The physician search industry is littered with unethical people

I could not agree more with the first line of Jim Stone's blog post. Jim Stone and his company, Medicus Partners, is probably one of the few good physician job search groups in the industry. I appreciate the candor and honesty Jim Stone and Bob COllins show on their blog. I am glad that their company is successful and growing, and that Jim Stone has been elected to the board of directors of the NAPR.

On the other hand, his blog post is yet another confirmation of what I have tried to say in my many and rather dark descriptions of the physician recruitment industry.

Here is the letter in full length as it appeared on Jim Stone's blog "dochunterdiary", no changes made, except that I could not resist adding some emphasis - the bold was added by me.

Start quote:

"The Scarlet Letter
30 May 2008

The physician search industry is littered with unethical people. Its downright shady at times. There are lots of fast talking, smooth sons of guns out there. I’ve made reference to some of the nefarious things that go on before.

We try to do business the right way. We don’t claim to have magic potions to make recruitment easier. We’ve got a group of very talented and experienced recruiters who are committed to helping their clients be successful. Our intentions are pure.

What I have a hard time with is the reception we get when we try talk to non-client prospects about what we do in an attempt to determine if it would make sense to partner up. I get that people get bombarded by recruiters and that they get worn out by them, but I think there are a couple of things worth noting before I discount that.

We’re the opposite of the hard sell. I’ve heard and delivered a lot of pitches, and none is as soft as ours. The reason for it is that we’re really interested in certain kinds of relationships and our responsibility is to determine whether those exist with the people with whom we converse. So it’s as much about feeling them out as it is them feeling us out.
Our people are sincere. We opt for a very courteous, thoughful approach.
We genuinely want to help make the physician shortage easier to survive in. We’re not the right firm for everyone, and that’s OK.
So, now YOU know that, but the people we’re calling do not. They don’t make any attempt to find it out either. We’re assumed to be the most wretched and cold-hearted thieves this country has seen since Enron. Our people are barraged with insults and taunts and hung up on with regularity.
Is it just because we’re in a business that has shady characters? If that were the case, are you equally rude to an attorney that calls? How about the commercial real estate brokers or financial management people?

This is an open letter to anyone who feels the need to belittle and taunt recruiters that call. I’m hoping you’ll email me to tell me why you engage in that behavior and what we can do to be less intrusive to you so as to avoid incurring your wrath. For the love of the children, please tell me how to get this scarlet letter off my chest! You can email me at jstone@medicuspartners.com to let me know what we can do better.

Jim"

End of quote

Jim, you know my opinion. I don't think you personally nor your company have to change at all. Yet, it would be helpful to actually enforce the ethical standards of the NAPR more strictly.

The reaction from physicians that you describe ("insults and taunts and are hung up on regularly") seems deserved, I am sorry to say. It is the echo, it is the fruit of past labors, what goes around comes around. AS I said above, this does not apply to you personally...
My blog, as much as you may dislike it, represents a rare documentation of the frustration that hundreds and thousands of physicians have gone through and are going through. Physician recruiters created hope with ads that stretch the truth rather liberally, then they do not deliver, cannot deliver what the ads promise or at least suggest, then the telemarketer behavior, then the sales tricks and the many white lies and all the rest I have been writing about for over a year....

What can physician recruiters do to improve their image?
Start by not promising more than you can deliver in your ads, call rural and remote areas what they are and stop labeling them as "easy access to desirable city".
Stop pretending you get jobs in desirable locations all the time, when you only get them once in a blue moon, then respect the desires of physicians about where they want to live - after all it is their life (!), stop trying to persuade them to move to the countryside just because most of your jobs are located there.
Give physicians the respect they deserve (remember, you live off them) and if they have their mind set on a location you cannot deliver, say so!
And "confess" to physicians job that there are indeed other ways of finding jobs besides recruiters (such as mass mailing) and that recruiters do not have access to many jobs (no access to all those non-commission paying jobs) and that recruiters have very limited access to jobs in densly populated areas and in big cities (e.g. Boston, New York City, Miami, San Francisco), on the waterfront and in high-demand areas in general. Just the statement "we are just one way, networking and mass mailing is another" would get you many points for honesty and candor.
Occasionally passing on tips about jobs that do not pay commission might help - which supposedly some recruiters are doing, at least that is what they claim...
Telling physicians about other sources of information about job search such as my blog might help as well.

I think it is not so much WHAT YOU DO, IT IS MORE WHAT YOU DO NOT DO or what you do not say, what you / many recruiters are silent about.

My recommendation: set really high standards, drastically enforce them, create a small group of truly ethical recruiters (maybe inside the NAPR, as a subgroup) and once you have established trust for these select recruiters and once you have created a "brand" then try to gain support for that "brand" and expand the membership.
I am not sure if "NAPR" is that brand, even if you would like it to be...

Will this be possible? Will this be financially viable - given that all my "be honest" requests basically have the potential to hurt the business? Many will say "no, can't do that, I would be ruining myself". I disagree. If you want to survive in the age of the internet, where physicians can find info such as the one found on my blog, you may need to do this to survive as a profession.
I believe you can be successful. You own career and the success of your company proves it!

All the best
Your Matthias Muenzer

Boy, you have the industry pegged!

This is a comment that I recently received on one of my past posts. It is so good, and so clear that it does not require any additions from me. Hear the truth about physician recruiters from someone who has done it, not just from me, who has seen it and has described it! Emphasis added by me.

Start quote:
Boy, you have the industry pegged! It is funny, I have been a "Physician Recruiter" for over 15years and started to work for myself at home because I hated the way the industry was run. I have given physicians the name and contact information to positions that do not pay me a fee (worked for free) because it was in their best interest. I was tired of working for people who played games with Physician's lives for the sake of the almighty dollar. Now, I may not be rich doing business this way. I "loose" a placement or a fee by handing over information but I can look at myself in the mirror everyday and I also know, if they took a job that I could not get a fee for, then that was ok because it only means they would not have been happy if they accepted a job from one of the hospitals which would pay me a fee. I am happy to say, once I started "giving" jobs away, I could still pay my bills and I received more referrals from physicians I had helped and I stopped calling myself a "recruiter" and became a "Physician Career Consultant". My advice to Physicians who are looking for a job is to interview the recruiter. Find someone with experience and with whom you can build a trusting relationship. Work with only one or two at a time but always know they won't give a lead for a position that won't give them a fee so keep control of your own search and look on your own as well. I am happy you wrote what you wrote and I also hope more physicians read it and are able to handle their career moves in a more positive manner.
End quote

Post jobs and find jobs for FREE on Sermo - a 60,000 and growing online physician community

I love Sermo, for many, many reasons. The community is physicians-only, it is free, you may even earn a bit of money by giving your opinion and it is a great community. Responses are many, diverse, friendly, supportive, interesting, funny. Sermo has a great humor section. What started in 2006 with just a few people is now a vibrant 60,000 physician community and continues to grow by about 1000 a month.

Here is one more reason to love Sermo: Recently they have started a job board - FOR FREE. And it will stay free. So, this is my new favorite in the physician job market. Please take look at Sermo.com, and if you are a physician, register for free and and look around. Go to the posts in your specialty, go to the "general interest section" and go to the job board.

The Founder and CEO introduced the job board with the below quoted post in Sermo. And, not to my surprise, I found that my opinions on the physician job market and in particular on physician recruiters are widely shared by my fellow physicians!

Quote start:

From the Founder: Return to Professional Courtesy - SermoJobs

Being the son of a physician I remember very vividly the role of professional courtesy. While I was always blessed with access to incredible physicians, dentists, and orthodontists, I can recall several occasions where professional courtesy became a topic of great discussion between my parents. To my father, and ultimately myself, it represented something much more meaningful; the willingness and desire of physicians to help one another in any way that they could.

Almost a year ago, when Sermo started to consider the features, services, and products that our community would find valuable, a Jobs Board quickly became a topic of great discussion. It has always been clear that a large physician community could benefit from a very powerful "network effect" if all physicians could use the medium for their collective interest. Then members of this community repeatedly posted jobs and contacted me about their strong interest in a jobs board. Then our Chief Medical Officer started talking about this in terms of a return to professional courtesy and it hit me. This community wants to cut out the third parties. Physicians want to connect to one another, network, discuss, and ideally resurrect the professional courtesy that was once so central to our profession. Sermo could do that As we researched the concept of a jobs board, the community was very consistent in the feedback:

• Demand for physicians is soaring, especially of late. The necessity to resort to recruiters is becoming all the more common.

• Physicians are frustrated by the intrinsic conflicts of interest that third parties (recruiters, head hunters, etc.) bring to the recruiting process.

• With so many financial pressures on physicians, the 10-33% of starting salary paid out to recruiters is increasingly unbearable.

• There is no single resource where physicians can present and discuss employment opportunities to and with one another.

Sermo Jobs is a free resource to all active physician members of the community and will not be accessible to any for-profit third parties. I can, however, foresee a model where physician employers such as hospitals, IPAs, and institutions could eventually participate, perhaps in a way similar to our client postings.

Job postings will benefit from the same community moderation and discussion that have made Sermo so successful. Should the author choose to engage in commentary around their posted job, they will not be identified as the author but their real Sermo user name will appear. This system allows the individual physician to independently choose if they would like to reveal their Sermo user name.

Sermo encourages the philosophy of physician professional courtesy and shared benefit between the job poster and applicant. It is our hope that when a candidate accepts a job position the two parties will share any financial resource that would have been spent as a recruiting fee thus keeping more money in the pockets of hard working physicians.

Daniel Palestrant, MD
Founder & CEO
Sermo, Inc

Quote End.

Thank you, Dr. Palestrant and thank you Sermo Team, for this great opportunity to pass on jobs directly from physician to physician. This is exactly what I wished for and predicted in the age of the Internet. No middlemen, no third parties that distract more than they help. Direct contact from physician / employer to physician.

Professional courtesy. Now we are talking!

Another grrrreat recruiter email! Have fun

Hello Dr.

We have many new and Great opportunities available in ALL STATES which include, $alary increase, sign on bonus, relocation packages. Locums and Perm National Positions Available!!! Open ended Assignments!!! Great rates $$$ All expenses are covered including lodging, mileage, and malpractice for Locums. VERY FLEXIBLE HOURS!!! GREAT FOR THE FAMILY!!! Must have a State license for Locums and Client will wait for Perm. Recent grads are welcomed. Excellent support staff and coverage. Possibility to covert to a permanent position. Low Stress Environment!!! All Submissions are strictly confidential.

Thank You,

Besides the very personal approach so familiar from too many recruiter emails "Dear Dr.", this recruiter apparently had help from his children armed with their new crayons! And I love the specific details! Are all his jobs so great? I guess so...I suspect he put all the superlatives from many many ads in a blender and out came....
It was very, very hard to resist calling him!
What else can you say if you receive such a customized personal message? You truly believe that he is "going to customize a search for you".

Have you been lied to by a Physician Recruiter?

On a physician-only online community, one of the physicians posted the following question:
"Have you been flat out lied to by a physician recruiter?"

107 physicians answered.
This is the break down of their responses:

42%(45/107)I have heard some second-hand stories of recruiters being untruthful, but have never experienced it myself.
36%(38/107)Yes
8%(9/107)Recruiters only lie when they move their lips
7% (8/107)Don’t trust recruiters nor the administration
6% (6/107)No
1% (1/107)I am astounded by this information

You be the judge....

Physician Recruiters and Divine Justice

Deceased physician recruiters realize to their great dismay that they are stuck in hell! Why?

They were told "heaven is oversaturated", so they chose a place with "easy access to heaven".

A Physician's View of Job Search

A colleague of mine wrote this comprehensive piece on job search, short and to the point. Wise. True. You will see why physicians always will give you more and better information than any recruiter.

The best jobs are with:

1. People you know
2. People recommended by the people you know
3. People who know the same people you know (listen carefully to the people you know)

You have to know what YOU want first:

academic versus private versus mixed
solo, small group, big group, employee of a large concern
small town versus metropolis
Coasts versus center
North versus south

Once you decide on the above, you have to do the market research. Get a directory from your society, count the number of society members in each state (this takes some time). Then take go to US census site and take population in that state for your target population (Pediatrics, young adults, middle aged, Medicare). Then figure out practitioners/100k target population. The places that have the lowest number are the places where you will likely do best in solo or small group practice. The places that have the higher numbers generally are the more desirable places to live, and you should consider joining a group. Another good resource is the Dartmouth survey of medicine which has a listing of specialists/population for almost every burg in the city. For example, in White Plains, NY, if you hit a pedestrian, you just hit a doctor. Also, do this for the major referring specialties for your practice - you need feeder fish.

So, if you are a shark, you need to know where the feeder fish are, and if there are already a bunch of sharks there.

Watch for signup bonuses - contract may say it is a "zero interest loan", or part of your buy-in, or other nonsense.

Watch for dictators - they are the majority partners and have the practice of burning through young people to keep costs low. Don't be a slave.

Get a handle on what is the MGMA average for your intended practice situation - your department should provide you with this. Negotiate starting above the mean.

Don't get enamored of the metropolis - you'll probably never afford housing. Better is if you work in a friendly, but out of the way place (much more doctor friendly) - then you can buy a pied-a-terre in San Francisco, Manhattan, or Aspen, or all three, if you invest in carwashes, gas stations, or become a slum lord in your small town.

If your spouse can't go where you must go, it's easier to divorce at your stage than at later when your net worth is higher (not from personal experience, but from watching a lot of car crashes).

Also, consider this: if you can find one or two other people to form a practice and commit to a three year business plan, and find a hospital willing to finance you (joint venture), you can start your own practice from scratch and make your own rules. You'll be hungry to start, but you won't beholden to a dictator and can become one yourself! (don't). If you find a partner, and you see an ad for more than one of your positions in Montana, go and stick up that hospital in Montana. If you don't have a partner going there with you, tell the hospital that you'll do the work of two and that you'll hire your own partner, and have them give you that other position's salary for all that extra work you're promising.

Actually, if you want to make money, go into hedge funds. You have no business in medicine.

In your specialty, you have billable services tied to revenue generating activities. Take the 10 most common activities and figure out ~how long it takes and ~how much it reimburses. From this, order these in terms of revenue density (reimbursement/average time). The priority from a purely financial viewpoint is to maximize the revenue dense items and minimize the revenue diffuse items. Things like GETTING TO KNOW YOUR PATIENT is probably why you went into medicine and is not billable, but necessary to generate the revenue dense items.

Rounding on inpatients and hanging out at the hospital and volunteering for committees are also revenue negative. In your figures, then budget a workweek and figure out how you wish to spend your time. For all the revenue negative or less dense times, figure out the opportunity cost compared to what would happen if all you did was the revenue densest activity. The difference between the balanced scheme and the fully revenue dense scheme is the money space that you should negotiate under.

You can then structure a business plan that includes using residents, physician extenders, and MLP's (slaves, slaves, and sharecroppers) to soak up some of the revenue less dense and negative activities and let you spend more time doing the revenue dense activities. Better yet, get the hospital to pay for these functionaries so that you are set free to sit in a windowless room and read EMG's day and night or whatever revenue densest activity it is you have.

Grim, but the hospitals and more knowledgeable practices crunch these numbers, and so should you. Radiology - pure revenue, no wasted motion of the jaw or ask me what - just neurons firing - is the extreme example. But again, money is not why you went into medicine, so let's step away a bit and get real and budget your ideal week of work. You have to know what it is that will keep you running on that wheel and how much it is worth.

If you find that the chairman - recommended jobs are not exactly what you want, you then have the recruiting industry. As long as you are mobile and not wed to absolutely having a metropolis with a Chinatown, and you realize that first jobs are like first wives, the recruiters are not so bad if you know what they're good for.

Matchmaker, matchmaker, make me a match! Typically, a practice makes a contract with a recruiter on contingency of a hire - typically this fee runs about $15-20k. If they hire you without a recruiter, the practice keeps that $15k - which is good negotiating room. Recruiters are then like a real estate agent and use their own ad language. But if you must, you should USE them. If you are a good candidate, their relationship just became worthwhile - to the tune of 15k. That's like a $300,000 house.

Don't be an easy mark. Let them know you are looking at other positions with other recruiters. Get them to pitch more than one position at you. That way, you can ask compare and contrast questions. They are your job-finding assistants and make them earn their keep. Get data - how many hip replacements at that hospital? How much trauma? How many orthopods? How many primary care physicians? Who else is practicing in your field there? The good recruiters will have this info.

Find out specific locations and do your homework. The web makes it very easy. Is that Lexus dealership in another state? Are there more WalMarts than Targets in that town? Is Applebee's haute cuisine in that burg? Get staff lists of that hospital and figure out where people trained and where they are from.

Check out the real estate in that town - you can get a baronial estate in North Dakota for what you pay for a studio in Manhattan. Know the school system if you have lil'uns. Is the place on Craigs list (or in really nowhere)? If so, what are these people buying and selling from each other? Woodcarvings of bears or antique Shaker dressers? Crossbows and used computers from the 90's or timeshares in Cozumel and slightly used Espresso machines? Unspeakable acts with fat strangers or skinny ones? Check out the symphony if they tout one - does it thrive (count number of different shows, less than 4 and you recognize all of the pieces and this is a symphony in trouble). Check out the Broadway shows they tout and see what the locals like (Mamma Mia or the Rockettes Christmas Extravaganzapalooza). Count the number of Starbucks, and you get a general count of New York City blocks this town is equivalent to.

At interview, look at the people you'll be working with. You'll spend most of your time with them rather than the people and activities that you love. Check out their teeth. Do they have a singing fish on the wall? Who is going to drive you crazy?

Negotiating - get a number and tell them you'll get back to them. Collect at least two offers.

Have a medical contract lawyer review - costs between 300-1000 bucks and is worth every penny if you have a good one. Make sure your malpractice is covered, including your tail and your next tail (cost of leaving - is it impossibly high?).

And finally, unless you're married to a woman (and then she decides), you decide by going eeniee meenie miney moe, and go with the place that gives you the most peace of mind.