Dr. Newton Wiggins sitting and smiling
Dr. Newton Wiggins sitting and smiling

Know before you go – what to know about site visits

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LAURIE MORGAN, MBA

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When a prospective employer invites you for a site visit, it’s good news. You’re nearing the end of their interview process, and they like what they’ve seen so far. The next step is up to you. Will you accept the invitation? And if so, how should you plan for the trip? Here is what to know about site visits:

Creating your shortlist: How many is enough?

An invitation to spend a day or two at a prospective employer is exciting. You can meet potential colleagues and experience the workday up close. Still, travel and time away from work as a busy resident or fellow can be tiring and stressful. If you’re interviewing with far-away employers or a large number of them, you may want to narrow your options.

The right number of site visits depends on your priorities and goals.

“This process is different from fellowship and residency,” says Newton Wiggins, M.D., a cardiologist with The Chattanooga Heart Institute at Memorial in Tennessee and chair-elect of the Early Career Professional Council of the American College of Cardiology. “We’re used to that finish line, and with training, you feel like could live anywhere for three years or five years. But when you’re looking at a more permanent move — a lifelong decision — more extracurricular things come into play. The biggest thing that you grapple with is the trade-off.”

As you get closer to your decision, he says it’s even more crucial to solidify your priorities. This means ranking factors like region, compensation, work/life balance and family needs. The right number of site visits depends on what competing factors you’re trying to satisfy.

“I think it may be overwhelming to look at more than three or four sites and try to keep everything straight,” says Jennifer Kendall, D.O. Kendall is a physiatrist and the program lead for medical spine with M Health Fairview in Maplewood, Minnesota. She’s also a member of the American Osteopathic Association board of trustees. She caveats that there’s no universal number of visits: “It depends what’s most important to you.”

Location is often the most important consideration. If you’re certain where you want to be, that may automatically streamline your choices. “I knew I wanted to be near family, so I limited my options to the Twin Cities area,” says Kendall.

But sometimes, focusing on a single market doesn’t make sense, according to Jennifer Hauler, D.O., MBA. Hauler is a family and emergency medicine physician and chief operating officer of Miami Valley Hospital in Dayton, Ohio. She points out that some types of jobs require candidates to cast a wide net. “Some candidates are interested in a specific type of medicine that is only practiced in certain settings,” she explains.

“The position may not look perfect in every way, but sometimes you need to be able to say, ‘I’m exploring,’” Hauler says. Setting aside time for more site visits can help you learn more and make a better decision.

Hauler notes that it might seem easiest to stay put after training. But if you have some flexibility, you might want to expand your list of potential employers and locations. The first job can be a great time to consider a new adventure.

“Inertia is common and understandable. You’re comfortable [in your residency or fellowship hospital]. You know how to navigate there. A new place has to overcome these things,” she says. “But for many physicians, this is a unique time in your career. It’s a brand-new start, and you really can do anything with that.”

Of course, geography isn’t the only priority. Wiggins wanted to be close to his family, so he restricted his choices to within a six-hour drive of Jackson, Mississippi. But another factor—work/life balance—was even more important to him and his wife. The job he chose in Tennessee was within his geographic boundary, but it wasn’t as close as some other options. It won out on lifestyle.

“You’ve got to know what you’re looking for,” he emphasizes. “Everybody is wired differently.”

How much do you know about the job?

Before a site visit, you’ll likely have had several in-depth conversations — probably including at least one video interview. Ideally, these interviews will have given you a clear understanding of the job. As you decide whether to accept a visit invitation, it helps to reflect on what you’ve learned.

Start by reviewing what you know about each position. This will help you refine your list of priorities, requirements and wishes. You may even be able to trim some prospective employers without the time and effort of a visit. And if you choose to accept an onsite interview, you’ll be clearer on what else you’ll need to know if they offer you the job.

At this stage, you should already know the fundamentals of each job: group size, call sharing, administrative duties, management structure, etc. If you don’t, it’s time to gain clarity. At a minimum, this should happen during the site visit. It’s even better to learn before you commit to the visit.

“I think we have a tendency as trainees to think that if it doesn’t work out, we’ll just go somewhere else. But what you don’t realize is that can be expensive,” Wiggins says.

For example, if your contract includes a non-compete, you might have to leave the area if you want to change jobs. The same could be true if the community can’t support your specialty in multiple facilities. The disruption of moving and changing jobs can be expensive and exhausting. Plus, building a new referral network in a new place can take time, which could suppress your income for a season.

You should also have a handle on compensation before your visit, says Robert Dolansky, D.O., MBA, family medicine physician and chief of urgent care and occupational medicine at St. Luke’s University Health Network in Allentown, Pennsylvania.

 

“By the time you are asked to visit,” he says, “you should already have had both a phone interview with a recruiter and some type of video interview. Salary and compensation typically should be brought up by the end of the second one.” If not, he recommends asking for at least a general idea before planning the site visit. “If it’s not in the range that you know you need, there’s no sense proceeding.”

Dolansky also advises that compensation rates vary significantly by specialty and market. If your specialty is in short supply in a particular area, hospitals or groups expect to pay more to lure talent. In more popular locations, a buyer’s market may prevail—giving physicians less negotiating leverage.

Online research can help you know what compensation you should be looking for. Resources like Medscape and MGMA, for example, track physician salaries. Other financial components might be important to your decision, such as productivity pay, tuition forgiveness, sign-on bonuses and relocation assistance. These topics should also have at least been floated by the time you’re planning a visit.

Be confident that they like you—but maybe not only you

Once you receive a visit invite, you can breathe a little easier. It’s clear this employer is interested in you.

“They don’t want to fly a lot of people into interviews. That’s expensive. It means time out of people’s schedules, and there are costs associated with their hours and dinners and so on,” Wiggins says. “If you’re there, they’re interested. You might be competing with one or two other people, but I wouldn’t get lost in that. That’s the big shift from fellowship training.”

Dolansky agrees. “By the time you get through all earlier interviews and you’re invited to come to the site, that’s a good sign that an offer—a formal offer—will be coming and that they really want you,” he says. “It’s a good sign that you’re—if not the candidate — probably at least in the top two or three.”

So yes, the site visit means you’re fully in the “hirable” zone. But the site interview is still a test—albeit a different kind of one.

Dolansky says, “Studies show that 25 to 30% of the hiring decision is based on background.” This includes factors like education and training. They’ll already know these fundamentals before you’re invited to visit. Once you’re on the premises, the focus shifts to how you’ll fit within the organization.

“We’re looking for their interactions with people during the site visit,” he explains. “We want a sense of their teamwork with others. How do they listen? How do they communicate?”

Dolansky says some employers will also assess you in a behavioral interview. This entails asking questions about how you handle challenges at work.

“We ask questions that put candidates in a situation and ask them how they’d handle it. For example, we ask candidates to describe a recent patient interaction that went well: ‘Why do you think was it successful?’ And then, of course, turning that around and asking the candidate to discuss a recent patient interaction that didn’t go well, why they thought it wasn’t successful and what they did in response.”

Dolansky says this interview approach is becoming more common, so it’s a good idea to prepare for it. Think through recent challenging or particularly successful situations before your visit. That way, you’ll be able to call them to mind easily.

Hauler also recommends considering the organization’s current needs. That way, you can describe how you’re a good fit. “Take the experiences you’ve had as a resident or fellow, and project yourself into that new environment,” she says. “You want to be able to talk about how you can contribute.”

Thanks to your training, she adds, “You can spot a specific niche of medicine that they need help with. If you have a special skill set or special population that you take care of, prepare to talk about how excited you are to contribute in that way.”

You’ll need to repeat these points, along with other basics, to many people throughout your visit. It’s helpful to have a succinct introduction memorized for these interactions.

“I think it’s good for folks to come prepared with a little elevator speech about who they are, what their training’s been, what they’re looking for, why they’re excited by this opportunity and what they feel that they can bring to the table,” Hauler says.

Remember you’re not just selling—you’re buying

The job search—especially the visit stage—represents a major shift from residency and fellowship. You’re still selling yourself, but now you also have the opportunity to choose. That means it’s not just OK to ask questions; it’s essential.

“Candidates should remember that they’re interviewing prospective employers as much as the employers are interviewing them,” Dolansky explains.

“We are very blessed folks in the medical profession in that there’s often more demand than supply. We can be selective about the opportunities we look at,” adds Hauler. “The interview process should really be a two-way interaction. You know the organization’s trying to get to know you and to understand if you’re the right fit for them. In this same respect, it’s an opportunity for you to understand, ‘Is this the place where I want to be?’”

If they’ve invited you to visit, employers want to sell you on their job, even as they’re confirming you’ll fit their needs.

Wiggins says, “Practices aren’t bringing in hundreds of people for this one job. They’re trying to recruit you to join them. So know that they’re going to be showing you their best side.”

It’s incumbent on applicants to find out what they need to know about the opportunity. This means researching beforehand, learning as much as possible during interviews and asking outstanding questions during visits.

“I think the number-one thing you want to understand is the job expectations,” Wiggins says. “What is the employer looking for? And is that something you’re interested in doing?”

And if you have reservations, address them directly. Hauler says, “If there’s anything candidates have read or researched or learned from talking to folks that they’re not sure about, it’s a great time to say: ‘I’m a little confused by this’ or ‘I’m interested in understanding this aspect of your corporation or your company.’”

Prepare to impress

Once you’ve accepted the site interview, the next step is detailed preparation. You’ll want to have questions at the ready. This isn’t just to get answers; it’s also a way to convey a genuine interest in the job.

You should receive an itinerary in advance with the names of the people you’ll meet. Then you should be able to find their bios online. If not, ask the recruiter for help. “Know who you are meeting with and their titles so you can ask appropriate, specific questions,” Kendall recommends.

She adds that it’s a good idea—and a stress-reliever— to confirm practical details ahead of time. You should know which building(s) to go to, how parking works, who you’ll ask for and even which entrances to use. That way, you can be sure you’ll arrive on time and unharried.

Prepare to dress professionally for the interviews as well. Business attire is expected. Pack something appropriate for a dinner in a fancy restaurant, unless the recruiter specifies a different sort of event. (When in doubt, ask—and know that it’s always far better to be overdressed than underdressed.)

Dolansky says it’s also helpful to mention any dietary restrictions before the visit. And most employers will ask if you plan to bring your spouse along, then help you make plans. Typically, they’re aware how important this is. If the job isn’t a fit for your partner or family, your chances of staying long-term are slim. If the recruiter doesn’t bring this up, be sure to ask before scheduling your trip

Ask about the details of daily work

An onsite visit is a chance to get a better feel for the ins and outs of the job. Prepare lists to help you gather information efficiently while you’re there. Consider factors that will affect your productivity, stress level and job satisfaction. These are much easier to assess when you’re physically present.

“I wish I would have known that the site visit isn’t just to see the space,” Kendall recalls. “I looked at the physical space—like: ‘How big are the exam rooms?’ ‘Was there a sink?’ and ‘Do I get an office?’ But I wish I had looked more closely at the equipment.”

If she were interviewing now, Kendall says she’d do things differently. She’d ask about clinic resources, such as educational materials and models for patient demonstrations. She’d also try to learn more about clinic operations and workflow to understand how they would affect her practice.

For example, she suggests asking about support staff, including ratios: “Is there one certified medical assistant (CMA) assigned to one provider, or is each CMA expected to support more than one? Will you work with the same CMA every day, or is there a pool so that you’ll be working with different people? Is there nursing support — and if so, what is their role? Will they answer phone calls, prep charts or help coordinate care for complex patients?”

Another workflow-related subject to ask about: their EMR system. You may have customized your current system to maintain productivity and reduce stress. If so, you’ll want to replicate those personalized changes in your new practice. If the employer uses a different platform, ask what resources are available to help you get the most out of it.

“If you trained with a different EMR, you might ask if there’s a training program, how it works and whether there’s help available to show you how to customize your templates and your order sets,” Hauler says.

Hauler advises candidates to make sure they’re asking the right questions to the right people. For example, if you have compensation questions, ask the recruiter to help you identify who to ask. This will help you get an accurate and complete answer. It will also keep you from wasting other people’s time and missing the chance to ask them more relevant questions.

“If you have questions about how productivity is tracked, you’ll want to make sure that you’re directing them to the right person during the visit,” Hauler says. “Because if you’re a surgeon and you meet the OR director, he or she can tell you about all the equipment, but they’re not your compensation person.”

Wiggins also recommends asking about a mentor, since this affects your productivity.

“Especially when you’re coming out of training, you really need someone to help guide you. You don’t know it all, and it is a very humbling process and a challenging time,” he says. “Know who your clinical mentor is going to be. Know who your research mentor is going to be. Meet them and make sure that you’ll work well with them, because they’ll have a large part in your success. And if none of that is laid out — if it’s going to be learning on the fly — it might be tough sledding when you move cross country.

Culture is king

Perhaps more than any other factor, workplace culture influences whether a job is a good fit. Is the organization an environment you can thrive in? What about the individual practice or department? The site visit is your best opportunity to get a sense of the culture and answer these questions. It helps to prepare before you arrive.

As a starting point, Dolansky says to learn the organization’s mission statement — either through online research or preliminary interviews. If it aligns with your values and goals, your next step is confirming that they put words into action. While you’re on site, investigate how well employee life matches the stated mission.

This doesn’t mean you have to grill employers with confrontational questions. Wiggins says you can get a good sense of culture simply by observing. Do employees seem collegial and comfortable? Are they unduly stressed or relaxed? How well do they work together as a team?

You can also use the same kind of indirect or open-ended questions employers use. “I might ask whether anyone in the group has recently left — and why,” Wiggins explains. And if the answer is yes, he adds, “I might ask the employer, ‘Would you mind if I contacted them?’ If you get all kinds of red flags, that might be a warning sign.”

He says asking about the number of open positions — and why they’re open — can help you spot a challenging or problematic culture. If most of the group’s physicians tend to stay and set down roots, that can be a positive indicator.

For more insight, Kendall recommends asking staff about their impressions and their job satisfaction. “I suggest candidates ask to speak not only to other providers but to CMAs, nurses, schedulers, administration, etc.,” she says. “Talk to them about their roles and how they think the site functions overall. Are there things they’re actively working to improve upon? Can they give an example of a project where multiple teams or areas of the clinic came together to solve a problem?”

Of course, it’s not always possible to meet staff during a visit, Hauler observes. For example, at a Level 1 trauma center, it would likely be impossible to meet with everyone you’d be working with. On the other hand, Hauler says, “If you’ll be working in a small group and your daily workflow will depend on teamwork with staff, the opportunity to meet your prospective colleagues and observe the typical flow could be invaluable.”

Dolansky suggests looking at the organization’s internal review methods, too. “You’ll want to look at utilization management, for example, how they handle patient complaints. And you should find out how they handle employee complaints, too. Do they do any kind of patient satisfaction scoring? Do they do any employee satisfaction?”

Hauler adds a few words of advice she always gives interviewing physicians. “You can ask me about our culture, but I don’t want you to hear it from me. Don’t believe me that we’re friendly. Look around as you’re walking through the hallway with me or the recruiter. Look at the folks saying: ‘Hey, Jen,’ and ‘Hi, Dr. Hauler, how’s it going?’”

And you don’t have to confine your observations to the official visit. “I also tell people a little secret trick of mine,” Hauler says. “Anybody can be a visitor walking into a hospital, right? So maybe you show up a few minutes early or stay a few minutes after the interview. Walk down to the cafeteria and have a bottle of water or sit in the main lobby and watch people passing by. There are public spaces where you can get a feel for some things.”

Hauler says questions about the pandemic can be especially revealing. “Ask how staff and physicians came together during COVID,” she recommends, adding an example: “Tell me something that you’re really proud of that your practice did during COVID.” These prompts get people talking more than standard questions, such as “Do you have a culture of kindness?” or “Do you have a patient-centered culture?

Stay confident

The job-search process can be overwhelming. You’ve got to ask questions, formulate answers and make the right decision for yourself. But the physicians who’ve gone before you want to reassure you. They say you shouldn’t be afraid to be honest about your priorities and ask all of your questions. Ultimately, it’s about finding a good fit.

Once you’ve arrived at the visit stage, Wiggins says, “The odds are in your favor. You have power as a trainee because they want you. So don’t be intimidated. Be yourself, and focus on finding a good fit.”

Hauler adds, “The people I’d love to empower the most are residents, interns and fellows who’ve not done interviewing before and think, ‘Well, what do I know? I don’t know anything about the practice environment.’” She says you’ve already accomplished something incredible by getting through training. You’re likely more prepared than you feel.

“Your residency and possibly fellowship have well trained you,” Hauler goes on. “You can say, ‘You know, I’m not familiar with this as an attending, but here’s my experience.’ Don’t underplay your training and the way it’s prepared you to be at this place, in this moment.”

Things may not be as clear as you like at this stage, but that won’t always be the case. As your career progresses, you’ll get more opportunities. You’ll also be able to adapt to your own changing interests.

“Some people will go on to develop an interest in academics. Some people want to be medical staff leaders,” Hauler says. “It’s OK in your interviews to say, ‘You know, in the future, those might all be things I’m interested in, but right now, I’m focusing on being a very good physician. But I’d love to keep the door open to talk about those things.”

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LAURIE MORGAN, MBA

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