Saturday, June 30, 2007

How to find more physician jobs than any recruiter

Physician Job Search

The best, most powerful, most successful and least advertised way of finding a job

1. Decide where you want to work and live. Consider the climate, the landscape, the economical situation and future outlook, the culture, your ability to pursue your hobbies, the cost of living and of real estate, the cost of malpractice, the possibility of working without paying malpractice, and financial issues such as being able to balance-bill.

2. Buy a list of all addresses, phone number and fax number of all physicians in your specialty in the desired area. This is much easier and cheaper than you may think.

List providers are, WebMD or MMSlists, the marketing arm of the AMA.

I prefer First, you can easily select just the right group of physicians you want. Second, you can purchase your list online, without having to call anyone. Third, there are no restrictions on the list you receive such as number of times you can use it (The AMA just loves to restrict you...). The cost per physician contact info is about 75 cents. For this you get address, telephone and fax number. InfoUSA also gives you year of graduation, name of office manager and a number of other useful little data. You will receive the list via email in CSV or Excel format. Either format is fine for your purposes.

3. Write your CV and cover letter. Have them reviewed, rewritten or may be written anew by an expert, such as a friend who is a marketer or publicist, an English major, or a professional writer, e.g. the people at I have personal experiences with and was happy with them.

4. Have your CV photocopied on quality paper at Staples, Office Max, Kinko, etc.

5. Use Microsoft Word to Mail-Merge your cover letter with the address list from InfoUSA and print the 100-500 personally addressed letters on the same paper as your CV. Your office store can do that as well for you. Sign all letters, fold and put them in envelops. Address the envelops with clear plastic labels, e.g. Avery, that you buy at your office store. You can print the addresses and your own home address on these labels using Word.

6. Mail your cover letter and CV to all doctors in your target area. Mail them so that they arrive on a Tuesday or Wednesday. This increases the chance of being read.

7. You may also fax your cover letter and CV (or maybe just your cover letter) to all physicians in your target area. You can fax all letters individually or you can use an Internet fax service such as This is my preferred fax broadcast system because it allows you to Mail-Merge your letter with your list of addresses with the same ease as MS Word. You can literally fax your letter to hundreds of physicians with a single click. This costs about 6-10 cents per fax. Please consider the laws about unsolicited faxes that apply in most states! You may be considered to send unsolicited faxes, which may be illegal! You are doing this at your own risk!

The response rate will be 1-2%, meaning if you mail or fax 800 letters, you will receive about 8-16 interviews. The more physicians you contact, the more interviews you will get. This is the least expensive and most effective, most successful way to find a job as a physician - and you can find it exactly where you want it. Obviously, you may repeat this after three to four months if it does not work the first time.

Sounds like too much work for you? You do not know how you can fit this into the schedule? there is a company that does all the legwork for you. It is called They will charge about 1.50 to 2.00 for each letter they write, print and mail. It is slightly more expensive then doing it yourself, but it saves you time. They have been doing it since 2003 and are very, very good at it. Since 2006 also offers this service, but they do not seem very enthusiastic about it. After all, they seem to live on recruiter ads and recruiters despise the direct mail method. It makes them obsolete.

8. Follow up, follow up, follow up. That means sending another letter, another fax or calling one or two weeks after sending the letter. Be persistent.

9. Parallel to all this, use the methods that I call "Passive search". Click here to find out more.

10. You do not need recruiters. With the above method you will find 2-5 times more jobs than the best recruiter will ever be able to find. Your application does not have a 20K price tag
attached and therefore your letter is much more welcome than a mailing from any recruiter.

Teaching medicine to residents and students

After truly enjoying teaching students, nurses and now residents as long as I have been training and practicing medicine I found that a few thoughts, preferences and priorities seem to be important to me and do not seem to change.

Physicians, and family physicians in particular, have to be competent in a large number of areas and therefore it is vital that the information presented is simple, easy to understand, and memorable. Out of a 40 minute lecture, residents, like everybody else, will likely remember only 2 or 3 facts or sentences. It is necessary that those 3 sentences are the right sentences and the most relevant and most important ones and that they are those that I really want to communicate. These 3 sentences have to be the skeleton or the outline of the topic and should be practical, usable knowledge. Lectures are meant to stimulate, to open the mind for a topic, to make students receptive for a topic, to give students a basic structure, a basic skeleton of a topic. later on they can put the flesh on the skeleton and the guts and the skin. The first thing has to be a clear overview that makes the big idea immediately understandable. A lecture or power point is not meant to provide exhaustive information!

I often start a lecture with “and here is the summary for the post-call-resident” and then say for example: "Dysfunctional uterine bleeding is treated with OCPs. And if the patient is over 35, you also give them OCPs, but you do an EMB first and ask if they smoke”. I summarize the basic message in one sentence, so that everybody remembers this single sentence message.

Or: “birth control pills are all the same. The only difference is that individual patients will react differently. Therefore you should know 3 or 4 basic, generic OCPs and prescribe them. Discourage brand names. Should the patient not tolerate the first OCP, switch to any other generic with a different estrogen dose or with a progestin from a different group – no secret algorithm to it.”

Or “for induction of labor you give 25 mcg of misoprostol until you can fit a finger into a soft cervix, then you switch to pitocin”

Or for introduction of fetal heart rate tracings: “The baseline should be 120-160 or exactly double the adult rate, the jitteriness of the baseline should be 5-25 and corresponds to the blood supply to the fetal brain, accelerations are good (and I give a thumb up) and decelerations are bad (thumb down sign)” And then I go into the details.

I try to teach MTV style meaning a bang or splash here and there is good – and I try to place the bang exactly at one of the three points that I hope they remember forever. I try to make the 3 points memorable with…

a. a joke,

b. an act ….I once had an imaginary interview with Chlamydia, who had a mean voice, was swearing frequently – which I replaced with beeeps. Chlamydia complained about his buddy gonorrhea who causes so many symptoms (fever, pus, pain), and who would get all the good Chlamydia killed because of drawing attention to the infection. Chlamydia called gonorrhea an old fashioned brute and cowboy, who is on his way out and proudly talked about receiving the award for “No 1 Cause of infertility”, then went on to say “it’s because I have stealth” – at this point I suddenly dropped under the table, so that I became invisible, and continued talking….Chlamydia also complained bitterly about the doctor’s who test and treat on suspicion, but was very appreciative of those docs that swabbed the vagina and not the cervical canal! And so on…it was big success….and a lot of fun

c. a video, such as the “dancing baby”

d. a song – if it is bad, it is even more memorable

e. sometimes I try short stories during slide shows, such as the introduction of PCOS as "a special gift from God to family practice", because it is important to recognize the condition early to prevent formation of too much terminal hair, to prevent obesity early oon instead of treating it later, and to be prepared for the treatment of infertility, for the prevention of diabetes, early recognition of HTN and so on. PCOS won’t kill you, but you need long term observation and help, " a gift to family practice". And I mentioned that God was sitting at the laptop running the creation software and creating this as a special goodie for FPs, and when he was done he went to South Beach for a few mojitos…and I had the photo of Ocean drive with the arrow pointing to a dark area "God is there!" and adding that “God is notoriously difficult to catch on camera”. That was the intro for the PCOS talk

I refuse to introduce topics with “this disease is veeery important because it is veeery expensive and xxx billions are spent annually on blablabla….” This is such a horrible introduction. Boring. Xxx billions means nothing to me, absolutely nothing. I can't even imagine a billion dollars, I stop thinking after 20 million, since I would retire and sail around the Caribbean if I had them. And what do the billions matter to your practice? Nothing, nada, zilch, zero. It might matter to federal policy makers. Are those people seeing your power points?

What matters to me is “what percentage of patients that walk through my office door have this” because that determines if I am going to do something about it, how seriously I am going to take it and what I am going to do…

And finally, topics should be taught in a clinically relevant way and not in a pathologically / systematic way. It is depressing when students or residents are shown long lists of differential diagnoses with weighing them according to clinical importance. It is absolutely impossible to remember the 22 causes of amenorrhea when they are presented as a long systematic list. It is an insult to the learner! Presenting a list without weighing the differential diagnoses by frequency of occurrence means that the teacher really does not care about the student and just slaps something on the slide in who-cares-what-you-can-learn-from-it style. Next time you as the student get presented such a list, either booo or make a frown and walk out.

The differential diagnosis of amenorrhea for example should be presented like this (taken from Kistner, Gynecology):

Option 1 – the right way

start quote

Pregnancy, and otherwise:

Hypothalamus / pituitary /stress 50-55%

PCOS 10-15%

Prolactinoma 7-10%

Asherman’s 5-6%

Hypothyroidism 1%

Ovarian failure 1%

end quote

You know immediately what is common and what is rare, you know immediately what to ask for in your history and what to look for in the physical exam.

Option 2 - the wrong way, too much to remember. All that remains after reading that is the impression that the topic is complicated and that you may have to consult a textbook or a specialist whenever a patient presents with that symptom.

It presents far too much information in a very badly structured fashion and confuses much more than it educates. Especially the long version at the bottom is a prime example of not well thought out presentation. Students and residents, do not put up with this kind of thoughtless teaching!

start quote

Causes of amenorrhea

  • Generalized pubertal delay

    • Constitutional delay

    • Hypergonadotropic hypogonadism

      • Turner syndrome

      • Gonadal dysgenesis with mosaic karyotype

      • Pure gonadal dysgenesis (Perrault syndrome, Swyer syndrome)

      • Gonadotropin-resistant ovary syndrome

      • Acquired causes (eg, high-dose alkylating chemotherapy, pelvic radiation, autoimmune oophoritis)

    • Hypogonadotropic hypogonadism

      • Chronic conditions (eg, starvation, excessive exercise, depression, psychological stress, marijuana use, Crohn disease, cystic fibrosis, sickle cell disease, thalassemia major, HIV infection, renal disease, thyroid disease, diabetes mellitus, anorexia nervosa)

      • Slow-growing CNS tumors (eg, adenomas, craniopharyngiomas, meningiomas, pituitary microadenomas)

      • Abnormal hypothalamic development (eg, Kallmann syndrome, Prader-Willi syndrome, and Laurence-Moon-Biedl syndrome)

      • Acquired miscellaneous disorders (eg, infiltration disorders [sarcoidosis, Langerhans cell histiocytosis, syphilis, tuberculomas], ischemia disorders [caused by trauma, aneurysm, obstruction of the aqueduct of Sylvius] and destruction [concentrated, high-dose exposure to radiation])

  • Normal puberty

    • Associated with hyperandrogenicity (eg, PCO syndrome, late-onset 21-hydroxylase deficiency [nonclassic congenital adrenal hyperplasia], immaturity of the hypothalamic-pituitary-ovarian axis, Cushing disease, androgen-producing ovarian or adrenal tumors, ovarian stromal hypertrophy)

    • Associated with absence of hirsutism or virilization (eg, immaturity of the hypothalamic-pituitary-ovarian axis, pregnancy)

    • Hypergonadotropic hypogonadism (eg, ovarian failure, high-dose alkylating chemotherapy, pelvic radiation, autoimmune oophoritis)

  • Anomalies of the genital tract

    • Müllerian agenesis (eg, Mayer-Rokitansky-Kuster-Hauser syndrome) breast present

    • Congenital or acquired anatomic obstruction (eg, imperforate hymen, transverse vaginal septum, Asherman syndrome, endometrial destruction due to severe infection or surgery)

    • Androgen insensitive syndrome-absent uterus with normal breast development

end quote

Now you know, now you have a good overview of the issue, now it is all clear, this is what you are going to remember, right? Although this is pretty good if you know about the topic already and it is a very good summary. but not appropriate for a power point lecture.

Option 3 - better, but not good yet. The following list is shorter and a little better, but there still is no order and no frequency of occurrence etc.

start quote

Differential Diagnoses:

Breastfeeding related
Norplant related.
Hypothalamic.Suppression of the hypothalamic-pituitary-ovarian axis.

Exercise induced.
Eating disorder such as anorexia nervosa

Endocrine such as hypothyroidism.
Polycystic ovarian disease
Pituitary or ovarian tumor.
Rarely, Mullerian duct agenesis or other chromosomal or developmental defect.

A young woman who has is Tanners Stage 1 at age 14 or who has had no period by age 16 needs to be referred to an OB-GYN for work up.

end quote

Comment: Mentioning Breastfeeding and Norplant is probably useless, since they areboth pretty obvious to the patient. Why put it in the list? A list is supposed to guide me in a situation where I do not know right away what is going on and where I am trying to find a solution, solve a problem. I know if a patient is breastfeeding or has a Norplant (or nowadays a Mirena), or I find out at the time of the physical exam.

Option 4 - the disaster: Systematic, in a pathophysiological / pathological order that is nice for pre-med, when you think and consider and ruminate about the basic mechanisms of disease, but which is a plain disaster in clinical teaching. If someone shows a slide of such a list, you should walk out of the room. it is a waste of time to show such things and it is an embarrassment for a teacher to be caught overloading students with things they will never be able to remember! The idea of a lecture is to provide a useful take home message. The take home message of slides like this is "Wow, this is so complicated, I will never be able to learn it".

I am muddling the point a bit by comparing the first list, which does not contain the DD of primary amenorrhea with the other ones that contain primary and secondary amenorrhea, but I hope to make a point. You need to show the relevant ones first, and place the DDs in order or frequency, in order of clinical importance. You cannot get lost with chasing the rare and improbable, you need to know the two, three or four most probable causes, and you need to know them by heart.

Start quote and feel free to very quickly scroll down once you get the idea


Primary amenorrhea:

(1) No period by age 14 in the absence of growth or development of

secondary sexual characteristics.

(2) No period by age 16 regardless of the presence of normal growth

And development with the appearance of secondary sexual characteristics.

Secondary amenorrhea

Can be a transient, intermittent or a permanent condition.

The result of dysfunction of the hypothalamus, pituitary, ovaries, uterus, or






Imperforate hymen

Abnormal Mullerian development – Rokitansky-Kuster-Hauser syndrome

Testicular feminization syndrome

5-alpha-reductase deficiency

Early failure prior to testicular development

Late failure

vanishing testes syndrome

Testis Determine Factor Gene deletion.


Asherman's syndrome:


OVARIAN DISORDERS – The major ovarian causes of amenorrhea are

hyperandrogenism, from internal or external sources, and ovarian failure due to

normal or early menopause.



Premature Ovarian Failure



poly-glandular autoimmune syndrome (type 1 and 2)

anti-thyroid antibodies

anti-adrenal antibodies

karyotypic abnormalities

radiation or chemotherapy

Turner's syndrome – 45X,O karyotype


Functional hypothalamic amenorrhea due to Exercise, Nonspecific stresses (emotional, illness)

GnRH deficiency - idiopathic hypogonadotropic hypogonadism -

Other hypothalamic and pituitary lesions

Infiltrative diseases: result in diminished GnRH release, low or

normal serum gonadotropin levels

i. Histiocytosis X

ii. Gumma

b. Hemochromatosis: hemosiderin toxicity for the gonadotrope

c. Tumors:

i. Craniopharyngioma

ii. Meningiomas

iii. Gliomas

iv. Metastatic tumors

v. Chordomas

d. Sheehan's Syndrome

end of looong quote

Please note: this is actually a good and appropriate textbook section, but unfortunately I see these things in lectures! This is not meant as any kind of criticism towards the author, this is only meant as an illustration of how not to teach! Back to imagining that this was a lecture....

Wow, I am so impressed by this presentation! The author must be a genius! I bow in reverence! What a great teacher!

You know what? I regularly either fell asleep during these lectures or wrote down a lot of things that I never look at later or I picked up one or two tidbits that I could never use later on because they were out of context.

If you really succeed in memorizing the last list, then what are you going to do? Are you going to test for histiocytosis X each time a patient presents with amenorrhea? How many Histiocytosis patients have you seen in your life? And you test for Hemochromatosis? And for Chordomas – wait, I have to look up to remember what that even is….

Lectures are not supposed to exhaust or to overload your listeners and YOU are not supposed to show off pretending that you are a genius and know infinitely much more than your audience. Be down to earth, be normal, be a friend, lecture like you would teach a good friend!

Here is a book that might be worth reading:

"Made to Stick": Why Some Ideas Survive and Others Die, By Chip Heath and Dan Heath, Random House, 289 pp., $29.95.

Coauthors (and brothers) Chip and Dan Heath – a Stanford Business School professor and an education entrepreneur respectively – spent a decade disassembling and trying to understand the inner workings of memorable, persuasive ideas, no matter what kind of packages they came in. They studied political speeches, urban legends, news reports, management directives, and marketing messages like Subway's – not to mention culture-crossing proverbs, the various fables of Aesop, and the many soups of chicken (for the soul). It didn't matter whether the ideas themselves were good or bad, just that they'd "stuck." Each of these ideas could be described using one or more of just these six attributes: simple, unexpected, concrete, credible, emotional, and story-containing. We can't always pack all that into a lecture, but some or most of it.

Keeping this is mind it will go a long way to being a great and successful teacher.

Friday, June 29, 2007

Drugs for less for your patients

Sometimes patients need to find medications for less. Here are a few tips. Please let me know if you have more advice on this topic!

1. Three companies that send medications by mail order. They do this in cooperation with most HMOS and also sell directly. Call the 800 customer service number of your HMO and check if they participate in one of these programs! These companies usually send you three months of medications, but charge only two copays. You save one third of the cost.

Caremark or


Express scripts




2. The “Partnership for Prescription Assistance” is an initiative that helps physicians and low-income patients find low cost and free medications. The program is accessible online at or by phone at 888-4PPA-NOW. It provides a single point of access to more than 475 patient assistance programs and connects to more than 150 assistance programs offered by drug makers themselves. It offers discounts on more than 1200 brand name and some generic medications.

3. Try

4. A company that orders drugs for you from a reliable Canadian pharmacy is “US Canadian Discount Drugs” in Hollywood, Fl. Tel: 888 989 0222. I nkow about them because relatives of mine live in the area. The company is run by Bernard Fox and Mel Stuart, two retired executives. They found a solution to high drugs prices that burden many seniors. They started as a service for the many not too wealthy retirees in South Florida, but offer their services to everybody. Call them and let them know what you need. They will tell you the exact price of the drug and will give you clear instructions. They have the medicines shipped right to your home and charge your credit card. They do not do birth control pills.

5. is a reputable Canadian pharmacy that ships to the US. AS you know the US pharma lobby has a very strong influence in the government and they succeeded in blocking some of the drug shipments from Canada to the US. All this "in the name of safety" - safety is such a great excuse!

6. Planned Parenthood in Boston on Commonwealth Ave has the least expensive oral contraceptives. Call them about their prices: tel 617-616-1600.

7. A great place to save money are prenatal vitamins. I recommend to my patients to take multivitamins (Centrum, One-a-day, Women’s daily, etc) instead of prenatal vitamins. Multivitamins have usually the same amount of folic acid, which is the only substance proven to make a difference in pregnancy. I also recommend store brand prenatal vitamins, e.g. Walgreen’s prenatal, CVS Prenatal, Brooks Prenatal, Wal-Mart prenatal, Prenatal Rx etc. My preferred over-the-counter prenatal vitamins are CVS Prenatal or Brooks Prenatal, since they contain 800 micrograms of folic acid, double the usual amount. On call I occasionally get phonecalls from patients asking for a "refill for my prescription prenatal vitamins". The last patient was paying $ 27 a month for prenatal vitamins. What a rip-off! You can buy CVS prenatal for the whole pregnancy for $25 .

If a patient is insured by an HMO it is less expensive to buy these vitamins over the counter rather than buying them with prescription. If you buy vitamins with a prescription you will be charged a $5 to 10 or even 15 and more in copay each month, which is higher than the cost of the over-the-counter vitamins. Only patients that are insured through Medcaid / Mass Health are better off with a prescription.

Recommendations for Graduating Residents

Yesterday we celebrated the graduation of the third year residents where I teach occasionally. Some recommendations for their years ahead:

1. Stay in close contact with you colleagues, talk to your colleagues, don't keep to yourself, exchange thoughts and experiences. Maybe even get together from time to time and present each other new research results or interesting articles.

2. Assemble a group of specialists that are easy to talk to, whom you can call at any time and just get an opinion, or a curbside consult, and who do not mind teaching you a trick or two. Don't go for the "just send me your patient" specialists.

3. Consider AudioDigest for your CME, they have excellent recorded talks that help you in every day practice.

4. Use new technology and new procedures wisely. Don't be the first to adopt them and not the last one. Be critical, consider the value for the patient and balance it against the cost to society

5. Find a financial consultant that is "fee-only". Don't fall for the insurance salespeople masquerading as financial advisers. You want impartial advice, not sales chatter. Create a 5 or 10 year financial plan and stick to it.

6. Buy a house. We are in a buyers market, it is a good time to buy. I always heard from my parents "we wish we had bought the house back then". Real estate always appears to be high at the present time, but in 10 years you will be happy to have bought it for the present price. Use Zillow to get crucial information and to research comparable homes. You can even buy and sell your home on Zillow.

7. If you need a new job, send a letter to every physician in your target area (direct mail). This is even better than networking. This way you will find three times more jobs and better jobs than the best recruiter will ever find.

8. Plan to go into your own practice. It is more fun, more good responsibility and good stress, you learn a tremendous amount, it is a life experience that you cannot miss (see this blog). Physicians are independent and are not meant to be herded into big corporations. The Walmartisation of medicine is overvalued.

9. Defend your patients, but also defend your profession. Speak out against more pay cuts, especially if they hide behind such funny names as "pay for performance".
Be especially sceptical of the so called "physician shortage". I will not believe this speculation until I see my income going up significantly. The price of any good or service is determined by supply and demand. We are still loosing income, so there is no shortage! Speak out against opening new medical schools and new residency programs. We do not need more physicians, but we may need more nurses, physician assistants, nurse practitioners and midwives.

I wish you all the best and a very bright future!

Thursday, June 28, 2007

Legal disclaimer for my blog

I read Kevin, MD's blog with interest. He has a legal disclaimer, several pages long. Very impressive, very legal, very proactive, very careful. I thought I should have a legal disclaimer for my blog as well. Here it is:

I have no assets.
I do have a European license, which does not need to be renewed.

End of legal disclaimer. Short and to the point. In a language every lawyer truly and immediately understands. I am sure you understand too.

List of Websites for my patients

These are the websites that I recommend to my patients. I tell them that they are thoroughly researched, no-nonsense websites, where nobody tries to sell them anything and that do contain "weird" information. I have this list printed and photocopied in each examining room and I often undeline a website or make an "x" in front of a particular website when I recommend a specific topic to a patient.

Here is my list, feel free to copy it and to send me new ideas: …MedLinePlus is the consumer health portal of the National Library of Medicine (NLM) and the National Institutes of Health (NIH). Very extensive, very good. NOAH is the “New York Online Access to Health” database, which is big and bold, like so many “New York” things. Uptodate patient information is an outstanding and very informative website published by doctors of Harvard Medical School., the official website of the American College of Obstetricians and Gynecologists. They have excellent “patient information leaflets” on all topics in Women’s Health., the government’s website for women’s health, surprisingly good, considering that it is presented by the government., the website of the famous and excellent Mayo Clinic The website of the Center for Disease Control has great information about infections such as human papilloma virus (HPV), Herpes, HIV, travel medicine and much more, the website of the Association of Family Doctors, covers all areas of medicine and explains issues in plain English, easy to understand

Special topics:, The website of the North American Menopause society The website of the National Osteoporosis Foundation - fighting osteoporosis and promoting bone health. News, resources and information on advocacy and prevention. this is the website that offers the best and most accurate information on contraception. You can even download a booklet "Managing Contraception" for free. They also have a very good book on perimenopause: "The Midlife Bible" by Dr. Goodman NCCAM is the National Center for Complimentary and Alternative Medicine of the National Institutes for Health, a great starting point for alternative medicine questions and information The national infertility association website – for education and support Good information about pregnancy This is a page on the website of the Continence Center of the University of California San Francisco
that has links to other excellent websites that inform about incontinence the site that keeps tabs on medical websites. They report all kinds of unscientific quackery on the Internet. Should a diagnostic method or treatment sound unfamiliar, very strange or too good to be true, look it up on this website.

Friday, June 22, 2007

"We personalize a search for you"

While physicians and HR people usually comment on my blog in words like "you are so right", "you point very well out what is wrong with recruiters" etc, recruiters are very upset at my blog and usually claims that I do "not have enough experience with recruiters".
Ooohh, yes, believe me, I do. I have been searching for a job for over 7 years and I have been in contact with recruiters for about 7 years. I have spoken on the phone to dozens, maybe a hundred recruiters, seen countless recruiter websites, aggregator websites that publish ads from multiple recruiters, and read innumerable newspaper and magazine ads. I may not be the ultimate expert, but I am most certainly knowledgeable enough to voice an opinion. And I most certainly write pretty much everything in this blog based on my own blood, sweat and tears.

And, before I continue, I have found a way to find more jobs than any recruiter, click here to read it
But, to support that I am not alone, here is another experience with recruiters that mirrors my own.

It is from a pediatrician in North Carolina who had serious legal disputes with a hospital at which she was practicing, who consequently lost her practice and is now recieving recruiter emails offering her employment in her own former practice! It does not get much better than that! It is the perfect example for the claim of many recruiters: "We personalize a search for you", "We taylor a search to your needs". Thank you, Dr. Johnson, for this contribution!

Here is a quote from Dr. Johnson's blog:

I know I'm supposed to be on a break, but the following e-mail (from a physician head-hunter) was in my In-Box today:

Dear Doctor Johnson

Our firm is representing an excellent opportunity for a pediatrician to join two others in a beautiful community in central NC.

This employed position offers a strong income and benefits package with shared call of 1:4. The physicians have their own autonomy in clinical practice and management decisions are made by the practice administration in consult with the physicians. Physicians do attend C-sections as required.

This position is supported by a private, not-for-profit, 145-bed community hospital and is the only hospital in the county serving a population of over 130,000. The facility had 800 deliveries last year. Located in the beautiful, rolling hills of central NC, the community offers all the charm and quality of life expected in a small town. Residents enjoy all the advantages of living in a small town while enjoying quick access to the Research Triangle. Greensboro, North Carolina’s third largest city is just 25 minutes away, while Charlotte, the largest City is only 1.25 hours south.

If you would be interested in learning more about this outstanding opportunity, please forward a copy of your CV for review or respond to this email. I will not send your CV to anyone without your prior approval.



Mr. X obviously didn't know that I am more-than-familiar with this "opportunity". Over the years, I've gotten dozens of these . . . as more Pediatricians came and went from the practice whose doors I opened in 1995.

Makes it kinda hard to just "forgive and forget".

......some material left out.........

Anyway, this is the umpteenth e-mail I've gotten about this job "opportunity" from headhunters who, if they had done the smallest amount of research, might've thought twice about sending me this particular "invite". And you'd think the geniuses running this practice would say to the recruiter, "If there's a Mary Johnson in your recruitment files, it's probably best not to send her this one."
Sometimes, I reply. Sometimes I shrug it off. Today I replied:

Mr. X, you are talking about Asheboro, North Carolina. It is my hometown. And a long time ago, I bought the sell. It is the worst professional mistake I ever made.

"The physicians have their own autonomy in clinical practice and management decisions are made by the practice administration in consult with the physicians."

That was not the case ten years ago. When this "practice administration" (still in power after all of the nasty & illegal things they've done) fired me after I intervened to save a newborn baby's life . . . a baby being mismanaged by another physician whose neonatology skills they falsely marketed to the public. Then they pulled every dirty trick in the book to ensure I could not stay and compete.

This "non-profit" has pounded me into the dirt for years and laughed as they pounded. But this story is getting out and around.

Respectfully, you (and every other locums company that has contacted me about this job in the last several months) should do a little more research on the situations you represent.

Mary Johnson, M.D., FAAP

And no. I don't feel any better for sending it. This guy has money to make and will blow me off.

No comments are necessary. Click here to read my instructions for searching the right way and finding more jobs than any recruiter can - click here.

What is bad, the recruiter or the job they represent?

Kevin,MD, quoted part of my post "avoid recruiters" (Thank you!) and received very good comments that are worth repeating here:

First his quote:
AM"Physician recruiters - An OB waxes negative on the experience:
I now believe that most contingency recruiters just do not care. They sell, sell, sell and sell some more. They go for volume, they go for the numbers. The more emails they send out, the more people they contact, the more chances they may have to get an answer and sell one of their jobs. That is why they remind me of used car salesmen and telemarketers. Their ads are just the nice marketing face, and you have to read them with utmost suspicion."
End of quote.

And here are three of the four comments:

1. One problem with recruiters is not with them but the jobs that they are recruiting for. From 20 years of observation in my own specialty, I have found that in general, the good people to work for have no trouble filling the positions by old-fashioned networking. Usually the ones who hire recruiters have to do so because something is wrong with the position. Perhaps it is a very poor payer mix, or the institution's management has a reputation of treating doctors poorly. Sometimes they want a physician compliant with their demands for unethical behavior but the local docs will not go along--and the local program directors knowing their reputation for sleaze will not steer graduating residents to them.

In short, most jobs with a recruiter attached aren't worth having in the first place.

# posted by Anonymous : 12:04 PM

This brings out an excellent and very important point. It's not the recruiter, it's the jobs they represent! Due to my blog I have received emails from very upset recruiters that resent what I say about them. One recruiter emphasized that he believes that recruiters are honest, hardworking, good people, that definitely earn their money. He went so far as to say that they are like a band of brothers. I felt he had a point. Personally I usually was treated well by recruiters, but they still never had the job I wanted. And that turned me off in the end.
And the comment is the perfect explanation: it is often not the recruiter, not the person, but the jobs they represent. Recruiter good, job bad...

Nevertheless, I have a beef with recruiters. None of them told me how to get a job in the area I wanted - in Boston and in Miami proper (NO, not "near", not "easy access to", no, actually IN those cities). None of them did as much as hinted at how to find a job there, nobody said "Hey, just mail all the docs in your chosen city a letter and you will reach all of them". That is my problem with recruiters!

2. Yes, the good jobs and positions don't need to rely on a recruiter. You need to be at the right place at the right time and/or know the right person.

I have always thought about returning to Oregon where I grew up so I scan the recruiting jobs out of curiosity. The exact same jobs have been advertised for the last 10 years. That tells me not to touch those with a ten foot pole

# posted by Anonymous : 1:13 PM

Yes, I have been saying them since post#1, good jobs and positions almost fill by themselves! Recruiters do not get them! But you can get them if you mail a letter to everybody in the area where you want to work....

3. Recruiters cost real money, and those practices willing to spend substantially usually have obstacles to overcome in attracting candidates. Sometimes it is nothing more than a remote location where a generalist or specialist would likely have to practice without much support while taking lots of referrals. Sometimes the location has an undesirable climate or a poor socioeconomic atmosphere.

And sometimes recruiters are the agents of serial abusers or are the pitchmen for institutions that promise much but habitually dishonor those promises and just turn to new hires when their old hires get fed up and leave.

It always pays to call the last doctor who left to get the story.
I have chased some doctors across the country when doing due diligence on practices. I am convinced that there is a lot of valuable information that can be had no other way.

# posted by Anonymous : 2:27 PMMonday, June 18, 2007

Recruiters cost real money. that is handicap number one for recruiters. 20K for filling a position? Employers are willing to do a lot, to try a lot of things before they pay 20K...And only those employers that have a problem may be willing to pay it. This is THE recruiter handicap. How are they going to overcome that? How could they? I have not found a satisfactory answer. Somebody explain it to me! An employer has a choice:
Candidate A is qualified and has mailed his CV in himself. No price tag attached.
Candidate B is equally qualified and comes through a recruiter. 20K price tag attached.
Employer decides for... you get three guesses!

That is the basic, basic, basic problem of recruiters. A problem they cannot over come. They have worked around it by massive advertising on one side and by the naivity and ignorance and lack of knowledge of physicians on the other side. Few physician know how easy it is to reach every and all physicians and employers in any given area, be inside a city or be it out in the country. You mail everybody your cover letter and CV, done. No other help needed! Maximum success.

With direct mail you reach 100% of all physicians in any given, any chosen area. Recruiters can reach a maximum of 20%. You, the single, lonely physician is able to reach 5 times more employers than the best recruiters. How do you like that????
Dear colleagues, you can do it, this blog can help! Click here for details!
And if you want someone to help you with the details, click over to "", they will write and print the cover letter and CV for you. You sign it and drop it in the mailbox. Done

Thursday, June 21, 2007

Better Tools for Physician Job Search

Years ago, when I asked my chief resident how I could find a job in the last year, he answered: "Aaahh, just ask all the attendings and if that does'nt work, call a scalper"
Today, he would add, "go on the internet". So, I googled "physician jobs" and "ObGyn jobs". The results were severely misleading. Recruiter website after recruiter website, then the websites that post recruiter ads, then the recruiting companies, then the occult and hidden recruiter ads disguised as "advice" that sneak up on you on student and fellowship websites, and on general health websites, and so on. In short, recruiters dominate the internet.

They seem to be number one when it comes to the physician job search. Not so.
In reality, recruiters handle between 10-15% of jobs according to a survey of 1000 practices (unplublished, by, which is consistent with my personal impression. The highest estimate I have ever seen was 1/3 or 33% of jobs. This estimate was published by a recruitment company and I believe it to be overly optimistic.

Print and direect internet advertising by employers may be responsible for filling 20-40% of jobs - in my estimate.

The remaining roughly 50% of jobs are filled by word of mouth, by direct personal contacts.

This has serious implications on how a physician should look for a job.

Networking should be effort number one, because most of the jobs are filled through personal contacts. This includes talking to anybody who is willing to listen and presenting them your "elevator pitch". The elevator pitch is a short presentation that includes who you are, what you are looking for, what makes you special and what makes you different than the rest. Handing out a business card with your contact info and maybe the elevator pitch is a good idea.
Networking includes contacting hospitals in the area where you want to work, I have discussed this in previous posts.

Networking includes sending a letter to every single physician in the area where you want to work and introducing yourself with a letter that essentially says the same as the elevator pitch. You may or may not include your CV in this letter. You will find the addresses and all other contact information of any physician anywhere at, where you can buy them for 50$ each. I have described this here - click here

Mailing a letter to each physician in your target area is especially useful, since you find all the physicians that have not advertised yet, that are just thinking about maybe hiring someone. This is great, since it gets you in before the competition. You automatically find all the physicians that have already advertised. They will simply think you are responding to their ad, even if you have never seen the ad. You will also reach all the physicians that have contacted recruiters, and you will be especially welcome, since your application does not have a 20K price tag attached (the fee the recruiter charges for brokering a candidate).

So, with one single activity, sending a letter to every physician in your target area, you reach absolutely everyone.
You tap the "hidden job market" as well as all other "markets". You cannot do better than that.
You can do this yourself, or you can have a company such as "" or "" do it for a fee.

Compared to networking and direct mail, all other methods of searching for a physician job pale. By looking only at print ads and internet ads you are limiting yourself at 30-40% of the job market, and by searching through recruiters, you limit yourself to about 15% of the job market.

Why is the Internet and why are the print media dominated by recruiters? Because they pay. Follow the money!Recruiters pay websites to post their ads and the websites do not mind giving them a little "editorial space" - and, voila, you have a nice editorial touting the "advantages" of recruiters. Print media need advertising, and they need recruiter ads. They survive because of these ads. And they do not mind publishing a few nice articles presenting the "advantages of working with a recruiter".

And so you have a completely slanted view of the physician job search on the net.

It does not help the balance of published material that physicians have no interest whatsoever in writing about the almost embarassing topic of "job search". They just get it done and go to work. Write about it? Please...I have better and more lucrative things to do with my time!

And that is the reason why physicians, why every new generation of graduating residents and fellows do not use the best tools to find a physician job. They simply do not know. And the older physicians do not bother telling them. We need to raise awareness of what physicians can do to find the jobs they want.

A physician job seach is a straightforward thing: contact all potential employers by mail. And Network. Done

Tuesday, June 19, 2007

The drawbacks of physician recruiters and the best way to find a physician job

EvilHRlady was kind enough to insert a quote of my post in her blog! It is important to tell the other side of the story of recruitment, the story of the disappointed and mislead candidate, the story of recruiters acting like mere salespeople, mostly interested in placement - nothing else. It is necessary to publish the the drawbacks, the downside of physician recruiters. Everybody should be aware of the criticism that is out there. Graduating residents and physicians in general looking for a job have to know how to best find a job, what techniques are available, how to network. They also should know what physicians recruiters can do and what they cannot do.

Nobody has published on the drawbacks of physician recruiters in an organized or systematic fashion. Some kind of balancing information has to show up if you google "physician job" and "physician job search". Information that comes from physicians, not from third parties. The view and the experiences of the job seeker has to be published. We need peer to peer information that cuts through the sales fluff on the Internet.

All you get if you Google your area of work and "find job" is hundreds and thousand of recruiter websites touting the same "advantages" of "fabulous" recruiters. If you look behind the curtain, you find that the "wizards of recruitment" are not quite what they claim.

They mostly turn out to be volume oriented sales people that add much less value to a job search than you expect.

Occasionally you read idealistic publications on what recruiters should be: the experts that know or sense or figure out just who is the right fit for a given job - and who know just how to find that particular person.

While that sounds very nice and reasonable - how can it be accomplished? How can a recruiter know the atmosphere, the intricacies, the issues of a particular job, practice or hospital? Even physicians that start working in a new job take 6 months to fully understand who has the power, who is nice and helpful, and who stabs you in the back. It takes months to find out what the personality of a practice or a hospital truly is.

Recruiters cannot, short of a miracle of clairvoyancy, find these things out with their usual tools. And their usual tools are: the 10-15 minute phone interview, a 10-15 point checklist and some common sense. As you well know, there is no defined professional training for recruiters, no exam, no degree. All you need is the ability to sell and the willingness to spend hours and hours on the phone.
Hey, that, and a $200-2000 off-the-shelf software package and you are ready to go. Blackdog software even comes with prepackaged canned answers to most arguments that "hiring authorities" and "candidates" might have.

That is all you need to become a recruiter. Should you go for the long-term success, for building relationships, for adding value etc, your business will grow slow. Should you go for the "quick placement", your business will grow faster. Quick placement means: a maximum number of phone calls a day, since this process follows statistics, the more phone calls you make, the more viable cadidates you get, the more placements you make, the more you earn. You also should immediately drop candidates that may not be marketeable, since they are a waste of time. I have experienced this when mentioning that I wanted a job in "Boston inside the I 95 ring" - you are usually not called back, you just get on the general email recipient list, and from this point on you receive job offers from all over the US.

And, on top of all this, medicine turns out to be an area where recruiters might be unnecessary. Why? Because it is not hard to find doctors. It is much easier to find a doctor than to find a certain manager in the hierarchy of a large corporation. Doctors advertise, their names are published in many lists that can be purchased with a few clicks on the Net ( Doctors do not hide, they are easy to find, they want to be found. You do not need any special knowledge or tools or help to find them

All a physician looking for a job has to do is get a list of doctors in their chosen area and send all of them a letter. Click here for a detailed description. Done. Response will be 1-2%. Send out 500 letters, you will get 5-10 phonecalls - very good ones usually. And with this method you uncover all the never advertised jobs, you tap the "hidden job market". You will find more positions than you thought possible.

Direct mail works extremely well! Why else would the NAPR, the National Association of Physician Recruiters, regularly do massive direct mail campaigns?

I highly recommend direct mail in addition to personal networking as a winning job search strategy for physicians. Direct mail and networking is all you will ever need!
Direct mail and networking is all a physician needs to find the best jobs!

Saturday, June 16, 2007

Avoid physician recruiters

I teach Obstetrics and Gynecology to the residents of a Family Medicine Program in Boston. This includes a lecture on "How to Find Your Ideal Job" that explains the dramatic advantages of the direct mail method for a job searching physician and outlines the drawbacks of working with physician recruiters.

A faculty members asked me why I was opposed to recruiters. Here is the answer: It was a long learning process over years, with many dozens of big and small bad experiences and big and small disappointments. In the end, I could count the good experiences on one hand and the bad experiences and disappointments were in the hundreds.

I started out with enthusiasm about recruiters, and with great hope. Here are these people that have "hundreds" or "thousands of jobs nationwide", that have "the best jobs", that "personalize a search for you", that routinely find "the perfect practice for you". Great! Call seversal recruiters, get a great job and start working!

It turned out quite different. I had graduated from one of the large Boston teaching hospitals and wanted to stay locally. And with "locally" I meant really Boston, specifically inside the I-95 ring. So I sent my CV to recruiter after recruiter, but strangely, such a job did not seem to exist. Even the recruiters that advertised jobs with "Enjoy all Boston has to offer" live and work in "the Boston suburbs" never had jobs within the I-95 ring. To my dismay, recruiters defined the "Boston suburbs" very creatively and differently than I did. The suburbs suddenly turned out to be Methuen, Lowell, Lawrence, Framingham, Worcester, Plymouth etc. Driving distances in ads were routinely understated; places advertised as "only 30 minutes from the city" always were an hour away.
Then, after a while, there actually was a job IN Boston, and I rushed to find out what it was. "Obstetrics only", and underpaid. At the time the usual starting salary was 150-160, this employer offered 120. A number of similar experiences later let me conclude that "within-city-limits" jobs coming through recruiters had serious flaws.

I realized in time that recruiter jobs were never "just great", there was always something off, the jobs always seemed to have a flaw, some drawback, concerning location or otherwise. My comfort zone in terms of location ended before the "recruiter area" started! And I grew more and more cynical when reading the oh-so-promising ads...

A few years later I went on another job search, and this time it lasted over 4 years. I wanted a position in Miami. Again, not outside of Miami, no, IN Miami.
On the internet I found, a website chockfull with recruiter ads, registered and up went my hopes again – over 75 jobs in Florida! There had to be something in Miami among them! For starters, the typical recruiter job descriptions are short, cryptic and vague. I understand the reasons for this very well, but it is still frustrating. I screen jobs by location and salary – and that is exactly what they never, ever tell you. I also was surprised to find that many jobs are listed multiple times by multiple recruiters. Great…

And the same frustrating game started all over again. “Oh, no I do not have anything in Miami”, "But what about Lakeland, Tampa, Orlando, Jacksonville, and the panhandle and, and, and". Lots of jobs, just never where I wanted one.

I adapted and listed myself on the Internet as looking “strictly in Miami, nowhere else”, "not Fort Lauderdale, not Naples, not Orlando, not Tampa". After all, I have family in Miami…

Do you think any of the recruiters cared about what I wrote in my profile? Not at all. I received literally countless emails advertising jobs in Florida – anywhere in Florida, except in Miami. It started to sound like Miami was the new Boston.

Sometimes I felt spammed by recruiters. I had just spoken to a recruiter in person and explained that I was looking really only in Miami, sorry, really nowhere else…and to my surprise next day I get an email about a remote California location, “home of the California puppy”, of course far away from the action, “a short drive” of 75 miles from LA. Did that recruiters not hear me? Did he not care? Or did he simply not take me seriously? Did he think I would change my mind that easily?

What would happen if I treated my patients that way – “Dear Mrs Jones, I don’t care if you just want the birth control pill, here, read this leaflet on hysterectomy, let's schedule it”

I adapted again and started answering my emails with: “Thank you for contacting me, but I am searching exclusively in Miami”.
Bam, now I got the “Miami AREA” emails and ads. The “Miami area” seemed to stretch from the Keys to West Palm Beach. What kind of map are these people looking at? What are their concepts of distance? Do they ever commute? One excited and eager recruiter told me that I could live in Miami, but "commute to work just slightly north of Fort Lauderdale". She obviously had never, never been on I-95 in rush hour…

Then I started to add one more sentence to my answer to all those recruiter emails:
“I am only interested in Miami, and only in a practice that has a phone number starting with the area code 305”. Now THAT usually worked. One recruiter audibly chuckled on the phone. He seemed to understand exactly why I was saying it. At least now the number of emails about Naples and Orlando dropped somewhat.

I loved the following answer “I do not have anything in Miami at this time, but I’ll call my clients I that area to see if they have something” Oh, yeah! I am still waiting today for those call-backs.
And now, here is the outstanding, rare, single, amazing experience with a recruiter – an actual, true and honest answer: “I don't have jobs there. If you want to find a job in Miami, you have to call the practices yourself, one by one. And if it does not work the first time, then try again in three months”. I was blown away, a recruiter that actually does not try to convince me that Backwater, FL is a great place to live and raise a family, but that instead gives me a tip how to land a job in the city I want.

This happened only once, one single time, on one lonely occasion, on one remarkable afternoon, in several YEARS of searching, after literally hundreds of emails and telephone conversations! The first honest and true tip from a recruiter, advice from one human being to another human being - no salesmanship. It happened only ONCE.

Do you begin to understand why I do not like recruiters?

You would not believe how many emails I received about jobs from West Virginia to North Carolina to Indiana and Idaho, even jobs in other fields of medicine like anesthesia and pediatrics! The recruiters who are sending me these emails seemingly could care less about my profile and my registration information.
Do you understand why I cringe when I read recruiters advertise “we personalize a job search for you”. Idaho instead of Miami, really personalized, great job!

I now believe that most contingency recruiters just do not care. They sell, sell, sell and sell some more. They go for volume, they go for the numbers. The more emails they send out, the more people they contact, the more chances they may have to get an answer and sell one of their jobs. That is why they remind me of used car salesmen and telemarketers. Their ads are just the nice marketing face, and you have to read them with upmost suspicion.

But then, when I was starting to believe that good jobs where I wanted them, were just not available, then I found “” They explained how direct mailing works and how it is superior to any other search method. After reading through their website, the behavior of recruiters suddenly made sense and it became completely clear why they did not have the jobs I wanted – and why they never will!

I tried the direct mail myself, and it worked like a charm. One mailing and I had seven interviews and three job offers. And that in a city that - according to recruiters - was “oversaturated”, where there were “no jobs”. Months later I tried mass faxing with the same success. And mailing is easy, the lists are readily available on the Internet, there are services that review and improve your cover letter and CV and ….of course there is “” that offers all this in one neat package for a very reasonable price.
And, no, I am not related to any of the folks at, I am not part of the company, they do not pay me, I am not on commission. I just love the idea, the method and above all - the results.

Sunday, June 10, 2007

Physicians - Best Way to Find a Job

This is how you will land a great job! Read the recommendations of a physician who has "been there and done that". This is advice from an insider!

Most important - forget recruiters. Recruiters get paid to lure you to suboptimal positions that could not be filled through word of mouth or print advertising. Don't be fooled by recruiter advertising.
You want the best jobs and recruiters do not have them and cannot get them. If you have the slightest doubt about that: Have you ever seen a recruiter ad for a Harvard position? Or for that well running practice in downtown Boston with an office overlooking the harbor, in downtown San Diego, in downtown San Francisco, Los Angeles? Have you noticed that recruiter jobs always are located "one hour drive to..." or described with euphemisms such as "Easy access to" or "Near...". Once you look closer, you find that most recruiter jobs are located in less attractive areas and /or have other drawbacks such as high turnover, unpleasant work atmosphere, low salary, high buy ins, etc. The function of recruiters is to fill the less desirable jobs! And those are the jobs YOU do not want!

All the following recommendations assume that you know where you want to live, where you want to work and that you have written a truly impressive CV and cover letter that bring out your abilities and highlight your potential. Please see my past blog posts about these topics.

So, here are the ways to find a job YOU want: For the "executive summary", click here.

1. Network, using your personal contacts and beyond

2. Directly approach the hospitals in your desired area.

3. Direct Mail to all physicians in your desired area (the best method of all!)

1. Network

Consider your job search a marketing project for yourself. Apply marketing principles, use marketing tools and you will achieve great results.

This is not the time to be shy, not the time to be disciplined and withdrawn, this is the time to make yourself heard, to be clear and loud, to be relentless, untiring, persistent, this is the time to be pushy! "Squeaky wheel gets the oil!"

Talk to anyone who will listen more than 2 seconds and give them your "elevator pitch".Write an "elevator speech", meaning a one-minute talk to introduce yourself. State who you are, why you are good, what you have to offer to an employer and what you are looking for.

Practice the elevator speech and use it whenever you can. It will become easier and easier.

Here is an example: "Experienced, Board-certified obstetrician-gynecologist with Yale training and multilingual skills – including fluent Spanish – seeking new practice opportunity in Boston to be closer to family. I have an active Massachusetts license and am available to start working in 3 months."

The elevator pitch is a short introduction to what you have to offer, what you can do for others. You say who who are, what you do, what you excel in and how you are different and better than others. You can end with a call to action, such as "and I can start in three months"

There are several website and even books that spell out how to write the elevator pitch.Print a business card (if you have Microsoft Publisher or something similar) with your phone number, fax number and your email address. Always carry it with you. Hand out this business card with your contact information as often as if possible. You could consider printing your elevator pitch on this card as well.

Start to network with your residency program director. It is part of his or her job to help you find a job. Then ask every single one of your attendings. Ask them if they know anybody who is looking or anybody with a practice you might like, or anybody wher you would fit in based on your personality and preferences.

Try to find out if there are any former alumni of your residency program in the area where you are searching. Having gone through the same residency makes you sympathetic to a doctor and gives you a psychological "foot in the door".

Ask your parents and grandparents and your in-laws to contact their primary care doctors, their cardiologists, their orthopedists etc. See if the doctors of your family know of a very busy attending that might need help, might need a new associate, that might have plans to expand his or her practice. Just following this recommendation I got two great referrals in no time exactly where I wanted it and with almost no effort. One of them of one of the best job offers I ever had.
Call your friends from medical school to see if they are in apposition to hire you or if their practices or departments are searching – you would have an automatic contact reference.

Ask distant relatives you have not talked to for 6 years to inquire at their doctors offices - and even speak to your present acquaintances.Tell them what you are looking for, where you want to be and what kind of practice you would like to join (you already have decided and formulated this after reading the first paragraph). Don’t make it too exclusive, or you will be left without a job and don’t be too flexible, because you will be abused by someone who just wants to earn money off your sweat.

You could also try to get contacts through social networking websites such as Friendster or other! There are no limits to how and where you market yourself. Think Guerrilla Marketing. If you do not know what guerrilla marketing is, read the classic book by Jay Levinson "Guerilla Marketing". He wrote and co-wrote a whole series of guerilla marketing books, including "Guerilla Marketiing for Job Seekers".

2. Actively contact the hospitals and their Ob/Gyn departments in your target area.

You can find all hospitals by going to MedLinePlus, then to "Directories", then to "American Hospital Association". There you can find hospitals by name, zip code and city. There are several other hospital directories you can search and you will find most of them at Pam Pohly's list of hospitals and directories.

Pam Pohly was a consultant before becoming a recruiter, which may explain why her website has so much useful information. By the way - recruiter websites usually do not have useful information. The only purpose of recruiter websites is to steer you to use their services.

The is a very inexpensive hospital directory for download for $97 at If you plan to search hospital data a lot, it might be worth buying it.

Once you have the hospital contact data, call the hospital and ask for the Physician Relations person, Physician Liaison or the Network Development person. Ask for the phone, fax and email.
Obviously you can also check the hospital’s website. The following link is a fairly complete and reliable list of hospital websites:

The usual providers of physician contact data lists (e.g. InfoUSA) all have lists of hospitals as well. The advantage of is their reasonable prices. And the fact that you can buy exactly as many or as few addresses as you need. You essentially only need the address of the administrative offices, and then address your inquiry letter to "Physician Liaison / Network Development".

While contacting hospitals and their departments you will encounter two opposite biases:

First bias: The doctors in your specialty will tell you: “There is no need here, we are all set here, we have too many doctors already, 10 years ago we were 5, now we are 13, it may look like a nice place to live, but believe me, it is a problematic place to practice! Why do you not look 100 miles further north or south, east or west, it’s much easier there, I happen to know someone there who is looking yadayadayada”. They obviously do not want more competition and are more or less openly trying to discourage you from coming. If they really wanted more physicians, they would already be hiring themselves!This is course does not mean that you do not have a chance. The local doctors maybe older, maybe all male, may not be that popular anymore, may have some political pressure against them and in reality you may have a pretty good chance of being successful in that particular community.

Second bias, quite opposite to the first bias: The hospital administration is always very enthusiastic and encouraging – they always need more people, there always seems to be room for one or even two or three more, “Yes, there clearly is a need, there is an opportunity, you will do well etc, etc, blah, blah. We can help you with this and that, with everything actually (except a salary of course, except with any money at all, the help usually stops at non-material things, and routinely the Stark rules are cited as a excuse). In fact they might be able to help you a lot with marketing, by providing information about the community, giving you lists of fellow doctors of other specialties, give you background info on the service area of the hospital etc. But the hospital does not care at all (!!) how much money you make, or if you make any money at all. Deep down they do not care if you are successful or not. They have in mind that every new doc means another warm body attracting more business to the hospital. Every new doc means more admissions to the hospital floors… and therefore much needed cash in their coffers.

The medical director often stands somewhere in between these two opposites, and it is often someone specially hired for that position (retired, semi-retired handicapped, working part time etc) and therefore frequently the best source of information. Medical directors usually are more neutral. So talk to the medical director and try to get crucial information:

How busy are the docs in your field, how is the population growing, which areas in town or in the county are growing and developing, which segment of the population is developing, are people moving in or out of the area, how is the industry doing? Are offices and factories closing or are companies flocking to town to open new ones? Real estate prices going up or down? That means people are coming into the area or are leaving the area…What does the future look like in the area?

Then get the names and addresses of the practices affiliated with the hospital and the names and addresses of the practices that are looking or might be looking and contact them directly by sending them you cover letter and CV.

3. And, finally, here is the most successful and least published method to find a job.
Loved by those who use it, despised by the recruiters that loose much of their attraction - if they ever had it. This is the very best way of getting any job anywhere, even in the very best, most attractive, most competitive locations.

Direct Mailing and / or Broadcast Faxing of your cover letter and CV!This is the most direct way of presenting your cover letter and CV to as many doctors as you want - in exactly the area where you want to be. You buy the names, addresses, phone and fax numbers of all the colleagues you might work for. Then you send them a letter, send them a fax or give them a call. Calling takes a lot of time, and therefore I recommend mailing or faxing.

The big difference that makes all this easy and feasible is the Internet with unparalleled access to physician contact information databases and the availability of Internet faxing. Something that was extremely time consuming 10 years ago, is now a snap. Applying to 400 physicians is now literally a project for one single weekend.

So, how do you do it? First you buy the physician addresses, the contact data. The sources for buying physician addresses and contact information, fax numbers, email addresses and numerous data about the practices are:,, WebMD and MMS, the marketing arm of the American Medical Association. The AMA has been selling lists of their members for profit for a long time, and so far this service has mainly be used by pharmaceutical companies to help their reps. is probably the most affordable list service. The drawback is that you have to buy in bulk, such as all doctors in one specialty for $297, all doctors in one state for $297, all doctors in all of the US $497, all hospitals in the US $97. Can't beat those prices, this is a lot cheaper then MMSlists.

Of all the data companies, I recommend, since you can buy all data directly online, with a very easy process. All other companies have a minimum number of data to buy, require a personal call, make you jump through hoops and restrict your use of the data. And Info USA offers the best prices.

Here is how to buy the addresses in detail.

Once you are on the website of, look in the center, go down and click on: "Doctors, Dentists and other medical lists". In the window that opens click on "Physicians and Surgeons Database" then check the specialties you are interested in, e.g "Obstetrics and Gynecology" and then, further down, check "office based". On the following page uncheck the specialties you are not interested in contacting, e.g. MFM, critical care obstetrics etc. On the next page, click on "select all members in office". Do not check the "fax number" box, since this will exclude doctors that have not listed a fax number. You want all the names and addresses and phone numbers! On the next page you can select the geographic area, whihc can be the whole country or just one zip code, or a radius of 500 miles around an address or just 10 miles. For example: you would like to join a practice within 15 miles of your parents home. Enter the address of your parents and select "20 miles". on the following page, leave everything unchecked, since it would only reduce your list. Then you get to review the list. Sould the list be too large, then choose a smaller geographic selection, or select by age or gender etc. Of course, you can also increase your list this wayOnce you are there, go to “physician lists”, and then follow the simple steps to select the doctors you want to contact. The price is 50 cents per address. Beats having to type it yourself. Info USA is the database which the other addresses and list providers get their data from. So, go to the source. InfoUSA will email you a list in CSV format, which you can import into Microsoft Outlook, Win Fax, Act, Excel or any “Contact Manager”. I would keep the original untouched in a safe place and import the data into your application of choice.

Here are a few additional tips:

You cold also buy or borrow the American Medical Association book or CD that contains all the addresses of doctors in the US. The CD costs about $1100 and does NOT allow downloading and exporting of the data into a database. Who knows, maybe you know someone, who knows someone who has the disk and would be willing to loan it to you for a weekend? The AMA is very big on restricting the use of their databases. They want to be sure to squeeze the maximum profit out of your good name.

WebMD sells booklets for $18 for each Metro area that contain ALL physician names, addresses and telephone numbers. You will have to buy a second booklet for the same area to obtain the fax numbers. The fax booklet will also cost you $18. Over all a lot cheaper than buying the electronic lists, but you will have to type in th addresses if you ant to use them on a large scale. I have used the booklets from WebMD only to confirm my database that I purchased from InfoUSA.

You should be familiar with a software program called “Address Grabber”. This is a very nifty tool to collect addresses, names, phone numbers from any electronic sources and insert them into your lists! It sells on the net as a download for $70. It allows you to “grab” and capture any address you see on your screen from any website, from any source with a single click. Very cool! If you can see it on your screen, you can transfer it to your database! Digest that fro a moment! You can produce your own lists!You highlight the address you want to grab on the Internet or in Word or in other software...and then transfer all that information into a contact manager such as Outlook or ACT! With a just a single click. The info will appear like magic in the correct place, address in address field, name in name field, fax in fax field etc. Very handy. It is well worth the money if you search for a job in a difficult metro area and have to harvest addresses from the yellow pages, from WebMD etc. Obviously it is good for many other things, such as building address databases for referrals, fund raising, other mailings etc. There is a more advanced version of this technology called “ListGrabber” which imports not only a single address, but a whole page of addresses, a "list", hence the name Listgrabber, all at once, with just one click. It costs over $250 and most likely it will not pay off if you are a single physician looking for a job. But it is good to know that it exists, you never know...If you are an employer with repeated need for recruitment data, this is the tool for you.

Then you write your cover letter in WinWord.
Go to the Mail Merge function. You find this under “Tools”, then “Letters and Mailings”, then Mail Merge. Follow the instructions WinWord gives you step by step. You write the master document, then insert the merge fields, then open the database and…merge. You can easily see and manage the merged letters with the “merge toolbar”, which you have to open.Then you print out all the 100 or 200 or 300 letters on white or off white or cream 24 lb paper. You get 100 or 200 or 300 copies of your CV done by you local Staples, Office Max etc.Then you choose white or clear Avery labels at Staples or Office Max for the address and for the “sender” information (that is your address). WinWord knows how to precisely deal with the size of these labels. You enter the number of the Avery label and Winword knows the size and formats the address information exactly for the label. Magic! Then you print the labels using the Mail merge function again. You then fold and stuff the letters in envelopes, have the envelope weighed at the post office, buy the correct stamps and stick them on. You drop all 300, 500 or 1000 letters off at the post office and Voila! Mass mailing. You almost have the job. Just don't ruin the interview!

There is a company that does all the hard work of the mass mailing for you: ‘”. Go to their website and read and browse. Here are some quotes: “We help more physicians find jobs than any recruiter or job board in the country, and the reason is simple: we work for you, not for the employer. Unlike a recruiter, we won't try to force you to work in a rural area. Most of our clients find jobs in their first geographic choice, and we can help you find a great job in any metropolitan area in the country. 99% of our clients find jobs, and we guarantee that you'll find a job or get your money back. Visit our website at" or call us to talk about our services and get a price quote. You will find a job with The Doctor Job. We guarantee it.”
They charge about $1, 50 to $2, 00 for each letter sent, but this is not too much. For that amount they review your letter and CV, maybe improve it, they get the names, addresses etc, they merge the letters, print them and send them to you. You have to sign them, to stuff them into the envelops and to put stamps on them, which costs money at 39 -63 cents a stamp. The service provided by “The Doctor Job” is very reasonably priced at $ 2000 – $3500. If that is too expensive for you, do it yourself. I did the mass mailing and faxing myself, and it cost about $1000, but it was a lot of work. I did never regret it though.

There is another company that provides this service since late 2006:, a website founded and run by a former in-house physician recruiter and a lawyer. Not bad overall, but they still live off recruiter ads...

Mass Faxing:Legal notice: Do Mass Faxing at your own risk and only after closely looking at the rules and regulations in the state you fax to! Unsolicited faxes are illegal in many states! I am not responsible for anything that happens to you as a result of mass faxing. You have been warned!
You buy the addresses from Info USA or WebMD, have your CV and cover letter (re)written by e.g. Quintessential, add a signature image at the bottom of the fax and then fax it to 10, 50, 100 or 1000 colleagues using JBlast.

Step by step: You get the fax numbers from the same list sources. You use the same cover letter and CV. You can either sit at home or at the office fax machine and manually fax the hundred or two hundred cover letters and CV copies.

You can mass fax using an Internet service provider called, who offers a fax broadcast service called Jblast. Jblast is great, since it is easy to operate and offers a Mail Merge function that works just like Mail Merge in MS Word. And is very reasonably priced. You can use your Word document and your CSV address and fax number list or your Excel address/fax number list.

I recommend using an Internet faxing service anyway, since you can get a personal fax number with an area code of your choice - yes an area code anywhere in the USA - and you can switch it at any time. Now you have a fax number that you can print on your CV. The advantage is that this fax number will follow you after you move and after you leave residency. This fax number is as portable as your yahoo, hotmail or Gmail email address. This is an advantage because employer can send you faxes even after you have moved away and still find you. Maybe this is the way you will hear about your dream job!

Important! Add a signature at the bottom of your fax. It makes it look a lot better, more realistic, more credible. I wrote my signature on a tablet computer, saved it as a file, emailed myself the file and pasted it into my word document between the "Sincerely" and my name at the bottom - voila!

Follow up!Believe it or not, your application is not that special! Yes, it may get lost, neglected, forgotten in the daily rush, put at the bottom of a pile, or it may just get thrown away for whatever reason. It therefore is a good idea to fax the same letter and CV or a slightly different, maybe shorter version - about 2 weeks later. Keep your cover letter and CV in front of your potential employers!

And of course, you could call the most interesting practices and ask to speak to the doctors. Always leave message that you called with your call back number. This is not the time to be shy! Squeaky wheel gets the oil.

Should you not get the right practice during the first mailing campaign, then try to mail to a larger group, let's say a wider area. Include one or two or three more counties, or a few more zip codes. Check the following: Are you sure that your CV is optimized? Is it really written by a professional? Have you made sure that Your letter arrives on Tuesday or Wednesday, when it has the highest chances of getting read?Or just try the same list again, who knows. Maybe this time they will actually open the envelope, maybe the practice situation has changed. Sometimes partners or associates or their husband or wives leave, sometimes people die or suddenly have to retire. So, just try again, I would recommend to repeat this every 4 months. It will work!

So, this is how you find a job! And where do recruiters fit in? The people who seem to have more websites and more presence on the web than Google and Yahoo? Once you know what you just read, you do not need them anymore. Behind every recruiter job posting is an employer that is desperate enough to be ready to pay $ 20,000 just to find someone.

Take charge, search actively and you get the job YOU want, not the job someone wants to sell you! Recruiters are...unnecessary for job seekers!

Tuesday, June 5, 2007

The most important issue in medicine

In my opinion the most important issue in medicine is the number of graduating medical students. Why? Because supply and demand determines the price of any good or service. Train too many doctors and reimbursements will decline. This has already been happening since the mid eighties! and it should NOT continue. The US are a better place to work for doctors than most European countries (and as a German I know this from my own personal experience), because someone was smart enough to freeze new medical schools.

Now we have a most unfortunate study trying to predict the future, which forsees a "physician shortage by 2020" and consequently university deans, eager fro the reputation, funds and power that come with a medical school, clamor to create new medical schools. In my humble opinion the author of this study resembles a "useful idiot" for the HMOs (remember that cold war term that so aptly described those people that supported communist ideas?)


Few people see it that way. Everybody seems busy with their everyday activities and misses the big picture. Any increase in the number of physicians is absolutley detrimental. Incomes will drop even faster than they have in the last twenty years. Did you enjoy that? Keep quiet about new medical schools! Did you like loosing income? Keep quiet about new medical schools!
Have trouble paying off your medical school debt? Just support new medical schools and more doctors! Have troble paying your mortgage? Just welcome new and more doctors!
Are you enjoying the power of HMOs? They will only get stronger the more doctors are around - they will always find someone who works for less!

We need less doctors, not more.

The latest issue of the American Medical News reports on the "burgeoning retail clinics". There is your competition that you did not see coming! There is your increase in health care providers and services that makes it unnecessary to train more doctors!

In Minnesota Blue Cross Blue Shield supported the opening of retail clinics and from 2004 to 2007 the number of visits increased from 9,800 to 33,800 and the charges per visit increased from 39.84 to 72.90! And you thought this was a minorthing and people would not go or would go only for insignificant issues!

Hey, those that went to a retail clinic seemed satisfied. In the same article a table shows that:
patients that were very / somewhat satisfied with quality of care - 90%, withhaving qualified staff - 85%, with convenience 83% and with cost 80%.

This is completely in line with physician practices! And you thought retail clinics were no competition?

Not only do we NOT have a physician shortage at this time, we have a physician oversupply. The oversupply will get much worse due to Internet medicine and retail clincs. HMOs will rejoice and their profits will grow, your income, my dear colleague, will shrink.
You have been warned.