Becoming a Physician Recruiter
Physician Recruiting: Lighting a Gentle Truth
Lighting a Gentle Truth
Q. How to deliver news to a physician that it’s time to retire?
A. Admittedly, this situation came to me completely unaware as an important facet of recruiting. I had the physician’s initial telephone interview successfully conducted to my satisfaction. I had received the doctor’s very impressive resume as agreed and had begun to query suitable clients looking for surgeons at this high a level of accomplishment. This candidate had decades of experience and commanded great respect from his peers and colleagues. There were nothing but good things to say about this physician no matter where I looked.
“So what was the problem?” I asked myself, after receiving courteous declines from clients regarding further interest in my doctor. For the life of me, I couldn’t figure it out initially. Then, some events unfolded that began to reveal the underlying cause.
In time, and against my wishes, the physician mailed me a hard copy of his complete curriculum vitae, totaling 70+ pages, after already having in hand via fax his more concise version of approximately 20 pages. I began to compare the two versions and the answer was rising to the surface clearly. The additional 50 sum odd pages were not so much career related as they were health and fitness related. For instance, several of the pages included documentation of a very recent life insurance policy issued for a million dollars, thus proving the doctor’s excellent condition of health at an advanced age in the upper 70s.
No one before me stood up to explain to this excellent surgeon that the time had come to move on with his life and enjoy his retiring years ahead outside the operating suite where he had spent his entire medical career. I realized that, aside from possible age discrimination issues that were understandably not disclosed to me by his references, there was an issue of deep intimidation preventing others before me from sitting down with the surgeon and having this conversation. No one wanted to put themselves in that position. When I realized the degree to which this fine candidate had gone to in pursuit of a practice opportunity, I felt far more decent humanity than I did run of the mill professionalism. This was not just another doctor I was job hunting for. This was a matter of compassionate, humility-filled truth telling. I simply had to be the one to admit to this doctor what was going on and why it had been so hard for him to get the attention of anyone before me.
At no time did the physician ever mention that others had attempted to tell him to consider retirement before now, and there was not a single hint of the doctor brushing off well-intentioned people. This surgeon, fully immersed in his career, had been blinded by what he loved, and he absolutely did not see what was staring him right in his face. It was one of the most difficult conversations I’ve ever had, in or out of recruiting.
The doctor and I spent a lengthy conversation discussing not only what he might do at this juncture in his life, but why he didn’t recognize his situation for what it was. This was a man who had no earthly idea what to do with himself outside of the active practice of medicine. He didn’t golf. He didn’t socialize. He didn’t have any recreational diversions and his life instead was completely dedicated to medicine. He wasn’t married any longer, having lost his wife some years before, so there was literally no one to counsel him on all the “what nexts” there might be in store for him upon retirement. Athletes typically receive much clearer signals regarding stepping down and moving on to other pursuits. Not so much in medicine. Usually, physicians find other pleasures to occupy more and more of their time before it comes to this crossroad, realizing that facing such a task is not something they wish to do, so they take necessary steps ahead, often with reluctance and regret, but steps are taken nonetheless. Such was not the case here I’m afraid.
Looking back years ago to the time this experience unfolded in my lap I see how I could have made one additional effort on this physician’s behalf. I was immersed with other things and didn’t think much about the longer term prospects for this surgeon. What I should have done was take steps to befriend this fine man beyond the point where our discussions brought us by staying in touch with him periodically for the foreseeable future. The next time something like this confronts me, you can bet I’ll do just that.
Physician Recruiting: Should a Doctor Sign an Agreement With a Recruiter?
Q. Should a doctor sign an agreement with a recruiter? I've come across this issue in various forms over the years. Here are some thoughts on the subject:
A. The cardinal rule should always be "read before you sign." That being said, I don't ask my physicians to sign agreements with Staffphire because I don't think it's ethical for a contingency based firm to contractually obligate its physicians when the firm itself is not equally contractually obligated with its candidate-seeking clients in terms of exclusivity. Retained firms, as in the field of executive search, are another matter perhaps. Further, I caution each physician to take great care in signing agreements with any firm or entity.
Some physicians come to me with agreements already in hand, signed with other recruiters, and I always offer to review the agreement with them to delve into what it actually obligates the physician to, or bars him/her from doing for a certain period of time. My primary emphasis is on the level of trust established between a physician seeking a new practice and Staffphire rather than pursuing contractual obligations compelling the parties on matters of performance and proprietary sourcing "possession". Without trust as the essential element, it doesn't matter what agreements have been signed prior to coming to Staffphire seeking practice opportunities.
Lastly, I believe it to be imperative for physicians to keep a log of who/when/where their CV has been sent to. Disregarding the value of such guidance does more damage overall than placing your signature on an agreement with a particular firm, generally speaking. If a firm requires exclusivity, it should be at the physician's request only. Otherwise, don't sign anything. Period.
Physician Recruiting: Placement Timelines
Many are attracted to the field of recruitment because of the significant fees per physician placement that are offered by client hospitals and medical centers that do not have the resources to conduct search efforts internally. There are many reasons for this, and some of them are policy based while others are situation based. This is a subject for another time because I’d like to specifically address the approach I take to assessing the total calendar time it takes to successfully place a candidate.
The main advantage to a client hospital when speaking about contingency-based firms is obvious. There are no out-of-pocket fees paid for recruitment unless a viable physician candidate is sourced, signed and begins employment. Thus, it doesn’t cost the client a dime to contract with a handful of firms that operate on a contingency fee structure. Personally speaking, the advantage to business on contingency for the recruiter is that I’m actually being paid for work done rather than for work promised, and that goes a long way toward satisfying my ethical goals. It’s an unbeatably positive and uplifting feeling to know that something difficult, complicated, time consuming and valuable has been accomplished when that check arrives in my mailbox.
From the beginning, when I initiate a search for a physician I don’t make any assumptions regarding how quickly I can make the placement. This rule stands true whether I’m conducting a search for a client hospital or whether a new doctor has contacted Staffphire seeking job search assistance. The rule stands true both ways.
The longest amount of time it’s taken me to place an active physician (not all physicians in my office are actively looking for jobs at a given time) is two and a half years. Now I might be asked why on earth it took 2.5 years to make that placement, but remember what I said earlier…the field of search is difficult, complicated and time consuming. Suffice it to say that the candidate was actively, earnestly looking the entire length of the search and there was no foot-dragging on his part.
The shortest length of time it’s ever taken me to place a physician is three weeks. Now, here’s where the placement timeline approach that I use comes in extremely handy. Taking all the physicians whom I’ve placed in my years in the field and averaging their individual placement times, I arrive at a number that tells me how long it takes in a calendar year to place a typical candidate. My personal number is 10.4 months. That means that I can expect to earn a fee every 10.4 months and no sooner. This number is crucial for my company in terms of planning and budgeting. There are peaks and valleys that must be endured and without this number I am lost. Without it, there is no guarantee that my work methods will sustain me during lulls that are out of my control.
My placement timeline number is not a guarantee that I will receive a check every 10.4 months, however, and it is good to recalculate the timeline number annually. It is also helpful to compute numbers for every three years in business, and every five years, etc. I have found few other tools that are truly worth their time and effort as much as my placement timeline calculation. It comes in especially handy when explaining the business of physician recruiting to those outside the field, including lawyers, bankers, investors and accountants. This 10.4 month mark I’ve set in stone has saved me numerous times from unnecessary expenditures and I consider it key to remaining in business, especially when things get tough.
Physician Recruiting: Whose Side Are You on Anyway?
Whose Side Are You On Anyway?
I get this question fairly often from the well-meaning but curious-minded segment of people I come across who would genuinely like to know whether I favor the doctor or the client hospital during a given search. After all, it is the physician who will ultimately be accepting the offered position and without whom there would be no placement and thus no fee earned for my services. Yet it is the hospital that is actually the party paying the search fee so by all rights my tendencies should be to lean in the client’s direction, especially in critical matters and at crucial times during the placement process.
My response is simple. I prefer to take the position of the Swiss in terms of neutrality. In a perfect world I favor both parties equally based on a number of factors including forthright intentions, responsiveness to the matters at hand, flexibility, practicality and a willingness to compromise. Ideally, when these factors are present in the requisite amounts, then both parties rightfully deserve and respectfully receive complete fairness and neutrality across the board.
What happens more often than not however is, in varying degrees, something else entirely. The hospitals I have the best working relationships with are those which place a very high priority on physician recruitment and retention. There are many priorities that C level executives have to face both long term and short term on an ongoing basis. There are quality standards and compliance issues to continually enhance and safeguard. There are the members of the board of directors who must be kept apprised and satisfied. There are personnel issues and matters of finance that must be dealt with by highly skilled people who report directly to the CEO and yet, among all these importances, recruiting remains key and the CEO makes it their business to stay on top of physician searches despite all other pressing matters with the exception of isolated, true emergencies. The dollars at stake compel the successful Administrator to pay close attention to their hospital’s recruitment efforts and I for one, take this very, very seriously.
Hospitals often have no idea when and where their next successfully recruited physician may come from. The very best Administrators I’ve had the pleasure of working with know to be nimble and to react decisively when a viable candidate surfaces, and such CEO’s are extremely proactive, having the systems and support staff already trained and in place to fulfill their roles when a viable candidate appears on their medical center’s radar.
On the opposite side of the physician recruiting fence stands the doctor who is hopefully as serious about their job search as the hospital is in recruiting them. The physicians most successful at job searches are those who make their search as high a priority as the Administrator at the medical center and understand that the role of the recruiter is vital, especially in terms of constructing and maintaining open and clear communication links between the parties involved. Physicians who are only half-hearted in their job search efforts will unfortunately receive only half-hearted results.
Physician Recruiting: Walking in Another's Shoes
Walking in Another’s Shoes
One point of interest worth writing about is the fact that most of my recruiting is done by telephone. I work across the country and meeting face to face with my hospital clients is both impractical and unnecessary. Because of this, I’ve become fairly proficient at building long distance relationships with people I may never meet in person. To this day I have clients whom I’ve never had the pleasure of physically meeting. I come from the school that teaches the value of a handshake and of direct eye contact, so adjusting to this has been challenging to say the least. What keeps me moving forward with skills development in the category of long distance productivity is reminding myself how busy my clients truly are and how much they themselves rely on the telephone to accomplish many of the items on their agenda. This is not to mention how little time an executive could offer to someone who makes it a point to meet one on one.
In order to become effective at meetings by telephone I’ve developed some techniques that I consider valuable enough to pass on to anyone who takes the time to discover them here. First, I make sure that I am in the right frame of mind to make the call. My head is clear, my mood is upbeat and my attention level is set at 100%. I will not make phone calls without these prerequisites in place. Second, I make sure the environment encompassing my office is stable for at least the next hour or so. That means that my neighbor to the right of me hasn’t decided to crank up his lawn mower next to my window and the neighbor’s kids to the left of me are through with their outdoor pool party.
Third, I refresh in my mind our last conversation by reviewing the notes I regularly keep and which I consider invaluable for maintaining relationships that are as productive as they are cordial. A good rule to keep in mind is that the first conversation with a hospital administrator is usually based to some extent on luck. The second conversation with said administrator has no luck at all involved. Administrators may be caught on the phone initially, but if they sense their time is being wasted they won’t ever allow that mistake to happen a second time. I cannot emphasize this point enough. Make this mistake and you’ll be banished to the land of voice mail for eternity.
Fourth in line, and the last puzzle piece to have in place before dialing the telephone, is visualization. I often keep my eyes closed for long periods of time when speaking with clients because I want to concentrate fully on what is being said and absolutely nothing else. Looking at things in and around my office while having a conversation is a distraction I cannot afford. Another component involved in visualization is slipping my feet into their shoes. I imagine what their desk must look like at any given time, and how many stacks of important papers line the top of it in addition to anything involving recruiting, which, of course, is the entire purpose of my call. Administrators are the best jugglers I’ve ever come across, and I take my cues from them. If they’re making the time to talk to me, then I’ve got to give them in return my very best.
Physician Recruiting: The Fight is in the Trenches
The Fight is in the Trenches
In my early recruiting days I mistakenly thought that placing the very best physicians I could attract meant that their backgrounds had to be both stellar and spotless. I was under the assumption that doctors who had malpractice suits in their work history were to be steered clear of because this somehow meant they were less than excellent in their performance. The example I have to illustrate my error comes from a debt of gratitude I owe to an Orthopaedic Surgeon who shall remain unnamed but kindly took the time to set my thinking straight before he chose to never speak with me again. The lesson I learned was so instructive that I’ve since changed my position on the matter of malpractice suits 180 degrees and now hesitate to work with candidates who brag about never having had one. What a turn around this has been for me to say the least.
On the surface, a physician who has one or more malpractice suits must somehow have questionable proficiencies. This seems logical at first glance. I mean if you see a car on the road that has obviously been in a few fender benders what would you assume to be the case with the driver? Not on par with the best on the road would be a clear and initial assumption. But fender benders are not a fair comparison to doctors with malpractice issues and here’s why. Fender benders occur when one or more rules and laws are disregarded. If every driver obeyed every single rule at all times then, with the exception of an act of God, there would be no accidents on the roads. The traffic laws were designed for drivers to obey and when they’re broken the results can vary from minor mishaps to catastrophic outcomes. Car accidents are sad and inconvenient to say the least, but are 100% avoidable if the rules of the road are followed to the letter.
At this point, malpractice suits become a very different matter. Because of the value of the lesson I learned years ago, I pay close attention to malpractice issues because they are often part of the package when great physicians are working under less than ideal circumstances. In other words, more often than not, physicians take on difficult cases for the love of medicine despite knowing of the increased risk of a lawsuit because the patient may not be in optimum condition for a procedure. I’ve come to admire these physicians and I press hard with my hospital clients to look at our society for what it truly is, and that is one where we are free to sue anyone over anything we choose and it’s up to the courts to throw out the frivolous among them.
Speaking in terms of surgeons specifically, the majority of them have the guts to agree to a procedure with a patient who is in less than prime condition because they know that the alternative would be no surgery at all and that presents greater risks to the patient in the long term. Surgeons who work in the trenches where the circumstances are almost always less than ideal are the real heroes in my book and for this discovery and all its resulting benefits I owe a debt of thanks to just such an Orthopod who made it his business to insure I got truthful news from the front.
Physician Recruiting: Only 24 Hours in a Day
Only 24 Hours in a Day
I work with physicians practicing every recognized medical specialty out there and I really don’t have a favorite that I enjoy placing over the others. However, I do have a favorite personality type and I’d like to focus on that type of physician here.
Not every physician wants to be in a position of having to look for a job. Let’s face it. There are many circumstances where life happens while you’re busy making other plans (thank you, John Lennon) so it’s not the reason a physician is job hunting that I’m concerning myself with here. Rather, it’s the nature and demeanor of the person behind the medical degree that I’m speaking about.
Somehow, over the years the majority of physicians I place are married with children and I’m assisting them in a cross country move to a town or city they’ve never lived in before. Moving an entire family is more complex than moving a single human being who happens to be a physician seeking employment, but it does have its benefits. One of the finest benefits, admittedly not readily apparent perhaps, in moving a family is that of having a second opinion, namely the opinion and input of the spouse.
The spouse’s contribution to a job search is crucial. For one thing, the wants and desires of someone you are married to weigh at least as heavily as any other single factor in a successful search. The spouse is often the one who relays information to the physician candidate, especially during times when the physician themselves is unavailable (after all, duty calls). But more importantly, the spouse gives me an additional perspective on the wants and desires of the physician seeking the job change and this second source of input raises the degree of accuracy I depend on to make decisions vital to the progress (and thus the outcome) of the search.
I want to know who is and who is not on board with a job change. I work best with physicians who know it’s a headache to be caught in the middle of a job search while running a full-time practice but they do it anyway because it’s imperative.
I work best with physicians who understand that although I am not a physician personally, that’s not why they’re working with me. I want physicians who make themselves available when I call, and in turn I give them my word I won’t waste their time when I do. I find it a pleasure to work with doctors who know it’s best to speak about job changes outside the office where they are free to speak candidly. Accordingly, they make the extra effort of using their personal time to speak with me in order to accomplish their goal when they could more easily be spending time with their family. They see the benefit in this from the beginning of our working relationship and that insight is something I truly respect.
In contrast, I find it very difficult to work with physicians who think it’s a waste of their time to spend more than five minutes on the telephone with a headhunter, when, after all, it’s they themselves who contacted me in the first place.
Just as a physician can only see so many patients in a given day, so can I only work with a given amount of physicians at any one time. The more flexibility and attention a physician invests in their job search, the more I as a recruiter can add to the equation. There are only 24 hours in a day and all the parties involved have to decide for themselves how best they would like to spend them.
Physician Recruiting: What is a Resume?
What is a Resume?
In terms of physician recruiting, a resume is additionally something else beside a comprehensive and much-sweat-over bulleted list of professional accomplishments, achievements and training that’s taken years if not decades to compile. It is a calling card of introduction that says, “Hello. I’m Looking for a Job!”
That’s what a resume says to me the minute it lands on my desk. Nothing more. Nothing less. I won’t discover much of anything beyond what is in writing at this stage, and it is exactly what is not in writing that concerns me as a recruiter. A successful placement is about what is not on the CV. Until I precisely know those things, then for all practical purposes I don’t know much at all. So the very first thing I do after reviewing what’s in my hands and reading it (not every recruiter actually reads resumes believe it or not) is place a call to the physician and make them aware that “Yes, I’ve received your CV and could you please give me a return phone call now that I’ve got it, thank you very much, Sincerely, Philip at Staffphire.” After all, what the doctor wants at this point in time is entirely different from what they’ve accomplished, no matter how current and timely their resume might be and how many years it’s taken them to aggregate their achievements.
I am quite serious about this. Other recruiters may assume they’ve got a placement right around the corner from the moment a physician’s resume enters their air space. I prefer to hold off on the excitement throttle until I get a good look at what prompted the physician to forward the summary of their hard work to my attention. “Why now?” is perhaps the first question I’ll need the answer to. What factors caused the physician to push the “Send” button emailing their CV as an attachment at this given point in time? And I’d enjoy knowing the long answer to this question rather than the short answer if you respectfully wouldn’t mind, Doctor.
Sometimes red flags fly before a search gets any traction. “Why does your resume list your home address as Billings, Montana when the area code I’m dialing to catch your voice mail is Reno, Nevada, Doctor?” Questions like this are responsible for getting to the truth behind any interest in changing jobs. The answers to such initial questions go a long way toward discovering the underlying intentions behind a physician’s inquiry, which, as I mentioned, is what the arrival of a resume actually is at the beginning stage and little else.
I’ve received absolutely stellar resumes from physicians who seem to spend more time sending them to recruiters than they do practicing medicine. I’ve also received CVs with almost no relevant information on them outside of a name and an address. This raises concerns that the “real” curriculum vitae is not available for review and I have to ask myself why on earth that is.
Truthfully speaking, the value of a resume must be shared equally by the sender as well as the recipient. I can tell a lot from reading through a high quality CV about the intentions of a job seeking physician all the while knowing that not every recruiter out there invests the same time and effort reading the fine print as I do. You get out of something often what you put into it and the investment of time and attention put forth by a serious-minded physician toward a job search, including the initial presentation of their resume, will almost always reap the dividends he or she is hoping for.
Physician Recruiting: The Interview
Physicians don’t really know where their CVs actually go once they put them out there. It is the hope of the majority of them (at least in my experience) that resumes aren’t sent anywhere without their express and prior approval, but this is often not the case. The subject of sending out resumes is to be saved for another time, so I mention it here exclusively for the purpose of what happens with a curriculum vitae in my office after I receive it, namely the candidate’s interview.
With note paper and pen in hand, the physician and I have already agreed to a scheduled in-depth conversation by telephone at an appointed day and time. Setting this appointment took place when the physician returned my initial call making them aware their resume had arrived in my office. This is not voice mail ping pong or telephone tag. Nor is it any waste of valuable time. This is relationship building from Step 1.
During the hour or so that it often takes to have a productive and thorough conversation, much is discovered about the physician’s wants and desires and much is explained about the process of resume presentation and tracking. This telephone meeting is about getting to know each other as people as much as it is about filtering through the details of professional medicine to discover what has transpired to drive the physician to the point of sending out their CV.
Over time, I’ve assembled a sheet of questions that is always right in front of me when interviewing a doctor. I ask many various questions that cover every topic from personal and family background and history to what their favorite recreational activities are and how often do they get to enjoy them. Discussion of this list of questions is to be saved for another posting, so I mention it here because it becomes the most important sheet of paper I now have on the physician beside their CV. I make dozens of notes while conversing and I’ve learned to transcribe them for legibility as soon as possible after the conversation ends. Otherwise, I can’t always decipher my own handwriting and I want things written out clearly while still fresh on my mind.
It’s what happens with the contents of this questionnaire after the phone call is completed that I want to specifically address here. Namely, a summary of my interview is prepared and attached forevermore to the candidate’s CV. I cannot emphasize this step in the process enough. The physician’s resume absolutely does not leave my office without the written and summarized interview attached. I don’t thoroughly understand why many of my peers refuse to go to this extent before presenting a resume to a client. For one thing, a resume is primarily an announcement from a physician that they’re job searching and not much else. For another thing, why on earth would I want to leave all the work involved in discovery up to the hospital administrator or the facility’s physician liaison who already have enough work to contend with before my candidate’s resume came along?
What I haven’t touched upon yet are the benefits to me as a recruiter that are worth their weight in gold every single time I complete an interview summary and include it when presenting a CV. Let me give you just one of them here. Imagine how crowded with pressing issues a hospital administrator’s desk is on any given day. Next, try to visualize the stack of CVs also occupying their desk that come in from the host of firms the hospital CEO has chosen to contract with. Now, somewhere within that stack of resumes lies the one forwarded to them by my office. When the Administrator finally sets aside time to review that stack of CVs, which one do you imagine they will elect to review first? The one with an interview attached or those without them?
Physician Recruiting: Welcome to the Neighborhood
Welcome to the Neighborhood
How long does it take for a newly arriving resident of a community (in this case a physician) to get an accurate pulse on what life in their new hometown is going to be like? I believe the answer varies depending on the individual but one thing that almost always adds to the complication is the amount of hyperbole involved in marketing lifestyle and amenities to attract outsiders. In other words, I don’t think I’d be a very good real estate agent. I tend to weigh in with the flaws as much as the advantages because anything else smacks of blatant sales tactics rather than statistics and I happen to be a statistics sort of fellow. I want the data that backs up what I’m selling otherwise I can’t sell it. I want the pluses as well as the minuses of living in a particular town, regardless of its size. Most of all I want to believe 100% in the community as I present it to a prospective physician and their family.
It seems that every practice opportunity’s locale has excellent outdoor activities and is nothing more than a short jaunt to the nearest major airport. Restaurants, shopping and amenities are all in excess of expectations. Schools are great, neighborhoods are comfy and weekend getaways are as diverse as they are exciting. The entire package is presented as if it’s going to be non-stop fun for the entire family all year round and there is a plethora of attractive brochures to back up these advertisements.
The expectation of a high quality of life pressures not only real estate professionals to resort to overly optimistic sales tactics in my opinion, but also causes recruiters to make the same sorts of claims in their job postings. This is one reason why I refuse to mention community attributes when posting practice openings. Add to that the fact that every job posting begins to sound like another and what you end up with is not much more than a lot of fluff to wade through as you sift for accurate, detailed information.
There is no such thing as a storybook community any more than there is a Ken or Barbie waiting in the wings for a perfect placement. I want to see what is behind the glossy sales pitch. I want to look under the covers and beneath the hood. I want to see a scratch and a dent every now and then that tells me this community is real. Every locale has had its share of good and bad times and without discovering at least a sampling of them, then I’ll remain skeptical, thank you very much.
One thing worth the dollar investment that goes a long way toward balancing the seesaw in terms of gaining an accurate perspective on a community is purchasing a year’s subscription to the local paper and addressing it in the name of the physician. A second task I’ll undertake, albeit cumbersome, is contacting the chamber of commerce and having them send to my office their customary pile of printed materials that they would much prefer to send to the doctor directly but I absolutely refuse to allow it. The price I pay for this is a file cabinet full of useless brochures, sometimes multiple copies of said brochures, but having my office become the responsible party for sifting through the literature is a rule that has proved itself invaluable time and time again.
Physician Recruiting: American Dreams through an Immigrant's Eyes
American Dreams through an Immigrant’s Eyes
One evening about nine years ago my son, Tim and I went out for Chinese to a restaurant in Dallas, Texas called BoBo China. What I’ve always enjoyed about eating here, beside the excellent food and service, is the plastic food on display in the lobby when we walked in. I always get a kick out of seeing an array of menu items tacked up on walls and rendered as brightly colored artificially appetizing replicas of what we’re likely about to order momentarily.
What makes this experience a relevant story is that our waiter was a physician going through the grueling training of an intern for the second time and working his way through American medical school (virtually all over again) at BoBo China to do it.
Every once in a while I have the extraordinary opportunity of seeing firsthand what resilient and determined physicians endure in order to achieve their dream of eventually practicing medicine in the United States. Because of the way visas are structured and allocated among the many countries making up the world we live in, it’s by no means a walk in the park for a medical student in one country to fulfill their wish of practicing medicine in ours. Often, a physician in their country of origin has to immigrate to one of a handful of countries other than the U.S., and once there be forced to go through portions of their training all over again in order to hop, skip and jump through visa hoops around the globe to eventually gain entry to America and admission to its medical schools. These physicians end up becoming some of the most highly trained doctors in the world.
Such was the case with the physician waiting tables at BoBo China. He had already completed his medical school training in China but wanted to practice medicine in America. The laws vary greatly from country to country, and regarding the issuing of visas from China, he was denied the opportunity of coming directly to the United States, so he had no choice but to opt for an intermediary stop of several years in Great Britain. Once there, he had to find complimentary programs that were closely aligned with his individual goals in medicine and additionally had to make sure that he was enrolled in programs seamlessly back to back so that his visa did not expire, sending him back to China.
Tim and I were extremely fortunate to have an extended conversation with this fine man in between the courses of our meal. What remains the most memorable is the overwhelming humility and gratefulness in his demeanor, having finally achieved his twelve year dream of arriving in the U.S., and being now only a few years away from having completed all the necessary steps in his training to become a full fledged practicing American doctor. This physician-to-be had an aire of genuine appreciation surrounding him that was fragrant and powerful, not to mention unfamiliar to my son and I as two fortunate Americans born and raised on U.S. soil.
Tim has a memento from our dinner that evening at BoBo China. Our waiter took the additional kindness of his time to write out our check in Chinese and give it to my son to keep as his way of expressing thankfulness for the pleasure of our meeting. An event as memorable as this one is sure to be permanently etched in our minds and remain there long after we’ve forgotten what it was that we actually decided to order. Dinner became the vehicle that delivered Tim and I firsthand to the threshold of the American Dream. Wow!
Physician Recruiting: The List (Or, How I Got into Physician Recruiting)
(Or, How I Got into Physician Recruiting)
Once upon a time I began to draw up a list of traits and obligations I did (and did not) want in the perfect business venture as I envisioned it. My personalized list of prerequisites if you will. The list was informal, resting on the backburner in my head, while I went about the affairs of making a living day-to-day …and looking over my tax returns year after year.
It must be noted here that I am essentially two things, if I were to describe myself informally over a cup of coffee. First, a family oriented fellow. Second, a workaholic. Carving out a white collar career that embraces these two personalities (and aspects of my nature) remains, to this day, extremely important to my personal and professional happiness, and, after all, happiness is written into the Constitution so its pursuit is fundamental. I don’t think there would be much disagreement with that from anyone.
My formal background lies in commercial and advertising photography and pictures have always been my first love professionally and personally. Most of the finest people I know are in advertising and I am fortunate to have as friends some of the greatest and most talented photographers, art directors, graphic designers and illustrators on the planet.
Long before physician recruiting made its appearance on my horizon, I spent many years in and out of full-time photography. This, primarily because what I happened to be pursuing visually at various points in time was not always something I could figure out a way to support a family with despite a bachelor’s degree. For instance, between the years 1987 and 1991 I fell in love with documentary photography and there were no jobs in that field, so, I worked full-time as an inside salesman in the camera department at Sterling Jewelry and Distributing Co., in Dallas (a family owned department store and now defunct) while I studied new ways of seeing and capturing situations. You get the idea. Keep in mind this meant I had to walk away from the money-earning work I was doing at the time, which was primarily industrial location photography for brochures and annual reports.
Another field I’ve always been associated with is sales. It got me my first job of running a newspaper route in Port Chester, NY from the age of eleven through fifteen and got me through high school selling men’s clothing at Byram Clothes on Main Street (now defunct as well, unfortunately). After my several years working at Sterling’s, I was most fortunate in working for Procamera, also in Dallas, where I spent close to ten years as an outside sales rep. I also moonlighted as a health and life insurance agent and dabbled in financial services during portions of my time in outside sales.
Once I discovered Physician Recruiting, my intention was to work it part-time and keep my small photography studio going part-time in tandem, but that’s a story for another posting. Right now I’d like to focus on how I found recruiting and why this is important enough for me to share with you.
I encourage anyone reading this post who is contemplating a career change to consider drawing up a list of likes and dislikes as I did, because, quite simply, it works. Not to mention that after building my recruiting company I came across an article in the (now gone) Dallas Times Herald (Dallas used to be a two-daily-paper city) about two Harvard Business School graduates who spoke about what they learned when selecting the right business to go into, namely, make a list.
My list, which I’ll share with you here in a moment, wasn’t realized until I was forty three. I mention my age at the time for two reasons. First, I didn’t go to Harvard Business School, I instead went to the non-accredited Graduate School of Life at Hard Knocks. Second, I want to emphasize the years of experience I’d already accumulated that prepared me for this next business venture.
The list as I remember it goes something like this:
· No college degree. I already had a college degree and didn’t have an interest in a second one. This was especially true after my application to Southern Methodist University’s MFA program in photography was denied circa 1986.
· No licensing. I didn’t want to invest the time and effort in earning any additional licenses, regardless of what they were. I’d already been licensed to sell life and health insurance and had studied for a while to be licensed in several Securities series, which I later abandoned. Anyway, I’d had my fill of licensure.
· No inventory. I wanted to warehouse zero inventory. I’m a service salesman rather than a product salesman at heart, and maintaining inventory meant keeping track of it and investing dollars into it, neither of which was I inclined to enjoy doing. This is not to mention the constraints of available storage space and the reality of turning the family sedan into an all purpose transport dolly. No thank you.
· No franchise. The good ones were out of reach in terms of dollars and besides, I didn’t want to face paying renewal fees until I could afford to hang out a shingle under my own name.
· No outside office. My son, Tim was born in 1988 and since then my goal was to office from home. I got into a heck of an argument with my manager at Procamera to do just that circa 1990, rewriting my job description from inside to outside sales. This meant that I would have a manager’s meeting every Monday morning at ten o’clock for the rest of my years at Procamera, but it was worth it. As long as I achieved my sales goals my schedule was my own. Being a workaholic meant that if my office wasn’t physically in my home, then I would almost never be there, and that would mean missing the entire growing up of my son. I grew up without a dad and I wasn’t going to deny myself the privilege of being there for everything from homework to school trips to soccer games to days out sick and trips to the pediatrician.
· No extended travel. What good is having an office at home if I’m always on the road I ask you?
· Low start-up capital requirements. Perhaps this is not a concern for everyone, but for me, raising a family meant capital was hard to come by and harder to hold on to. Having to invest substantial sums of money into a new business simply wasn’t in the cards.
· Low overhead. It’s one thing to have low start-up costs; it’s another serious consideration to keep the monthly overhead manageable as well. This meant being able to budget wisely and realistically, which goes without saying.
This list still has a pie-in-the-sky feel to it without having already developed the following skills and attributes (here are a few of my favorites):
· A strong ability to build your own structure. In other words, there are only two ways to earn a sustainable income. Build the necessary framework to generate a living wage by answering completely to yourself, or, have a boss tell you how to manage your time in exchange for a paycheck. You either create your own structure, or have someone else create it for you.
· Develop a high degree of productive self-discipline.
· Believe 100% in the product or the service being offered (i.e., being sold)
· Focus on bottom line results and master the art of multi-tasking.
· Develop an ability to flex your focus from small details to the larger picture and hone this ability until you can do it effortlessly and by second nature.
· Possess leadership skills and use them effectively, even if a sole proprietor.
· Keep your level of ethics and degree of integrity high. This refers to morals as well as work ethic.
Periodically, over the years I spent developing the above list of likes and dislikes, I would go to seminars, read the business section of the daily papers and browse through business magazines at the bookstore. It was one day while reading classified advertisements in a business opportunity publication at Borders Books in Dallas that I saw a 3-line classified ad for physician recruiting.
This simple ad caught my attention to such a high degree that it literally jumped off the page and went straight for my eyes. I never looked back. I went home, did a lot of inquiring and investigating, and after much trial and error, built my company. Physician recruiting fit 100% of the requirements I’d been looking for and making the list as I’ve described it here is the reason why. Not to mention an article in a now defunct daily newspaper about two gents who graduated from Harvard. Incidentally, their list lead them to the successful ownership of a string of long term care facilities in Dallas Fort Worth and who knows where else by now.
Physician Recruiting: People 101
I lost a high school graduating classmate yesterday and his passing reminds me of why I am so deeply immersed in a people-oriented business. There is an underlying thread that runs like a vein of precious metal through all my daily tasks. My setbacks and achievements, while some minor and others major, some noteworthy and others less than so, are all connected by one core and central goal: Relationship Building. The great majority of colleagues and peers I have the good fortune to be associated with are scattered across the country, each busy building their individual framework and singular version of a meaningful life. The clients and physicians, esteemed in their own right, offer me the privilege of serving them that otherwise would be denied me and sorely missing from any other career I might be pursuing.
Regardless of how caught up in particular situations I may become at a given time, the force that drives me to succeed is the opportunity of building strong bonds between my physicians and myself, my clients and myself, and all the various vendors and service people I have the pleasure of working with and whom I refuse to take for granted through the assumption that they will always be there tomorrow morning, regardless of time zone or area code.
It was no small or coincidental reminder that I was made aware of Howard Bernfeld’s passing by a posting on Facebook yesterday, the very day he died and probably within a matter of only hours by loved ones, family members and those closest to him through the years. Rather, it was a huge reminder that we live in a world of contrasts where we are more interconnected than ever before and in more ways and with more devices than ever before as well, yet more distant from each other in terms of more than simply miles. How is it that immediacy of availability seems to correspond in lockstep with its degree of takingness for granted (my own term to coin here)? I have no clear answers, and perhaps it’s best left to poets, philosophers and statisticians in sociology. But it is something definitely worth pondering.
Not every physician I work with is going to become my best friend anymore than each of my 400+ high school graduating classmates has become my best friend over the past four decades. But the chance is always there. The potential for what lasts is always present. That’s what I love about this business. Most of the people I work with on a regular basis are many miles away, and often little reminders come along that tell me the reality of not ever meeting face to face is high. Relationships are built over the telephone and that makes the bonds especially valuable to me. I don’t often have the opportunity for a handshake or to look someone in their eyes when we speak. So the weight of what is said somehow increases in importance. Figuratively and literally speaking, our words are all we’ve got. They’d better be good.
I’ve always believed in knights and armor. In doing the good deed and fighting the good fight. At the end of the day, despite my idealism, I know there is a bottom line that is achievable, worthy and satisfying. Howard, from what I’ve discovered, fought the good fight to the very end of his life, and incidentally, fifty eight years young is far too early to leave this world in my book.
Placing doctors gives me a strong sense of accomplishment that I haven’t found in endeavors of years and decades past. Keep in mind it’s more than simply about the money. That’s something that stands on the practical, I’ve-got-to-make-a-living side of the fence, which, quite frankly, doesn’t offer much beyond material satisfaction. I believe the grass is indeed greener on my side. The side where I stand comfortably assures me that the most recent physician I’ve placed is, by proxy and by profession, going to fight the good fight for me every single time they take on a new patient.
Yes, I have retained the inner child. I know there is war and there is peace. I know there is good and bad and right and wrong and humility and egotism and heroism and cowardice. I also know I’m squeamish at the sight of blood and don’t belong anywhere near an operating suite, yet I place doctors right smack in the middle of them in exchange for a living wage.
My hat’s off and my prayers are with you, Howard. I apologize for not making the effort over the years to know you any better than I did. I know you were in the Port Chester High School Marching Band and we graduated together in June of 1972. I know you have an older brother Bill and that your dad, Arnold Bernfeld, was heavily involved in Scouting and looked handsome and commanding with his beautifully carved pipe. He was also a merit badge counselor I am proud to say I worked with when I was a Boy Scout on my way up the Scouting ladder toward Eagle.
There is an Orthopaedic Surgeon here in Minneapolis Saint Paul by the name of Dr. Scott Anseth. My fiancé, Judith and I call him the Boy Scout because of his cheerful, upbeat and no-nonsense way of practicing medicine and more importantly because of his excellence in knee replacement surgery, which Judith underwent going on two years ago. Now, I get truly lightheaded at the thought of replacing a knee, and I’ve seen enough YouTube videos to know I would pass out cold in the surgical suite. I’ve learned I’m as close to medicine as I can get without fainting. Physician recruiting gives me everything I need as long as there is a strong, fresh pot of coffee in the waiting room.
Physician Recruiting: Booted to Tin Duck 2.0
Booted to Tin Duck 2.0
I have a favorite example of taking things for granted. In this case, it was clients being taken for granted by a web designer who shall be allowed to romp freely in the land of the anonymous. Here, however, we’ll name him Glen and our little Glen was tinkering with the goose that laid the golden egg. The one goose, mind you, who was doing just fine on its egg-laying own, thank you, Mr. Good Fortune, very much.
Now Glen had carved for himself a little ol’ niche. Pretty as a baby’s bellybutton. He discovered he could build inexpensive, one-shot websites for what seemed to be an endless stream of willing clients (yes, me included) with anxious money in hand. He could do all this mind you, for a lot more money than he could earn by delving into the finer points of web building and adding more complex (i.e., time-consuming and thus money burning) features. This tale, incidentally, refers to my first incarnation of a physician recruiting website, circa 1999. Now at about this time, say about two seconds after launch, I began to ask for enhancements and upgrades, that being the time I discovered this fellow wasn’t into bells and whistles. His thing was to build the dadgum “she’ll load in a jiffy” website for ya gosh darn it, then move on down the internet road with the little bit of html code he’d learnt real good.
The huge, lurking mistake I’d like to point out here is not that Glen wasn’t into bells and whistles; it’s that he didn’t fully understand client development.
I believe there is a correlation between what we take for granted and what has lasting worth. At times I think they are in direct opposition to each other, or maybe it’s just me who has faulty thinking at the times when I think they’re on parallel tracks. How about this. The more we take something for granted the greater assumed worth it has. The less we take something for granted the more actual worth it has. To put this another way, the more we take our clients for granted, the greater the loom of disaster when it strikes…and it will.
The ancient wonders of the world have come and passed. They were the magnificents of their day. Four were destroyed by earthquakes: The Hanging Gardens of Babylon. The Mausoleum at Halicarnassus. Colossus of Rhodes and the Lighthouse of Alexandria. One by pillaging and fire. Another by dismemberment (i.e., scrapped and used for parts). Can anything we do exceed the grandest of what exists on such a scale, and yet they’re gone? Of the seven, only the Great Pyramid at Giza is still standing.
On the surface, there was nothing wrong with building simple websites for a voluminous number of willing clients. After all, Glen had more business than he could handle at the time. That is, until one day when the lure of a much bigger client attracted his attention and he switched gears from building one-shot websites to doing graphic design and page layouts for a large catalog company wanting to outsource and go digital. Now he was up to his eyeballs in work (i.e., deadlines) and was making a ton of money until he broke his leg in a motorcycle accident and was laid up on the LazyBoy for a few months. The catalog business wrapped up with him hopping around on crutches, but they left, dissatisfied because of missed deadlines due to his broken leg. By this time, his one-shot website business had gone elsewhere and he had no additional experience (he never did put in the necessary time and effort to learn those bells and whistles) to offer clients whose websites he’d already built. Glen was deadset against repeat business until this misfortune caught him by his short hairs. He then became a believer but it was too late. Glen ended up going to work in-house at a catalog production shop.
So what comes with lasting worth you ask? Truly, from what I’ve learned it is that which you do for others. Glen didn’t want to add a page view counter to my home page because he didn’t know how to and didn’t want to invest the time and effort to learn. Now adding small features like this could have aided him greatly (i.e., saving his bacon) when the time came to go back to his one-shot clients and reconfigure their relationship, starting, incidentally, with an apology.
We take relationships for granted. Common as table salt whence salt was reserved for kings. Back in the time of Ishtar’s Gate, before the Colossus was built. Salt was a slave’s dream building the eighth gateway to Babylon, now not standing either and among the seven.
What do we know has value? Who do we hold in high esteem? Why are we obsessed with the immediate when builders take their time? How much steady, how much structure do we intend to put into relationships we envision lasting?
What we have is now so much than rather what we take for granted. Giving is something we can always do. What is precious? What is priceless? What is timeless? What’s forever here on Earth? What gift is of ourselves? Find these things and give. We leave a trace of us behind calling it legacy. We read the metro section and we’re glad it’s not come near us. Are we valuing our clients right now? We watch the evening news and say a prayer from the living room couch. Value your clients. Be selfless. Be passionate. Be an enthusiasm generator. Take the bus to work tomorrow and pay the fare of the man behind you. Love what you do.
Clients don’t swim in an endless stream. Don’t take your waters for granted. They are not like stamped tin ducks on an endless chain at the arcade. You can’t knock ‘em down like there’s always gonna be another standing in line. Be there for your clients when you’re asked. Lend them your hand. Do for them that favor. Lift your finger when it costs you and don’t count up the tally. Walk around the block. Get to know your neighbor. Throw the ball back in the schoolyard for heaven’s sake. Get to know a stranger. Get to know your clients. Be the same man in your suit as you are in weekend shorts. Answer the door when it is knocked upon. Buy popcorn and Girl Scout cookies. Don’t become the stodgy grouch you once swore you’d never be. Befriend thieves to walk with angels. Take in a stray. Stop waiving the neighborhood children off your lawn. Give away your dry umbrella in the pouring rain.
A fool sees himself eternal. The ancient wonders of the world have come and gone. By any means, in exchange for all you have received, by every means give. Give your knowledge as if onyx and opal. Give your lessons as if amber and tiger’s eye. Give your grace like diamonds. Give it like pearls. Value your clients. So what comes with lasting worth? Truly I tell you it is that which you do for others. Value your clients above everything. They are the magnificents of our day.
When good fortune stares you in the mirror give your thanks. Don’t hold back on the greatness of your stores. Value your clients. They are like precious stones. They come like ice when once it was drawn from ships by horses. They come like spices to your table from across the seven seas. Hold your clients dear to you. Make an imprint. Make an impression. Make an impact. Make it lasting. Don’t be the pearl diver in the bath. The valuable is selflessness. Exchanging all the lasting for the fleeting brings the realization they are the same. Like a Lincoln penny, they are heads and tails of each other. I used to place coins on the railroad track. Hot and flat and as thin as they could get and still two sided. Can’t have one without the other and are we, in all our importances, as thin? Church starts on Monday morning, friend. Walk your sermon.
Physician Recruiting: The Swan and the Wire
The Swan and the Wire
To see a swan fly at night is a beautiful thing. White feathers against the glow of a street lamp, wings stroking the air with its curving, long and graceful neck. So striking. So elegant against darkness, lying like a theatre backdrop behind it, in a moonlit envelope. I was at the age where, if not a school night, my father would let me stay up wide awake, late enough waiting for him to come home. He was a doctor.
I was watching this silent marvel of a bird gliding low above main street in my hometown when out of nowhere it struck a wire it could not see, strung across its flight path, wrapping around it with all its power accumulated, snapping its neck, a twisted white pretzel, crashing to the ground with an awful thumping sound into a heap only something dead could fall into and keep that lack-o’life still. I wanted my father there. He was a doctor after all. If he would’ve been there he could’ve saved that swan – my swan – at least as I believed it then.
I was taken by this experience so much so that I remember the vividness of it to this day, sitting here to recollect it onto paper. A uniformed policeman drove by in a squad car not more than a minute or two later and he stopped, got out of his patroller, picked up the entirety of it and tossed it, in a bulky, lifeless heap, into the dark of his back seat. Off he drove and main street was again an open thoroughfare with traffic none the wiser that would soon enough be coming right along.
Dad made house calls in the years when they were common and well in order. We don’t see that custom much anymore, a sad report. It’s a bygone thing. A relic of the past likely not to return. Children crying from a hike in fever and Dad taking their temperatures and giving them penicillin. Shots in the bare bottomed seat of their pants - they wouldn’t want the needle’s stick but it had to be done and that was that. Dad was quick in a jiffy about it. To dry their tears he’d give the child a lollipop or a wrap of taffy from his jacket’s pocket. If dad had bandaged my swan he’d be as good as new I thought…before the days when I received instruction it wasn’t always to be so. Dad wouldn’t learn of the swan until he got home. He was on call that night, delivering a healthy baby boy in the earliest hours I counted after midnight.
I told him all about it over percolated coffee plus we split a baker’s Danish. Dad would drink his black while mine had lots of milk and sugar. Mother would turn it on then head off to bed the nights that father was on call, and wait to hear the details the next morning. Dad never let me play with the tools and things he carried in his bag. “These are tools and never toys,” he’d say before he’d wrestle me into bed. He showed me his stethoscope and the thermometer he used. He had a squeeze ball like contraption with a cuff he used for blood pressure and a box with vials of medicines for all kinds of different ailments.
I remember one night that Dad came home; it seemed later than all the times before. The sun was coming up while he was telling me about a man who was very ill and had been sick for a long, long time after getting injured at a factory job. Dad was quiet in his tone. I felt somberness drifting through his words. I’d never seen my Dad like this before, though I learned later that Mother had always been there for him, with coffee and her hand to hold. Dad said, “The hardest part is not blaming yourself when someone you’re caring for passes on.” He said that “sometimes no matter what you do you can’t give your patient what they need most.” “Why not!” I thought, finding life that very moment to be unfair. “Learning to let go is something I struggle with to this day,” Dad told me. “Like my swan?” I asked my Dad, with some elementary semblance of comprehension. “Yes, like your swan, son,” my Dad responded, if ever in a gentle tone it was that night, as he tucked me into bed and sent me with good wishes for a sweet dream off to sleep.