Dr. Armus’ practice is in what many would describe as the far north Chicagoland area, or south of Milwaukee in Racine, Wisconsin.

His practice is robust because, like virtually every other area in the country it is under-served with respect to dermatology.  The benefit for Dr. Armus is virtually unlimited patient demand and a leverage with payers that allows him to get paid at least 50% more per patient than his metropolitan counterparts.  Not to mention Steven’s home is probably three times the size of a home in the city and half the cost.

The downside… Dr. Armus has to drive 30 minutes to get to Milwakee  and 45 minutes to Chicago.

So, in recruiting for Dr. Armus who do we target? We target recruit to early career dermatologists who are done being paid in proximity to the beach, (or rather the “The Loop” or Rush Streeet if they’re already in the Chicagoland area).

Does your practice fit the profile of Dr. Steven L. Armus?  If so, give us a call at 512-280-6810 and we’ll consult with you free of charge on how to recruit to your practice and conduct a thorough analysis of your goals/prospects for recruitment.

Note: Article has been written with the permission of Dr. Steven L. Armus

Dr. Steven Armus founded his practice in 2000. Dr. Steven Armus has achieved the distinction of fellow in the American Academy of Dermatology. He is a member of the American Medical Association and the Wisconsin Dermatology Society. Steve Armus is Board Certified in Dermatology and prides himself on the level of care he provides in both general and cosmetic dermatology.

Read more about Steven Armus and if you happen to think you’d like to join a practice like Dr. Steven Armus’ and you have all the requisite board certifications, then please be sure to contact us ar 512-280-6810 and we’d be happy to make the introduction.

Steven Armus

It was not long ago that I had a relatively successful physician recruiter, not affiliated with Integro Healthcare, ask why we still had recruiters making cold-calls or “dialing for doctors” as we like to call it. For those unfamiliar with where this question comes from, I will provide a little background

At one time, a physician recruiter was nothing more than a person willing to open the phonebook and make as many calls as possible per day in order to source potential candidates. Gradually, over time, as technology increased the physician recruiter’s reliance on the phone decreased. Mass snail mail and email gradually took over as the preferred method of candidate sourcing, not to mention the influence online job boards has had.

The most drastic decrease in use of the phone occurred immediately after the “dot com” bubble burst and overnight there were thousands of IT recruiters out of work and looking for other industries to recruit within and, quite naturally, many of them made it to physician recruitment, spawning a whole new race of beings who believed a physician could be effectively recruited almost entirely through use of the internet.

There are arguably both pro’s and con’s to this rise in technology as it pertains to physician recruitment, but call me old fashioned because I believe there is no substitute for phone time with both your client and potential candidates. The rapport that has to be built in order to be an effective recruitment strategist and consultant to your client, as well as a career counselor to your candidate can just not occur entirely or even largely through email. Your computer can only serve as a convenience for brief communications, but never as a substitute for proper discussion and negotiation.

Perhaps you think my stance is axiomatic and I merely laud the use of the phone for posterity sake. Maybe that’s some of it, but the numbers also support my stance; that is, once you scrutinize them a bit more closely.

So, admittedly, in our firm and in most firms email is the primary vehicle for candidate sourcing. In other words, of all the physicians placed last year by Integro physician recruiters, the number one method the candidates were initially sourced were through our pretty amazing email distribution list and proprietary method for mass emailing. For many, that stops the argument right there. However, being into metrics and a bit of a numbers geek, I chose to delve a bit deeper and speculate as to if there were any other ways to gauge viability of a sourcing method.

I posited that while sheer number of physicians placed was of course a great metric for the efficacy of a particular source, I decided that the ratio of physicians placed to the number of candidates who responded initially to a particular method would also be quite telling.

Here’s what I found… a non-training candidate sourced by cold-calling (defined as CV sent in response to phone inquiry by physician recruiter) was almost 10 times more likely to take a job than someone who merely responded to an email. I exclude training physicians on purpose, because they are much easier to reach by phone than practicing physicians and they will send their CV to virtually anyone who asks the right way. Now, of course, in the time it takes to make 10 phone calls you can send out 10,000 emails, but still there is something to be observed and learned.

When you source a candidate through the phone, they aren’t going to hang up, fire up their computer, update their CV and then email or fax you a copy, lest they be very interested. However, responding to an email with “how much is the base?” or “where exactly is this opportunity?” is not very time consuming.

Also, there is the undeniable factor that the rapport built when connecting with someone on the phone is just much superior to any email sent. If you can effectively engage a candidate initially over the phone, then you have earned a bit of their trust, whereas you may have almost done the opposite with an initial email contact with how much spam and fraud is brought to us courtesy of the internet.

Furthermore, is the golden candidate who is a busy physician who is quite happy with where they are, but always wanted to get home to (fill in name of community you currently are searching for here) more likely to be trolling the job boards and checking email? Or is that stance more often taken by itinerant physicians who have no real idea where or why they want a particular job?

This is just food for thought, as I would never espouse a lack of email/internet use in candidate sourcing. It has proven to be quite effective. However, it is my stance and those of the professional physician recruiters at Integro Healthcare that those who choose to augment their online sourcing methods with old-fashioned phone calls will go from the “relatively successful” title I gave the non-Integro recruiter I referenced in the first paragraph, to the elite recruiter status which is the only status acceptable within our firm.

As an aside, while writing this, a candidate did just text me that he is sending a signed contract to my client. Oh well… I may have to figure out how to express my enthusiasm for their decision in 160 characters or fewer, but I’ll take it.

At Integro Healthcare, we pair the best of modern technology with the attributes and methods of successful veteran recruiters so as to most effectively leverage our superior resources. Please call 512-280-6810 or contact us online by filling out the form below to setup a time to discuss further.

Since our physician recruiters are really more like group practice consultants than mere headhunters, we go beyond consulting with you as to the immediate financial package offered to a prospective physician candidate and we actually help you structure the totality of the deal, to include buy-in arrangements for down the road, if needed.

Physician practice buy-in is a topic robust enough to have its very own website itself, but I will try to tackle it as best I can on this physician recruitment website, which is going to require several installments…this is part one and contemplates those practices offering immediate partnership.

On Buy-in / Part 1 / Partnership from Day 1!

I would say that at least once a week I have to advise either an existing client or a prospective client that they are looking to add a partner, as opposed to an employee (or independent contractor), entirely too soon. Very often the conversation goes a bit like the following:

“…and honestly to sweeten the deal we’d even be willing to offer the right person partnership from the very beginning,” says Dr. Doe.

“Why would you do that?” I reply.

“Like I said, to sweeten the deal for recruitment purposes…also, we don’t want someone to just work here for a year and then leave”

Let us scrutinize this interaction a bit further. At first, Dr. Doe says the immediacy of partnership is premised on the notion that it will help their physician recruitment endeavors. Then, when pressed a bit further, he reveals that it’s also based upon a concern that a physician will leave sooner than ideal, with ideal often being “ever.”

Let me first ask something of the reader. Have you ever heard of any other industry where such a notion is advanced? In other words, have you ever heard of two bakers who just met going into business with each other?

So why would a physician do it?

The only thing worse for a physician or group of physicians than being overworked and undermanned is being in the position where you wish you were once again.

While the wrong physician added to the practice on an employed basis can have an absolutely ruinous effect, the wrong physician added to the practice on an equity basis is even worse. Having to dissolve a partnership agreement makes parting ways exceptionally more difficult.

That said, if you are truly unhappy with a physician candidate you recruited or, conversely, they are truly unhappy with your practice, a partnership arrangement is not going to keep anything together. It’s just going to make the split more challenging. Really the best thing to promote a successful, long term relationship is to do your due diligence on a person ahead of time which is something a professional physician recruiter or physician recruitment team can help you with.

But honestly, there is no substitute for time spent with a person and most people can hide their bad habits for at least a few months to even a year before their true self emerges and it’s not until then that Dr. Doe above knows whether or not the person they have hired is “the right person” and therefore someone they want as a business partner.

I will say that often a client of ours has different, much more altruistic motives in offering partnership form day one. Very often we deal with older, financially secure physicians who have no desire whatsoever to make any money off of the professional service of another physician who joins them, but rather they just want to recruit to provide for the continuity of care for their patients, for continued employment for their staff and for the sake of perpetuity of their life’s work.

Therefore, they offer partnership because they want their newest addition to reap all financial rewards of their hard work. That’s wonderful, but it does not necessarily follow that such a thing requires any sort of equity sharing. Profit sharing does not require ownership. If you’re really that serious about not making any money off of them, why not bonus the individual to the degree where they take 100% of their respective revenue minus their respective overhead?

I must counter this article by saying that I am sure there have been plenty of scenarios where an immediate partnership arrangement worked out swimmingly and we even have a client that is probably the most successful dermatology group in all of Illinois that offers just such a thing and has it organized to where it is not problematic. But this is the exception to the rule. Generally speaking there should be some sort of partnership track. How long? I will save that for the next article.

As professional physician recruiters who have dedicated their professional careers to physician recruitment, we advise our clients on a number of matters including issues related to buy-in. If you’d care to talk with us further about such an issue, please feel free to call us anytime at 512-280-6810. or please fill out the form below.

by Bo Claypool

First off, let me begin by giving nothing whatsoever but a rave review for the Medical Group Management Association (MGMA). They are truly an excellent organization dedicated to the furtherance of medical groups and healthcare in general. They provide an exceptional amount of resources and guidance to a number of physicians, healthcare executives, administrators… they work hard to benefit pretty much everyone under the sun involved in healthcare delivery. Please in no way think this article is intended to besmirch the MGMA. This website is predicated upon promoting discussion and presenting different points of view and they may not always be accepted by all or any, but it’s just the way we happen to feel.

Here’s a little background regarding the MGMA and it’s relevance to the physician recruitment industry. They publish the most thorough and well used tool for the evaluation of physician compensation (not to mention compensation for a number of other healthcare positions) that many practices use to not only devise compensation structures for their prospective physicians but they also use in revisiting a practice’s compensation structure for their existing physicians. The annual publication is very intuitively laid out, both by physician specialty and by region. It really is the very best publication out there for this purpose. That said it is inherently flawed, as are all compensation surveys and they tend to overall reflect lower figures than what is accurate.

“Of course a physician recruiter would say this,” you say… “they want you to inflate your offer to prospective candidates as much as possible to make it as competitive as possible and therefore their chance of success is that much greater.” While this does admittedly occur within the physician recruitment industry, it is not actually what is behind this criticism of the MGMA numbers (you will see it is actually a criticism of all compensation surveys; the MGMA’s is just the most well known to physician recruiters and administrators).

The MGMA numbers are derived the same way all physician compensation surveys are. They are dependent upon and extrapolated from raw data provided by survey respondents. Now let me ask you this: When it comes to responding to a survey, which practice is more likely to have the time to fill out a lengthy questionnaire? The bustling practice, bursting at its seems with activity and revenue or the practice with a little extra down time that provides for doing things like filling out surveys? The MGMA has seemingly picked up on this and they added the enticement of giving the fairly expensive annual report for free to those practices who complete the survey in order to try and get greater response. But again, I ask you: Who is more likely to care about getting free books? The busy practice with deep pockets or the slower one?

It’s seems fairly intuitive to me that the MGMA numbers as well as any compensation survey that depends on respondent participation is going to be skewed in favor of the slower practices and therefore the practices whose physicians make less and therefore the numbers will overall be lower. That said, if you keep this in mind the MGMA numbers are still very useful. Just realize they might be a little low.

As professional physician recruiters, we realize you may not have any idea as to how to formulate a compensation package that is both competitive but also financially feasible. Insofar as you want us to, we will assist within this process and would be more than happy to talk with you whenever so either call 512-280-6810 or fill out the form below.

by Bo Claypool

I tend to take a stance on the so-called physician shortage that is quite unpopular within the world of agency physician recruiters. While there is obviously some degree of scarcity present, which I demonstrate below, I really think it is to an extent exaggerated and a concept propagated by agency physician recruiters to engender fear in recruiting entities so as to create the notion that anyone who chooses not to use an agency is doomed to failure.

I’ve been very frank with prospective clients who I don’t think need the expertise of the physician recruiters at Integro Healthcare to fill their position in telling them just that, though that’s not to say that these people won’t still benefit immensely from the use of qualified agency physician recruiters. I will get into in this further in another article, but long story short, since qualified physician recruitment agencies lead to greater candidate acquisition due to superior resources and because the true goal of exceptional and effective physician recruitment is not just to get a warm body in the door, but rather to find a long term and perfect match for your opening, the use of an agency firm makes rather practical sense even for those who don’t necessarily need to in order to merely fill their position. But I digress… the point is that not everyone needs us and that is fine and not a reason to scare people into use of your services. I take umbrage with use of scare tactics and I don’t think the situation is a bleak as the salesman for some physician recruitment firms would have you believe.

No, I think if you want to see a true shortage in healthcare look to nursing. But again, that’s not germane to the discussion at hand. I do, however, think it is appropriate to say there is not a wealth of physicians like there used to be. Let me show you an example of what I am saying… quickly just glance at the picture below and without closely scrutinizing the intricacies determine what you think I have provided a picture of…
If you’re like me, upon first glance, you probably assumed this is one of the physician recruitment pages that list job openings in one of the many publications geared toward physicians… and you’d be wrong. While this is in fact taken from the publication for the American College of Chest Physicians, it is taken from the January of 1987 issue and it is not for “positions available,” but rather for “positions sought.”

If you look closer, you will see that most of these are ads placed by fellows in their final year of training looking to find a position; very much like anonymous singles ads, where anyone interested in the candidate replies to an anonymous PO Box, as though these physicians are almost ashamed that they have to resort to this. Do we ever see this anymore? Never. In fact, these days a Pulmonary Critical Care fellow like the ones describing themselves above are literally inundated on a daily basis by recruiters looking to place them. I think this speaks volumes as to the change in supply versus demand of physician candidates in just 22 years and furthermore is certainly evidence in favor of the argument that there is a degree of physician scarcity present.

That said, just because there isn’t an overabundance of candidates to the point where candidates have to put out “want ads” for jobs, it does not necessarily follow that we are therefore in a state of horrendous shortage either.

Let me propose an alternative… let’s say from an epidemiological standpoint there is at least a sufficient number of physicians to cater to the incidence of disease in our society. However, let’s also suppose that physicians, like other educated professionals with the financial means to do so, by and large prefer to live in major metropolitan areas. Therefore couldn’t it be the case that this imbalanced distribution of physicians leads to a dearth of qualified physicians in more rural areas, but to actually a saturation in major cities?

Sure it’s possible, and I also recognize that I could be flat out wrong. The validity of this theory also will vary by specialty. But still, I just don’t think things are as bad as some would have you believe. Maybe it’s just because me and my firm have had such success redistributing the talent to where it’s really needed that I feel this way.

Regardless of your practice’s setting, please feel free to call and discuss with us how the physician shortage has or has not affected your recruitment goals. We can be reached anytime at 512-280-6810 or by filling out the form below

by Bo Claypool

If you are already familiar with the concept of what tail coverage is please feel free to skip to paragraph 4.  If you are in the role of physician recruiter or in the process of recruiting a physician and are unfamiliar with the concept then do not worry, as we have seen many a physician, administrator, etc. who has never had to deal with either the arrival or departure of a physician and has therefore not encountered the term before.

To understand tail coverage, you must recognize that in the world of professional liability or “malpractice” coverage there are two types of policies; “claims made” and “per occurrence.” The full explanation between the difference between the two types, and the rationale for one over the other is beyond the scope or interest of this article.  All that is needed to know is that a) “claims made” policies have become commonplace and “per occurrence,” while still available in some markets, has fallen into all but total obsolescence and b) with a “claims made” policy, in the event that a physician wants to seek employment elsewhere or leave their carrier for whatever reason, very often supplemental insurance or “tail coverage” is needed to cover the physician for any claims made after they have left their prior carrier but in which the alleged claim of malpractice actually occurred while they were covered by the prior carrier.

In other words, if Family Practitioner X is under a claims made policy while working for Family Practice Y and subsequently wants to terminate employment and join Family Practice Z, lest Family Practice Z has the same carrier as Family Practice Y and the carrier also provides for reciprocity between the two groups, Family Practitioner X will need tail coverage to protect both himself and his prior practice Y against any claims made after he has left, but in which the disputed event took place during his tenure with Family Practice Y. Also, note that tail coverage varies in price according to a number of factors, but generally speaking the largest factor is, as determined by an actuary, how prone their particular specialty is toward claims of malpractice.  So, tail coverage for a primary care physician is going to be much less than, say, an obstetrician or perhaps an orthopedic spine surgeon.  Now that you have been given a very cursory primer, the question remains…

Who pays for this? Is it the responsibility of the physician, the prior group or the new group? An argument can be made for all three: 1) It can reasonably be argued that the physician whose professional service that needs to be covered should pay for it since they could be potentially bankrupted absent a “tail” but 2) It can also be reasonably argued that the prior group has some responsibility because most plaintiffs attorneys seeking remedy on behalf of their client will not only sue the physician in question but also the group they belonged to since often the group as a whole is of much greater financial wherewithal than the individual but 3) It can also be reasonably argued that the entity the physician is joining should pay for the cost of tail coverage, since if they do not it is often the case that the physician cannot afford it on their own and the group they are leaving may very well not want them to leave.

The answer is not necessarily cut and dry, but our opinion as experienced and professional physician recruiters is that the hiring entity should take the stance with respect to all physician candidates that it is reasonable to make it easy for a physician to join your group but it is not your responsibility to make it easy for them to leave.  In other words, you probably need to at least share in the cost of covering your doc’s tail, if not paying for it outright.  Furthermore, you should stipulate in their employment contract that should they leave of their own volition, or if fired with cause then they are responsible for the cost of tail coverage.  It is generally accepted that only in the case of a physician being let go without cause should the practice dismissing them be on the hook for tail coverage.

With that said, I am well aware that as a hiring entity, the prospect of paying for tail coverage can strike you as rather costly.  Such is especially true if you are in a specialty prone to malpractice complaints; as physician recruiters we have seen plenty of six-figure tails.  If you are in such a specialty, really one of the only ways around such an expense is by hiring someone right out of training, but as contemplated on another article on this website that strategy in and of itself can be problematic. Furthermore, you may want someone who is not right out training and/or it may not make sense to hire someone that green.

Here’s another proposition, which is generally considered as reasonable but will differ by specialty and with location.  Perhaps cover their tail entirely, but structure it as a loan with, say, a two year forgiveness period.  This will help encourage them to stay for at least the length of the forgiveness period. In other words, cover their tail but attach some strings that benefit you.

This is just one of a number of novel ideas we have had as experienced physician recruiters.  To talk to us further about this topic or others related to physician recruitment please feel free to contact us by phone at 512-280-6810 or by filling out the form below.

by Heidi Dawson, RN, CMSR

A part of the art of physician recruitment known to professional physician recruiters is being able to know the resources available and how to make them work for you. These resources can help the recruiter to discover the complete background of a health care applicant to make a better decision in selecting candidates most qualified for the opening. One of the most valuable of these resources is the National Practitioner Databank.

The databank was started as a means of alerting inquiring parties such as hospitals and other health care facilities of any formal or informal actions taken against a medical professional. This resource will divulge malpractice payments or malfeasance reports across state lines on a national level. Before the creation of the databank by the Health Care Quality Improvement Act of 1986, this information was only available pertaining to the physician’s actions within a certain state. Physician recruiters and hiring entities were unable to find out if the physician being recruited had any problems in other parts of the country unless disclosed fully by the applicant.

The National Practitioner Databank does not disclose its information directly to the general public or to physician recruiters directly. The only way that those in physician recruitment can get the information for an applicant is to ask the applicant that they requests the information on their practice history from the National Practitioner Databank, which is known as a “self query.” As a physician recruiter, you might have to wait 2 – 3 weeks before the applicant returns the National Practitioner Databank report to you. For this reason, it is important that you inform the applicants as soon as possible of their need to request a report. Obviously an unwillingness to submit to this request is a red flag and probably opens up the need to ask further questions of a candidate.

The process for an applicant to request their information from the databank is simple, but they should be aware that there will be a nominal fee payable by credit card only. This fulfills the fees for requesting information from both databases in the National Practitioner Databank. The physician recruitment agency or the health care facility can determine whether or not they will reimburse the applicant if he is accepted for the position. The application form must be filled out on the National Practitioner Databank website, printed and signed before a notary public before being mailed to the National Practitioner Databank address on the application. Once the signed form has been received, it will take up to two business days to process the information, after which the report is mailed to the inquiring health care professional. The total time can be up to two full weeks.

Why would those in physician recruiting bother to use the National Practitioner Databank? Information about disciplinary actions taken against doctors is readily available on the Internet on a state by state basis, and much of this information is accessible to the public, but reporting of merely allegations of medical and professional malfeasance is not listed on the state databases. A physician might have received a reprimand for his behavior nine times, but unless a formal action is taken, a physician recruiter or hiring entity would never know by relying only on the state-provided information.

All formal and informal disciplinary reports against a medical professional are listed on the National Practitioner Databank, but the results from the databank need to be interpreted carefully by physician recruiters  and hiring entities alike. Simply on the basis of a payment for a claim of malpractice does not necessitate the need to omit that candidate from consideration for a position. Settlement out of court can occur even if the doctor is innocent of the charges, but wants to avoid the bad publicity a trial would bring. Further investigation into the total history of the health care professional needs to be made by the physician recruiter.

The complete professional history of the medical professional can be assessed with the National Practitioner Databank. Should there be a question about a malpractice claim payment, examining other actions taken against the doctor should be done. Included in the databank are: revocation, suspension, censure, reprimand, probation, surrender, denial of an application for renewal of a medical license, and withdrawal of an application for renewal of license. The privileges a medical professional has at a clinic or health care facility and any adverse actions taken by professional societies to which he might be a member. If there are several reprimands for similar actions or from several different facilities, it could be an alert to the physician recruitment agency or hiring entity that that applicant might not be professionally qualified.

Other things for physician recruiters to take into consideration when using the National Practitioner Databank include the fact that the information from the databank might not tell the entire story. The applicant’s credentials, peer review, and continuous education or assessments need to also be factored in to determine if a health care professional should be hired. These factors can add weight to the report from the National Practitioner Databank.

The physician recruiter should carefully look over the report from the National Practitioner Databank provided by the applicant for any evidence of tampering. The databank has gotten complaints from third parties, such as physician recruitment agencies, of databank reports submitted to them from physicians which had been tampered with. A history of several instances of altering the documents before turning them over to the recruiters has been made. Should there be any signs that any of the information was changed, the physician recruiter can request another copy from the physician or omit him from consideration for the position.

Professional physician recruiting services know how to use the information from the National Practitioner Databank to their best advantage. Without being able to directly access the physician candidate’s history on the databank, the recruiter must be able to trust that the report given to him from the “self-query” filed by the applicant is accurate. An assessment of the report should only be a piece of the larger picture of a physician candidate’s application, but obviously evidence that the report was changed in any way could signal an underlying problem that the candidate wishes to hide. Such actions can bar the candidate from being considered for employment, depending upon other data available from the application. Using available resources to your best advantage is a hallmark of professional physician recruiters.

To learn more about the National Practicioner DataBank and its use in the physician recruitment process please feel free to contact us by calling 512-280-6810 or by filling out the form below.

by Bo Claypool

Physicians are highly familiar with medical/surgical concepts and while many are capable of dissection within the human body, many to most are not qualified or really desirous of dissecting a complex legal document without the help of an attorney.

So, put yourself in a candidate’s shoes for a moment. Imagine you have just interviewed with the Cleveland Clinic and the Mayo Clinic. You have family in Rochester and your spouse has family in Cleveland. Both positions offer the same compensation package and benefits, not to mention they both carry the same level of prestige as you perceive it. You also happen to like your prospective co-workers at either clinic equally. They have both made you an offer with seemingly equal tenacity and both have presented you with their standard employment contracts that are prohibitively long, ominous sounding and completely outside of your interest or capability to decipher.

However, Mayo decided to add an addendum to the front of the contract which is a very well-written, cordial and heartfelt invitation from your prospective department’s chairman that also outlines the highlights of the contract and invites you to sign the letter as merely a gesture of your intent to join the team, whereas the Cleveland Clinic did not include such a personal touch. Which position do you already feel better about, if only slightly? Sometimes it’s the little things than can make a huge difference as a physician recruiter and a well-written letter of intent can tip the scales in favor of your practice opportunity over another.

A letter of intent is a non-legally binding written gesture and agreement between candidate and prospective employer that outlines the terms of employment and says that we agree in principle to pursue this proposed relationship to the best of our ability, and to the exclusion of all others, and that barring some extenuating circumstance such as an inability to create a mutually agreeable employment contract, we will be working together. Letters of intent are certainly not idiosyncratic of just the physician employment world, and they basically stand upon the premise that when someone makes a promise, if even just an informal, non-legally binding one, they will stick by it. Furthermore, for physician recruiters, a letter of intent is seen as a candidate reaching an enormous mental milestone within the interview process, as most candidates with any scruples will not sign a letter of intent, lest they truly, truly intend to take the position. Moreover, it is generally accepted that once the letter of intent is inked, the easier it will be for the candidate to take the step of inking the contract itself.

Here are some tips when it comes to a letter of intent (“LOI”):

o Make sure there is a warm, heartfelt tone. Most properly drafted employment contracts are dry and unforgiving, so make the LOI serve the functioning of buffering the contract with some “warm fuzzy” sentiment…but don’t overdo it. Have someone else read it, like your physician recruiter, to see if you have laid it on too thick;

o Be sure and hit all the highlights of the employment agreement, such as pay, benefits, term of contract, etc., but there is no need to include anything that could be seen as a negative, like non-competition language. Since the LOI is not a legal agreement, why would you include within it something like a non-compete which concerns termination of employment, when employment has not even been established?

o Notwithstanding the foregoing about being warm and heartfelt, also be as brief and succinct as possible. The candidate will probably have plenty of reading to do when it comes to the contract itself so no need to overdo it with an unnecessarily verbose LOI. A single page is adquate;

o Make sure it is clearly spelled out that the LOI does NOT constitute a legally binding agreement as failure to do this will make it much less likely of getting a signed LOI;

o Have a place on the LOI for the prospective candidate to sign, but also have a place for the representative of the hiring entity to sign and make sure it is already inked by this person prior to presenting the LOI to the candidate. There is something nice about receiving an LOI already half-executed in blue ink. It makes the offer all the more real (yes, this may sound cheesy, but this is true);

o Most importantly, do not consider the recruitment process to be over once the LOI has been signed and that the contract negotiation period is a mere formality. While a signed LOI is encouraging and a great sign, you are a LONG way from home before you have a new addition to your practice;

o As soon as feasible after the mutual signing of the LOI, formal contract review and negotiation should begin. The longer you wait to get to a mutually agreeable the contract, the more likely you are to not ever get there. You never know… physician recruiters abound and they might just pop up with a better offer before you have made a legally binding agreement.

At Integro Healthcare as an experienced team of professional physician recruiters, we have assisted with writing countless letters of intent for various entities. We would be more than happy to review any letter of intent you already have written and should you like some guidance or for a free sample of one, please feel free to call us at 512-280-6810 or by filling out the form below.

by Bo Claypool

It is a simple fact of human nature or mere observation of the affliction that is the human condition: people lie. Therefore, it reasonably follows that physician candidates lie.

Certainly a lack of truth is not necessarily endemic to physicians being recruited or even very common, but in many situations it is not necessarily in a prospective candidate’s best interest to be completely forthright when going through the interview process. We will examine in this series a number of situations of candidate dishonesty that we have observed over the years as professional physician recruiters and how you can protect against it.

Part I – Physician recruiters / Recruiting entities being used as leverage within financial negotiation with an existing employer

Many candidates pick up a phone and answer an advertisement for employment as an impulse to workplace dissatisfaction. Perhaps the physician just doesn’t like one of their co-workers or maybe they are unhappy with their work schedule and lack of vacation. Maybe their call schedule is much more hectic now that two of the other group physicians have left.

There is a veritable cornucopia of grievances I am presented with everyday that physicians have over their existing practice and quite often such grievances are more than enough to justify employment elsewhere. But often as well, such grievances are only sufficient impetus for a physician to “see what else is out there” and ultimately take the offer of a prospective employer to use as leverage with their existing employer.

This is most common when a candidate’s largest issue with their current employer is financial and they express interest in a location of similar size and demographics as to where they are currently practicing. The reason for this is intuitively obvious… if a physician who is unhappy with their pay can demonstrate that they can make more in an area of similar size, patient demographics and payer mix then that is a compelling argument for them to be paid more.

So, say a physician in Houston wants $50,000 more per year in salary. Is it more persuasive if he is able to demonstrate that a prospective employer in Dallas or the very rural Midwest is willing to give him what he wants? If the physician goes to their existing group with an offer from the latter, the likely response would be, “Yeah, sure the money is better but you have to live in the middle of nowhere,” whereas there is really not an appropriate response other than to capitulate or part ways if the financially aggrieved physician can show a similar practice in Dallas is willing to pay the additional $50,000.

As an aside, candidates who are doing this can very often have very real intentions of relocating if their existing group does not meet their needs, and often this is how they justify such a tactic. Furthermore, from this perspective it is not altogether an unreasonable approach if the candidate is forthright with all parties involved. That said, I don’t ever want to be a pawn, or at least an unrecompensed pawn, in someone else’s negotiation strategy, nor do I want any of my clients to be either.

So how do you protect against this? We advise all of our clients to have any candidates who are formally offered a position (as in, given something in writing, be it in the form of a letter of intent or employment contract) sign a non-disclosure agreement that precludes them from sharing the contents of the offer with their employer. Why? Because if the physician in Houston as contemplated above merely alludes to an offer in Dallas, rather than having it outlined in black and white, their argument becomes much less convincing. It’s sort of like the guy who talks about his model girlfriend who lives in Canada but no one has ever seen… she’s considered myth until actually produced. The same goes for offers of employment.

So, of course it is best to make it known to all candidates of your intention to have them sign a non-disclosure agreement well before they interview. In fact, if you are using a recruiter, you can weed out anyone looking to use you as leverage by having the recruiter disclose in the first conversation with the candidate that there will be an expectation of an NDA being signed prior to any formal offering being made. Furthermore, as a client of Integro Healthcare, if you like you can blame us for this rigid stance and we will even take on the responsibility for requiring that you have this stipulation because for all intents and purposes we do.

NOTE: The following paragraph is merely layperson advice, resting on the knowledge of NOT AN ATTORNEY but, again, of a layperson. The following should not be construed as legal advice or adequate substitution for the formal legal opinion of a licensed attorney.

Within your non-disclosure agreement presented to a candidate prior to presenting them with a written offer, be sure to include a liquidated damages clause. If you can prove beyond the preponderance of the evidence (51% likely) that a candidate violated the NDA, then a court will find that you are entitled to remedy, however calculation of such damages would be difficult for a judge and that is why a liquidated damages clause is needed, which is basically a pre-agreement betwixt both parties that $XX,XXX amount of dollars is a reasonable calculation of actual damages incurred by the hiring entity in the event of a breach of confidence. More than it’s practical use in court, a liquidated damages clause makes the gravity of the agreement much more real to the disclosed party; they know they are on the line for a pretty penny if they get caught violating the agreement.

Furthermore, make sure that it is further specified that such liquidated damages are not punitive in nature, but again, a reasonable and mutually agreed upon figure reflective of actual damages. These two suggestions are applicable in most states, but there is a degree of variance present in some, so always have an attorney review an NDA before presenting it.

Also, if you would like a sample or template NDA for the purpose discussed in this article, please feel free to contact us by phone at 512-280-6810 or by filling out the form below in order to speak with one of our knowledgeable physician recruiters and who can provide you with a document that is at least a good starting place.