Students completing their residency face perhaps the greatest challenge they've ever experienced: the search for the perfect job.

You spent years preparing to be an emergency physician. But chances are, you haven't spent more than a few days preparing to enter the competitive world of emergency medicine. It's never too late to start, but the sooner you get going, the better, said John Keene, MD, FACEP, president of Emergency Treatment Associates in Poughkeepsie, NY. Dr. Keene has also taught residents and moderated ACEP Management Academy classes on finding employment as an emergency physician.

"When I was a resident a long time ago, I started looking for a job about March and really didn't make my decision until June," Dr. Keene said. "I have found that in the last five to seven years, residents are starting to look in September and October."

Many residents attend Scientific Assembly and other emergency medical meetings and use it to network with other physicians, he said. With a source of roughly 25,000 emergency physicians nationwide -- a small medical community compared to other specialties -- residents can find that networking plays a crucial role in finding an appealing position, Dr. Keene said. Networking provides a springboard for the job search process to begin.

When starting a job search, you should first consider certain personal and professional goals. Among the considerations are:

• Economic goals -- what kind of salary and job position interests you?
• Lifestyle goals -- what type of personal activities do you want to participate in and how much free time do you need to pursue them?
• Career goals -- where do you want to be in five years and how fast do you want to get there?
• Location -- how important is it?
• Hospital preferences -- do you prefer high or low patient volume, trauma vs. non-trauma or middle- or low-level patient economic status?
• Medical groups -- do you have a preference for large or small groups or would you rather be employed by a hospital?

"I suggest that you make a priority list of the things that are important to you," Dr. Keene said. For most residents nowadays, location sits at the top of the priority list when starting the job search. Most emergency physicians choose a location and decide to stay there for two or more decades," he said. "You want to make sure it's the right fit."

Decide which goals are important and look for a position that will allow you to attain them. And before you begin the search, develop your curriculum vitae. This is the first impression future employers get from a prospective physician, and appearance and organization are crucial. Your CV should include a chronological listing of professional experience, with the most recent position at the top. Any nonmedical experience obtained between medical jobs should be included to prevent an assumption that information is being withheld. Other important information should include:

• Outstanding accomplishments and awards, even if nonmedical outside interests
• Lectures given only at national and/or regional presentations marital status, birth information and number of children
• Address and phone numbers

Residents have three basic choices for how they want to look for a job, Dr. Keene said. They can gather information themselves, find a headhunting agency to provide the information for them, or use both methods to compare notes.

"The agencies can do a lot of leg work for physicians," Dr. Keene said. "It certainly can facilitate things for residents."

Job seekers have many resources from which they can find job opportunities. ACEP members have access to a comprehensive job board, emCareers.org. One of the most widely used sources is the Annals of Emergency Medicine. In the Annals classified section, residents can find listings for opportunities under academic, administrative and individual or group practice. The listings often indicate the size and background of the facility, its location and the annual compensation.

Other useful resources include the American Hospital Association Guide and publications produced by other medical associations. EM Resident, published every two months by the Emergency Medicine Resident's Association (EMRA) includes a classified listing of job opportunities. In addition, EMRA produces a job catalog which is mailed annually to EMRA members and is available for purchase by nonmembers.

When the Offers Come In

Once you are offered a position, evaluate the situation and determine whether or not it is the right one for you. Take a look at the goals you set earlier and decide whether the following criteria will allow you to meet them:

• What is the current volume of patients visiting the emergency department? How does the current volume compare to previous years?
• What is the ratio of physicians to patients?
• What are the demographics of the patients?
• Does the hospital have a strong or weak presence in the community? Is the hospital profit or nonprofit?
• Is the hospital a teaching hospital or non-teaching?
• Does the emergency department handle trauma cases?
• What kinds of other staff does the department include -- nurses, lab technicians, house staff, etc.

After a thorough review of your goals and the employer's criteria, you will have a better understanding of the position's suitability. And finally, before you accept any offer, take your time to weigh the pros and cons and make sure it's the right job for you.