When Santhosshi Narayanan, M.D., began applying for hospitalist positions in 2008 after finishing her internal medicine residency at Michigan State University, she was much more concerned about finding the right program than about where it was located.
“I wasn’t focused on any particular geographic region initially,” she says. However, she had crossed Texas and California off her list because of the lengthy licensure process and was leaning toward staying in the Midwest, with Michigan, Ohio and Indiana higher on her list of desirable locales.
So when she saw an online job posting at PracticeLink.com for a hospitalist opening at St. Mary’s Medical Center in Evansville, Ind., she immediately applied.
Within a matter of days, she had received a phone call from the medical director at St. Mary’s, who offered to answer her questions about the position, the program, and to learn more about what she was looking for.
Not only did Narayanan like what she heard, she also was impressed that he had dropped what he was doing to make contact with her. After that initial phone call, Narayanan was invited for a physician site visit to continue exploring whether St. Mary’s might be the place for her.
Hanika Gupta, M.D., in contrast, knew exactly where she wanted to be. A third-year family medicine resident at the University of Pittsburgh Medical Center in McKeesport, Pa., Gupta decided early on that she, her husband and young son were destined for northern California, where they had spent time and had family.
Identifying where she wanted to work made life simpler in some ways, and more difficult in others, only because her employment options were then more limited. Fortunately, the East Bay area of San Francisco, where they wanted to live, has many health facilities. Gupta was contacted by recruiters regarding two openings in the area and uncovered another opportunity on her own, subsequently conducting site visits at all three.
Dan Mumme, M.D., a cardiothoracic surgeon who recently joined the MultiCare team at Tacoma General Hospital, thought initially that he and his wife would return to the Minnesota area, where he did his undergrad, or Wisconsin, where he spent five years in the general surgery residency. But when a former colleague from Wisconsin who had moved to Tacoma alerted Mumme to an opening in the cardiothoracic unit, he decided to explore it.
He had not spent time in the Pacific Northwest but had heard good things about it. After an initial phone meeting with a MultiCare recruiter and a follow-up discussion with one of the surgeons at a national meeting, Mumme was offered a site visit to see if there might be a fit.
Taking the next step
Mike Peterson, CMSR, AASPR, manager of provider services with MultiCare Health System, typically does an initial interview with physician candidates to answer their questions, describe the practice and detail standard compensation packages.
If, after that interview, it looks like a good match, Peterson will then forward the candidate to the lead physician in the practice for a next-level evaluation. If it doesn’t look like a good fit, applicants go no further.
Recruiters can answer your questions about a position—and they can become your biggest advocate and often your personal guide through the interviewing process.
After demonstrating to the recruiter or hiring manager that you are qualified for the open position and interested in pursuing it, additional interviews typically follow. Although Narayanan went straight from an interview with the medical director to a site visit, other facilities may have more steps in the process.
At MultiCare, if all goes well during both the recruiter and the lead physician interview, MultiCare may schedule a video interview, depending on the candidate’s location and availability, or plan an in-person site visit.
Making travel plans is your next step, which, thankfully, most recruiters are happy to handle on your behalf. “There are very few expenses a doctor has to pay on a site visit,” Peterson says. Airfare, hotel, rental car, meals and gas are all covered by the potential employer.
The larger expenses, such as airfare, hotel reservations and car rental, are often direct billed back to the hospital, eliminating the need for candidates to lay out any cash.
However, some facilities will allow you the option to book your own travel arrangements and then submit receipts for reimbursement later, which was the case for Narayanan.
Because of her close proximity to Evansville, the medical director made it clear that Narayanan could drive or fly, whichever she preferred, and that the medical center’s recruiter could take care of making travel arrangements for her or that Narayanan could plan her travel and be reimbursed. He then had the recruiter make contact with Narayanan to choose a date that was convenient for her and to make sure all of her travel needs were met.
The same was true for Mumme—the MultiCare recruiter booked his flights, made hotel reservations, and took care of scheduling his entire visit. Gupta was able to combine three site visits into one and split the expenses between two facilities, which they appreciated.
The physician site visit experience
Most candidates opt to do a physician site visit on a Friday or Monday, says Peterson, so they can use at least one weekend day for their visit and minimize the days off they need to request from their current residency program or position.
In Narayanan’s case, she visited Evansville on Friday and Saturday. The first evening, she had dinner with other hospitalists to get to know them, to see how they got along with each other, and to allow them to get to know her.
She asked them questions, such as, “Do you have a back up plan for unusual patient numbers?” as well as questions regarding physician retention and the stability of the group. In turn, they asked questions related to her family, her confidence level with procedures, and generally assessed her personality to determine if they could all get along, she says.
The second day, Saturday, was Narayanan’s official interview day. First thing in the morning, she had a meeting with fellow hospitalists to talk about the types of patients they serve and about their work process, and then had formal interviews with the medical director, chief medical officer and a hospitalist, followed by lunch with several hospitalists.
In addition to meeting them and evaluating how friendly they were, Narayanan asked how many patients they typically saw in a day and how strong the critical care support was from specialists—issues that were foremost in her mind.
In the afternoon, a real estate agent retained by the recruiter gave her a driving tour of the area and then took her to the airport for her flight back. Since she and her fiancé did not have children at the time, schools were not a major concern, but she did want to know about housing and recreational activities in the area.
Mumme was impressed from the get-go at his site visit in Tacoma. “The recruiter did a phenomenal job,” he says, from picking him up to shuttling him to his many interviews and appointments, to answering his questions and making note of questions she needed to research for him.
In between a series of interviews the first day with administrators and potential colleagues, Mumme met with two surgeons, anesthesiologists and PAs in a conference room. While meant to be informal, the session proved pivotal in his decision-making.
“I could see the interactions between surgeons, anesthesiologists and PAs and that they genuinely got along; I could tell it wasn’t a fake environment.” He saw firsthand that they weren’t putting on a show for his benefit. Dinner that night was with two surgeons and the medical director.
His wife flew in the next day to take advantage of a tour of the community provided by a local real estate agent and then had the chance to walk around Tacoma and see the ocean. That evening, the Mummes were invited to a casual dinner at a local pizza joint, where several doctors and kids came to hang out. The Mummes left feeling like Tacoma could be home.
Gupta’s site visits were similar, but more condensed. In both cases, she arrived for a morning full of interviews followed by an afternoon of house hunting. During her visits at each facility, she spent considerable time getting to know her potential future colleagues, the nurses, even those at the front desk. “It’s crucial to get to know the people you could be working with,” she says. “I wanted to know if our values matched.”
Viewing her employment as a long-term commitment, Gupta was concerned about the people more than anything else. And it was the people who ultimately helped her make her choice. “On one visit, I met a nurse who had been there 37 years. That spoke volumes about the facility.”
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Though spouses and children typically accompany physicians on site visit trips, children generally do not attend professional dinners. In some cases, MultiCare has gone so far as to fly a family member to the physician’s home to provide childcare so that the parents can focus on the people and scheduled events during the site visit and not worry about their children while they are away, says Peterson.
Shadowing a shift
Although the focal points of most site visits are interviews and discussions with potential colleagues, Emergency Medical Associates (EMA), headquartered in Parsippany, N.J., also offers physicians the opportunity to spend a shift with a fellow physician.
Shilpa Amin, M.D., an attending emergency physician at Saint Barnabas Medical Center in Livingston, N.J., had the opportunity to observe a four-hour shift during one of her site visits at another hospital and found it extremely useful.
So when she accepted a position with EMA, which did not have a structured position to help with recruiting, Amin offered to be the liaison between physician candidates and recruiters and to schedule “shadow shift” opportunities as requested. The program officially launched in October 2012.
Amin now has a team of seven physicians who have been educated in how to effectively respond to doctors’ frequently asked questions and how to host physicians who want to shadow a shift.
During that shift, “You can learn a lot about how the physicians work with PAs, how easy it is to use the emergency medical records system, and how to work with scribes,” among many other things, says Amin.
Surprisingly, despite how useful and eye-opening a shadow shift can be, few candidates take advantage of the opportunity. Amin estimates between 15 and 20 percent say yes to a two- to three-hour shadow shift when offered, despite the fact that it can give an accurate picture of what life at the hospital would really be like.
The job offer
Going on a physician site visit does not necessarily mean that an offer will immediately follow.
Sometimes they do, and other times it can take weeks to hear news—good or bad—or even months, as in the case of Amin, who interviewed with a program only to learn during the site visit that there were no current job openings.
While on one hand flattered that they were so interested in meeting her, Amin was also frustrated that she might have an extremely long wait before an opening occurred in emergency medicine.
Within a couple of weeks of her site visit, Narayanan received an offer from St. Mary’s. Before signing it, however, she wanted to bring her fiancé back to make sure he liked the community. About a month later the two headed back to Evansville, also on St. Mary’s dime, to be sure it was where they wanted to live and work. After that visit she signed the contract. Six months later, in June 2011, she started work.
Mumme also received an offer in about two weeks, but heard status updates regularly from the recruiter, “which was helpful,” he says. He never had to wonder where things stood.
At MultiCare, job offers are not typically made during the site visit but can come soon after, says Peterson. The health system then gives physicians up to two weeks to make a decision. They can have more time if needed, but after that two-week window, Peterson and his colleagues will continue the hunt for a doctor to fill the opening. In some cases, an offer will be rescinded if the first candidate cannot commit and an alternate candidate has been found and has accepted an offer.
Gupta strongly advises against jumping at an offer too soon. “Don’t make a decision the day of the site visit. Go home and consider [what you’ve been offered] before jumping,” she suggests, mainly because you want to be sure when you do say yes, you and your family will stay put for a few years.
Evaluating the community
In addition to considering the job opportunity, it is equally important—perhaps even more so—to become familiar with the community in which you would live and work.
Housing is one of the biggest issues, especially in cities where housing prices are well above the national average. Are you certain you can find a nice place to live given the compensation package you may be offered?
As part of the site visit process, Peterson connects candidates with one of the five area real estate agents who have offered to be a resource to potential new hires.
They provide tours of the area, give them an overview of the different neighborhoods, show them houses if they request, as well as shopping, schools, even golf courses. The idea on the site visit is not so much to go house hunting, but to decide whether the practice and the community are a good fit for what the doctor is looking for.
Other questions Gupta needed to have answered had to do with the safety of the area, whether there was a quality day care close by, and the quality of the schools. She really wanted to find a community similar to the one she was leaving.
Peterson recommends looking closely to see how happy the doctors in the practice are. Does this look like a place where you would want to work? What kind of interactions do the physicians and nurses and PAs have with each other? Did you connect with potential colleagues? Can you see yourself there? Those are the bigger questions that should guide any employment decision—and after the site visit, many times the ball will soon be in your court.
“If you get to a physician site visit, we’ve already been impressed by you,” explains Peterson. It is at that point that you need to start considering whether you truly want to work there and become part of the community.