David Liu, D.O.
David Liu, D.O., made a positive impression on an in-house recruiter through thoughtful communication. – Photo by Frank Graziano.

Many physician recruiters have decades of health care experience, postgraduate degrees and certifications needed for our many roles with hospital systems and large employers. The “hat” that is most important to you, the candidate, is our role as gatekeeper.

We make the critical first screen decision about which CVs meet the search criteria, and we advise practices about when, and if, they should make an exception to those criteria. We are the timekeepers, “pinging” our medical directors and practice managers to get those calls made, and we share opinions about which candidates merit urgent attention and which belong on the back burner. The recruiter does not make the final decision, but the recruiter supports the decision makers with observations, data and history that often carry weight in the selection decision.

You can improve your chances of getting an offer for the job you want by understanding your gatekeeper. When you present yourself as a physician with common sense, good communication skills and willingness to help us connect the dots on your candidacy story, that gate is more likely to swing open.

The old saying that you only have one chance to make a first impression is still true. Today, though, your first impression is most often digital, captured and saved in a relational database, forever a part of your record with that employer. Today’s recruiters can see the history of your interactions not only with one hospital, but also with their colleagues throughout the hospital system.

This longitudinal record helps candidates who present themselves well and comport themselves professionally throughout the process. For candidates who stumble, the quickly shared information can lead to a perplexing series of dead ends. To have a successful job search, follow these tips.

Who’s who in recruiting

In-house physician recruiters

In-house recruiters are employed by the hospital system to assist practices on the medical staff. “In-house” is often a misnomer; we are often officed in regional or market offices, or remote/virtual offices. Almost always, in-house recruiters live and work in or near the area for which we are recruiting. We spend time in the hospital, and we live in neighborhoods where physicians in this practice and med staff tend to live. We pay our mortgages with our salary, supplemented by bonuses that align our efforts with the hospital’s most urgent needs. We are overhead expense for the hospital system, and our cost-per-physician hired runs $8,000 to $15,000.

In-house recruiters only help practices that hospital administration wants to support. If a practice lands itself in “time out” with administration, search support may be indefinitely on hold. Your CV may not ever get to a practice that has a job to offer unless the practice leadership’s alignment with the recruiter’s hospital is strong.

While we do have favorite candidates, in-house recruiters are focused on helping the hospital attract and land the candidate who will have the greatest positive impact. We are part of the strategic development process for our hospitals. Our paychecks depend on our relationships with our hospital executives, and we tell them everything—positive and negative—about the candidates on the slate.

Contingency physician recruiters

Contingency search firm recruiters work with hospitals and groups on a contract basis. They function much like realtors—paid a fee for services by the employer “buyer” according to a contract. Fees typically fall in a range of $20,000 to $40,000 per physician hire. A contract stipulates they will be paid $X if a candidate they introduce is hired, shows up and works at least a stipulated time period, usually six months. Contingency recruiters’ income is tied to how many candidates they place.

A contingency recruiter may be your most motivated coach because the firm only gets paid if one of their candidates lands the job. They may revise your CV, improve your formatting and layout, correct your grammar or typos and advise you every step of the way.

Highly desirable cities don’t need to pay fees to attract candidates. Hospitals and groups in any area that lands on “Best Places to Live” lists get plenty of candidates without paying additional fees. You need to go directly to employers in competitive markets.

Retained physician recruiters

Retained or hybrid recruiters (retainer fee + a fee if placement is made) work on contracts secured by their search firm. The employer pays a retainer to cover costs of search, plus expenses. When/if the search closes, a final payment is due upon the physician’s start date.

Retained recruitment is typically the most expensive path for a hospital or group because they are paying for the recruiters’ time. Employers weigh the retained search expense against the more dire risk of not filling the position, especially if the specialty is needed to keep the service line open. Retained firms are more common for rural and small-town searches, or otherwise very difficult searches. Why? Those hospitals do not have enough searches annually to have in-house physician search. A retainer fee ensures a recruiter’s time is invested in pitching this specific job to find the needle in the haystack.

Retained recruiters are often extremely skilled, highly trained salespeople. They are tasked with getting physicians to see the advantage of a taking a job in a place that otherwise hasn’t been successful in recruiting candidates. That’s why they call you about places that are seemingly unrelated to the preferences you listed.

A retained recruiter’s firm is being paid for their time, but the profitability of the search declines with passing weeks. They want the candidate signed as quickly as possible and may push you to be available to interview on short notice, to decide quickly, and for the hospital to get the contract finished. Their needs and yours align as long as the job really is the right fit.

As rural hospitals and groups often rely on retained firms’ recruiting expertise, the firms play an important role in setting administrators’ and hospital board expectations. You can thank your retained firm for educating the executive suite about why that big sign-on bonus is important to get you to take a chance on their community.

Be consistent

It is perfectly fine to tailor your message to a location, but do so with the knowledge that recruiters in other markets (health care term for a metro or geographic area) are likely to see that email juxtaposed with your explanation of why you are interested another location.

For example, a resident who writes to a coastal recruiter that her family loves warm weather and is only looking at locations within 20 minutes of a beach needs to undertand that that email will be in a database adjacent to her email to a hospital in the same system in Denver—1,300 miles from the nearest beach. The family may love to ski, too, but doubt about the family’s fit with inland locations can’t be undone.

Be explicit about when you’re available

The most dangerous shortcut on a CV is omission of the end date of training or a job. Residents and fellows leave off the end date, trusting readers to know how many years that fellowship requires. Medical directors and practice managers often speed read, and CVs often get separated from cover letters. Both your CV and your cover letter should explicitly state when you are available to start a new job.

Don’t lead with money

When a candidate asks about compensation in the first email or within seconds of opening a conversation, red flags fly. Follow the recruiter’s lead and wait until compensation comes up in the natural flow of conversation. As the recruiter explains that the compensation structure is A+B+C, it is perfectly acceptable to ask what the first-year compensation range looks like. Or, you can introduce the topic after you have determined that you like what you hear about the practice, hospital and position scope. Try: “Most of the positions I’m looking at are falling in the $X to $Y range. Is this position similar?”

Be truthful

Lying in order to secure a job interview will start the relationship on thin ice. If discovered, a lie can eliminate you from consideration for any other job with that hospital system—and maybe worse.

When a candidate applied for a position at a hospital more than an hour away from the home they were building, the recruiter knew the long-term potential wasn’t there and declined an interview. A few weeks later, the recruiter received a PDF scan of a builder’s home purchase agreement in a much closer community. “Will you set the interview now?” the physician asked. But the PDF looked odd. The font didn’t match, and the address was askew. The candidate had copied and pasted another address to a purchase agreement to make it appear the new home was close—and with that, any potential to build trust was lost.

Disclose early

If you have something that could impede your ability to secure licensure, get credentialed or obtain medical malpractice coverage at normal rates, your recruiter needs to know immediately. Candidates sometimes delay disclosing, perhaps in hopes of having a chance to interview before the practice finds out about an issue. That tactic always backfires and makes those candidates look deceptive.

Physicians who are direct and honest with recruiters have the best shot at earning our advocacy.

One physician quickly earned my trust and respect. Due to an awful domino chain of bad luck and missed timing, the candidate was suddenly unemployed. But the physician answered all of our questions even before we asked and his references were quick to respond, so each member of the decision team was able to get to “yes” in short order and welcome him to the team.

Take direction if you’ve requested advice

When you ask a recruiter for feedback and help, act on what they tell you.

One resident had been trying to get a job in our area, so I provided some feedback on the presentation of his CV and cover letters. He contacted me again recently, promising he had worked on his CV, but forwarded the same document he has sent me four times in two years. It still looked unprofessional; I did not forward it to the practice.

Caryl Bowers with St. John Associates, a contingency search firm, had a different experience with a candidate she worked with this year. The candidate had been looking for months without any employers showing interest. Bowers helped the candidate revise his CV to display his versatility and breadth of skillsets. “I presented his new CV and narrative to a number of hospitals,” recalls Bowers, “and within a day, he received phone calls from three interested employers.”

Resist the impulse to argue or complain in an email

It will end up in the record of your candidacy. “End-run” the recruiter only if you understand that the lead physician is going to send your email straight to the recruiter for verification and rebuttal.

Most commonly, an end-run is the nail in the proverbial coffin, ending the candidacy as the decision team compares the complaint with the record on file. You don’t want to come off as defensive or discrediting of the staff’s selection process.

Use the cover message field to connect the dots

Online job boards have a free text field for you to communicate to the employer. Use that space to explain why you are seeking to live and work in that area, and confirm that you have the skillset the position requires. Tell the recruiter if you have family in the area, or if your spouse has a job lined up there. A brief cover message targeted to the job is much more helpful than a page-long missive about how well you think you have been trained and how much you care about patients. A candidate who writes, “I’m prepared for a fast-paced, high-acuity inpatient environment” is simply expressing an opinion. The one who writes, “I’m spending my chief year in a 600-bed Level 1 trauma center where I typically have 15 to 18 patients per shift on my service” is using facts to demonstrate that she is already comfortable in a facility similar to mine.

Don’t rely on voicemail

When reaching out to recruiters, a voicemail is fine as long as you also email and attach your CV. But voicemail is often the last thing we check because 99% of important communications come in via email, team chat apps or text.

In-house recruiters are bombarded with voicemail from search firms and vendors pitching candidates and services. We get wrong numbers and cold calls and inquiries about specialties we’re not recruiting. I get voicemail from retired physicians trying to figure out how to upload a CV and from wrong numbers.

If you do leave a voicemail, be sure to spell your name and be very specific about the reason for the call. Cite the specialty and the affiliated hospital. The recruiter you are calling may have 50+ open searches at seven hospitals, so a message asking if “that” search is still open wastes your time and theirs.

Stay in touch with your target employers

Internal medicine PGY3 David Liu, D.O., has been pitch-perfect in his communications about a hospitalist job in Denver.

Liu sent a beautifully written cover letter. “I am aware that you are currently looking to fill immediate openings,” he wrote, “but I would love to introduce myself right now.”

His cover letter was full of specific details about his program that demonstrated that he would be extremely well-prepared to hit the ground running. He sends me an updated CV when there are significant additions, such as starting a moonlighting job. He’s not waiting for the group to fly him in for an interview; rather, he lets me know when he’s in town for a family visit in case we could squeeze in a brief meet-and-greet. Liu is extremely respectful of my time and asks when he should be back in touch in order to avoid overcommunicating.

“Dr. Liu,” I asked, “how did you learn how to ‘handle’ me, the in-house recruiter, so effectively?” He answered, “I just know that Denver is a highly competitive city. That means that even with a strong CV and ties to the city, I have to be proactive with my top choices in order to make sure I am on that candidate slate when a position finally opens up.”

Our timelines did not sync up this time, but Liu’s effective communications ensure that he will be quickly at the top of the candidate slate when the time is right.

Know that we’re rooting for you

Once you have successfully run all the gauntlets and settled into the community, there is nobody cheering and singing your praises louder than your recruiter.

We get ridiculously teary-eyed and happy the first time we hear “our” recruit paged overhead or featured on a facility website. One more physician who is happy, busy and thriving in the right job means we’re doing our job well.