friends’ business. Until they also eventually start to not show up.  It’s a weird way to run a business, but this was a huge sign I had of how important it is to show up.

Teaching martial arts for 20 years, I see this constantly.  Who are the black belts? The best students? The most competent, the stellar athletes?  Not at all. The black belts are the students who showed up. They came to class and kept coming to class, slowly learning and progressing.  The most amazingly athletic students- they were aiming to be a +1– they fell off because they actually had to apply themselves to progress rather than rely on their raw talent.  The slow, steady, quietly competent and attentive students were the ones who became terrific martial artists. They showed up.

The best vet student, intern, resident, or faculty isn’t necessarily the smartest.  Smartness helps, as does wisdom, but to be excellent you first need to show up. If you’re a student, be there before anyone else on your team and leave after everyone else on your team.  Offer to take extra on-call responsibilities. Study when you get home. One vet student with whom I worked answered a call to participate in a research project. She was so capable and engaged that she became integral to other projects, and now she has her name on three published research articles.  Those who put the time in, get the rewards.

This goes all the way up.  The most productive faculty aren’t necessarily the smartest or the most ruthless.  I know some faculty members who never come into their office when they are off clinic duty.  They’re fine faculty members, but they won’t ever be amazing until they start showing up.

We’ve talked before about how to avoid being a -1: aim for zero.  Here is where we start to see how you can go from a zero to a +1. Start by being quietly competent. Then show up.  The world is run by those who show up.

How to Choose Your Internship

The Vetducator- screen shot of the VIRMP matching program website.

Where you got to vet school does not substantively affect your internship prospects, but the institution where you do your internship may affect your future residency prospects.  Selecting the most appropriate internship position is particularly important for those bound for residencies. For those bound for private practice, the primary goal is to avoid a bad internship.  Internship programs change in quality over time, so there is not a reliable database of bad internships. These are some variables you should keep in mind as you consider your future.

First, I am very evidence-motivated and fact-oriented, so I made a table.  This table had each program as a row, and column headings for important variables, some of which are listed below.

Specialties.  If you want to do an ophtho residency, of course you have to go somewhere which has ophthalmologists.  Otherwise, you want to have surgery and internal medicine at a bare minimum.

Number of interns.  If you are one of two interns, you may not have as many opportunities for collaboration and support in the program.  If you are part of a 28-intern mob, you may become just another faceless, poorly-paid doctor. Decide where you want to fall in this spectrum.

Amount of emergency work.  Every intern’s salary is justified by the ER work they do.  Some programs provide good backup for their interns on ER so that they learn quite a lot.  Some leave them to sink or swim. The more time you spend on ER seeing cases, the less time you may have with specialists who are focused on teaching you.  Be cautious of anything over 25% ER time.

Cost of living/Salary.  Most interns get paid poorly, but being paid poorly in Athens, GA is different than being paid poorly in Philadelphia, PA.  In Athens, you can get a decent duplex in a safe part of town. In Philadelphia, you’ll probably be longing for those self-defense courses you took in undergrad.

Reputation.  This is only relevant if you are interested in a residency.  In general, academic internships have a better reputation, mostly because their faculty are ‘plugged in’ to the post-grad system and know people at other institutions.  The reputation is not necessarily related to the actual quality of the program. If you get an internship in a small private practice with one surgeon and one internist, it may be harder to get a residency than if you get an internship at, say, the University of Tennessee.

Geography.  Most people I know ignore geography, and it’s understandable as to why.  It’s only a year- you can dig yourself out of snow every day for that short amount of time.  For a rare few, this is an important variable. For most people, though, geography is (and should be) irrelevant.

Identifying an actively bad program is a different decision tree, and requires personal contacts at a large array of institutions.  Assuming most programs aren’t bad, the characteristics listed here are the ones I think are most useful in deciding where to go. What are other variables you think are important in internship program selection?

Make Sure You Have What you Need for the On-Site Interview

Traveling is harrowing under the best of circumstances.  You may get lost, you may have flight troubles, your baggage may not make it.  This is compounded when you are traveling for an interview. Will you be well rested enough, prepared enough, and avoid getting run-down?  Some of these things you can’t control. One thing you CAN control is packing correctly. The best resource for this is a checklist.

Checklists are becoming more popular in human medicine and, trailing behind as always, in veterinary medicine.  We did a study documenting that addition of some checklist steps dramatically reduced adverse anesthesia incidents.  Checklists are effective because human brains are actually terrible at retaining 100% of the information they should retain.  This is doubly true if it is an event you rarely encounter. Traveling for an interview is probably not something you do every month, so creating a checklist is key.  Here are some suggestions:

  • Toiletries.  Although most good hotels will have the essentials, you certainly have your own things you need to bring.  On my list is a hairbrush, deodorant, toothbrush, toothpaste, razor.
  • Clothing.  Obviously you need a suit if you are doing an interview.  Make sure it is folded to minimize creases. When you arrive at your destination, hang your suit up first thing.  You may need to iron it or your shirt/blouse. On my list are undershirts, shirts, underwear, socks, pants, pajamas, tie, dress shoes.
  • Electronics.  It is one of the most frustrating experiences to get to a destination and realize you don’t have your laptop charging cord.  On my list is a phone, phone charger, power adapter, laptop.
  • Miscellaneous.  This obviously includes a wide range of items, but for me includes books and headphones.
  • International.  If you are traveling internationally, you need a separate section for this.  Hopefully you know the visa situation before you pack. On my list are passport and foreign currency.

I travel a lot, but you would not believe the number of times I have been saved by having my checklist.  Ease some of the burdens on your mind in an interview by automating the packing part of the travel. Make up a checklist ahead of time, and then you have no worries packing!  Do you use a checklist? Have you ever forgotten something critical for an interview? Share in the comments!

The Vetducator Podcast- Dr. Diehl

Podcast Episode 5 – Dr. Katie Diehl

Dr. Diehl and I worked together at the same institution and enjoyed discussing and engaging in research. Since I left, we have continued to work together and have some great collaborations. Dr. Diehl talks about the unique circumstances of finding and obtaining an ophthalmology residency as well as what she looks for in candidates and how she likes to help students be successful.

Internship Letters of Recommendation Flowchart

Last week we did a whole series on letters of recommendation. One of the most complex is for those applying for internships. Therefore, I created a (relatively simple) flowchart to help you decide what letters of recommendation you should get for internship applications.  

Core disciplines are internal medicine, surgery, and emergency/critical care.

Ancillary disciplines are cardiology, neurology, oncology, anesthesiology, and radiology.  

Peripheral disciplines are anyone outside your species focus (e.g. you are applying for a large animal rotating internship and the letter-writer is a small animal internist), ophthalmology, dermatology, pathology, behavior, theriogenology, and ABVP specialties.

The Vetducator - internship letters of recommendation flowchart.
Click for larger image.

Choosing Letters of Recommendation for a Faculty Position

The Vetducator - letters of recommendation series image.

Aim for zero.  Seriously. The faculty selection process is largely based on the interview.  All of your written materials are designed with only one goal: to get you an interview.  Once you interview, all of your written materials will be of minimal value, unless those materials ‘ding’ you.  Therefore, your strategy is simple: aim for zero.

Consider what those recruiting a faculty member want out of a candidate.  They want someone personable and low maintenance. No department chair wants to recruit someone who is going to be a pain in their side.  Your letters, therefore, should primarily speak to your collegiality. Therefore, you can get letters from three sources: supervisors, colleagues, and mentees.

Supervisors.  See the above description of what a department head is looking for.  If your current head can write that you are low maintenance and highly productive, that makes it easy to offer you an interview.  If you are finishing your residency, obtain at least one letter from a faculty mentor, and preferably two.

Colleagues.  This could be someone in your discipline and someone outside your discipline.  If possible, a letter from each of these is ideal. It’s important to demonstrate that you can get on with others in your discipline as well as those outside of your discipline.  You should definitely have at least one and preferably two letters from colleagues.

Mentees. These are preferably residents who have now gone on to bigger and better things.  If you are an administrator, they may be faculty you have supervised. In general it is better to solicit letters from people with whom you no longer work- that way there is no concern of inappropriate pressure applied to them.  If you trained a resident, they loved you, and they are out in the world as a specialist, they have no pressure to write you a good letter except that they loved working with you. If you are a resident, a more junior resident or a former intern who liked working with you may be good.  This category is not a requirement and these letters of recommendation should be considered additional to the core letters.

I strongly advise you get at least one letter from a supervisor and one letter from a colleague.  You need people who will speak to your collegiality and productivity/work ethic. Ask potential writers if they are willing to write a good letter, send them the position description, and give them plenty of notice/time to put a letter together.  Remember your goal: get an interview.

Choosing Letters of Recommendation for a Residency

The Vetducator - letters of recommendation series image.

The letters of recommendation for a residency are key.  These people will hopefully not only write you a letter but advocate for you in the residency selection process.  Fortunately, the strategy for this letter is simpler than the strategy for letters of recommendation for an internship.  I really have only two guidelines:

1) All of your letters should be from someone in the specialty to which you are applying unless it violates (2).

2) At least one of your letters MUST be from where you are currently working.  If you are doing an internship, all of your letters can’t be from your student days.  If you are doing a specialty internship, all of your letters can’t be from your student or rotating intern days.

My recommendation is therefore as follows:

At least 1 letter from a specialist in the field at your current institution.  The more the better.

If you do not have a specialist in your field at your current institution, get a recommendation from someone in a core discipline (internal medicine, surgery, emergency/critical care).

The balance of letters can be from specialists not at your current institution.

The reason you need a letter of recommendation from someone at your current institution, even if they are not in your specialty, is to demonstrate that you are not a monster.  If I were to read an application from someone from a private practice internship- which did not have an anesthesiologist- and they had 4 letters of recommendation from anesthesiologists from where they went to school, I would wonder, “Did they peak in vet school?  Is there NO ONE working with them now who can vouch for their medical competence? Anesthesia includes knowledge of information from all kinds of disciplines- if they can’t do basic medicine, will they be a competent anesthesiologist?”

In general, more letters from people in your specialty is good.  If you have your choice of specialists, those more well-known or connected may be slightly preferable.  But a great letter from just any surgeon is probably better than an OK letter from a renowned surgeon. If at all possible, those writing for you should already be boarded and have a lot of experience writing letters of recommendation. If this is not possible, unboarded people in your specialty will have to do.

Choosing Letters of Recommendation for an Internship

The Vetducator - letters of recommendation series image.

You want to get a great internship and you need letters of recommendation.  Hopefully, you have followed the advice already given to let potential letter writers know of your interest and asked them ahead of time.  In addition to strategizing your clinic rotation selection, you need to strategize who should write you letters of recommendation. First, let’s look at some caution areas.

1) The vet you have worked for since high school.  Most non-academic veterinarians do not know how to write a good letter of recommendation.  I have read dozens of letters from these professionals and, though they are very positive, they are not very helpful to me as an evaluator.

2) The non-veterinary boss.  Unless you worked in a veterinary research lab in vet school or undergrad, any paid employer is unlikely to know enough about clinical veterinary medicine to write you a compelling letter of recommendation.

3) Only letters from outside your institution.  If I get an application from a student from the South Harmon Institute of Technology and NONE of their letters are from faculty at South Harmon, I get instantly suspicious.  Is this applicant difficult to work with, so those at their home institution would not write a good letter for them? You should have at least half of your letters from faculty at your home institution.

4) Letters from the non-clinical field.  If you are applying for a clinical internship, you need people who can speak to your clinical acumen.  If you did a rotation in microbiology, that may be interesting, but may not bear on your abilities as a clinician.  If you did research with someone whom you did not work with on clinics, that also falls into this group. If you can get your letters without resorting to one from this domain, that would be better.

Now that we have gotten the problem areas out of the way, whom SHOULD you ask?

1) Core clinical discipline faculty.  This is surgery, internal medicine, and emergency/critical care.  If you don’t have a stellar performance in at least one of those disciplines, you probably won’t make a very good intern.  If you can get letters only from core clinical discipline faculty, great.

2) Ancillary clinical discipline faculty.  This is cardiology, neurology, anesthesiology, oncology, and radiology.  These disciplines are clinically oriented and interface with many other disciplines.  You may have 1-2 letters from this group in total.

3) Peripheral clinical discipline faculty.  This is anyone outside your species focus (e.g. you are applying for a large animal rotating internship and the letter-writer is a small animal internist), ophthalmology, dermatology, pathology, behavior, theriogenology, and ABVP specialties (unless you are applying to an internship in one, such as shelter or exotic animal).  You may have 1 letter from this group in total.

You have 3 letters of recommendation at a minimum and up to 4.  Therefore, my recommendations are thus:

2+ letters from core disciplines

+/- 1 letter from an ancillary discipline

+/- 1 letter from a peripheral clinical discipline OR outside your home institution

If you cannot find people to write you good letters based on this recommendation, you may ‘downgrade’ each category.  Realize that, if you only have letters of reference from peripheral clinical discipline faculty, your application is likely to be looked at with substantial skepticism.  The intern year is a time to hone your core clinical skills. The program evaluators want to make sure you have at least some basis in those core domains before accepting you into their program.  Make sure your recommendation writers demonstrate your core medical knowledge.