You’re doing well on your job search. You’ve narrowed your focus and have gotten past preliminary interviews to the point where it’s clear that there is a likely match between what you are seeking in a new job and what a hospital or practice has to offer. It’s time to go take a look.
A site visit, which may be as short as one day or as long as three, is your opportunity to size up both the practice and the community. On a typical site visit, you might fly in on a Thursday, have meetings, tours, and interviews on Friday, enjoy dinner with key physicians or administrators that evening, and then tour the community with a real estate agent on Saturday. You may choose to stay through Sunday in order to further explore the community.
Jolene Yates is a physician recruiting consultant with Banner Health in Greeley, Colorado. She says that a site visit is critical for any physician considering a job offer.“Through phone conversations, they can get the essence of the job, but they really need to experience it firsthand,” says Yates.
Before you leave home
Afshin Malaki, MD was completing his OB/GYN residency in Brooklyn, New York, when he and his wife, Lis Annette, began thinking about where to settle down with their two young children. They read articles about career options and researched cities as potential job opportunities came their way. “We made a checklist of criteria,” says Malaki. “We wanted to live somewhere not too small, but not a metropolitan area either. “Malaki and his family ultimately chose Ames, Iowa, where he now practices at the McFarland Clinic, a 166-physician multi-specialty, multi-site group. Ames, a university town, has a population of about 55,000 and Des Moines is less than an hour away.
As soon as you know you’re going on a site visit, request information about the area and the practice opportunity. Visit the Chamber of Commerce website, read the local newspaper online, and use the internet to dig deep. Resist the temptation to limit research to only what you hope you’ll find. Play “private eye” to uncover both positives and negatives about the community. Ask your residency program director and colleagues if they know of other doctors who have settled in the community you are considering and don’t be shy about calling those individuals. They can share their experiences and clue you in about what to be on the lookout for.
Request a copy of you interview agenda in advance. Who you meet with will depend on many factors including the size of the group or hospital, the structure of the organization, and the length of your visit. Be prepared to meet many new people over a short period of time. It’s not uncommon for a hospital to host an informal breakfast or lunch buffet and invite the entire medical staff. “We want to be sure candidates meet everyone who they might be affected by in the practice and give our providers a chance to meet the candidate,” says Amy Chang, the primary care physician recruiter at Pacific Medical Centers in Seattle. Expect to have one-on-one or small group meetings with other physicians, administrators, and even board members.
If you are making your own travel arrangements, schedule flight layovers to accommodate delays. Confirm your reservations and flight status the day before you travel. Don’t take a red-eye; you’ll want to be rested for your interview. Schedule a buffer day on each end of your trip if at all possible, and be sure to carry on your interview clothes and other essentials in case your bags are delayed.
When in doubt, inquire in advance about how to dress for your interview. Chang says physicians should simply ask about appropriate attire. “If you’re in a rural area, a three-piece suit might scare people. But in Seattle, a polo shirt and Dockers won’t fly,” says Chang.
If you want to look around the community with the help of a real estate professional, find out if your recruiter is arranging that appointment and, if not, ask them to recommend someone. Decide in advance whether your want to look at houses on the market or just become familiar with neighborhoods. Be sure to quiz the real estate agent about the community while you are driving around. “They know everything,” says Justin Tidwell, the managing director of physician recruiting at Martin, Fletcher, a Dallas-based search firm. “They’ll tell you the truth and connect you with people in the community…schools, religious facilities…if they don’t have the information you want, they can usually find it.”
If you have children (or plan to), find out as much as possible about the local schools and arrange to meet with the principals of the ones that are likely options. Educational opportunities were important to the Malakis on two levels. First, they wanted to make sure their children, ages 5 and 7, would have access to good schools. They visited both public and private schools and recently enrolled their children in a private Christian school. Before moving to the United States for Malaki to do his residency, Lis Annette was an anesthesiology resident in Denmark. Now that the couple’s children are in school, she plans to resume her career. “This was a criteria . . . that we would be in a place where she could finish her residency without a long commute,” Malaki says.
Decide in advance if your spouse or partner is going to explore career opportunities during the site visit. If that’s the case, ask your recruiter for ideas. While he or she probably won’t be able to arrange interviews, you can probably get local information and leads that will be useful and time-saving.
Who pays for your site visit expenses?
It’s standard for the hospital or practice you are interviewing with to pay for travel expenses including airfare for you and your spouse or significant other, airport parking, rental car, hotel, and most meals. If you have any doubt about what you are responsible for versus what will be taken care of, simply ask your recruiter which receipts to turn in. “We pay reasonable expenses and most candidates are very considerate and sensitive,” says Deborah Akins, the manager of medical staff recruitment at Pacific Medical Centers in Seattle. Only occasionally, she says, does a physician turn in excessive expenses, and when they do, it doesn’t make a good impression.
Akins encourages physicians to socialize with friends they know locally during the site visit, but says they should not take advantage of the fact that their expenses are being covered. “If you go out for dinner with another couple, don’t turn in the ticket for all four,” she says. Also, don’t nickel and dime the facility by turning in receipts for the bottle of water you bought at the airport or the bag of chips you ate out of the hotel vending machine.
Some facilities will have airline tickets and hotel charges billed directly to them. If that’s not the case, be prepared to put expenses on a credit card and turn in your receipts as soon as you complete your visit so that you can be reimbursed promptly. If you are interviewing with more than one practice or hospital during a visit, submit your receipts in a fair manner.
What to do during your site visit
Arrive for a site visit having done your research. “When someone interviews with us and they start to ask questions that they’ve prepared in advance, that impresses me and our interview team. They’ve done their homework and they want to know more,” says Akins.
How you present and conduct yourself throughout the day is critically important. Be professional. “A first impression is a huge thing,” says Chang. “Be conscious of your body language. Sit with your feet on the floor to get grounded and concentrate. Make good eye contact and pay attention to your handshake,” she advises. Chang says physicians should be careful when talking about why they might be dissatisfied with their current position. Too much negative talk can come across as anger or bitterness.
As you are being shown around the hospital or clinic, you will likely be introduced to many physicians and staff members. “Be prepared to meet people impromptu, even if they’re busy,” says Akins. Try not to take it personally if they don’t drop what they’re doing to spend time with you. Akins says it’s appropriate, however, to ask for contact information during these casual encounters if you meet someone you’d like to follow-up with by phone or e-mail later. And don’t hesitate to strike up casual conversations with nurses, maintenance workers, and administrative staff you meet along the way. You can learn a lot by asking, “How do you like working here?”
Even though you will have researched the community and done your homework about the hospital or practice you are considering, you will still have questions. If you don’t have any, make some up. Not asking questions is a sign of disinterest, according to Tidwell. His team of agency recruiters prepare candidates with appropriate questions before they head out to interview. “Make sure you write your questions down,” he says. What you inquire about will depend, in part, on your specialty and the arrangement or contract under consideration.
Internist and geriatric specialist Cory Krueger, MD, had practiced near Philadelphia for 20 years before relocating to Cottonwood, a small town in central Arizona. “I came from an area where there are lots of specialists. Could I practice where the closest neurologist was 45 minutes away?” he says, recalling the questions that ran through his mind while visiting the area. “Talk to people in your specialty,” he says. “Try to envision what your average day will be like. It will help you make an informed decision.”
Watching for “red flags” during your interview
You are being recruited because, presumably, there is a need for your services. But that is something to confirm during the site visit and, if needed, in follow-up afterward. “I had to be convinced that there was a need for another doctor,” says Krueger. “I knew the hospital would support me for a year which was all well and good, but I didn’t want to be poor after being here for a year.” Krueger spoke with physicians and nurses whom he felt had “no ax to grind” and they confirmed that he would be busy. “My practice is full now. The community had and continues to have a need,” he says.
Roger Bonds, the president of the American Academy of Medical Management, says physicians should use the green, yellow, and red light system when considering issues that arise during a site visit. “When you hear something negative, it’s a yellow light,” says Bonds. “If one surgeon gripes about administration and is negative about the world and about medicine, you may be able to discount that by 100 percent.” When you start hearing the same thing repeatedly, however, the light may turn from yellow to red and warrant more research.
“Anywhere you go there will be some politics,” says Tidwell, “some places more than others.” Make sure that should you accept an offer, you will be received warmly by colleagues inside and outside of your specialty—not just from the hospital CEO. On the other hand, don’t be discouraged if one doctor corners you to explain why you’ll never have a successful practice in his town. Every medical staff has a resident curmudgeon.
On the personal side
Unless you’re single, relocating is a family affair. “It’s critical that the spouse comes, even on the first trip,” says Akins. “They have to make sure they want to live there, too.” Akins recalls one instance in which a candidate’s wife wasn’t interested in coming for a site visit. It turned out that she wasn’t at all on board with the idea of relocating.
Jolene Yates agrees and says the spouse is often the “80 percent decision maker.” Yates is also happy to have candidates bring children on a site visit and her organization will pay airfare and hotel costs for an extra person to watch the little ones while mom and dad are interviewing and touring the community. “Definitely tell the recruiter if you’re bringing kids,” says Yates.
Akins encourages candidates to make sure they have time during the site visit to explore the community on their own. “Schedule some downtime, do something fun,” she says. “Drive around, take in the city, go to a ballgame. You may not do a second interview, so make the most of it.” If you have a special interest like hiking, golf, or the arts, ask your recruiter to arrange for you to partake in those interests while you are in town.
“Make sure the community has activities for the family, or it won’t matter how good the job is,” says Tidwell, and recalls setting up a white water rafting trip for one couple during a site visit when they expressed interest in the sport. “Be convinced that the area has everything you need,” he advises. He says sometimes it’s a single issue that will sway a candidate and their spouse toward or away from a community. “Maybe they want their kids to be able to play on competitive sports teams,” Tidwell says.
Malaki had been to the Midwest only one time prior to his site visit in Ames, Iowa. He says physicians should spend plenty of time during a site visit getting a feel for the community. “What’s the general impression . . . in the supermarket, on the street, how friendly people are,” he says, regarding what to look for.
Yates says that a physician and spouse or partner can get to the heart of what a community is like in three simple steps: go to a supermarket, get a haircut, and visit a local diner. “Go to the grocery store and look at things you normally buy,” suggests Yates, as a way to get a sense of the cost of living and also whether the items you enjoy are readily available. If you’re used to eight varieties of apples and find only Red Delicious and Granny Smiths on the shelf, that may be indicative of a cultural (or at least a culinary) mismatch. “Talk to the checkout person,” says Yates. “Ask what they think of the hospital, the doctor group, how long they’ve lived there, what they like, what areas of town are best and which ones to stay away from. Ask these questions everywhere you go,” she says. As for the haircut, Yates contends that barbers and hairdressers know everyone and everything, and they’re happy to talk. The same goes for patrons and staff at local diners. “Just chat with people. If you hit a diner, a grocery store, and a hair salon you’ll pretty much have it,” says Yates.
Tidwell agrees that follow-up is important, whether you are interested in the job or not. If it’s obvious that there is not a match, a simple “thank you for your time, I enjoyed meeting everyone” will suffice. If you want the job, say so. “Let them know you are interested and what your time frame is,” says Tidwell. Those in charge of coordinating your recruitment will want to know where they stand. “If you have other interviews lined up, tell the truth,” he says.
Go home with as much information as possible, but be prepared to do more research based on what you learned during the site visit. If you were impressed with everything you saw and everyone you met during the visit but something still seems amiss, pay attention to that. “Listen to your gut,” says Yates. Your intuition is there for a reason.
The number of sites you should visit will depend on how many offers you seriously consider once phone interviews and initial research are complete. Travel to as many locations as needed, but don’t waste your time or anyone else’s checking out possibilities on a whim. Most physicians make several site visits before accepting a job; others travel to only a handful before finding the perfect match. Malaki made eight site visits before setting on the McFarland Clinic and feels he made the right choice, professionally and personally. “Here, people take pride in what they do,” he says, noting that the clinic is well-organized making it possible for him to be efficient and deliver good patient care. His wife and children are equally pleased. “They love it here,” he says. END
Karen Childress lives in Cortez, Colorado. Her article, The Trailing Family, appeared in our September/October 2007 issue.