Saturday, April 21, 2007

Medical Malpractice (1)

I was very sorry and upset to read that "Flea" a fellow blogging physician has to review old textbooks because he is facing a lawsuit. I do not know anything about the case, but it encouraged me to write down my opinion on the medical liability system.

While still living in Germany I had heard about the ridiculous outgrowths of the American product liability system:

Woman is stupid enough to dry her poodle in the microwave oven. Microwave oven cooks poodle's liver, poor poodle dies.

In Germany she would have been the target of giggles and open laughter, of reprimands for killing her poodle and of instructions about what a microwave oven does and what you can use it for.
Not so here in the US. Here she wins lawsuit and becomes rich. What is the moral? Stupidity and ignorance are nothing to be ashamed of, you actually are rewarded for it. If you act stupid, the legal system does not consider you stupid. It declares you a "victim" and compensates you handily.

The spilled coffee of a McDonald customer is another outstanding example. While the woman should have received a few bucks for her dry cleaning bill and a reminder that fresh coffee is indeed hot - which is how everybody wants it and why we buy it in the first place -a jury awards her a few millions. Clumsiness makes you rich!

And these awards are especially aggravating, since they are a crude and insensitive slap in the face of any working person! I cannot emphasize this enough! Why should the woman with the spilled coffee get an amount of money that I as a physician will have to work for - day and night - for about 20 years? Have you ever thought about that lack of balance? What on earth could be worth 20 years of physician work? Can you fathom the loss of proportion? Can you even begin to understand how ridiculous these awards are?
It discourages you from being a hardworking, honest person. Instead it makes you think about other possibilities to become instantly rich by acting stupid and pinning the responsibility on someone else. What message do these awards send???

Another recent example that infuriated me was a Boston globe article about an oh-so-poor-and-suffering family who had lost a dog to an electrical shock, caused by an insufficently insulated manhole cover. The family and especially the poor child now was supposedly miserable and depressed. The article personalized the dog by addressing it by name only, never as "dog". The article contained a photos of the child with sad face and downcast eyes - can it get more cheesy? And the lawyer actually demanded a "compensation" of a one year salary of the CEO of Nstar! Excuse me, would the dog have earned that salary if it had not died? What were they smoking? That family deserved a bouque of flowers, a new dog and a "we are sorry"letter from NStar with the promise to fix the insulation on those manholes. And the state should go after NStar to make sure they solve the problem. The shocking part was that the Globe actually became an accomplice of the greedy lawyer due to the understanding and supportive undertone of their reporting.

A very sinister example is the true story of a couple in NY who was under psychiatric treatment after repeatedly abusing and harming their own child. Finally they KILL THEIR CHILD! Consequently they sue their treating psychiatrist for not stopping them from killing their own child.... AND THEY WIN.

This is the ultimate absurdity. It also is a brutal message that you pretty much can do whatever you want. You are just not responsible for what you do. This is truly sinister and is my best example that the legal system has gone wrong.

I think patients should be compensated for faulty medicine, but without the theatrics of lawyers wildly dramatizing during a courtroom show and without the immeasurable "pain and suffering" component.

Patients should be compensated according to a table or list. You loose the left hand and you earn such and such a year, you get such and such amount of money. Period. No jumping up and down of a lawyer in front of a jury, no tear-jerker videos or any such nonsense. You loose the right hand, you get such amount, you loose hearing, you get such and such. Period. End of story. It is simple, fast and fair. And it would save the state a lot of money.

Now, we already have such a system and we all know it. And it works. It is called "Workers comp". What stops us from doing something similar in medicine? "Patient's Comp", and for the field of Obstetrics "Mother's comp". Pedetermined compensation. Streamlined process. No lawyer BS. No theatrics - hey, if you tell me, that I may become a millionaire if just complain a lot - then of course I will declare that I suffered a lot, a whole lot and I will be depressed and unable to work and I will have incureed all kinds of losses etc etc. And I will describe my suffering in multiple colors and I will look depressed and worn out when I show up in the courtroom. Nobody can prove me wrong, it's subjective and cannot be measured.

On the other hand "Patient's Comp" would be fair and fast.

There are other approaches of course. Lawyers could be prohibited from becoming partners of the plaintiff as they are now and could be forced to reimbursement by the hour instead of being paid with by contingency.

And, hey, what about reimbursing lawyers the same way we get reimbursed - with a global fee? That would solve 95% of all liability issues right away. And the lawyers would hurry up like you have never seen before. No endlessly drawn out pondering and discussing and describing and musing and debating and thinking about commas and single words and all the implications of tangential issues....

And, another approach is simply not having malpractice insurance. It is well known that lawyers go after the deep pockets, and our malpractice insurance contracts with 1/3 or 2/6 million coverage is an open invitation to sue. Greed drives the malpractice misery. Try getting a lawyer to sue a physician with no insurance - "sorry, you do not have a case". And I am not making this up. There are areas in the US where you can practice - very happily I may say - without carrying malpractice insurance. One of the consequences: colleagues in those areas get sued a lot less, and I mean a lot less! I have spoken to lawyers in those areas. They were very unhappy about their situation. Needless to say that I could hardly contain my happiness about their situation.

But not having insurance will ultimately damage the occasional truly mishandled patient. Therfore my preferred solution are special health courts, where decisions are made by judges who actually understand about medicine plus a compensation model that discourages courtroom theatrics and is based on predetermined tables and list. Something comparable to Workman's Comp.

What is so hard to understand about what I just wrote?
Nothing is hard to understand, and we all know who keeps us from having a rational system.

In the meantime I recommend the following:

1. Asset protection, to keep your personal assets out of reach of greedy lawyers. You essentially have to be pennyless on paper. Very possible. Dramatically decreases the incentive of a lawyer to sue you. The first thing they check, even before considering the merit of the suit, is the plain and simple money question "What are the defendant's assets? How much is he or she worth"

2. The lowest insurance amount allowed by law, taking away some of the incentive to be sued.

3., a company founded by a neurosurgeon fed up with sleazebag "experts" who will testify anything the plaintiff's lawyer wants. They send warning letters to the lawyer as soon as the process starts and also to the plaintiff's expert witnesses as soon as they are named. The expert witnesses are notified that they will be prosecuted in several ways if their testimony is less than evidence based. Professional complaints filed with their professional society, legal claims etc. Go to their website
And it is not expensive! Works best as a prophylactic tool.

4. Consider relocating your practice to a state that allows you to practice without professional liability insurance. Massachusetts does not! Practicing in a state that allows "self insurance" of physicians would save me personally 70,000 a year. Not pocket change. I certainly would know what to do with the money. And I certainly would prefer this amount to go towards the education of my child instead to the education of a greedy lawyer's child.

More to follow!

Thursday, April 19, 2007

Physician job search on the Internet - a few small tricks

Here are a few innovative uses of the Internet when searching for a job.

Create a Google Alert to help you in your search. Google alerts can be found in your Google account. Should you not have one already, then you need to get one. Get an email account at, then sign in and look for "My account" or "other services". Should Google be your homepage, then go to "more services" and you will find the alerts.

An alert is a search that is run automatically for you every day or every week etc. You can for example search for "physician opportunity ObGyn San Diego" and "ObGyn job San Diego" Physician need ObGyn San Diego" etc. You can create as many alerts as you want, then track them over a few days and weeks. Delete the ones that do not yield results, keep the ones that work. Every day you will find the results of these searches in your Gmail inbox. this way I found several excellent hints and tips. Often you find recruiter ads, but you may be able to find who is searching through a recruiter and contact them directly. If you know the city or county well, where you are searching, you can read between the lines of the recruiter ads and often figure out who exactly is advertising. Or, once you know that someone in a certain city, town or county is searching through a recruiter, you can simply mass fax everybody in that city, town or county and you are likely to find the one practice that is advertising through a recruiter. I have done exactly this more than once with good success.

Also, if you have a Google homepage, you can very easily set up a separate tab for job search. Open a new tab and then go to the "add stuff" button and look for "Job search" buttons and gadgets, which are essentially search engines fields that will be on a specific tab of your home page. You can search, one recommendable search engine and others with truly a few clicks. Others that I have on my job search tab are:, then or "Job Search Universe". You can even set up your "own custom search engine" - supposedly, but I do not understand how. Maybe you do.

LinkedIn might be a thought. Try registering and making connections to the area where you are looking. Sometimes connections work in funny ways. I was talking to an accountant of a physician whose practice I was considering buying, when he told me that another ObGYn had suddenly died and that his practice was up for sale. Too late, two other local colleagues had already scooped it up. Maybe LinkedIn or another social networking site may get you where you want to go.
Quote from the Toronto Star, copied from the LinkedIn Press pages: "LinkedIn is free and it’s one of the best networks. First, you join and create a personal profile. Second, you invite all your friends and associates to join. Your network will grow quickly as you recruit members who recruit members. ‘From a job hunter’s standpoint, LinkedIn represents an opportunity of a lifetime to establish a powerful network of influential colleagues and friends,’ says Guerilla Marketing for Job Hunters by Jay Conrad Levinson and David Perry.” But remember that this is mainly networking in the business world, not in medicine.

Decipher recruiter ads, skip the middleman and contact the employers directly. Recruiters do not tell you where exactly the job is until you have sent them your CV and THEY have presented your CV to the employer. Then they have secured the right to be paid! If they told you where it is, you could just call and get the job. Often solo recruiters or smaller companies describe the location of a practice by inserting text literally copied from local tourist agency material. For example, Fort Lauderdale is often described as a place with "23 miles of pristine white beaches", a line taken directly from the visitors bureau leaflet.

In February 07 I saw an ad about a "Miami suburb with a Venetian pool with 820,000 gallons of water" - and anybody who has ever taken a tourist tour in Miami has made a stop at the gorgeous Venetian Pool in Coral Gables. If you google the "820,000 gallons" of water, you get Coral Gables and the Venetian Pool. Sometimes it is that easy to find out where the jobs are. So, google those sentences and you will often find out within a few minutes where the jobs are. Then go to the yellow pages, get the phone number of the local hospitals and contact the physician liaison at these hospitals to see who is hiring. Voila! $20,000 saved, and you can hint at this fact during the salary negotiations and maybe get a better salary or moving money, better benefits, etc.

Often, you will read a sentence like "affiliated with a 231 bed hospital". You can find hospitals with number of beds by going to the American Hospital Directory (, then clicking on the state and then going down the list until you find a match. You can also go to MedlinePLus, then to the hospital directory. To find more hospital directories, click over to Pam Pohly's website and see a long list of hospital direcetories.

Nevertheless recruiting companies are catching up and are beginning to figure out what Google can do. The most detail you will get on the website of more advanced companies is "multispecialty practice in Georgia looking to hire".

Tuesday, April 17, 2007

Recruiters respond only if it pays for them

Whereas I receive hundreds of wordy emails about "exceptional opportunities" recruiters are incredibly frugal when I ask them questions about anything else - anything that is not "sales".

When I receive emails trying to incite me about jobs in Ohio, Idaho, central (never coastal) Pennsylvania, West Virginia etc I now email back asking politely why I might have received such an email. It is well known that I am exclusively interested in Miami. Miami and Miami Beach, not "Miami area". I have no intention of moving somewhere to the Midwest or into the "center" of any state. I want to move to Miami. I have family there and if I move, it will be there, nowhere else.

I ask the recruiters why I have received that email and do not receive an answer. I ask if MidWest is noted in my profile as preference and I do not receive an answer. I request that my profile be corrected and I do not receive an answer. I ask if Miami is clearly marked as preference in my profile, and I do not receive an answer.

I am aware that there is one or two profiles of me in background databases used by recruiters to share jobs and candidates. A long time ago I briefly considered high paying jobs in non-Miami locations and since then I have been receiving emails about jobs of that kind. So, why not correct it now?

But recruiters are not interested in talking to you, unless it is one of the following:
Are you going to submit your CV to me?
Are you intested in this job?
How did the interview go? Immediately followed by...When are you going to sign the contract?

Everything else is unnecessary fluff and will be avoided. Whatever does not sell is a waste of time. The ABC of sales, Always Be Closing. That is the recruiter mind and the recruiter life.

I do understand it, I sympathize with it. And you will too, if you ever, ever worked for "commission only". It's very simple: No sales, no money. Only the sale counts. Everything else is a waste of time.

Dear colleague, only if you have worked for pure commission can you understand the mentality of recruiters. And this mentality is worlds away from the mentality of a physician.
You just have to be aware of it. Unfortunately many young colleagues, after many years of living in a purely educational environment, and after having been kept away from business thoughts, are NOT aware of this and fall prey to recruiter sales tactics. We have to change that.

How to Find Your Dream Job

Finding a job is not all, it is only a small piece of being happy, of finding fulfillment. A single job is only a fraction of your career and your career is what really matters. There is good advice on the Internet, sometimes where you least expect it. It is worth taking a break occasionally and looking at the big picture, considering what you really want and what you are best at.

Take a look at what I found on WikiHow, it gives you tips how to think about your personal big picture:

1. How to Find Your Dream Career. Want to know how to find your dream career? Here are some tips to avoid career pitfalls so you can find the job you desire.You can view the rest of this page at:

2. How to Analyze Your Skills and Job Options. Want to be an astronaut or a baker or a carpenter? Choosing your options is never going to be that easy; what you need is to collate the things you are good at with the things you enjoy doing and then see where that leads you. Analyze your skills first, think about what you want to use, then choose your job options.You can view the rest of this page at:

3. Elevator Pitch. Many structured interviews... start with a question like "tell me about yourself." The interviewer doesn't really want you to go back to grade school and talk about your childhood. This is a specific question with a specific two minutes or so, the interviewer wants to get you to relax and loosen out your vocal cords, understand your background, your accomplishments, why you want to work at XYZ company and what your future goals are. Here's how to narrow your life down into a brief but relevant and professional answer. You can view the rest of this page at:"

Your Matthias Muenzer

The Churn of the Job Market

If you have been searching for a job in a big city while living there you know this fact of life: People are changing jobs, switching alliances and affiliations. There is the attending that had moved from one large medical center A to the B and now is moving back from B to A. Then a colleague gives up OB and has to leave hospital's C physician group, since they only want people who do Ob AND Gyn, she is now employed by hospital D. Others produce too little and have to leave, others have conflicts with the style of a practice or with one of the personalities in a group practice, others finally have the finances and the space to open their own practice, others want to go back to teaching. Some are recruited by neighboring hospitals (4 attempts in the last 3 years to hire me away). Some die or suddenly discover that they have e.g. leukemia. These are all personal experiences.

Be it in the city or on the countryside, there is a lot of change. Yes, some physicians stay where they are for 30 plus years. True, but there is a large number of physicians who change jobs.

The author of "What color is your parachute?", an excellent book on job search and career change, calls this the "Churn". He smartly mentions this as something that should give you HOPE. The job market does not consist of the publicly known "open positions", which may seem scarily small in number, it is much, much larger. This constant change, which has been estimated as 7-8% of all jobs means there is always opportunity, always. It also means that the opportunities are much larger in number than what a peek into the usual professional magazines show you.

I personally was very surprised by the amount of job switching that was going on in Boston when I was looking for a position and starting to feel helpless for not being able to get "into the loop". There just was no way of predicting who would suddenly have an opening and almost as soon as I heard about it, it was gone, taken by someone else.

Who gets these jobs that open as part of the Churn? People who are nearby. A personal friend or a colleague in the same specialty working nearby that talks regularly and privately to the physician who is switching is a classic candidate to take the job.

I just could not be "the friend" or "close acquaintance" to all my colleagues in the, let's say, Boston area. Nor could I have my ears everywhere. And probably you could not either, in your area. Usually I heard about these changes AFTER they had happened. And I said to myself "Wow, I wish I had known", or "I wish Somebody had told me about it" or "I wish I had asked there".

There is something that you can do. You can send your cover letter and CV to all the doctors in your desired area. It does not matter if they are looking or not, if they are planning to change jobs or not. Those colleagues who are not interested in your CV will throw it out, but a few will read and give you a call. And suddenly, you are "IN". Your CV landed on the desk of the doctor that is just about to sign the contract with other group or on the desk of the managing partner who just found out that a member of his group is leaving. And once you have their attention and no or very little competition, you usually have the job - unless you really mess up the interview.

Direct mail is the solution to that feeling of being helpless and having to watch other people in your desired area switch jobs constantly and watch them getting the jobs you would have wanted. All of the sudden, you have a handle on an area. You know you will get in, if not today, then in one or two or three months. Even if nothing is advertised in magazines or on Internet job boards.

And forget the recruiters, they are only called if all else fails. Who wants to pay 20,000 if the job will fill for free? They are the last to know about all those jobs that change hands under the radar, they are the last to know about the hidden job market. Notice they never talk about it? Actually, they know very well about it, and they talk about it on their seminars and congresses. But that knowledge is only for THEM, not for you. They are trying very hard to uncover that hidden market, but the success is extremely limited by the hihg price they demand for their servcies. Recruiters will not tell you what they do to get the jobs and candidates. That knowledge is for "recruiter eyes only", or so they would like. But here it is: Cold calling, cold faxing and direct mail.
Recruiters do not have access to the hidden job market. They may know about it, but there is no access for them. They may know which Mega-Group or HMO is hiring, but not the nice, attractive, in-town jobs that are filled quietly and far from public advertisements.
Forget recruiters. Recruiters have no function for candidates. It is a waste of time for a candidate to approach a recruiter or to answer a recruiter. Recruiters get paid by employers to fill the less desirable jobs. You do not need them. Period.

Direct mail is it. Do it yourself - following my advice in previous posts - or click over to They will do it for you for a very reasonable price and will make it easy and less time consuming.

Your Matthias Muenzer

Saturday, April 14, 2007

The big nonsense about "physician shortage"

You hear the pitiful whining about physician shortage or impending physician shortage. Someone apparently figured out that we will need, what, 80-100.000 of us more in 20 years? And now we should open the doors to thousands of students and hurry up, make tens of thousands of new doctors, found new mdical schools, and on and on.

I absolutely disagree with the notion of physician shortage and believe it is a slick maneuver of the HMOs to gain more doctors willing to work for less.

The power of HMOs came with an oversupply of physicians that we have had in this country since the 1980s. You read correctly: OVERSUPPLY.

The cost of a service is determined by supply and demand. This is so simple that most people forget it, although the sudden rise of gas prices after hurricane Katrina should have reminded everybody. Physician earning power has dropped to about 1/3 of what it was in the mid eighties. Yes, the colleagues that were watching the first season of Miami Vice, if they had time, earned three times as much as we do.

That alone is proof of an oversupply. Studies about future demand are all nice and well. You can look at supposed demand as uch as you want, the basic economic truth is that the payments for physicians have decreased dramatically. 20 years ago an ObGyn earned 400 K and a very nice home in the best area of Boston cost about 400K. Nowadays the very same house costs 1.6-2 million and the same ObGyn (working a lot harder and seeing about twice the number of patients) earns 200K. Do the math. That means that we have an oversupply of physicians!

They only people interested in more physicians are the HMOs - in an attempt to lower the reimbursements. The HMOs are the ones who talk up a "future shortage of physicians". There is no such thing. The HMOs just need more doctors to be able to continue paying less and less.

Do not buy into the myth of "physician shortage", there is no such thing, it is pure propaganda. What they are saying is: we want to continue to pay you too little, but we want you to live in not so attractive places and work harder for less. What that talk of physician shortage means is: We do not want to do what the market asks us to do, instead we want to continue to pay what little we have been paying! There is one solution for any "physician shortage" - increase pay until they come! It's called "market economy".

We do not live in a socialistic planned economy, fortunately. The socialistic planned economy is so efficient, so great and so successful that it has brought countries as large, as powerful and as full of natural resources as the Soviet Union to its knees!

There is no good way of planning physician supply. Who knows what will happen tomorrow and how it will impact physician supply and demand? Maybe we will find the gene for motivation to exercise or the gene for weight and obesity and the manipulation of that gene will make all the heart diseases shrink to 5% of what they are now?

Planning physician supply 20-25 years into the future? Maybe another Internet style change will surprise us. Who would have predicted the impact of the internet on our daily lives 25 years ago? Well, maybe Bill Gates, but not the majority. When considering prediction for the future, do you remember what 60's thought the cars of the future were going to look like? There were pictures of large ship like cars with fins, rotating seats, driving fully automatically...Just what we have now.

So, you think we can foresee the demand for physicians in 25 years? What about foreseeing the ability to pay all those physicians? Have they considered that? Aaaaahhhh, no, not that point, we will just divide the money that is available among more people.....

After I see the income of physicians steadily rising above inflation for 5-10 yeas, and after we have made up (!) for what we have lost in the last 20 years, then, and only then, am willing to believe that we need to train more physicians. NEVER BEFORE THAT. Before that it is all HMO propaganda to me.

Your Matthias Muenzer, MD

Thursday, April 12, 2007

A classic recruiter email

Here is one of my favorite recruiter emails. After telling a recruiter in person - on the phone - and repeatedly and in no uncertain terms that I was looking for a position in Miami, Florida and only and exclusively in Miami proper, yes, in the city of Miami, not too far from downtown, not in Fort Lauderdale, not in Naples, not in Orlando, not anywhere in central Florida, no, no, no, really only in, after telling a recruiter all this I received the following email on the very next day:

"Dear Doctor (note the nice personal touch), I hope this finds you well. You are receiving this because you are on the mailing list for new and exciting Ob/Gyn jobs! Although we represent OVER 400 Ob/Gyn jobs NATIONWIDE!!! (So what? But you have none where I want it! - and what are all those 400 jobs going to do for me???) I wanted to let you know about an exciting new position in Northern Los Angeles County!! (Just what I was looking for, Miami is right next to LA, talk about "personalizing a search for you") Here are the details: Easy access to Los Angeles (I just hope the devil will tell these guys after they die "Hey, you have easy access to heaven! Hah!)~ OBGYN physician needed to join a solo practitioner. The salary is $180,000 and will include malpractice insurance, health insurance, and dental coverage. Call coverage will increase to 1:3 with the addition of the new OBGYN. Partnership is available. Option to be Independent Contractor if physician so desires. This is a great community for a practice (and so is every single place a recruiter will ever tell you about, did you notice that yet?). Our ("our"? Does he live there? - of course not) wide array of art galleries showcase solo and membership exhibits of photography, paintings and other works of art with weekly readings open to the public. We also are the home of an enormous poppy reserve established to protect California’s native wildflowers. (So, the location is remote enough to house the last surviving poppy flowers....need I say more?) The California poppy, California’s state flower, can be seen by the hundreds blanketing the lush green fields and is a truly breathtaking sight. A wide variety of activities are available for those people who enjoy sports and other outdoor recreational opportunities (and if you do not enjoy sports and outdoors activities, but enjoy listening to concerts, theater etc? Another hint that there is nothing, but nothing cultural going on in that town!). Try your luck at catching the big one on our placid lake, which is stocked every two weeks (Which is stocked every two weeks? Did I read that right? The lake does not even support fish – is it toxic or just too small?), or go for a round of golf at one of the area golf courses. We are also teeming with places for fine dinning and shopping for everything from designer clothes to fine antiques. (All this blabla is usually copied and pasted without any further thought from local tourism brochures. Yet, it may help you pinpoint the town by entering the info in Google. In this case it yields the town of Lancaster, Los Angeles County, a mere 75 miles or 1 hour and 30 minutes from Rodeo Drive or from LAX. A prime example that teaches you what recruiters call a “short drive to LA”). This position will fill QUICKLY, so do not hesitate to fax or email your CV immediately (Old sales trick to push you forward by creating fear of competition and loss, never, ever believe something like that!). As I mentioned we do represent over 400 Ob/Gyn jobs Nationwide, so if there are other areas of interest please do not hesitate to contact me. I can be reached 7 Days a week at 800-xxx-xxxx until 10 PM EST. I look forward to hearing from you. Bxxxxxm, Txxxxxxp, Consultant (they never represent themselves as”salesmen”, but use cute euphemistic terms such as "Manager", "senior vice president", "consultant", "representative", "client advocate" etc).

What an instructive email. So many lessons about what is wrong with recruiters in one single email...
Forget recruiters, click on this link to find more jobs than any recruiter will ever find!

Remember, the function of physician recruiters is to fill the less desirable jobs.

Behind every recruiter ad is an employer that has given up trying to fill a position using the standard means and now is ready to pay 20 K to have it filled.

Don't fall for recruiters! And, send me similar email or write me your "recruiter story".

Matthias Muenzer, MD .....Search the right way!

Wednesday, April 11, 2007

I admire physician recruiters

Here are the top reasons why I admire recruiters!

They have a "positive mental attitude" (as written by Jim Stone of They are able to see a "great place to raise a family" and a "great place to build a practice", where I see just, well, Desert Gulch, a place where I would neither want to exile my family nor would want to build a practice. And where in general I would not want to be caught dead after sundown.

They have magical, mystical, truly superior means of transportation, very much like Harry Potter's broom. A town they see as "only a short drive from LA" to me is 75 miles away and it takes me an excruciating 3 hours on a good day to get to the city.

While they can "enjoy all Boston has to offer" from a small town on the New Hampshire border, I get frustrated with all the woods and rocks. And for me the hour plus drive to Boston pretty much takes the fun out of it. I believe one-hour commutes are overrated.

They know much better than I what to do on the Internet. They know that you best use Google to "find physician recruiters where you want to go to" (Healthcarerecruiter blog), while I merely have been able to find employers that offered me jobs.

They know that the "best practices" are located far outside the city, while I sheepishly was looking INSIDE the city for a practice.

They know that a good job search starts by contacting a recruiter, one single recruiter, preferably in a small firm (recommended by recruiter Rebecca Gresham on a product-placement article on the otherwise very respectable MomMD), while I erroneously thought that starting your search by contacting recruiters is the equivalent of shooting yourself in the foot.

They know that it is much more ethical and professional not to tell your clients about your limitations and they know that it is absolutely wrong to refer your clients to someone that might be better able to help them than you are. Meanwhile I am still making the horrible mistake of sending my patients to a specialist or a more appropriately talented or equipped colleague as soon as I cannot solve a specific problem myself.

Imagine that!

Monday, April 9, 2007

Recruiter marketing: Trying to sneak in under the radar (2)

The following article in MomMD is an excellent example for insidious recruiters marketing - sneaking in their sales pitches into non-recruiter websites such as MomMD.
Note that the author is Rebecca Gresham. Note that nothing in the article says who she is or what she does. After reading this article I first I assumed that she is a journalist or a female physician or medical student like most members of MomMD.

Read the article:

By Rebecca Gresham
You're a busy woman; juggling everything from patients and insurance reimbursements to soccer games and family vacations. With a list of to-do's a mile long, it can be difficult-if not down right impossible-to make time to find a new and better practice opportunity when you're ready to move on from your current one. "Working with a recruiter can help you conserve what often feels like your most precious commodity: time," says Kelly Marsh, Director of Marketing for Seaboard Health Care Search in Nashville, Tennessee. Marsh also points out another important incentive working with a recruiter offers. "Search firms generate income by placing physicians at facilities they've contracted with. Since these fees are paid by the facility, the work done on the physician's behalf is free of charge to them." Below are three ways in which working with a physician staffing firm can make you feel like time is definitely on your side.

Very well written, really convincing, it really hits home. Here we have a woman who knows how it feels to be an overworked mom, a woman writing to support other women. The author might be a female journalist, who writes about "career transition", maybe based on her research, maybe based on her own experience. Truly well written, it could be a textbook example right out of the marketing classic "Marketing to Women".

It surprised me that any journalist would promote recruiters as obviously and blatantly as this article does. It surprised me that she did not mention any other methods of finding a job, any other approaches. She does not mention networking, something most women excel in. She does not write about specific tips for networking, whom to contact, what to say, what to look for, how to follow up. She does not mention approaching hospitals directly, she does not mention mailing your CV, she does not mention that there are companies that actually write or rewrite your CV for a low fee, she does not mention that there are companies that mail, fax or email your CV to potential employers, she does not mention anything except "recruiters". I wondered why...So I clicked on her name. By clicking on "Rebecca Gresham" a link to a dot-org website comes up. Harmless enough. Following this dot-org link I landed at "Seaboard Healthcare", which turned out to be a "joint venture" of a hospital and - look at that, who would have thought so ! - a recruiter company! Not enough surprises though - by clicking further onto the page that lists the staff or board of this recruiting company, I find three names, one of them Rebecca Gersham, the director of research of said recrutier company.

So, we have an article written by a recruiter, who acts somewhat like a journalist and quotes a fellow staff member at her own (!) recruitment company. She never mentions that she is a member of the same recruitment firm or a member of any recruitment company for that matter. She tries to sell the reader the usual recruiter sales pitch under the guise of a "objective and neutral" journalist. This is truly shameless cloaking of your own identity for a very clear purpose - to appear more credible. This is truly shameless product placement and abuse of the trust the directors of MomMD have placed in someone.

In my opinion this is misleading and unethical. The lack of ethics apart, the whole sales pitch is dangerous misinformation. Followings these "recommendations" would delay the physician's job search significantly or derail it completely. These "recommendations" only, but only benefit the recruiter - as I have shown in previous posts on this blog.

This shows that recruiters publish articles in the guise of neutral writers to lend credibility to their sales pitch. MomMD has a policy that no direct or indirect advertisements be published in the messages section. Does this apply to the articles as well? It should. Members of MomMD deserve not be be mislead.

Your Matthias Muenzer, MD
Proud MomMD member

Trying to sneak in under the radar - recruiter marketing

Physician recruiters advertise in the medical literature, in journals and on websites in a way that sneaks up on you. You often do not know that you are dealing with a recruiter promoting his services until it is too late. All too often you read the material resented to you by recruiters with more trust than you should.

An old example from my resident days was the "Best friends manual to finding a job". Very nicely and most effectively titled booklet. It impressed me since I like the "best friend" part. I believe good education in general should be presented the way a best friend woudl explain things to you.
This booklet was handed out (for free obviously) by Weatherbee, when they still were recruiting for permament positions.

The insidious and dangerous message pervasive in recruiter advertising is the following:

When you want to find a job, start be networking, ask your attendings, your friends etcetc.
Polish you CV, make sure it does not have typos
And then of course you want to answer those recruiter calls, because recruiters have sooo many resources, so many contacts, so many jobs and....
best of all it is all for free for you!!!

This message is exceedingly dangerous and misleading for several reasons:
They act as if they are giving advice by mentioning "networking". Recruiters realize that this is the common way of finding a job and they want to appear "mainstream" to gain your trust, so that they can place their true message.

Recommendations about "polishing your CV" are usually brief and not too useful, since recruiters do not make money by helping you, only by placing you. They mention the CV and cover letter because you are an easier sell if you look good on paper. Recruiters hardly ever mention resume writing services, they occasionally say "show you CV to a recruiter since we see many CVs each day". Strangely I have never ever received a single useful comment of a recruiter about my CV. They just wanted me to submit it - because then they can sell me. The CV is their chip, their "proof" that you wish to use their services. That is their most significant interest. They pretty much do not care about the quality of the CV, unless it is devastatingly poor.

Note that recruiters rarely mention actual networking techniques, even though they are masters of networking. They live by networking, but they are not too keen in sharing "networking techniques", since it may interfere with their business. Check to see how many recruiter websites and publications talk about how to find telephone numbers and addresses of physician employers, how to engage someone in conversation, how to give a winning short presentation of yourself on the phone, how to cold call practices asking for a job - even though they themselves do it several hours every single day.

The most dangerous issue is the omission of other successful techinques to find a job, meaning using Internet marketing databases such as InfoUSA, WebMD and others to buy inexpensive physician address lists and mail everybody your cover letter and CV. This way you gain access to 100% of job openings, including the "hidden job market" and go far, far beyond the abilities of any recruiter. And that is why they are silent about this most successful techinque. They fear -and rightfully so - the impact on their income.

The next dangerous message, and their main message, is to make you believe that the after "networking" you should contact a recruiter. And once they are at that point, then all of the sudden the information really flows and becomes colorful and detailed. They talk about what to talk to the recruiter about, what to emphasize, what not to forget, they remind you to be respectful and answer all those calls, they might mention that you should limit yourself to one or at least a few recruiters, how a good relationship is important etc etc bla bla bla.

Anytime you see that kind of message, anytime you get the feeling that this is the pattern, you are dealing with a recruiter.

My recent encounter of that kind was reading the website of "NetPro" the "med/peds" job website. Another example of trying to get in below the radar. The website is very careful about not emphasizing that it is a recruiter website. The site comes across as an "information" website.

My recommendation:

Recruiters have the left-over jobs, since employers have to pay them 20K. Employers try numerous other things to fill jobs before they call a recruiter.

Recruiters have only access to the bottom 10% of the job market, you are interested in the top 20%.

Recruiters earn a living by selling, not by helping. They are salespeople, not advisors, not helpers, not counselors. You do not ask a telemarketer for help in choosing a product, you do not ask a car dealer for advice on which brand to choose, because you already know the answer. You do not ask a recruiter for help or advice, because you alrady know the answer: "Take one of my jobs, they are the best".

I believe recruiters operate on the edge of ethical, since they never tell you about other ways to find what the job you want. If they do not ahve the kind of job you want, they will try to convince you that what they have is better than what you had in mind. They will try to distract you with other offers, they just try to sell you what they have. They do not get paid by helping you, they only, only get paid by selling you.

Always remember: the function of physician recruiters is to fill the less desirable jobs!

If a recruiter calls you, answer politely, but firm: "Please take my name off your list and please place my name on your companies do-not-call list. Thank you, have good day".

That is the best way of answering a recruiter call. It saves you a tremendous amount of time, time which you can use to get the job YOU want. You can do that very effectively and efficiently by networking, by direct mail or by contacting "", a company that does the direct mailing for you. And of course by reading the other posts on my blog

Your Matthias Muenzer, MD

Saturday, April 7, 2007

Internet tools for job search and practice marketing

When I was training in Germany, my native country, is was normal for medical students and residents to send out a few letters applying for a residency position or for a position as attending. Unlike here in the US there was no match, and you could start a residency position whenever you wanted during the year. Sending out letters to the heads of departments was normal and your success was mainly dependent on timing. If your letter landed on the chief's desk when he happened to be looking for a new resident, you had the position.

Back then I discovered a thick book on the desk of the department secretary and was thrilled that it contained all the information that I would need to apply to any hospital and any department in the country. I bought the book.

I had all but forgotten these books when I graduated from my residency in the US and started searching for a job. I had seen the Foley books with contact information for physicians in New England, but they seemed expensive and I did not buy them. The thought of just mailing hundreds of colleagues in mass mailing style to find a job had not crossed my mind.

So I searched by word of mouth, browsing through advertisements and contacting recruiters. A few years later I discovered "Thedoctorjob". I had seen their ads here and there, but had never thought anything about them. Their ad line "Pain relief for your job search" did not signal that they had a completely new approach to job search, no, it sounded like the same old, same old recruiter firm, just with different angle. Maybe they should have advertised "A revolutionary, fresh, innovative, different approach" "an approach like no other" "go far beyond word of mouth" "Go far beyond recruiters". I wish it had been something that told me at the first glance that this was a new and unique method.

After a while I ended up speaking to them and learned about their direct mail method. It made immediate sense. Minutes after I hung up the phone I was googling the term "doctor addresses". I found and a short time later I knew that I could do a mass mailing campaign myself, since I was familiar with Word and it's Mail Merge function. I just needed the address lists.

And a whole new world of job searching opened. I tried the direct mail method with smashing results. In an "oversaturated area" where recruiters "had not had a job in five years" doors were opening - 6 phone calls of interested physicians within 3 days. WOW. And the more I thought about it, the more it made sense.

Think about it. All you need is to get your cover letter and CV in front of employers.

And the employers are physicians. And physicians are easy to find, they actually want to be found. After all, they want patients to find them. They are listed in all sorts of directories. And the pharmaceutical industry has been collecting their contact information for a long time - to guide their reps. And recruiters and their organization NAPR use direct mail to find the jobs that they try to sell you for 20K.

I was so exited that I offered to give a lecture at the residency program where I teach. They loved the lecture and I repeated it several times.

This innovation was possible due to the availability of databases on the Internet. Marketing databases are now so easily accessible, that it takes just a few minutes to find them. Then you can play around with them, at least with some of the databases. When I did for the first time, I was completely amazed at the potential. You can select all 35-40 year olds with a white Volvo 850 made between 1998 and 2000 that have a median household income between 60 and 80,000 and like fishing, just to name an example. To know about these databases is very useful long after your job search. It comes in handy when you are marketing your practice and would like to target a certain segment of the population. There are also lists of people with certain health conditions. You can market very specifically to patients with hypertension, diabetes, gout etc. There are lists of (female) executives, people with an annual income over 1 million for example, CEOs, owners or renters, and you can market to people with very specific hobbies. Try this out and play around with it by going to InfoUSA.

The Internet has more potential for the future. Should you be interested in real estate you will now Zillow, which gives everybody unprecedented access to real estate information, thus far the privilege and guarded secret of real estate agents (e.g. lists of comparables). Zillow now allows you to sell your house on the net, you advertise your house with a littel flag on a map, you can post photos of your house etc. Fabulous! A similar trend could come in physician job search. I can imagine a job database, a job board, where you can post job offerings with photos, lets say of the practice, the hospital, the staff, you could add videos, lets say the employer or practice owner talks about his philosophy of patient care or about what makes his practice special. Hospital CEOs could mention why their hospital is a great place to work. The office could be signaled with a flag on a map, community information could be accessible with a button, salary information could be accessible with a button - tailored to the specialty of medicine and the location, cost of living could be equally accessible. And of course you could email your friends and colleagues about a particular job that you end up not taking. A new style of internet recruiting. ther could be video templates for job ads, just like we now have templates for websites. These video templates could make it very inexpensive for hospitals to effectively advertise jobs. Once a hospital has created their video template with the general info about the facility and the community, the template can be adapted to every job in every specialty very easily and with little cost. You Tube makes it possible today. There is an idea for a new business!

Candidates could post videos answering the usual interview questions and explaining what sets them apart from the rest and why they are great candidates. It is conceivable to post video references from residency program directors or fellow attendings, or maybe from the hospital CEO. References to websites and publications on the web may become standard. CVs could be illustrated with photos and copies of documents. Who knows what will develop.

One thing is sure, the Internet has just begun to change the face of job search and recruitment. The availablity of marketing databases and the ability to gain address to physician contact information with a few clicks, to merge letters with contact information in large scale and to mail and fax the personalized letters is already here, within a few clicks for everybody. Publishing has been made "democratic" or public by MS Word and Publisher, marketing has been placed within everybody's reach by software such as Outlook with Business Contact Manager, ACT! and other Contact Managers, by large databases and by software to easily harvest data and build your own databases such as AddressGrabber and ListGrabber. Not to mention advertisement tools such a Fax Blast or Email Blast Programs that allow you to reach thousands of people with your marketing or job search message.

Look around on the Internet, explore. There are many extremely interesting posiblities for physicians that have been in routine use for marketers for years, that are now readily available for physicians and of course hospitals - to find jobs, to recruit and to market your practice, our services, your facility.

I talk about it more in the future.

Your Matthias Muenzer, MD

Wednesday, April 4, 2007

Be very clear about the function of a physician recruiter

When you search for a position as a physician you literally cannot avoid recruiter advertising. They will be in your face no matter where you look, in journals, in magazines and especially on the Internet. It is helpful to be very clear about the exact function of a physician recruiter.

Recruiters are hired by an employer that is ready to pay 20,000 commission to have a position filled. Usually that means the position is not that easy to fill. The location might not be desirable, the pay may not be that great, the working environment might leave a bit to be desired, or the need might be very urgent. Good positions are easy to fill without paying someone 20K to go out there and search for months. The function of physician recruiters is to fill the less desirable jobs.

Recruiters are hired by an employer and they are the agents of that employer. The employer pays and therefore the employer calls the shots.

This also means that the recruiter is NOT working for you, the searching candidate. You are not paying for the recruiter. You do not employ or hire the recruiter. You do not call the shots. When you contact a recruiter, you are dealing with someone who is looking to fill a position in order to get paid, not to help YOU FIND a position. You are NOT dealing with someone whose job it is to help YOU, the candidate. A recruiter is NOT YOUR AGENT.

The recruiter is pursuing YOU, he is a "headhunter or "dochunter". You are the hunted. You are not the hunter! You are not in charge. Do not expect a recruiter to behave or function as a "candidate search agent", "search advisor", a "career advisor", a "career consultant". They do NOT get paid for any of that, so why should they do it? Even the most idealistic individual slows down over time when he or she does not get paid. Only the communists believed that humans work out of idealism, and that is why the red empire crumbled and disappeared.

If you have any doubts where the focus of the activity of a recruiter is, go to the very good blog "". Two experienced recruiters Jim Stone and Bob Collins write in good style, have excellent thoughts and I agree with most of what they are saying. When you read their blog you realize that it is about their relationship with their employers - the hospitals and large practices, their issues with filling positions, the difficulties in filling the jobs that are not so fabulous, the attitude problems of the people who hire them and so on and on. Take a look at the blog, it is worth reading. It is all about how to fill that position! It is NEVER about how YOU, the candidate can get WHAT YOU WANT. They might even "persuasively" work with you to make your recognize that what you want is not what you really "need" - I wrote about that quite nervy statement in a previous post. They do not so much care about what you want, they are just make a living getting the employer what the employer wants. What you want does not get them paid! What you want does not put food on their table!

Dear candidate, as soon as YOU hire and PAY a search agent, you can trust him or her to work in YOUR interest. Until then, the plain truth is that recruiters are on the payroll of an employer and that they represent the interest of an employer.

If you really think that a recruiter is "free for you", you believe in the proverbial "free lunch", or in Santa Claus or in the Easter Bunny for that matter!

I am not opposed to recruiters at all. They have the valuable function to fill positions for employers that could not otherwise be filled. I am just opposed to their very misleading marketing that tries to make you, the candidate, believe that they are "your search agents". They even offer to "customize a search for you". And all that "for free". Please!!!

To begin your search by contacting recruiters (plural) limits your choices right from the start down to 10% of all available positions. Networking and direct mail will get you access to 100%. And if you are naive enough to believe that one single recruiter will be your "search agent", then you just racheted your choices down to a extremely poor 5%.

What upsets me the most is that too many graduating residents are not aware of these figures. Too many graduating physicians still believe that using recruiters is an "OK" way to search for a job, that it is a mainstream way to find a job. There is an incredibly crass lack of knowledge and understanding about how the the physician job market works. The employers certainly know how to find candidates, they all know about recruiters and when to hire them. That is not the issue. The problem is that too many candidates, too many residents do not know about the best or even the right way to find jobs! They know something about networking, a bit about where to look for ads, but they do not know enough about ACTIVE search by contacting hosptial and by using direct mail and fax and where to get he addresses of physicains on the Internet for direct mail.

That is why I am writing this blog, that is why I have a website and that is why I support "" - a fabulous service that helps doctors find jobs where they want. If you are looking for a job, skip the recruiters, and go straight to my blog, my website and to "".

Your Matthias Muenzer, MD

Sunday, April 1, 2007

Reading material on "Physician Job Search"

I thought I should list additional resources for searching for physician jobs that I have found over time. The fact that this list is so short shows that there is really not much good information on this topic that is specifically tailored to physicans. This has to change!

Sadly, when you google "physician jobs" you are overrun by a endless barrage of recruiter websites, which are pretty much useless - unless you want a job in Desert Gulch, AZ or Podunk, NY. These sites all rechant the recruiter marketing pitch, which for the job searching physician is distracting at best and truly dangerous at its worst. Moreover, all these websites drown out the scarce useful information available on the Net.

My all time favorite and truly innovative website with enlightening information is I cannot say enough good things about these people, except that we all should support them and spread the word about them to all residents, residency program directors and practicing physicians.

I have the4 do-it-yourself version of what they do here in my blog. Click here for the info.

The job websites, the job boards that I recommend to look for postings are: - this is the most professional appearing large recruitment website with just enough direct-by-employer ads to be useful.

The "Medical Economics" Journal has a series of 5 or 6 articles on the physician job search. Find it by going to the "Medical Economics" website and then search for "job search". They still suffer from the notion that recruiters play a role in a successful job search and they have not caught up to the direct mail job search method as it is beautifully done by - a thoughtful article you should read. Even though it was written by an emergency physician, many of the points and caveats apply to all araes of medicine.

Some of the best articles for new physicians can be found here: Please be aware that this is the website of Merritt and Hawkins, a retained search firm, so you will encounter a favorable bias towards using recruiters in your job search - which we know is nonsense. That aside it is very good. Published by a former-executive-turned-recruiter Pam Pohly, this site contains numerous valuable lists of links and resources. You will find great links to long lists of professional associations, hospital directories, very good tips about writing a cover letter and CV, how to prepare for interviews, how to conduct yourself in an interview. It is very noteworthy that such good information does not come from a long time recruiter, but from a former consultant that later went into recruiting. Just skip the whole talk about recruiters being helpful in your job search. While not written for physicians, the chapters on resume writing are excellent and the interview tips are not bad either. This site offers a lot of very good content - for free. Info by medical students and residents concerning job search

At you will find an article by consultant Jack Valancy, who occasionally publishes on the website of the American Academy of Family Physicians. He emphasizes finding your perfect career and job and to help you with this he has published a questionnaire called "Finding the perfect job". It helps you find out what matters most for you and what feelings and goals should be the basis of your career planning. This article in the Princeton Review emphasizes: know yourself, know your strenghts, and then, only then decide what you want to do and apply

The American Academy of Family Physicians (AAFP) in general has good and balanced info, but does not go into much detail, it is a bit superficial. this is the company that writes good cover letters and good CVs, trustworthy, fast, professional. I recommend them (no commission or any other benefits for me) This website offers a bit more advice and less distracting recruiter blabla, so it is worth looking at.

There are three books I highly recommend:

a. What color is your parachute? The classic book, the bestseller on job search and career.

b. 101 Answers to the toughest interview questions. An excellent book to prepare for questions you most likely will be asked during interviews. The better prepared you are the better you look.

c. The idiot's guide to cover letters.

Less interesting links, go there only if you have a lot of time: this link will take you to some good and interesting advice on job searching by Cejka search. It is a valubale source of information about writing cover letters, CVs and interviewing. Otherwise they are just trying to lure you onto recruiter websites and into recruiter offered jobs. They discourage you from looking in the big cities and try to tell you that the country side is much better - no surprises here

The website of the American College of Physicians ACP has only moderately good information, visit

New England Journal of Medicine website. They have a few tips concerning job search, but they still feed the misconception that recruiters have more than a marginal function in the physician job search. Overall well meaning website, but doesnot have really good information. Misses the bite this list of the University of Chicago has numerous resources and books, but just the titles. you will have to do the rest yourself

these three links are interesting pages on that has many ways of searching for a job and gives good tips

Job Star Central..... a good list of info from the public libraries in CA general purpose tips for writing a CV and cover letter, not specifically greared towards physicians. Moderately useful.

End of list

I wish you a lot of success in your job search! Please let me know if you find a great and helpful website! Post a comment on my blog please.

Your Matthias Muenzer, MD, Obstetrics and Gynecology, Medford, MA 02155

Google enters physician job search by bidding on "TheDoctorJob"

In a surprising move that was announced this morning during a press conference at the Headquarters of Google Mountainview, CA, the search giant has placed a bid to purchase the promising upstart "". This relatively small company based in Orlando, FL seems so successful at searching jobs for physicians while achieving an unprecedented level of customer satisfaction, that it caught the attention of the Google network development and acquisitions department.

Alex Winston, spokesperson for Google: "Thedoctorjob has developed a very promising search methodology. Taking advantage of our creative potential and financial flexibility we will work with them to transition to a multilayered vertically and horizontally integrated and fully transparent mobile virtual search engine for physician jobs. Given the increasing demand for physician jobs and services, we foresee a great future for our common venture."

Rumors of an eyebrow raising sum are circulating. Adam Avitable, a representative of the Orlando search firm that was founded in 2003, said in a unconfirmed email that "The conversations are off to a good start, and this is all we can say for now".

The NAPR, also based in Orlando, declined any comment and the connection was abruptly terminated after a muffled expletive. We also tried to reach the NAHCR, but gave up after being placed on hold and having to listen to the country classic "you broke my heart and stole my truck" for over 10 minutes.

California based consulting company DCPAMPA - "Decision Consideration and Preparation Approach Management and Planning Associates" has been called in facilitate the talks.

To read more, go to