It's very important to start thinking about your life after fellowship early during your fellowship to be prepared to what awaits you. Starting from your career track choices as discussed above to your ABP certification and landing your dream job.

Board Certification

Know the ABP board requirements early! Eligibility criteria can be found on the ABP website: general subspecialty and pediatric infectious diseases requirements. Pediatric infectious diseases board exam is only offered every other year (November of odd years). It is a good idea to do the yearly in-training exams as these give you a good feel for the test. Doing the monthly questions on PREP-ID offered by the AAP and taking board review courses such as the PREP offered every other year in Chicago may be a good idea as well.

Briefly, to be able to sit for the board, you need to:

  1. Fill the application on the ABP website between February and April of the year the exam is offered, at www.abp.org. This will include general information, your Scholarly activity and committee members, licensure information (active license required to apply), and payment of a little less than $3000 (changes from year to year). Late applications will cost you more money! Dates and fees are generally listed by the ABP few months in advance.
     
  2. Your scholarly activity materials must be submitted by your subspecialty program director at the end of your training. These include
    1. A personal statement where you describe your work, your learning process and your achievements. Per ABP, it should be "several pages in length and comment on the fellow's intended career path upon entering fellowship and reasons for choosing a specific area of scholarly activity. It should describe the scholarly activity and the fellow's role in each aspect of the activity, as well as any preparation beyond the core fellowship curriculum needed to ensure successful completion of the project. The personal statement should describe how the scholarly activity furthers the fellow's career development plan, and should reflect upon the educational value of the pursuit of the project."
       
    2. Your work product: "projects in which the fellows develop hypotheses or in projects of substantive scholarly exploration and analysis requiring critical thinking. Specifically, abstracts, book chapters, and review articles would NOT be expected to meet the requirement for Scholarly ActivityExamples of acceptable work products per the ABP are:
      1. A peer-reviewed publication in which a fellow played a substantial role
      2. An in-depth manuscript describing a completed project
      3. A thesis or dissertation written in connection with the pursuit of an advanced degree
      4. An extramural grant application that has either been accepted or favorably reviewed
      5. A progress report for projects of exceptional complexity, such as a multi-year clinical trial
    3. Your signature and the signatures of your program director and members of your SOC on your work product
       
  3. Once these are accepted, you will receive an acceptance notice from the ABP and will be able to schedule the test in the Prometric website.
     
  4. Remember the test is computerized, offered one day every other year, 4.5 hours long, and divided into two sections. Make sure you review the Prometric policies before getting ready to sit for your exam.

Finding and landing a job!

  1. Types of jobs
    Your job search will mostly depend on the career path you decided to follow. Whether it is academic medicine that you decide to pursue, or private sector, industry or public health, know the "market" and the need so that you know your strengths and what you can add to the table. Talk with your mentor(s) about where to find opportunities that might not be widely posted or that you may have missed on a first pass. Know your goals! Be strict about what you are looking for in a job. You can even write a mission statement for yourself that describes what your ideal career would look like, including long-term. Know your strengths and skills.
     
  2. CV, cover letter, biosketch
    Get in the habit of updating your CV early in fellowship; follow your institution's standard format. Also prepare your NIH Biosketch, and write a cover letter prior to starting your application process.
     
  3. When to start and typical timeline: 
    Start thinking about your job early in your second year, and start browsing websites and developing connections during this time. At the latest, you should begin seriously investigating job opportunities around the beginning of your third year. This includes reviewing online sources (see below), exploring opportunities at your current institution, and reaching out to other institutions of interest. ID Week in October is an excellent time to ask your mentors to introduce you to people and to begin seriously networking for jobs. While there is no defined interview season, the most common time for interviews is late fall through early spring. Keep in mind that once you have accepted a position, the credentialing and licensing process takes at least a few months, and often longer.
     
    If you have visa limitations (such as needing a waiver for a J1 visa), you should start this process even earlier, as many states close their applications in the fall of the year preceding your start date. Likewise, if you have other restrictions (e.g. geographic), it would be good to start this process early. It never hurts for an institution to know that you are interested; hiring situations often change and the more you make yourself available, the more likely you are to be in "the right place at the right time."
     
    Throughout this process, try not to put all of your eggs in one basket, and continue to apply for and pursue positions even if things look promising with a specific job. Until you have been offered a position, there is always a risk that something may significantly change. Plus, it doesn't hurt to have more than one option when negotiating your contract.
     
  4. Where to search
    "Look everywhere and talk to everyone" was common advice given by recent job seekers. Unfortunately, jobs are not all listed in the same place, and some jobs may never be posted. The PIDS website is a good place to start if you are searching for an academic job. Other organizations and websites advertising jobs include: IDSA website, LinkedIn, Doximity, PhysiciansJobsPlus, indeed, Simply Hired, practicelink, careermd, pedjobs, and the JPIDS classifieds (check CID and JID, too), in addition to known search engines.
     
    Industry jobs may be posted on monster.com, pharmaceutical company websites, LinkedIn, or Doximity. CDC jobs may be posted at usajobs.gov. NIH jobs are posted on their website as well as their clinical center website. The FDA posts job listings on its website.
     
    Contacting a recruiter may also be useful.
     
    Sometimes, word of mouth may be your key: ask around, check with your program director, reach out to programs about potential jobs, and improve your contact repertoire during meetings such as IDWeek, PAS and PIDS/St Jude. If you are interested in a particular hospital or region, talk with faculty at your current institution to identify contacts at hospitals of interest. You can contact them directly with a CV and cover letter expressing your interest, but it also helps to have a faculty member facilitate the conversation.
     
  5. Interview
    The interview process depends on the institution at which you are interviewing. Some places conduct a phone interview first. Most academic centers will invite you for the first interview where you will get a big picture view of how they work, and then, if you are a good match with their program, invite you for a second interview where you can discuss details. If there is someone in particular you'd like to meet (such as the microbiology director or a particular scientist you may collaborate with etc.), ask for it. It shows them you know what you want and it lets you learn more about the institution and your interest. During the interview, be yourself, ask about what interests you, how you would fit into the institution's goals, and how they can fit into your career goals. This is a huge step, so don't be nervous about asking questions. At some point in the process, you will likely be asked to give a 30-45 minute talk about your research or area of interest. Begin preparing for this as you begin applying for jobs.
     
  6. Negotiating the contract:
    Remember: everything is negotiable!
     
    In general, institutions follow national averages to make a salary offer, taking into account their location, cost of living, and your experience. When institutions make their offer, they usually expect you to negotiate. However, many lawyers recommend not placing so much emphasis on the salary, especially at first, but making sure the contract terms fit well into your career path and the quality of life you are looking for. You can start up negotiating other important factors such as FTE, wRVU (discussed below), call hours, clear promotion/advancement track etc...
     
    FTE refers to the way your time will be allocated. If you are interested in pursuing a career in Infection Prevention, this cannot be done if you're only allocated 20% of your time for this task. This applies to any area of focus you decide to enter. Don't feel bad addressing these issues early on! Remember to include teaching in your FTE allocation if you're in an academic setting.
     
    Also, negotiating lab space and material, startup costs, and initial financial support when you're expected to bring in grants is extremely important if you'll be following a research track.

    All of us, regardless of which track we choose are obviously asked to see patients. Some institutions use the work RVU as a standard to the expectations for every physician. The wRVU is directly derived from your billing! Know what the RVU expectations are (for the first 3 years, as those may be low in your first year but increase with time), and see if they are reasonable for your FTE allocated for clinical work.
     
    Consult with your mentors regarding appropriate FTE allotments, startup packages, and RVU expectations. Employers know that you are new to this process and will not be surprised that you need to consult your colleagues. Doing research shows that you are informed and puts you in a better position to negotiate.
     
    Ask a lawyer to look at your contract since most of these contracts are written in official language and are not easy to understand. Two very important clauses you need to review are the non-compete clause (which would prohibit you from working within a certain mileage radius if you decide to leave the institution) and the malpractice tail insurance (which would cover any malpractice suits that may be filed years after your leave the practice). Remember to check the benefit packages such as life insurance, long-term disability insurance, retirement plans. Also, ask about loan repayment packages, as many institutions offer that as well.

Maintenance of Certification

It doesn't stop there! You will need to continuously show enthusiasm in learning to maintain your certification. MOC categories are detailed in the ABP website. Briefly, every MOC cycle (5 years), you need 40 credits in part 2 (Lifelong learning and self-assessment), 40 credits in part 4 (Performance in practice) and 20 additional credits in part 2 or 4, paying a fee, in addition to a secure examination every 10 years and good professional standing. You have credit by being in a training program (10 part 2 and 10 part 4 points per year), and these points will be added in to your "bank" at the point you graduate fellowship. Residents (and fellows who have not yet gotten their general peds certification) can earn Improvement in Practice (Part 4) points while in training, and the points they earn will be "in the bank". Once they pass the initial general peds certification exam, they are automatically enrolled (no additional fee) in their first MOC cycle, and any points that are "in the bank" count towards their first cycle's requirements.

Part 2 credits are activities that help you assess and improve your medical knowledge. Those are obtained from many activities that generate CME and include self-assessments, that have been reviewed and approved by the ABP. You can find all the approved activity when you login to your ABP portfolio. You can find all the approved activity when you login to your ABP portfolio.

Part 4 credits are acquired through participation in ABP-approved quality improvement (QI) projects. You may find activities within your institutions to be involved in, if your institution is a MOC portfolio sponsor, or you may elect to do QI projects through the AAP (such as EQIPP), or the ABP. The ABP will also credit you if you have a publication (whether in a peer-reviewed journal or in a national meeting) describing the implementation and outcomes of a QI project. More recently, the ABP added a new exciting QI pathway: it will "award credit to structured, well-designed QI projects that are based on accepted improvement science and methodology." If you are interesting in creating or working on a QI with other physicians, you may apply to get credit from the ABP for your work after a short application and a small fee (up to 10 physicians may be involved in this type of work).