Physician Recruiters and Divine Justice

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

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

A Physician's View of Job Search

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

The best jobs are with:

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

You have to know what YOU want first:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Physician Friendly States - Consider Them in Your Job Search

Where are you going to practice? States actually are quite different when it comes to being "Physician Friendly". Massachusetts for example deters physicians with high cost of living and one of the lowest reimbursements in addition to unusually restrictive state rules, such as being forced to carry malpractice insurance as a condition to licensing, prohibition of balance billing and other unsavory goodies, which for my own good I cannot mention here. But then of corse, everybody just cannot explain why, oh why there is a primary care physician shortage in Massachusetts! I don't know either, can't figure it out.
This article by an editor of "Physician Practice" is worth reading. I am quoting an abreviated version with gracious permission from the author - Thank you!


Begin quote:

The Best States to Practice: America's Physician-Friendliest States
By Bob Keaveney, executive editor of "Physicians Practice"

Kansas, South Dakota, Oklahoma, Indiana and Texas are the most physician-friendly in the country, according to Physicians Practice's biannual analysis. We examined factors that affect a doctor's ability to work relatively hassle-free while still making a nice living, and found that the big flat, open spaces of America's Midwest outshine the glitzier coastal states as attractive places to practice medicine.

We emphasized factors such as malpractice climate, reimbursement, and cost-of-living — not so-called "quality-of-life" issues, we find that the simple-life states tend to fare best. Places like Hawaii, New York, and California may be terrific places to live, but the cost of living is just too high. Also, densely populated states tend to be similarly thick with physicians.

Our methodology
We didn't consider the subjective, so-called "lifestyle factors", the main ingredients of the "best places to live" rankings, Since there is no particular "lifestyle" that most physicians would agree is ideal. For those rankings, see Money magazine's, found at www.money.cnn.com/best/bplive, and Sperling's BestPlaces, www.bestplaces.net. As for Physicians Practice, we sought to identify the best places for a physician to work.

We considered the following:

Malpractice climate — We disqualified any state considered "in crisis" by the American Medical Association.
Physician-patient ratios — In our analysis, a lower ratio is better. Using an examination conducted last year by the New York Center for Health Workforce Studies (based on 2004 data by the U.S. Census Bureau, the AMA, and the American Osteopathic Association), physician-patient ratios affect a range of factors, from physician salaries to contract flexibility. The consolidation of commercial payers is putting a squeeze on practices. Having fewer physicians in your area increases your leverage.
Cost of living — Using data from the second quarter of 2006, the U.S. Bureau of Economic Analysis indexes the states against one another, with a median score of 100; the higher a state's score, the higher its cost of living. Thus, a lower score is better. For example, Hawaii scored 161.3; Oklahoma, 88.5.
Reimbursement — Medicare uses a similar indexing system for its Geographic Adjustment Factor. Hawaii's adjustment factor in 2006 was 1.044; Oklahoma's, 0.913. Commercial payers often tie their reimbursement rates to Medicare. For our analysis, the higher the score, the better.
Cost of living/reimbursement margin — These measures are closely linked; neither can be examined in a vacuum. Some states have costs of living that are relatively high or low in comparison to reimbursement rates. We evaluated and contrasted both of these indices to gain a sense of which states actually fared best.

Selecting America's most physician-friendly states is a subjective task. We recognize that factors affecting your particular quality of practice and life will include many additional variables.

Texas: A new law, passed with the assistance of the Texas Medical Association (TMA), established caps on noneconomic damages — money for pain and suffering — that plaintiffs can win in a malpractice suit. "I think the liability climate is one of the best, especially for physicians," says Ledon W. Homer, the TMA's president.

"We've found that a lot of doctors who relocate and never go back have gone from California to Texas," says Mosley. He made this exact move himself 15 years ago, and he found the stories of a unique Texas culture to be accurate. "One of the first things I saw was a bumper sticker that said, 'I'm from Texas. What country are you from?' And it really is like its own country."

Indiana is one of only two states to appear on our list all three times we've conducted this analysis. Its malpractice climate is "currently OK,", its cost of living is the 12th-lowest in the nation, and for every 100,000 residents, it has 180-200 physicians. "One thing that's kind of unique about Indiana that a lot of people don't really know about is that it really has a lot of great universities," he says. "Notre Dame, Purdue, Indiana University, Valparaiso, Ball State. People don't really think of Indiana as an academic university kind of place, but it is."

Oklahoma offers rock-bottom cost of living and comparatively low physician density (150 physicians per 100,000 residents)- combined with good reimbursements and generally higher incomes.

Kansas has the seventh-lowest cost-of-living, low physician density, and good reimbursement. were the deciding factors. Several physicians report that the biggest advantage is the people. Heartland folks just seem nicer. There's more respect for physicians. There's a greater willingness to trust."
Good economics make Kansas a great place to be a doctor. You can get a really nice home for a lot less than you'd pay in California. Kansas does have a $250,000 cap on noneconomic damages.

South Dakota has a friendly malpractice climate, they have the [noneconomic damages] cap. But it's also supply and demand, the supply of physicians is fairly low. The Plains state remains one of America's least-dense with doctors per capita. It also has the ninth-lowest cost of living.


Consider what matters - Don't get us wrong. We're not suggesting you pack your bags and move to Topeka or South Bend. We do suggest, however, that if you're ready to move — and more of you than ever, it seems, are — start your search by asking yourself what you're looking for in a practice setting and lifestyle, and then look for areas that meet those needs. Many physicians start with a place in mind, and then hope for the best, which is exactly the wrong way to proceed.

You may have familial or some other personal connection to a particular area; that's fine. But if you're just trying to indulge a fantasy by, say, insisting on practicing in Hawaii, then you're possibly setting yourself up for disappointment.

Consider the practice's size, compensation model, call-coverage policies, opportunities for partnership, and culture. Think also about how well-run the practice seems. For example, ask about average patient wait times (more efficient practices tend to have shorter waits) and about its use of information technology.

Bob Keaveney is the executive editor of Physicians Practice . He can be reached at bkeaveney@physicianspractice.com.

End quote

What Physicians Think of Recruiters

A quote posted by "PsychMD" in one of the forums of studentdoctor.net, which I am adding to the other quotes from physicians who somehow have arrived at the same view of physician recruiters as I have. I have described this very extensively in my past blogposts.

Just a general comment re. recruiters mailing you. Everyone starts getting junk mail recruiting around the time when they start to appear listed in several databases (available free for anyone who looks), such as medical licensing boards, the Specialty Board Certification site, hospital privileges staff lists, even final year resident rosters which are available on many programs' websites.

I wouldn't encourage anyone to pick a job pitched by a recruiter who has your name from a database and has no clue who you are and what you want. Plus, of course, they will all tell you that the "market" is pretty tight in the major cities, because most major hospitals in most major cities do not even go through these recruiters; they have their own in house recruiters, or recruit staff through internal networking; they have where to pick from. Look for a job based on where YOU want to live and where YOU are familiar with the local medical scene. Do your homework well. Lots of jobs picked through recruiters are jobs that are not already filled locally for a variety of reasons, not all of them good, in many cases.

All that aside, there are some rural area jobs that are GREAT, and the only reason they don't get filled is their more remote location. For someone who doesn't have a lot of pre-existent family obligations (such as a spouse who also needs to find work in a non-medical field), or are just starting their families, and do not mind being 1-2 h. away from a major airport or other larger city amenities (nowadays a lot of stuff can be available on line anyway!), some of these jobs are true gems.

(This pertains to all specialties, not just cardiology.)

Recruiters Have the Less Desirable Positions

A colleague whom I know from emails, but with whom I have never spoken about recruitment or recruiters, sent me an email today which I am quoting literally after having removed his name on request.

I am amazed how closely his experience mirrors my experience with recruiters.
May I point out that he finds that positions coming through recruiters are in "...less desirable practice locations...a candidate must keep in mind that these recruiters work FOR the hospitals, and not the candidate...these recruiters usually will not heed the candidates' needs...since stopping my search, I continue to receive recruitment flyers and e-mails (as I am sure many of you do)...those who would take these job opportunities may lack the insight into the economic realities of private practice..."
Recruiters may argue as much as they want, this is how they come across to a majority of physicians. And, please, do not tell me "it's a few bad apples", those few bad apples seem to incredibly busy and seem to just pop up everywhere!


"As a relatively recent recruit to (2003), and subsequent recruiter (2005-6) for my former practice, here are my observations.

When I was searching for a position, I looked at these incredible and unbelievable offers. I too, looked at Merritt, Hawkins, and Associates' findings over the last 6 years. I then observed a trend when I actually called these opportunities / offers. Although not universal, most of these positions offered by "recruiters" such as Merritt, Hawkins & Associates are in less desirable practice locations. Not necessarily rural, but nonetheless less desirable. Factors including geographical location, payer mix, competition, etc., may all come into play.

One must ask why a hospital needs to utilize these search firms and pay them tens of thousands to recruit a urologist. A candidate must keep in mind that these recruiters work FOR the hospitals, and not the candidate. Even if a candidate specifically mentions he/she does not want to join a multispecialty practice nor want to be on the east coast, these recruiters usually will not heed the candidates' needs and will contact the candidate anyway when they have any job offer remotely resembling (or NOT!) what the candidates want.

Since stopping my search, I continue to receive recruitment flyers and e-mails (as I am sure many of you do) advertising $500,000 starting salaries almost on a weekly basis. I know of one such offer and its exact location if anyone wishes to move to a rural Arizona town. Contact me directly and I won't even charge you a finder's fee!

Now the question: How do all these practices afford to pay these huge salaries with all these benefits? I will bet the practices are not paying these costs. These incentives are subsidized by the hospitals.

I can not imagine offering these incentives and having the recruit be "let down" in year 2 when the hospital subsidy ends and reality hits. The short term gains may be great for the candidate, but one must evaluate the long term consequences of taking such a job position.

Those who would take these job opportunities may lack the insight into the economic realities of private practice, and may not be ideal candidates whom I would want to eventually call "partner". Experienced managers know the emotional, production, and financial costs of having to replace an employee. Imagine the headache of having to replace a urologist... It's true that this recruitment process is like choosing a life partner (for both the practice and the candidate); one must chose very, very carefully."

Great books for Physician Job Search

Two useful publications for physician job seekers:

The first is the surprisingly good "The Ultimate Guide to Finding the Right Job after Residency" by Koushik Shaw, published in late 2005. This is probably the most useful book for the physician job search that I have come across so far. It is short, concise, to the point (sometimes a bit too short), but it covers absolutely everything that is relevant from getting to know your personal preferences in your work life to determining where exactly you want to live and work, how to find a job, how to interview, and - kudos for this section - how to analyze a practice you are looking at, what questions to ask a potential employer to uncover risks and possible mismatches early. The author goes into details of analyzing benefits offered by an employer and negotiating a contract. He even goes into the basics of opening your own practice.

Overall very well written, in good style, very easy and quick to read and extremely informative. One smart book everybody should read at least once and at least one year before graduation. It fits the motto of my blog perfectly "What I wish I had known as a resident". I highly recommend it.

Here is a review by Paul Gill on Amazon.com:
"This book is an absolute must have for any graduating resident. The author has put an enormous amount of research into a concise and organized fashion, allowing even the time restricted resident to conquer this book in a few short sittings. I have discussed this book with several junior attendings and private physicians, and they are all amazed at how much accurate and insightful information is hidden in this short concise book. It will save you weeks or even months of research and grant you an amazing head start into identifying and obtaining the right career. I truly believe this book will substantially increase your chances of a successful and happy career choice plus teach you to avoid many of the common pitfalls."

Published by McGraw Hill it costs $21 at Amazon or at your local book store. If you are a physician searching for a job and only want one resource, read this book. If you have a bit more time, read my blog "The Summary on Physician Job Search" too, where I have summarized my experience and my knowledge about this topic.

While we all would love one single access point to the job search, it does not exist yet. It is doubtful it will ever exist, because there are so many different people and so many different ways of going about finding a job. New interesting websites for job seekers are added all the time, recently it was Jobfox.com, a site worth visiting, exploring and watching.


A free publication is also worth mentioning: The recruiting firm Comphealth's "Best Friend's guide to find a job", which you can download for free here. It is a remake of Weatherby's booklet with the same title. Caution, you get what you pay for. It is free, because is a marketing tool for Comphealth and on every other page you stumble across sentences like "If you have any questions about xxx, call your Comphealth representative, who is well trained and very experienced, especially in xxx". And so on...

The information is good though and you can't complain about the price. As you would expect, the information is severely restricted to anything that will help to make you a client of Comphealth and make you more sell-able to Comphealth. A better CV, a better cover letter etc will ultimately make you more sell-able and therefore will benefit Comphealth. Any information that would lead you away from Comphealth and make you an independent job seeker such as tips for networking and for approaching hospitals directly and for direct mail are absent. But that's what you can find on my blog. Comphealth's "Best Friend's guide to finding a job" is an excellent complement to my blog.

As a side note - I would demote anybody from the rank of "Best friend" who would try to recommend that I use recruiters as my main way to find a job. After all recruiters know about maybe 50% of all jobs, not more. And here I am overly optimistic in my estimate, since a maximum of 30% of jobs are handed out through recruiters, according to a recruiting companies research. The real percentage of jobs brokered by recruiters might be lower, since nobody can accurately estimate the size of the "hidden job market" and the number of jobs filled without any participation of the public. The only way to approach the hidden job market, and that means all those jobs that either are not advertised yet and all those jobs that might be filled before they are ever advertised (because they are so attractive), all those jobs are off-limits to recruiters. But YOU can easily find them by networking, by sending your cover letter and CV to EVERY doctor in your target area and by using "TheDoctorjob.com", who can do the legwork of direct mail for you for a fee.

There is another book available on the topic of physician job search. It is called:
"The Physician's Job-Search Rx: Marketing Yourself for the Position You Want" J. Kashani, W. Allan and K. Kelly. I DO NOT recommend it. It was published in 1998, it feels outdated and actually is outdated. The internet and its possibilities are not discussed as you would expect, and overall it just pales compared to the excellent style, balanced handling of topics and thorough research of Dr. Koushik Shaw's book.

Physician Recruiters Love Direct Mail, But Will Never Recommend It To You

Recruiters are hired by an employer and they are the agents of that employer. The recruiter is NOT working for you, the searching candidate, simply because you are not paying for the recruiter. 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. Recruiters are called recruiters because they recruit. The recruiter is pursuing YOU, he is a "headhunter or "doctor-hunter" or "doc-hunter". Rumor has it that in a far far away and remote corner of the web there even a recruiter website called "dochunterdiary.com".

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?

Nevertheless, sometimes recruiters work in the job seekers interest, when it happens to coincide with their goal of filling a position. Such a match or coincidence is possible. Recruiters will support you, the job seeker, as long as it is in their main interest. Their main interest is closing the deal.

Let's assume for a moment that a recruiter is really, truly on your side, on the job seekers side. In that case, your recruiter would tell you how to find a job independent of his listed jobs, he would tell you, teach you, instruct you how to network, in that case the recruiter would point you to the most informative and most helpful websites for job seekers, the best job boards with the most job postings, the journals with the best ads. A recruiter that was truly on your side, on the job seekers side would advise you to call hospitals and their physician liaison departments (yes, some actually do that!), and finally he certainly would advise you to mail a letter to every physician in your specialty in the area where you want to work (NO recruiter will do that).

A recruiter that is on your side would give you pretty much the advice I am giving in my blog. Right? Take a close look at it. I have summarized most of my tips and tricks on the blog "A Physician on Job Search". My blog is not a "logging of current events", no, it is a publication of experience and recommendations. Please look at them and compare that with your typical recruiter information.

Reality check:
Now, compare what information recruiters offer you with what I am offering on my blog. Recruiters offer you tremendously helpful tips such as "how to answer a recruiter call", "how to get along with your recruiter", "what information to have ready when a recruiter calls" "why the countryside is worth taking a look at", "Disadvantages of city jobs" (we know where that comes from) and they of course help you with truly grave decisions such as "should I contact one or more than one recruiter during my job search?". You get the picture!
Oh, sorry, yes, they may give you a few hints about how to improve your CV and how to behave during the interview, after all, that makes you more marketable....

Too many graduating residents are not aware of these rules. Too many graduating physicians still believe that using recruiters is a mainstream way to find a job. Too many graduating physicians are not aware that they do not need recruiters at all. It is the employers who needs recruiters, not the job seekers. Employers need to fill positions.

Recruiters need physicians, "candidates". On their blogs they muse about the ideal candidate - someone who is happily employed and doing a great job, and not even thinking about switching jobs. They have names for good candidates, they call them "MPC" - most placeable candidates. They think about the tip of the iceberg - the candidates that are actively seeking and think there must be a large number of candidates below the surface, just like the iceberg has most of its mass below the surface. Recruiters look for ways to find those candidates, to tap that untapped mass of candidates...If they just could find a great approach to all those hidden candidates!

This is of absolutely no concern whatsoever to a job seeker. Job Seekers need jobs. They do not care about the hidden iceberg of silent candidates. They are the candidates.
Job seekers assume correctly that advertised jobs, and especially jobs coming through recruiters, are only the tip of the iceberg. The larger number of jobs is hidden under the surface, often never advertised. Jobs constantly change hands in big cities and only the insiders know about it. This is called the "churn of the job market", the hidden constant movement. Physicians change jobs all the time, from one hospital to the next, sometimes within one community, sometimes they switch to the neighboring hospital or health care system. These jobs are not posted, they are talked about over coffee, over lunch, in the locker room, on local CMEs, on informal department meetings, on the golf course and so on.

Recruiters hardly ever have access to the hidden job market - and here I am just trying not to be too radical by saying "no access at all". The churn of the job market is like the "gray" or the "black market" - a semi-underground affair.

Yet, you the job seeker can easily break into that hidden job market! Not just by networking, but even more easily by direct mail. Job seekers can find easy access to this hidden job market by sending their cover letter and CV to every physician in their area of interest. I have frequently described how in the smallest detail. Please go to my blog "A Physician on Job Search" and check the posts "Active Job Search" among others. You can also have others do the leg work for you by going to "TheDoctorJob.com". This company will optimize your cover letter and CV, merge the cover letter with a list of doctors in your area of interest, send you all the letters. You sign them, put them in envelopes and stick a stamp on the envelopes.
It works.

And because this method is a threat to recruiters, they will never recommend it. It makes you, the job seekers completely independent, self-sufficient. You do not need anybody's help and yet, you can reach every single doctor in your area of interest.
Recruiters are extremely familiar with direct mail, they use it. They appreciate it, they love it. The NAPR routinely send out massive amounts of mail to all physicians looking for positions and for candidates. Yet, you, the lowly job seeker will never hear about this from any recruiter.

Direct mail is the most basic thing. I want a job. I send a cover letter and CV to a doctor who might have a job. Repeat a thousand times. It is so simple.

Direct mail is the job seekers ticket into the hidden job market! You have to know about it if you want to find the best possible job for you!

14 Must Know Facts about Physician Recruiters

Physicians are not well informed about job search methods and about recruiters, about how they really work and about their limitations. Residents in particular lack awareness of the disadvantages of working with recruiters. Graduating residents are just stepping out of an educational, basically helpful environment. They are naive in business matters and rarely understand the economical pressures that shape recruiter behavior.

The fact sheet below was developed after years of personal experience with physician recruiters, based on being a candidate looking for a new job as well as an employer looking to hire a new associate for my practice. I am writing specifically about contingency recruiters, and that these facts and rules do not refer to retained recruiters, in-house recruiters or locum tenens recruiters.

Recruiters will deny all of these facts or at least try to gloss them over. Many actually will claim to be proud of avoiding one of the drawbacks below, which is ...just marketing. I leave it up to you whom to believe: a physician without any financial interest that reports out of personal experience and research, or recruiters who defend the living they make based on marketing slogans.

Also consider that there are always the "exceptions that confirm the rule". There are those recruiters that market less "aggressively", that really care about you, that do visit the practices they represent, that are straightforward about what they are able to accomplish and what they cannot, but that does not change the big picture I am describing.

As much as recruiters may try, as nice or good hearted or ethical or hard working or well-meaning they might be, some facts will never change:
a. recruiters are hired and paid by the employer
b. they charge a $ 20,000 fee for their services and
c. they only get paid after closing the deal.
These facts lead to all the consequences and problems described here. I am not trying to indict recruiters, I am describing the basic framework they practice in.


1. Physician Recruiters are hired and paid by employers to fill a vacancy. They are not hired nor paid by the candidate. This is much more important than candidates think! Their loyalty therefore is to the paying party, the employer, not to the searching candidate. They do not get paid to consider the desires, careers or preferences of the candidates. The candidate is useful as far as he or she fills the job the recruiter gets paid to fill. A recruiter for example will never "negotiate a salary" for you, as some claim. You really think they will go against the employer who pays them and create higher costs for them? When it comes down to it, recruiters are not on the side of the job seekers. They are on their own side: closing the deal and getting paid.

2. Recruiters charge $ 20,000 to fill a position. This is the biggest handicap for recruiters, something that no recruiter can overcome. This creates a barrier to hire them. This places recruiters at a severe disadvantage compared to you, the physician, when you are looking for a job and applying for a position. You come without the price tag and instantly are more attractive.
Obviously you could argue about the significance of those 20K. Maybe the hiring hospital is flush in money and can afford to spend it, maybe they consider physicians valuable enough to spend that kind of money on recruitment, maybe the loss of revenue with an open position is even more expensive, but 20,000 are still 20,000. Maybe the yearly collections of the physician (neurosurgeon) dwarfs those 20K, but to me as an ObGyn it means about 8 complete "9 months of prenatal care plus delivery" and to a family physicians it means seeing a whole lot of patients!

3. 80-90 percent of private practices refuse to work with physician recruiters, since they are very expensive. The usefulness of recruiters in medicine is reduced dramatically by the fact that they cannot reach that 80-90% of the job market - which is most of the private physician job market and pretty much the whole job market in desirable areas.
Keep in mind that 50-60% of physician jobs are filled through networking, 10-30% through advertising by employers on Job Boards and 15-25% by recruiters. What kind of help can you expect from someone who can only reach 20% of possible jobs?
What do recruiters do in response to this? They tell you that those areas are "oversaturated" and try to lure you to under served areas, where recruiters do get jobs.

4. What does a day in the life of a recruiter look like? Recruiters are salespeople and spend their days on the phone. Recruiters spend part of their day cold-calling practices, groups and hospitals to see if they are interested in their services. Then they pay large fees to NTNJobs, eHealthCareers and numerous other Internet boards to post job descriptions. Then they spend a few hours each day cold calling physicians, sending fliers, postcards or e-mails to program directors, specific departments and numerous physicians fishing for applicants.
Candidates will usually respond to recruiters by e-mail, submit their CVs and recruiters then forward these CVs with names blacked out to the potential employers.

Recruiters love to give you the impression that they have resources or skills that you don't possess, yet, once you see what they actually do, you realize that you can do it perfectly well on your own. No, they don't have secret sources in high positions; they just want you to think that. Unlike what they sometimes claim, most recruiters do not visit practices and they do not get face to face with physicians. Usually they work nationally and seeing offices and physicians means travel and would be very time consuming and expensive.

5. Most recruiters subscribe to a background database, usually the NAPR "Job Bank". Paying subscribers store short profiles of jobs and candidates in these confidential, recruiter-only databases. Since thousands contribute to these databases recruitment becomes more efficient due to sharing of resources and combining efforts. "Maybe my candidate fits your job". Fees are usually split between the recruiter who has the candidate and the one who has the job. This is the same model that Realtors use. When a recruiter says "we personalize a search for you", (I love that slick line) he means that he enters your name in the recruiter background database and checks if there is a matching job for you. The only problem is: the whole database is filled with left-over and hard-to-fill jobs.

6. Occasionally recruiters market themselves as "screening candidates and practices carefully" to give themselves an air of quality. Based on my personal experience I doubt this. Screening does not fill positions and only filling vacant positions gets them paid.

7. Recruiters are first and foremost salespeople, not helpers. Given the fact that recruiters only get paid their $20,000 if they close the deal, they are highly motivated to sell.
This explains their behavior:
They contact as many physicians as possible per day, hoping to find the one that can fill the job. They try to convince you that the jobs in "Desirable city" are not so desirable and that the countryside jobs they have actually might be better for you.
Recruiters loose interest in you immediately if you insist on a job in very desirable area or if you are looking for part time jobs. Their chances of getting paid in all these scenarios are very low and therefore the interest in you vanishes.
Because of the pressure to sell and the strong competition, all too often the candidate becomes just a number, a meal ticket, a means to fill the job, to close the deal and get paid.

8. Physicians can easily find 2-5 times more jobs than the best recruiter. Doctors have been the target of marketers for a long time. They are all listed in multiple databases. List of doctor contact info can be easily bought from a large number of sources, some of them in a few minutes online. Check out InfoUSA.com! Since physicians are so easy to reach, candidates do not need any help from recruiters. Medicine actually does not appear to be an appropriate field for recruiters.
Please refer to my blog for excellent information how you personally can find more jobs than any recruiter.
Physicians applying to an employer without a recruiter do not have a 20,000 price tag attached and they immediately become a preferred candidate. Recruiters vehemently deny this in public, but admit it privately. In the end recruiters are more of a distraction and burden to a job seeker rather than a benefit.

9. Recruiters are not "free for the candidate". This is a common marketing myth. Yes, the employer formally pays the fee. This fee is "recruitment cost" and therefore part of the overhead, the expense, caused by the candidate. The employer will recover this cost from the employed candidate in one way or another. Getting a job through a recruiter usually means a lower salary or fewer benefits, at least in the frist year.
Although, the true price of working with a recruiter is less visible and much higher: you get a less desirable job!

10. Recruiters may have many jobs, but they do NOT HAVE GREAT JOBS. Here I have to declare my own bias. I consider jobs in attractive, large cities "great jobs", an opinion that not everybody shares.
No matter if we talk about city or countryside though, the recruiters tend not to get the best jobs. The most attractive jobs are never advertised and are filled by word of mouth or direct mail. The moderately attractive jobs are advertised in print and on the Internet. Only those jobs that employers just cannot fill, even though many physicians look at them and decline, are handed over to recruiters to fill.
Recruiter told me" We get jobs in areas where there are more jobs than applicants" and "The function of recruiters in medicine is to fill the less desirable jobs", and Pam Pohly, another recruiter writes "Recruiters get the hard to fill jobs". Do you really want one of those jobs?
Ask yourself before talking to any recruiter: Do I really want a less desirable job?
After all, why would any employer pay 20,000 to a recruiter if a job can be filled by word of mouth of with $400-800 of advertising in a few journals?

11. Physician recruiters advertise using their own language: "easy access to", "a short drive to" means the locations is 1 to 2 hours from an attractive city. "Easy access to city A and B" is even worse, this job is in the dead middle between 2 separate suburban areas. "A great place to raise a family" means there is absolutely nothing to do in that town. If you are single, you are dead!
Much more important is what recruiters do NOT mention, such as high turnover of associates, low salary, high-buy-in and other hidden drawbacks.
But how can a recruiter find out in a 10 minute phone conversation what goes really on in a practice or hospital? They can't and the candidate is the one who suffers the consequences.
Recruiters sometimes "forget" to mention drawbacks of jobs, since that disclosure would hurt the sale.

12. Recruiters advertise insidiously by masquerading as "job search experts" and "advisers". This kind of marketing is much more dangerous, since it is often not recognized as the advertisement it is. This misleading marketing includes posing questions such as "How do you choose the recruiter that is right for you?” The implication of this question is that there is actually a recruiter that is right for you. Posing this question is similar to "Should I shoot myself in the left or right foot?" NO, you should not shoot yourself at all, and NO, you should not use a recruiter at all!
Often recruiters post tidbits of helpful info on their websites, such as links to licensing boards, short "5 points to improve your CV", but that is all marketing fluff to attract you or to make your CV more marketable. They will never give you advise how to best find a job - outside of recruitment. That would be bad for business and would threaten the basis of their existence. Therefore this info is never complete nor truly useful. In the end is only a means to get you as a client. Nothing wrong with that, you just have to be aware.
Anytime you read - anywhere - that someone recommends recruiters or even considers them a good alternative to networking, you are dealing with either a recruiter or someone who just has no clue about how the job market works.

13. Recruiters are NOT advisers, helpers, career counselors, CV writers or job market experts. They are usually neither qualified nor versed in any of these matters. They may read a lot of CVs, but that does not make them experts at writing or editing them. They will not take the time to go over your CV and advise you. They check your CV mostly for one single question: Can I sell this candidate?
They are not experts in the job market, even though they spend their time trying to fill job vacancies. Recruiters know only a small segment of the job market, the segment that is available to them. Do not trust their opinions in that matter, their opinions are shaped by the marginal 10-20% of jobs they are aware of.

14. Worst of all: recruiters do not disclose their limitations. They will not tell you that they cannot get jobs in desirable cities and locations. They will not tell you that they cannot get jobs with desirable practices. They will not tell you about alternative ways of finding jobs. This is a serious ethical issue - imagine a physician not treating a patient, just because he personally is unable to perform a certain surgical procedure! We send our patients to someone else who can help them. Recruiters never do that. Physician recruiters simply tell you that the great areas where you are looking for a job are " oversaturated". In reality this is a code for "unreachable for recruiters who charge 20K to fill a job". They will never tell you: "Just mail a letter to every doctor in Desirable City and you will get a job", because this might threaten the foundation of their existence. Imagine all physicians just mailing letters to eployers and getting jobs! Instead recruiters tell you "Call back in a few weeks, maybe I have something then". The obvious idea is to keep you as a client and maybe get that commission later, in blatant disregard of what you want and need! I consider this a lack of responsibility towards clients.

Summary: AVOID physician recruiters!

The better way to find a job is a simple and very successful method: mail a letter containing your CV with a cover letter to every physician of your specialty in the area where you want to work. You buy the list of contact info online from e.g. InfoUSA.com, then load it onto your computer and mail-merge it with your cover letter in Word. Voila - hundreds of personalized letters addressed to every single physician in your area of interest. Most successful!!
See my previous blog post for a detailed description.

How can all this come up after recruiters have been serving the physician community for 20 years?
Personal computers and then the Internet have changed our lives. Contact information for physicians, once hard to find and expensive, can now easily selected and downloaded on the web within a few minutes. A PC can easily produce hundreds of customized, personalized letters and the new Internet fax services allow us to fax a letter to thousands of doctors with a few clicks.

That, together with Internet job boards that are becoming easier to navigate and with physicians and hospitals becoming more computer savvy, leads to a future of job searching directly without middlemen. More and more candidates will contact employers directly and
viceversa.

So, what keeps recruiters in business?
It is those employers who sadly do not know how to find candidates and those employers who do not have the personnel to recruit themselves. It is those colleagues who pay recruiter fees, who allow recruiters to pay for their advertising avalanche on the web. It is all paid by us, the physicians! This can change! I have described in detail the know-how that employers need to recruit successfully. Please check past posts in my blog for this.

What happens when you register at the recruiter job bank

The following quote is from the "dochunterdiary.com" blog, written by Jim Stone and Bob Collins, two competent and smart recruiters from the search company Medicus Partners, who work in committees of the NAPR as well. It lists in great detail what happens when you, the candidate, registers at the recruiter tool "World Job Bank". Extremely enlightening!

Here is the blog post. I do not like to quote that much, almost a complete post, but this quote is so full of data that it cannot be shortened without loosing impact.

Start quote:

"A World Job Bank Physician Registrant’s Experience

Ever thought about the kinds of contacts our physicians receive when they register on the World Job Bank?

This will give you an insight into one physician registrant’s experience: Dr. X, a female, board certified internist, registered on the World Job Bank. She wanted a traditional, permanent internal medicine position and limited her geographic preference exclusively to New England.

Within hours she received numerous voice mails and e-mails. Over the course of six and one-half months, she received 189 e-mails from recruiters at 35 search firms and 72 voice mails from recruiters at 20 search firms.

The following is a breakdown of the e-mails Dr. X received: She received 66 e-mails with brief practice descriptions from one recruiter. Of the 66 e-mails, three positions were for geriatricians, one was for emergency medicine, one was for a hospitalist position and 60 were for general internal medicine. Sixty-five of the 66 e-mails were for geographic areas in which Dr. X was not interested. Only one of this recruiter’s e-mails was for a position in New England. Dr. X also received 33 generic e-mails containing no practice information (e.g., “Are you still looking for a position?”). Of those 33 e-mails, six had nothing in the subject line and one recruiter sent a questionnaire for the doctor to fill out (requesting her geographic preferences which Dr. X had just listed on the World Job Bank). Another 32 e-mails were from one recruiter. One of his e-mails described a practice opportunity in Dr. X’s desired geographic area, the remainder (31) gave brief practice descriptions for geographic areas in which she was not interested. Fifteen e-mails were received from a second recruiter at the same firm, none were for the geographic area in which Dr. X was interested. Dr. X received another 43 e-mails from other recruiters which contained brief practice descriptions. Seventeen of the 43 e-mails gave brief practice descriptions for geographic areas in which Dr. X was interested, the remaining 26 were of no interest to her.

The following is a breakdown of the 71 voice mails she received: One recruiter left 14 messages asking if Dr. X was “entertaining practice opportunities,” but did not mention any opportunity. Another recruiter from the same search firm left three voice mails which were identical in wording to the first recruiter’s messages. A recruiter from another firm left 14 messages stating he had a practice opportunity but gave no details and stated he would “take her off his list” if she indicated she was not interested. A recruiter from a different firm left three messages about Dr. X’s supposed preference for jobs in the Chicago area (she only wanted New England.). One recruiter gave brief information about a practice opportunity but didn’t provide a state or even a general geographic area where the practice was located. Another recruiter apparently dialed the phone and forgot, or didn’t realize the doctor’s voice mail was recording. No actual message was left but Dr. X got to hear a recording of the person chewing and crunching on what sounded like a carrot! Thirty-three voice mails contained nothing more than the recruiters’ names, phone numbers and infrequently their companies’ names. Only three voice mails gave some information about practices in Dr. X’s desired geographic location.

To summarize: Dr. X received 260 contacts (both e-mail and voice mail). Of the 260 contacts, only 20 contacts provided information about practice opportunities in her specified geographic location that were potentially of interest to her."

End quote.


I am speechless from the shock that a recruiter would actually publish this. I have nothing to add, except that it matches my personal experience exactly! Dr. X, I feel for you! Since I have this representative story, I can postpone counting and examining the statistics of the response that I have received. You may have read it in my previous posts, I have been looking in one particular Desirable City, where recruiters typically just cannot find jobs. We all know why. Who in their right mind would be sitting in a practice or hospital in a fabulous location and pay a recruiter $$$$ to have a position filled, when a simple ad in a few journals, at NTNJobs and eHealthcareers would bring in dozens of applicants?

The other remarkable point is: Recruiters are in such a marketing and selling frenzy that they simply do not pay attention to what candidates want. Right from the start I found this rude and careless. I always wondered why on earth recruiters did not read my profile and kept on sending me positions that were as far away from my desired city as could be.
Now I know that they are just too busy emailing and cold calling and mailing anybody that leaves their contact info within their reach that they cannot think. It is a selling frenzy.
And by the way, no wonder recruiters have "to work so hard" if they waste their time in this fashion. They spin their wheels for nothing, or worse, they get a backlash. I am part of that backlash, by the way.

My humble opinion: I you do not want to be the next victim of time-wasting spam called recruiter advertising, don't bother using recruiter job banks!

Instead, read my blog for better ways to find the great job you want!

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 InfoUSA.com, WebMD or MMSlists, the marketing arm of the AMA.

I prefer InfoUSA.com. 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 Quintcareers.com. I have personal experiences with Quintcareers.com 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 JBlast.com. 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 TheDoctorJob.com. 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 Doccafe.com 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.

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 Thedoctorjob.com), 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 InfoUSA.com, 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 "thedoctorjob.com" or "Doccafe.com" 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

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 (InfoUSA.com). 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!

More recruiter comments

CEO, Physician Recruitment and Retention said...

For all of you that read this, get ready as a candidate to pay thousands to the "new" search firm called thedoctorjob.com. Actually, the job sourcing they do was invented by and is utilized by EVERY firm that is out there, except that you do not have to pay for it with recruiting firms. Just ask any recruiter out there.

Also, just as he states, watch who you listen to and talk to...having placed thousands of physicians myself and with my colleagues I must admit, even physicians can be wrong.

Lastly most of recruiters are there to serve the following purpose: Do the work you do not have the time to, and do the work as your representative. If Dr. Muenzer is the expert on all recruiters, then I guess he has not talked to very many. The world is full enough of know it alls, and not enough of those that will do all it takes.

Dear CEO Physician Recruitment and Retention,

I am glad to hear a comment to my blog from an actual recruiter.

You are completely correct. The method of sending a professionally prepared CV and cover letter directly to all physicians in your area of interest is old. I started doing it 23 years ago back in Germany. It is being used by recruiters as one of many sourcing techniques, such as direct mail, mass mailing, mass faxing, mass emailing.
That of course raises the question: If you use it successfully why do you never mention it to your customers? Too good for them? Could it be that you are upset that someone is giving out the "secret recipe"?
The method of sending letters to potential employers is probably as old as letter writing itself. To claim it as an "invention" of recruiters seems just a bit short sighted. It reminds me of Al Gore inventing the internet.

I also agree that recruiters provide a service for physicians that do not want to do the recruiting themselves. That nevertheless requires a comment.
Recruiters help employers fill a position. Recruiters usually are called when positions cannot be filled easily through word of mouth or simple print advertising. Recruiters usually do not help physicians search for jobs. They may run a search in their databases to see if a job fits the requirement of a candidate. But recruiters are not hired and compensated by the job searching candidate. Therefore, they do not truly work for the candidate. They do not go out and do mailing specifically for that candidate. They do not help the candidate improve the CV or cover letter. Recruiters recruit for an employer. Otherwise they would be "search agents". Search agents do exist, but are not very popular.

This differentiation between working for an employer or for the candidate might sound like splitting hairs. Nevertheless it is a very important difference: "Whoever pays calls the shots".

I usually teach my residents that they can search actively or passively. With an active search they are in control. Active search includes networking methods such as calling every conceivable contact and talking to every person that is willing to listen to get in touch with a potential employer. Active search means: mailing out your CV and cover letter, faxing it or emailing it to potential employers. Click here to read more details.

Passive search means reacting, reading, listening. This includes reading advertisements, job postings, visiting websites, looking on the internet and also leaving your search in the hands of a recruiter. Once you do this, you are passive, you are responding, reacting, not acting and therefore you loose control and power.

You have to take what you are offered! You do not go out there and get it yourself.
Let me repeat that: You are limited to what is offered to you, you do not go out there and get exactly what you want. You do not create or uncover your own opportunities.

Recruiters love to claim that they "search for candidates". Recruiters usually only search recruiter databases. They search in a database of positions where employers have agreed to pay 20 K to have that position filled. This alone shows that they are not acting in the interest of the candidate. As a candidate I would never dream of approaching an employer with the condition that 20K has to be paid to a third party. That would be completely ridiculous. Imagine me applying to a Harvard hospital stating that hiring me required a payment of 20K. They would refer me to a psych clinic or to their social worker on call. You understand the point?

Mailings cost money. Nobody understand that better than a recruiter. For $1000-1500 I can do a mass mailing myself, for $1500-2500 I can have thedoctorjob.com do it. If I have thedoctorjob.com do it, I am still in command, I still search actively, since they just do the mailing for me. They do not search for me, they just write or improve the CV and cover letter and they have the list of doctors in my target area.
I determine where I search, I call the shots, and consequently, I pay.

And for a whopping $20,000 you can have a recruiter "do the search". Yes, I agree, the physician candidate "does not have to pay it". Formally it does not come out of the candidates pocket. Formally...but the candidate usually ends up paying it anyway. He pays by lowering his chances of getting the job - since he may be competing with candidates that do not come with a recruiter, he may pay by receiving less benefits, maybe even a lower salary. I have commented on that in a previous post. Recruiters do not want candidates to know that. An empployer once said: Sorry I cannot pay you more the first year, since I have to pay the recruiter. After I mentioned this to the recruiter, he answered: "she was not supposed to say that according to the contract". Literal quote!

Recruiters seem so intensly immersed in their recruiter world that they actually seem to believe this "at no cost to you" thing.

The big, huge, overwhelming cost to pay for a recruiter, is that recruiters do not get into the desirable areas. Wherever there are more candidates than jobs, jobs are filled without recruiters. And I have this quote from a recruiter, from one of hundreds I have spoken to. You know it, we both know it: recruiters get paid to fill the less desirable jobs. Period.

And who wants the less desirable jobs?

That is the true price you pay for using a recruiter: you get a less desirable job.

So, you have a choice: Search actively by networking and mass mailing (DIY or thedoctorjob.com) or search passively (e.g by answering recruiter calls) and accept a lesser job.

And, as the last point, I have been in touch with many, maybe too many recruiters by phone and email, nice ones and rushed ones, eager to sell recruiters and more relaxed ones, younger and older ones. In house recruiters, retained and commission driven ones. I think I have seen enough in the 6 or 7 years I have been in touch with them to be able to judge.

Maybe I am not a know-it-all, but when it comes to recruiters I definitely am a know-enough. I might even say I have had enough too.

Your Matthias Muenzer, MD

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 Gmail.com, 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 Indeed.com, one recommendable search engine and others with truly a few clicks. Others that I have on my job search tab are: www.Oodle.com, then http://gjsearch.googlepages.com/ 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 (AHD.com), 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".

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:http://www.wikihow.com/Find-Your-Dream-Career

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:http://www.wikihow.com/Analyze-Your-Skills-and-Job-Options

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 answer...in 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:http://www.wikihow.com/Develop-Your-Personal-Elevator-Pitch"

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 TheDoctorJob.com. They will do it for you for a very reasonable price and will make it easy and less time consuming.

Your Matthias Muenzer

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 Miami...so, 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 www.obgynxxxxx.com 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!