Employment Models: 1099, W2 Hourly or Salaried, which is right for you? UPDATED for 2024

An important question during most interviews in the Health IT industry is: Do you prefer W2 Hourly, 1099 or Salaried employment? Normally the candidate will understand the distinction between Salaried employment and W2 hourly or 1099 /"C2C" (Corp to Corp), but many questions arise during this part of the interview as the candidate tries to determine which scenario is best for them, particularly if it is someone that is new to consulting.

I won't delve much into salaried employment, which is pretty self-explanatory. Salaried employment or Permanent employment is when you accept an internal position with a company where you will earn a salary, receive full benefits and any other bonuses that company may offer. You can consider it like a marriage... you go into it, hoping it will last forever.

The 2 models I would like to dig into are W2 hourly and 1099 (C2C) and what the distinctions are between them. Consultants that have been in the industry for years normally prefer one to the other, but are typically open to either depending on the company they will be contracting for. Frequently when speaking to folks that are just venturing into the consulting arena, they express confusion over which option is best for them. Below is a simple break down that covers the basics.

W2 Hourly: In layman's terms W2 hourly is like short term employment. You receive an hourly rate for your work, you will often have the opportunity to opt into partial benefits, you will fill out necessary Tax Forms and the company will take out taxes prior to paying you. Your "employment" will last for the duration of the engagement that you have accepted. At the end of the engagement you will be free to accept another engagement from another company or if you're working for a company that is on their toes... they may have a new engagement to offer you and you can extend your time with them.

1099 Contract & Corp to Corp: The difference between 1099 and Corp to Corp is simple. In the case of 1099 you will use your social security number and be paid as an outside contractor by the company, this scenario is rarely practiced anymore. 
In the case of Corp to Corp you will have created a legal business for yourself (LLC or S-Corp etc) by registering through your state and obtaining an EIN (Employment Identification Number)  You will sign a business agreement/contract between your company and the firm you are going accept the engagement through. Many firms are trending away from 1099 and Corp to Corp agreements. The reasoning behind this trend is two-fold; due to multiple recent lawsuits in the industry and to the IRS cracking down on companies that utilize independent contractors when they deem the company should have brought the consultant on as a W2 hourly employee.** Typically the lines are blurred when discussing 1099 vs Corp to Corp because the term "1099" has become a catch-all phrase for both. As your own business entity you will be required to invoice the company you are contracting for. You will be paid an hourly rate for your services.

Which is best for you? Lets break them down:
Salaried / Permanent Employment
Benefits:

• Security - the security of internal employment within a company and the opportunity to advance within that company. 
• Full Benefits, bonuses, PTO, 401K etc
• Regular pay schedule
• Necessary equipment provided
• Company covers liability insurance
• Corporate Credit Card for travel when applicable (in most cases)
• Being on a consistent team

Potential Draw backs:

• Income is often less than what you can bring home as a W2 Hourly or Corp to Corp Contractor
• If working for a consulting firm or EMR vendor you don't always have the freedom to choose your engagements and must go where the company sends you.
• May have to relocate/no freedom to live where ever you want.

W2 Hourly

Benefits:

• Company deals with the taxes and covers liability insurance
• Option for benefits / PTO / 401K (in most cases)
• Equipment provided (in most cases)
• Regular pay schedule
• Regular travel reimbursement schedule or paid travel when travel is required
• Freedom to choose your engagements
• Potential for higher income vs Salaried employment

Potential Draw backs:

• Largely responsible for finding your own engagements
• Typically benefits are partial and dont include PTO 

Corp to Corp
Benefits:

• Full control of your business endeavors
• Higher income (in most cases) than Salaried or W2 Hourly consultants
• Freedom to choose your own engagements

Potential Draw backs:

• Must pay your own taxes on a quarterly basis*
• Often must provide the company you are contracting for with invoices from your business
• Must maintain your own liability insurance
• Must provide your own benefits
• Typically must provide your own equipment
• May be paid 30 days on invoice in some cases
• Not eligible for certain perks of internal employees like rental car discounts, car insurance/coverage, etc.

*Always consult a CPA / Accountant when creating your own business to gain a full understanding of the tax laws and expectations.
** Tax Lawyers have explained that an old and somewhat obscure Federal Tax Law (#1706 from 1986) states that if the I.R.S. determines that a self-employed worker should have been an employee, it imposes substantial back taxes, penalties and interest on the hiring company AND on the contractor — even if the self-employed worker fully paid his/her taxes. For this reason many companies are shying away from using Corp to Corp (and 1099) contractors unless those contractors can prove that their business meets the federal criteria listed in the law. (employs at least 2 other people beside themselves and family members OR if they are in a partnership with someone other than family members OR they have incorporated (S Corp, C Corp etc) and file a 941 and pay yourself a salary) 
For more information on this law consult your local Tax Attorney.

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Traveling Weekly for Work ~ What is it REALLY like?

Over the past 8+ years I have spoken to hundreds of EMR Professionals that want to enter the world of the traveling consultant.  Most consultants in our industry will travel weekly on a Mon-Thurs or Sun-Thurs schedule with exceptions for longer stays on a client site or variable remote work. 
When discussing the nature of weekly travel to a "newbie" I have learned to play devil's advocate.  The first person I ever interviewed when I entered into this Industry had never traveled before.  He assured me that he "LOVED" to travel and was totally "psyched" about the opportunity.  Six months into his engagement he called me to resign, said he couldn't take the weekly travel any longer.

Recently I discussed the rigors of weekly travel with some seasoned road warriors.  Below are results of the Q & A from those discussions:
What made you decide to start traveling for work? Most Frequent Responses:  Higher Income.  New Surroundings and co-workers with each new engagement. Enjoy travel & seeing new locations.

What was the hardest adjustment you had to make when you transitioned into traveling weekly for work? Most Frequent Responses: Being away from family(pets). Missing out on family or other functions (weekly bowling or child's plays etc) and having to leave spouse to do all the work. Navigating the airports, luggage, flight delays, airport security etc.

What do you wish all consulting/staffing firms offered that would make your travel life easier for you?
This question received the most diverse answers, some of the most frequent responses were:  Corporate Credit Card for travel, better discounts on hotel, car, flights etc.  Occasionally paying for spouse to travel, like over the holiday work weeks etc., better assistance for new travelers, even something simple like a handbook with traveling suggestions.

What did you have to give up when you started traveling weekly?  The number one answer was time with family and friends, some other responses were: freedom to join sports leagues or meet friends for dinner once a week during the week, and for single folks: having a pet, being home during bad weather (someone had a water-main break in sub zero temps and didn't realize until they got home days later) and being in one place so it's easier to start a romantic relationship.

What did you gain from becoming a traveling consultant?  Some of the top answers for this question were:  better income, seeing out of town family & relatives more, greater independence, being able to travel to new places, less stress, meeting new people, and quiet time at the hotel in the evenings.

Here are a list of tips from the road warriors:
1.  Pack Light!  Learn to pack everything you need for the week into a carry-on bag.
2.  When traveling coast to coast, find extended stay hotels and if you travel home, leave most of your belongings at the hotel during your absence.
3.  You can bring your pet, just check for local pet friendly hotels.
4.  Always have an extra charger (computer, phone, iPod etc) handy.
5.  Make sure your ID, discount cards, credit cards etc are kept in the same place, are always handy and are in a front pocket for safe keeping.
6.  Keep a folder or file or zippered pouch for all your travel receipts so they're easy to locate at the end of the week for the purpose of scanning and emailing or mailing to your employer. (if you're 1099, for tax purposes)
7.  Set up a calendar alert to remind you to log your time & file your expense receipts each week.
8.  Know the name and number to your employers IT Helpdesk in case you have problems with your company issued lap top.
9. Whenever possible do not wear a belt, difficult to remove shoes, hair pins, excessive jewelry, etc so that you can move through airport security quickly.  Make sure your laptop is housed in a safe but easy to manipulate bag, keep your pockets empty etc.
10. If you are single and live alone, make sure you have a neighbor or relative that can check on your place of residence in your absence.
11.  Provide neighbors and relatives the name and number of your hotel, along with your cell phone so they can easily contact you in case of an emergency.
12.  Have the number of your direct boss, a company co-worker and your direct report at the client hospital programmed into your cell phone, that way if your flight is delayed you will be able to alert people of your delay.

If you're a seasoned traveler and you have other important tips I've missed, please feel free to add a comment below!

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Shrunken Terminology ~ Know Your Acronyms

Most of us have heard the story of the woman that sent a text to family members informing them of the death of a loved one and then ended the text with "LOL"... assuming that acronym meant "Lots Of Love".  (for those of you that are still 20 years behind on tech/abbreviated communication, LOL = laughing out loud)  I question her method of choice when informing others of a relatives passing more than her lack of knowledge when it comes to text-speak, but lets move on.  When reviewing a teenager's text history one can become boggled by the new shorthand that has been created since texting and twitter became the #1 form of communication.  Here are just a few examples:
WTH = What the Hell?!
BRB = Be Right Back
LOL = Laugh Out Loud
IDK = I Don't Know
The acronym trend is growing and some people, mostly age 30 & under are actually starting to speak this way.  Is it due to laziness?  Are we so bombarded by information that we must shorten terms to absorb it all?  Are we in such a hurry that typing or speaking the entire term would be too time consuming?
When it comes to large corporations, using acronyms to shorten terminology has been around for a very long time, the same can be said for government/military terms as well.  Here are a few examples:
Corporate:
CTG = Computer Task Group
HIT or HCIT = Healthcare Information Technology
COB = Close of Business
CEO = Chief Executive Officer
Military:
POV = Privately Owned Vehicle
POW = Prisoner Of War
BDU = Battle Dress Uniform

The list goes on and on and on.  The use of acronyms is also abundant in the Healthcare Technology Industry.  Most EMR (there is one example) systems have multiple acronyms that describe specific technology or specific job titles, not to mention the various healthcare acronyms for various areas such as the "OR" (Operating Room) or "ER" (Emergency Room).  When creating a resume or creating an online profile on a social networking site like linkedin it is important to spell out the terminology along with the acronym, or eliminate the acronym all together.  Spell check will not catch incorrect acronyms and often will auto-correct them instead.  For instance, EHR (Electronic Health Record) is often auto-corrected to HER. 
HIMSS (The Health Information & Management Systems Society) has created a booklet with over 2700 Healthcare IT related acronyms and terms which is available for purchase. http://www.amazon.com/Dictionary-Healthcare-Information-Technology-Organizations/dp/0976127776
In addition, there are many web sites that offer a shortlist, such as: http://en.wikipedia.org/wiki/Acronyms_in_healthcare or http://www.idph.state.il.us/ehrtf/ehrtf_acronyms.htm . 
The rule of thumb should be when in doubt, spell it out!
IOH.  This was JM2C but UGTP, so I'm going to get  a *$ and GB2W!
(I'm out of here,. This was just my two cents but you get the point, so I'm going to get  a starbucks and get back to work)

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On-Boarding Paperwork ~ A Necessary Evil

Whether you are consulting as a salaried full time employee or a W2 contractor or a 1099 contractor there will always be necessary paperwork you must complete as you begin work with a new employer.
The on-boarding paperwork for a 1099 contractor is normally more minimal since you are representing yourself as your own business.  For the purpose of this post, we will only be covering the expected on-boarding paperwork for W2 contractors and salaried FTE. 

Each employer will have specific paperwork that MUST be completed.  Below is a list of the standard documents that must be filled out / signed etc and a brief explanation of their purpose.

Required forms by all employers:

Offer Letter:  Your potential employer should send you a written document (usually via email) that will lay out your pay, responsibilities and job title.  This document will be signed, scanned and emailed back and normally the hard copy will need to be mailed in as well.

I-9 Form:  The I-9 form is a legal document that is required by the government.  It's purpose is to provide employment eligibility verification.  It is used to verify identity and make sure you are eligible to work in the US.  The I-9 form requires you to fill in information and also provide 2 forms of identification (drivers license, SS card, Passport etc) to a 3rd party who will also have to sign the form verifying they reviewed your ID.  Depending on the method in which you will be working, this form might be completed on site and signed by another company representative, or if you are working remotely it may be signed by a notary and then your ID will be copied and emailed or faxed to the employer along with the I-9 form. In some states notaries cannot legally sign the I-9 form, in those cases a separate form will be provided for their signature. The original form and a copy of your ID will also have to be sent via email to the employer.

Various Tax Employee Withholding Forms:  these documents will require an ink signature and the hard copy must be provided to the employer.

Application: The application is used to verify previous employment, to provide references, to specify which position you are applying for (and being hired for) and it is a way of formally showing your intention and interest in employment.  The application is usually completed electronically.

Benefits Form:  (may not apply to all W2 hourly contractors) The standard benefits forms will normally require you to select which benefits are of interest to you and also require your signature.  The variety of benefits available will depend on the employer.  Normally an electronic signature is required for these forms. If you opt out of benefits there will be an "opt out" form to sign.  The benefits forms will also include a 401K form if the company provides one.

Employee Handbook: When beginning new employment you will receive an Employee Handbook that outlines the guidelines that company has in place.  You will be expected to return a signed hard- copy form stating you have received the handbook.  (it is ALWAYS a good idea to read through the handbook)

Additional forms that may be required:

Approval for automated payroll:  Many employers now pay by automatic deposit as opposed to a paper check.  In order for you to receive automated deposits you must fill out a form providing your banking information and also provide a voided check.  The employer will require the hard copies of these documents.

Background check approval: Depending on your line of work a background check may be required.  If it is required you will need to sign a release form allowing the company to run the check.

Drug Screen:  In may industries, particularly the Healthcare industry, drug screens are required prior to hire.  You will need to sign a form and have a drug screen conducted during the on-boarding process.  Some Healthcare positions also require a vaccination record.

Vacation Memo: Some companies have various vacation packages and may require you to sign a form stating that you are receiving a specific amount of vacation time.

Comp Plan: If you will be receiving any type of commission over and above your normal income you will likely have to sign a document that provides a break-down of your commission plan proving that you understand how your commission plan works.

Client Agreement: If you are working for a Consulting Firm or Staffing Firm at one of their client sites it may be necessary to sign a document that lays out the expectations of that client, adhering to their regulations etc while you are actively engaged with them. 

Credit Card Form:  If you are expected to travel for work or entertain clients you may be provided with a company credit card.  Depending on the type of credit card you may be expected to fill out a standard application for credit and the company may also run a credit check.

Electronics Agreement:  If your employer will be providing you with any electronics (cell phone, lap top etc) you will be required to sign a form verifying that you received those items and they were in good condition. (same goes for company cars or other company property you may be using during your employment)

Security Clearance:  If the position you have been offered requires Government Security Clearance you will be expected to provide proof of clearance.

Proof of Certifications: If the position you have been offered requires various certifications, you may be required to provide proof of those certifications.

So why, after going through various stages of interview do you now have to go through tons of paperwork?  I call it the CYA mentality. (cover your ass)  You are CYA to make sure you receive the benefits, commission, vacation you are entitled to, and to make sure that legally you are in the clear in case the IRS comes calling.  The companies also have a vested interest in covering their butts in case for any reason you have misrepresented your qualifications or things do not go well with your new position.  Instead of viewing the on-boarding process as a grueling waste of your time, try to view it as a necessary evil that could potentially protect you in the future.  Fortunately most companies have internal employees that are in place to walk you through each step of the hiring process and make it as painless as possible.

Next time you are rolling your eyes in frustration at yet another piece of paperwork, remember the CYA theory and keep in mind you are not only doing this to comply with company regulations, you're doing it for your own best interest.


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Interviewing: What are the Industry Standards?

When beginning the interview process with a candidate I often am asked how many interviews they should expect to go through to be considered for hire or placement.  That is a good question and the answer depends greatly on what type of position you are interviewing for and what type of company you are applying to.  Below are some examples of various interview processes that would be considered industry standards.  Of course, there are always exceptions to the rule.

If you are interviewing with a Consulting Firm:
For Permanent Employment (salaried):  You can expect 3 interviews:  1 with a Recruiter, 1 with a Peer, 1 or more with people from the Executive team.  Your Recruiter should be in regular contact with you to assist you through the process.
For Contract Engagements (W2 hourly or 1099): You can expect at least 4 interviews:  1 with a Recruiter, 1 with a Peer, 1 with an Executive team member and 1 with the client you are being submitted to. Again your Recruiter should be in regular contact with you to assist in the process.

If you are interviewing with a Staffing Agency:
For a Permanent Position at a Healthcare Facility (salaried/internal): You can expect at least 2 interviews:  1 with the Staffing Firm Recruiter and at least 1 with the Healthcare Facility.
For Contract Engagements (W2 hourly or 1099): You can expect at least 1 interview with the staffing agency Recruiter.  Some clients will request to interview, others will just expect the agency to send the best qualified candidate.

If you are interviewing directly with a Healthcare Facility:
For a Permanent Position: You can expect at least 3 interviews:  1 with an internal Recruiter, 1 with a peer and possibly a panel interview* with a few people from the team you will be joining if hired.
For a Contract Position (normally 1099): You can anticipate at least 2 interviews: 1 with an internal Recruiter, and 1 with a Supervisor from the department you would be joining if selected.

Normally when being considered for a permanent / salaried role you will be expected to speak to more people, this is due in part because the company will be investing more time, energy and money into your career and they will want to make sure your qualifications and personality are a good fit for the team you will be joining.  Often times people become exasperated by having to go through multiple interviews.  Keep in mind that when a company hires you, whether it is an agency or firm or healthcare provider... you will be a direct reflection of that company, so they want to make sure they are making a smart hiring decision.  Most professionals want to go to work for a company that makes a commitment to their employees, not one that uses the "Spaghetti Theory" and throws people against the wall to see if some will stick.  More interviews (within reason) allow you to gain valuable information about the company, the people you will be working for and with and the responsibilities you will be expected to handle once on-board. 

For more information on what questions to ask during an interview or tips on phone or Skype interviewing please see my previous posts on those subjects.

*panel interview:  when a group of people from a company all interview the candidate at the same time, usually over the phone.

Is the Holiday Season a Good Time to Seek Employment?

Many people believe that Mid-November through Mid-January is the worst time to look for employment but the opposite can be true.

While it may take a bit longer to secure interviews because many people take vacation at this time of year, vacation time can afford you the extra time you need to research openings in your field, update and improve your resume and market yourself.

More and more employers are continuing to source for qualified candidates through the holiday season.  Some are even wanting to start new hires a week or two before the Christmas break to get orientation out of the way, so the new hire can get a running start in January.

When applying to job openings in November & December, be patient and make sure you follow up.  You are likely to receive automated responses that your contact is on vacation.  If a alternative contact is provided, don't be afraid to reach out to that person as well, they may not be able to assist you, but you don't know unless you try. 

If your contact is out of the office, make a note of when your contact will be returning and call them or email them the day AFTER they return.  Normally folks return from vacation to an over-loaded inbox & voice mail box, by giving them an extra day you will ensure that you aren't reaching them when they are feeling over-whelmed.  By checking back with them you are also ensuring that your resume didn't get lost in their inbox while they were away.

If you do secure interviews during the holiday season, make sure you alert the potential employer of any upcoming vacation time you may have scheduled.  Check with the people you plan to use for references and find out if they will be on vacation and unavailable during the holidays as well.

With a bit of extra planning, finding a new position during the winter months can be just as rewarding as any other time during the year.

Happy Holidays & Best Wishes in Your Career Endeavors!

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Great Qualifications Won't Always Get You The Job

I've seen some amazing talent come & go in this industry.  Just because you have the most sought after certifications and a high level of technical experience doesn't mean you're a shoe-in for any opportunity you apply for.

Most people that have rare and highly sought after expertise are aware of their unique abilities and often feel they can demand extremely high pay rates and control every step of the interview process.  While higher rates can often be accommodated, a person's attitude during interview process will normally be a strong indicator to whether they are chosen for the position.  Being condescending, rude, overly-demanding or short-tempered can quickly eliminate someone from the candidate pool, even if that pool is very small.

Recruiters understand and respect that everyone is busy and that a candidate's time is valuable.  We will do our best to accommodate the candidate needs and schedule interviews around their availability... however, when asked to provide available times to interview.... coming back with 30 minutes tomorrow at 1pm isn't going to cut it.  Clients & Executives also have busy schedules, so it is imperative to provide a few day/evening times for up to 1 hour that you can chat with your potential employer.  It should go without saying that if either party must cancel or reschedule an interview that all parties should be notified as far in advance as possible.

If you want a position, don't play "hard to get" assuming this will make you appear more valuable to the potential employer.  It actually has the opposite effect.  People want to work with people that are enjoyable to be around.  If you have other opportunities on the table, it is certainly a good idea to say "I've been offered a position at XYZ Company, but have not accepted yet, I would prefer to work with your company but I must make my decision by COB tomorrow".  It is not a good idea to say things like:
"This interview process is taking too long, I could get a position anywhere" or "My qualifications are highly sought after and your company would be lucky to have me" or "Did you READ my resume?!, why should I have to go through a technical interview" etc.

Admittedly Recruiters do not always have in depth knowledge of each particular skill-set they are interviewing for.  A Recruiter's knowledge is usually surface deep over a broad range of qualifications and skill-sets.  It is up to Recruiters to scratch the surface, make sure the candidate has the necessary specifics and the right personality/attitude to be a good team fit.  The subsequent technical interview or client interview will dig deeper and get into the nitty-gritty regarding the technical/managerial or clinical expertise.  Therefore, talking down to a Recruiter due to their lack of understanding of specific technical or clinical skill is a sure fire way to be eliminated from the candidate pool.  Everyone wants to be respected. 

As you move through the interview process, try to think to yourself "If I were on the other end of this conversation, would I want to work with me?"  Of course the interview process is a 2-way street, if you are treated in a condescending fashion, if the potential employer misses calls, doesn't provide adequate information or is rude... you certainly should decline further discussions.

Here are just a few more tips to navigate the process:

Do have a resume that clearly states your experience and highlights your skills.
(see my post on building an eye catching resume 9/2011)
Do smile while you're on the phone... it's true that people can "hear a smile".
Do NOT be rude or condescending, even if the person on the other end is.... if the call is going poorly you can thank them for their time and hang up.
Do not OVER-sell yourself.  It's been my experience that the people that work the hardest to prove to you how great their qualifications are, are actually the ones that lack the necessary qualifications for the position.  Desperation is a turn-off.
Do provide a variety of dates/times when you are available for an interview.
Do have flexibility where your hourly or salary rates are concerned.  Sometimes the experience that can be gained from a position can outweigh a few dollars in rate.
Do talk about rate expectation and full job requirements up front, no point in continuing to interview for a position if the rate is completely unreasonable or if the requirements are not something you would find interesting.
At no time during the interview process or on a job site should you yell at or talk down to another person.  Professionalism is key! News travels fast in this industry.  There is a lot of truth in the old adage "Treat others the way you want to be treated."

As a side note, most Staffing Firms and Consulting Firms have a Candidate/Resume Database where resumes from anyone that has ever applied are stored.  The database will also house a record of any contact / interview / placement activity for each candidate.  Often Recruiters will search that database for resumes that match specific qualifications that match new job openings.  Emails or phone calls are then placed to any candidates that might be a fit, regardless of how long it has been since they originally applied.  Recently I sent just such an email to 15 Analysts and there is one particular reply I received that surprised and amused me... it read:  "You & your company should've hired me 4 years ago!  You can go to hell!"   First, I wasn't with the company 4 years ago so I cannot speak to their experience then....  2nd  No matter how negative this person's experience may have been, responding like this to an email will immediately black list them from the company... and Recruiters share information with each other across the industry, they ask each other about candidates, if they've ever worked with those individuals, what their impressions were etc.  The best advice I can provide is don't burn any bridges.  Just because you had a prior negative experience does not mean the company, employees and management hasn't changed.  Be honest about your experiences in a professional manner and see if they can be addressed, if not, move on.  Sometimes the best response is no response at all.

Zen and the Art of Finding Your Dream Job

First things first, do you live in the moment?  Many of you are probably nodding your head, thinking the affirmative.."Yes...I live in the moment".  But do you really?  When you are eating your dinner are you thinking about each bite you take?  Are you thinking about how good it tastes, how you (or someone) worked to prepare it, how thankful you are to be nourishing your body, or are you thinking about how yummy dessert will be, or all the clean up that will need to be done after dinner, or what you have to accomplish before bed?  Yeah, I thought so.  Most of us would like to think we live in the moment, but we really don't.  Our minds are always busy worrying about what we must accomplish or fantasizing about something we'd like to happen, or mulling over something that we recently experienced and wish we would've handled differently.  Unfortunately there are no mulligans in real life. 

So why is the "living in the moment" philosophy so important when you're seeking new employment?  Because your attitude and the energy you are projecting will have a huge impact on how successful you are at finding the job of your dreams.  Now I don't claim to be the Employment Guru, but I've learned a thing or two about how to get hired and who is more likely to get hired over the years. 

The more desperation a person gives off while in the interview process the less likely that person is to get hired.  But, it's not as simple as controlling yourself during the interview process... you literally have to change your thought patterns.  If you are constantly stressed about finding employment, you will be seeping stress from your pores, it will reflect in everything you do.  People that are wound too tight are difficult to be around.  Have you ever been around someone that is always stressed?  They're moving too fast, making mistakes, difficult to deal with, often short-tempered and rarely cheerful.... who wants to work with that?  You might be thinking..."If I could just find a job I wouldn't be so stressed anymore" but who will hire you when you're in that mental space of stress and despair?

To quote Dr. Wayne Dyer... "change your thoughts, change your life".  A few years ago I was unexpectedly laid off.  I had recently exhausted much of my savings moving across the country.  I was in a new town, only knew a few people and had never been without work in my life.
When these situations happen, your first instinct is to go into panic mode (what will I do? how will I manage? what if I don't find work? ...on and on goes the little voice in your head).  The best thing to do is take a deep breath, clear your mind and come up with a plan.  Build a good resume, prepare a spreadsheet and market yourself (see my other posts for more on these topics).  As you're going through your day to day process of finding employment take time to breathe, relax and be thankful for what you DO have.  Here is a short list of things most people can be thankful for:  being alive, family, friends, the ability to see, hear, read, feel, walk, talk, taste, a roof over your head, a soft place to sleep, a hot shower, a cold beverage etc.

When you make an effort to put yourself in a place of gratitude and relaxation you are opening yourself up to all the possibilities.  Each day as you are seeking employment visualize the ideal job, the position you most want to fill.  When your mind begins spinning into negativity... STOP! take a walk or a shower or watch a funny video... then re-group and get back at it.  People want to work with people that are upbeat, positive and exude thoughtfulness. 

Try to remember that what you put out into the world is what you will receive back. There is a reason for all the old sayings like "you reap what you sow".  Call it Karma or Kismet or whatever you will...your rate of success will increase with your rate of positivity.  It's ok to give yourself a break.  You've worked hard, you've gained valuable experience, be in a place of gratitude and go find that dream job!

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How to Use Linkedin.com to it's Fullest!

Linkedin.com has been around for many years and it's popularity has been growing quickly over the last few years, especially among those in the technical community.  Linkedin is more than a networking site, it is a career enhancement tool!  This blog is intended to provide the reader with suggestions on how to create a good Linkedin Profile, build a strong presence on the site and use it to your advantage to further your career.

Your Linkedin Profile:  When creating your profile, it should read similar to your resume.
>Start with a paragraph or two in the Summary section that outlines your career experience and future career goals.  Include your email address in this section or put it directly next to your name so that people can easily contact you regarding your expertise and also invite you to join their network.
>You will want to provide a work history that includes any employment relevant to your current (or desired) career path. 
>You will also want to bullet point responsibilities with each position listed to show a brief over-view of your most important skills and qualifications. 
>In the Skills section, don't go over-board.  List only the most important of your qualifications here.
>In the Websites section you should list your company site, any personal blogs you may wish to share or other business related sites you may have.  I strongly suggest that you not list your Facebook page or blogs where you discuss issues unrelated to business.  By including personal sites you can open yourself up to unwanted discrimination.  The same goes for your Twitter account, if you're using Twitter to vent about your political views or amuse your friends with how drunk you were Saturday night, this isn't information you want your business network to review.
>You have the option of adding sections to your profile.  The sections for Certifications, Courses, Honors & Rewards and Publications are all beneficial for adding industry related information that will augment your experience.  Unless it is relevant to your career, I recommend not bogging down your profile with what books you're reading or where you've traveled etc.
>DO NOT include a phone number if you are not prepared to field calls from Head Hunters and Sales Professionals!
>Don't be afraid to ask for recommendations!  Once you have started to build your list of connections, ask the people that have worked closely with you to provide recommendations.  Most employers will review your Linkedin Profile prior to interviewing you, it is beneficial to have those references there to reinforce your abilities.
>Be thoughtful.  Always consider who you are asking to join your network or accepting into your network.  Do you know this person?  Have you worked with them?  What are their qualifications?
You can invite anyone to join your network, but if you don't know the person and they flag your invitation as unwanted solicitation, Linkedin will smack your hands and take away your privilege of inviting contacts unless you have their email address.
>Providing recommendations.  You can and should recommend people you have worked with, however only recommend people that you have strong knowledge of their work and professionalism.  You wouldn't want to recommend someone publicly that you have only known for a short time and later find out that they've been fired from previous jobs for their lack of work ethic or other issues.  It is ok to say No when someone requests a recommendation.
>Groups.  There are what seems like an infinite amount of groups on Linkedin for you to join.  When reviewing groups to join consider how many members the group has, what information is being provided by the group and how it relates to your career. 

Utlizing Linkedin when seeking new employment:
>If you are on the market, put together a well thought out message regarding what type of position you are seeking, location, responsibilities and any other expectations that are important to you and send that message to your established contacts on Linkedin. 
>Post your desire to find a new position as a Discussion on the groups that you have joined in your industry.  Don't forget to include your email address.
>Search the multitude of job postings in your industry related groups and also via the "Jobs" tab found at the top of your profile page.
>When you discover a job posting of interest, whether through Linkedin or the other job boards, you can search Linkedin to find a decision maker from that company and try to reach out to them directly to let them know you have interest in their opportunity and would like to discuss how best to apply.  This direct approach doesn't always net a response, but if done professionally might give you an "in" where other applicants fall short.

Update! Update! Update!
>Each time you change jobs or finish an engagement or receive a promotion...make sure you update your profile to reflect that change! 
>If you change employers be sure to update your employer website information in the Website section of your resume.
>If you have experienced a Lay-Off or your engagement has ended... ask some of the people you worked closely with to provide a recommendation for you.

In closing, it's important to check your Linkedin page at least once a week to review any messages you may have received.  Imagine your Linkedin Profile as a live Resume, always being reviewed, considered and actively representing you in your absence.  By keeping up with your messages and updating your profile regularly Linkedin should be one of the most significant tools in your employment process.

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How to "BREAK INTO" Healthcare Information Technology - Updated 2021

I receive regular calls and emails from people that are interested in becoming employed in Healthcare Information Technology.  People hear there is a huge need for Healthcare Technology professionals so it would seem finding a position in this industry would be easy.... but it can be a catch-22.

The Healthcare Systems and Consulting Firms are seeking people that have years of experience in the industry, and many opportunities require certifications in specific EMR Vendor products to boot. With this in mind, even someone with a substantial IT background in another industry or a Nurse with no informatics background can find it challenging to land a position. Over the years I've read numerous publications claiming to provide the solution to this dilemma, it is my impression that there is no fool-proof method to the madness.

Below are some useful suggestions for breaking into the Healthcare Technology Industry. Initial steps will be listed and then the information will be divided into sections that will give tips that are associated with specific background and education.
Step 1. Create a resume that highlights your Healthcare and/or Technology background and education.
Step 2. Be prepared! Know the type of opportunities you want to consider, the geographical area or areas you will be searching, and the salary range you need to support yourself.
Step 3. Don't fly blind: Create a spreadsheet to track your employment processes, and be diligent about filling it in. (Finding a career can be a full time job. Be ready to spend at least a few hours a day focused on your search.)
Step 4. Get connected:  Use social networking to connect with industry professionals that might be able to assist you in your search.
Step 5. Get Educated:  Explore industry related web sites, and sign up for industry related newsletters (Like HIStalk) to stay on top of the latest information.
Step 6. Use the job boards and search engines like www.indeed.com to assist you in your search.
Step 7. Make sure you're applying to the right places. Most Consulting Firms hire industry professionals with extensive prior experience because their clients expect highly qualified consultants from them, however, some consulting firms are open to hiring professionals with limited experience but tons of potential, and offering training (or certification) in exchange for a 12 to 24 month agreement of employment. While consulting firms typically are only looking for people that are already highly skilled, and open to contract employment - some will consider training & permanent (fulltime/salaried) placement. Read the job description carefully to know what it is they're looking for - and don't waste your time & theirs applying to jobs that you are not qualified for.

For Healthcare Professionals lacking Informatics experience... is your current healthcare employer planning to implement a new EMR or upgrading their current system? If so talk to your Supervisor and the internal IT Supervisor about your desire to enter into a Informatics role. Your current employer is always your best bet. If your current employer is not involved in an implementation seek a Healthcare role at a healthcare facility near you that is. Make your desire to fill a dual role between your healthcare expertise and informatics clear when you are involved in the interview process. Another idea would be to continue with your healthcare career while going to college for Healthcare Informatics Management or to obtain your degree in Computer Science.

For IT Professionals lacking Healthcare/HIT experience.. most healthcare systems have a need for core technology professionals with a background in DBA, Wireless, helpdesk and many other areas. Try to find a position within Healthcare facility that can utilize your previous technology expertise. When you interview, make it clear that you would like to eventually advance your career into working with the EMR software. Sometimes you will find opportunities that need a combination of both EMR software experience and other technical expertise, in these situations if your existing experience is strong enough many healthcare facilities will hire and train for permanent positions.

For College Graduates that have a Healthcare Technology Degree but no work related experience... while a degree in HCIT looks fabulous on a resume, it can be more difficult than the above scenarios when trying to land a career with no prior work experience. Use your school's career-placement team to assist you. Normally most colleges will have a career-placement department that partners with area companies that are eager to hire recent graduates. Next focus your efforts on all the hospitals within a sensible commute distance from your home. Scour their web site career section for any entry level position that will match your educational background. Follow up by looking on Linkedin for the person that might be the manager of that position and message them with your interest and inquire if they have any suggestions on how you can land an interview. If you are having challenges finding the ideal position, settling for second best until you gain valuable experience is never a bad idea.

The option of working directly for an EMR vendor... sometimes the EMR Vendors will hire people with any of the above qualifications. The Top EMR Vendors are Epic and Cerner followed by the rest (Meditech, McKesson, NextGen, Allscripts, etc). Most EMR Vendor companies will require relocation to the city that houses their corporate offices. (Ex:  Epic Verona, WI and Cerner...Kansas City)
While Epic and Cerner may be considered a dream space for most HCIT Professionals due to the strength they have in the market, most vendors have strong non-compete clauses in their employment contracts. If you chose to work for a large EMR vendor you will gain invaluable experience but if you decide to leave their employment you may find yourself unable to work with their product or at their clients for 12 - 24 mos.  One should always pay attention to the fine print when signing an employment contract.
Hopefully this information will help you in your journey into the Healthcare Technology Industry.

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When NOT To Apply

We're all busy.  If you're like me, you get to your desk in the morning and immediately start trolling through your emails.  Usually there are dozens waiting.  Whatever your chosen profession, you must zip down through the subject lines to determine the order of importance in regards to response. Normally you immediately delete the junk, open the urgent notices and categorize the rest. Being a Recruiter, the top of my priority list goes to resumes that were submitted the night before. (and of course, anything from my boss)

Since Recruiters often use the major job boards to post opportunities, many of the resumes we receive will come from people submitting through the specific job board they use.
Unfortunately there is a growing trend of submitting a resume for a job even if you do not match the requirements provided in the job description.  I mentioned this briefly in a previous blog but I am going to elaborate here. 

Lately, if I receive 50 resumes from the job boards, a full 50-75% of them will not match the required qualifications of the job.  Due to the economy, there are so many people that are desperate to find work that in their desperation it appears they review a subject line without reviewing the job description and apply in hopes of obtaining any work.  A few years ago I was taking the time to email each person thanking them for their resume and explaining they did not have necessary qualifications.  Sadly, now I just delete these resumes because I do not have time to respond to them all.

This process is a major time-suck both for Recruiters and for applicants.  If you are not qualified for the position you are applying to, you are wasting time that could be spent applying to appropriate opportunities.  If a Recruiter has to wade through dozens of resumes to get to the one that has the desired qualifications it is a waste of their time as well. 

Here are a few suggestions to navigate the job boards: 
1.  Be VERY specific when you are searching for jobs.
     a.  Make sure to use key words when you search, even if you are searching a specific geographical
          area.
     b.  Set up searches so that any new positions matching your qualifications will be sent to your
          email.
2.  READ THE ENTIRE JOB DESCRIPTION!
          Sometimes you might be using a keyword that means different things in different industries
          so by reading the full job description you won't mistakenly apply for something that isn't
          a match for your qualifications.
3.  When in doubt, add a cover letter.
         If you have found a job posting and you aren't 100% sure that your qualifications are a match.
         Add a cover letter when you submit your resume providing an over-view of your experience
         and inquire if the position might be right for you.

A perfect example would be when I posted an opening in the Dallas market for Healthcare Technology Trainers.  The job description clearly stated that prior Healthcare Technology Training experience was a requirement, yet 99% of the resumes I received were Dallas area school teachers.
Had the respondents read the entire job description they would have realized that the position was not Teaching but was Technical Training in a healthcare environment.

If you find a position that is not a fit for your qualifications but is in a similar industry and you would like to find out if that company might have an opening that is a match for you.... DO NOT submit your resume to that position via the job boards. DO... visit the company's web site to review their job openings.  That way, if they do have something that is a match for you, you can apply directly to their site.  If not, I suggest emailing your resume directly with a cover letter stating your qualifications and your desire to be considered if they have any opportunities arise in your area of expertise. 

Some job boards offer automatic resume submittal.  Basically, if a job is posted that ticks specific key words you've chosen, your resume will automatically be submitted.  I strongly recommend against this option because it is not a fool-proof method and most of the time your resume will be sent to positions that are not a match for you.  The best way to find new employment is to dedicate a few hours each day to scouring the internet, newspapers, local and national staffing agencies.

Remember that Recruiters want to fill the job openings as much as you want to find a job... so with patience and attention to the details, you will find what you're looking for!

Tracking your Employment Processes / Gotta Love Those Spreadsheets! UPDATED 2016

Since we are still in a time of great activity in the Healthcare Technology space, it is extremely important to track your application / interview process while you are on the hunt for your next position, whether it be a consulting gig or permanent employment. 
There are a number of reasons to keep comprehensive notes on your process: 

>So you are not duplicating your efforts. 
>So you don't appear haphazard by accidentally applying to a place you've already interviewed.
>So you don't miss an important interview or the opportunity to follow up with the right person.
>So you do not risk being submitted to one position by multiple firms.
>For your own sanity!

Once you have created your eye-catching resume and updated your linkedin profile to showcase your qualifications, you will want to create a spreadsheet to track your progress.  (If spreadsheets aren't your thing you can create the same format on a legal pad)

From Left to Right you will want to create the following columns, making sure to provide enough width to the column so you can clearly see the data entered.  (this makes it easier to print as well)
1. Date Today's date
2. Company/ Client Name    This doesn't require much explanation.  Enter the name of the Company that you have applied to.
3.  Firm Name If you are applying to the job via a recruitment company
4.  Location This is important if you are considering relocation for a perm job or will be required to travel for a contract position
5. Source This is optional, but can be helpful to list if you found the position through an online job board, a referral etc.
6.  Date Submitted to notate the date your resume was presented to the client
7.  Name of Contact who did you communicate with about the position?
8.  Contact Info  email, phone number etc of the contact
9.  Job Title Title of the job you applied for.
10.  Follow Up notes on any follow up you made after you applied
11.  1st Interview track the dates and method (phone, video, onsite) of your initial interview.
12.  2nd Interview " "
13.  Notes it can be helpful to have a large column for any important notes.

The above is just a suggestion, you might have the need for more or less columns or prefer a different order.  This is your personal tool to keep your process clean and simple. 
  
By tracking your activity you will limit the risk of mistakenly being submitted multiple times to the same client or re-applying to a job you previously interviewed for. 

A great alternative to creating your own spreadsheet is using this free online tool: JibberJobber
You can learn more at www.jibberjobber.com

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The Initial Interview! Do's, Don'ts and Definitely Do Nots!

I thought of naming this  "How to talk your way out of a job" due to some previous experiences, but I want to provide a broad scope of examples on what do to and not to do during your initial client interview.  Since most initial interviews in our industry are conducted over the phone, I am going to focus on that format. 

All my life people have had the tendency to tell me everything about themselves.  I often feel like I have a blinking sign on my forehead that says "Talk to ME! I want to know all about you!".  I can't count how many times I've been innocently standing in the grocery line waiting to check out, and if by chance my eyes meet with the person standing behind me they immediately strike up a conversation.  In a matter of minutes I am learning about this person's family, medical history, current employment situation and what they're planning for dinner.  Fortunately I like people and I normally find their stories interesting or thought-provoking.

I've found that people also have a tendency to become overly comfortable during a phone interview and discuss things that probably wouldn't be a topic of conversation were they face to face with their would-be employer.  Am I interested in how many EMR Implementations you have been involved in?  YES!  Am I interested in your recent colonoscopy?  NO!

To follow are a number real life examples of what NOT to do in interview:

1.  Be mindful of the time.  Most people that tend to chatter KNOW they tend to chatter.  If you're a chatty person, prior to your call write down notes on the important points about your qualifications that you want to make sure you cover and questions you want to ask as well.  Have these notes in front of you and get a timer!  Keep an eye on that timer... if you are talking non-stop for more than 3 minutes you will want to think of a way to wrap up.  I'd like everyone to stop reading for a few minutes and stare at the nearest clock for 3 entire minutes..... I'll wait.......humming the theme from Jeopardy quietly to myself while I wait............
You didn't last the entire 3 minutes did you?  Get bored?  The pace of a typical conversation is 140 - 180 words per minute*.   You do not want to exhaust the interviewer with a constant stream of blah blah blah.
1a. Don't speaksofastthatnoonecanunderstandwhatyou'resaying... if you're asked to repeat yourself more than once there is a barrier.  Whether it has to do with language, your talking speed, or the phone connection, slow down...repeat yourself and then ask the interviewer if that was better.

2.  Don't go off on rabbit trails.  Stick to the topic at hand.  You are on the phone to discuss your qualifications for your (potential) next career step.  At no time should you discuss medical issues, family issues, how many cats you have... etc.  By law, the person interviewing you cannot ask you about your health, family/marital status/children, religious preference or ethnicity.  You should not bring these things up in your interview process unless absolutely necessary.  The interviewer is allowed to ask if you are able to complete the tasks that are required of the position, if for some reason you have a disability that may not permit you to perform all the requirements they can ask you how they might accommodate you.  I am not saying that you shouldn't develop a rapport with the person on the other end of the call, however you do not want to bring up topics that might be used to discriminate against you. 

3.  No matter how much of a jerk-wad your previous employer was, keep it to yourself.  I've conducted numerous interviews where people have vented to me about their previous employer.  That never leaves a good impression.  If you're that disgruntled with your ex-employer... seek therapy, but remove that anger/resentment/frustration from the interview space!  Inevitably you will be asked why you left your previous job(s).  Keep the answer short and simple.  "There were some professional differences between my boss and myself" is a good example. Fortunately and unfortunately this is a tight knit industry where news travels fast.  If you had a conniption fit at your last job, threw your coffee mug across the room and stomped off, it wont take long for your potential employer to hear about it.  On the other hand, if you are always professional and were working at a facility for a notoriously difficult to work for IT Director, and you chose to resign, people will know that as well.  No one wants to work with a hot-head.

4. Definitely DO NOT use the restroom during the call**.  You read that right...  In the age of cell phones, zoom interviews & blue tooth technology, people seem to forget what they're doing while they're actively having a discussion.  Never mind that it's a distraction for the people trying to peacefully use the facilities if you're in a public place but... WE CAN HEAR YOU!  Yes... we can hear you as you relieve yourself, flush the commode, wash your hands (hopefully) and exit the facilities.  

5.  For God's sake.... don't yawn!  Ok, so there are interviewers that may have some of the bad habits I've mentioned above... but even if they're boring you to tears... mute the phone to giggle, yawn, sneeze, etc.

6. Don't waste your time! Wanting to end the interview prematurely:  If the person you're interviewing with is completely unprofessional, rubs you the wrong way, or something you've heard has indicated this job isn't what you're interested in... best to politely interrupt and say something like "thank you for your time, due to what you've just told me, I realize this job is not a fit for my career desires, and I dont want to waste any more of your time" and end the call.  Keep in mind if you're interviewing with a Recruiter or going through a technical screening you may want to hold your judgment, since you probably wont be working directly with those individuals and admittedly Recruiters don't always have all the information on a position.

7.  Don't keep them waiting.  Be on time for your call.  If you schedule an interview be courteous and call or answer on time.  If you must cancel or reschedule send an email or call to notify the interviewer as far in advance as possible.  If you miss a call and don't provide notice... unless it was nothing sort of a catastrophe... you will probably not get a second chance.  

8.  Don't take it personally. On occasion you will be interviewing for a position that is not a fit for you or your current qualifications.  Its not easy for a Recruiter to tell you that your qualifications are not up to the expectations of the position (trust me).  We want you to be a fit as bad as you do.  When you are turned down by a potential employer do not take it personally.  If it was meant to be, it would've been.  There are so many job opportunities in the Healthcare IT industry you will be sure to find the right position with a bit of do-diligence.  If you are turned down for a position and you truly believe you had the skills the employer was seeking, write an email thanking them for their time, letting them know you have continued interest and express any skills you feel they may have misunderstood or over-looked.  Then ... let it go!  Keep in mind it is the employer that knows what they want.  Writing scathing emails or yelling over the phone is never the way to end an interview process.  As I mentioned before, news travels quickly and you always want to walk away leaving people with a positive impression.  Let's be honest, if you are repeatedly being turned down for positions that seem to be a match for your qualifications, it might be time to consider how you are coming across during the interview process, talk to a Recruiter you can trust and get some interview counseling. 

DO's:

1.  Ask questions.  Always have a list of questions prepared for an interview and make sure they're answered before you're off the phone.  Each of us want to be happy with our career choices.  Its in your best interest to be fully informed about the opportunities on the table.

2.  Eliminate background noise.  Try to find a quiet place without outside distractions. Barking dogs, children yelling, TV, Radio, Wind etc. can be a distraction and can turn-off a would-be employer.

3.  End the call on a good note. Thank the interviewer for their time and inquire what the next steps will be so you are prepared.

4.  Send a quick follow-up email. The following day you should send an email thanking the interviewer for speaking with you, reiterating the next steps you're anticipating "I look forward to scheduling my next interview with the Department Manager as we discussed" and providing your contact information again.

With these tips in mind you should have successful, productive initial telephone interviews.  If you interview over the phone and do not hear back from the interviewer within the timeframe they discussed with you, always pick up the phone and call that person to follow up.  If a Recruiter told you they would call you by Friday COB and you've not heard from them by Monday at 8am... pick up the phone!  By keeping a spreadsheet to track your interview processes you can greatly increase your chances of landing a position.

Happy Chatting!

Tim Tolan penned a blog about a less than successful interview from a recruiter's perspective: http://healthcareittoday.com/2011/09/29/hey-mr-healthcare-it-candidate-please-stop-talking/
*(source) Science News / Science Daily
** This actually happened to a colleague of mine.

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