The when, what and who of your site visit

Allan Sison, M.D., knew exactly what he wanted from his 2014 site visit to Texas Children’s Hospital and Baylor College of Medicine.

As a pediatric hematologist/oncologist, he had already honed his leukemia research bona fides at Johns Hopkins University. So it was important to discover if Houston was a good fit for his flourishing bench scientist and clinician skills.

Although administrators had their own interview agenda—even asking him to do a “job talk” to evaluate his research achievements—Sison wanted assurances that Baylor would support his contributions and ambitions long-term.

“Since I was coming from a place that was very highly focused on laboratory and clinical research, I was interested in finding out how these institutions value their faculty,” he says. “Were the lab researchers as important as the clinical researchers, and were the researchers as important as the clinicians? That’s what I wanted to know.”

Whether you’re interviewing for your first or next opportunity, making the most of a site visit is critical. A face-to-face meeting allows you to assess the situation by what you see, hear and intuitively feel. Meeting decision-makers is your chance to nail the parameters and potential of the job while getting a feel for future co-workers too. Although the schedule will be tailored to your circumstances, knowing a few basics, what questions to ask and what concrete steps to take to learn about the community will help you find the right job in the right place.

As Sharee Selah, director of physician recruitment services for the University of Maryland Medical System, notes: “It’s like anything else you do. You have to be willing to put time and effort into it. You shouldn’t approach this any differently than you did in learning to practice medicine. That means putting in energy and resources before the jobsite visit to get results from it.”

Checking out the place

Touring the community is part and parcel of most site visits, whether you do it with a realtor or a hospital staffer. Obviously, if it’s familiar territory, you can forego the outing. If the environment is new to you, however, you’ll likely welcome the opportunity to see what the area has to offer beyond just a fine medical practice or superb hospital.

A little preliminary sleuthing can help you customize your visit to see if the place fits your family’s needs. Fortunately, today there are many ways to get the skinny on a place you might call home. Your recruiter will be an important resource in finding out your needs and then matching them to possible options.

The organization’s profile on PracticeLink.com is another good first stop since it will give you a taste of the medical environment along with potential community links. Since most municipalities use the information super highway to park the names of major employers, the latest housing prices and other features that make the place unique, you’ll want to check them out, too.

Also, national websites such as uschamber.com/chamber/directory, bls.gov and city-data.com offer wide-ranging bits of information on the economic health, lifestyle attributes and cultural makeup of cities.

Kathryn Norby, current director of Children’s Clinics and past director of physician recruitment at Fargo, North Dakota-based Sanford Health, keeps up with current events throughout the eastern region of the state where she and her colleagues placed 60 to 70 physicians annually. Because she knows how important it is for physicians to connect with the community, she recommended places, events and other resources.

One Sanford Health candidate, for instance, registered his young children for a kid’s run held during his site visit after noticing on a Fargo website that it would be part of the area’s annual marathon. The heads up allowed the family to experience a slice of North Dakota life. “It has to be the right practice,” says Norby, “but it also has to be the right community with all the right pieces that make you want to call it home.”

Likewise, Lee Moran has worked with many Erlanger Health System candidates who learned before landing what Chattanooga had to offer.

One candidate, for instance, had investigated programs for his autistic teenager. Another wanted to explore indoor and outdoor rock climbing venues after learning that the city is the capital of the sport. Still another worked with Moran to tour local synagogues and meet the rabbis. “This was first and foremost on his list,” she says. “He had done his homework online, which is critical. You really need to check out anything that’s important to you before you get to the place.”

When, What and Who

Although there’s no one-size-fits-all model for site visits, familiarizing yourself with three basic “W’s”—when, what and who—will help you prepare.

When does a visit take place?

Site visits occur either when administrators have an immediate position to fill or they’re intrigued enough with a candidate’s CV to meet and keep the person on their radar.

Sometimes a face-to-face is the first time the two sides talk, but for the most part, a site visit follows a prescreening telephone or even Skype interview concerning the job and the person’s qualifications for and interest in it.

 

What does the visit include?

A site visit is designed to integrate many different tasks in a relatively short, albeit intense, daylong or overnight stay. During that time, you’ll not only be navigating various interviews, but also exploring the medical facility, touring the community and attending a social event.

Even though site visits follow a somewhat standard format, they’re still tailored to each candidate, depending on the specialty, job opening and even type and size of the organization. Meeting with stakeholders who may be key to your understanding of the practice—or your success working in it—are a crucial part of your day.

In addition to meeting a cross section of people who make the practice work, you may have to participate in other activities germane to the job. Because Sison’s potential position was 75 to 80 percent research, he had to deliver a talk during his two-day visit on progress in determining if blocking a molecule—called CXCR4—on the surface of leukemia cells from interacting with healthy bone marrow cells can make the malignant cells more sensitive to therapy.

Who should join you?

You’re the star of your site visit, but your spouse and/or children have important roles, too. Some recruiters prefer that candidates come alone so they have no distractions. But since family members are often the major reason physicians reject offers, it’s helpful to include your partner for his or her real-time impressions. It’s not universally the case with children, however. Although some organizations are amenable to everyone being present initially, administrators often prefer that you wait until there’s an offer at hand before including your whole family.

As much as you love them, your children can create logistical challenges. That’s not to say that recruiters won’t adjust, however. For instance, when a recent candidate for a job at Chattanooga, Tennessee-based Erlanger Health System asked if he and his wife could bring their youngest child along, Lee Moran, director of physician recruitment, happily obliged.

She resolved the only strategic issue—dinner with the partners—by scheduling it at a restaurant within walking distance of the hotel so his wife could leave if it got too long for their little girl. “Luckily for us it was a pediatric group,” says Moran. “It was probably a better situation to work around than if he were meeting with cardiologists or surgeons.”

Who foots the bill?

A potential employer should pick up the entire tab for your site visit. That usually includes airfare, hotel, meals and other incidentals such as a rental car, airport parking and even baggage fees. It doesn’t cover personal expenses, such as toiletries, sightseeing trips or the mini-bar. Even though most groups do the booking for their candidates, in some cases you have to pay upfront with reimbursement later. Whatever the plan, get it in writing.

Also, although your partner’s travel expenses should be included, make sure you understand the situation with children. Not all practices underwrite the entire family unless a candidate accepts the job and/or returns for a suggested second visit. But they all should be willing to pay whether or not an offer is extended or accepted.

Finally, keep in mind that this is a professional visit, so only submit reasonable, related expenses. You don’t want to shoot yourself in the foot like the candidate who tried to charge an employer for a six-pack of beer purchased in the middle of the night before his big interview—a move that brought into question the soundness of his decision-making abilities.

Getting answers

Formal face time with senior partners, administrators and others is a site visit’s main event. During your initial phone conversations, you likely answered screening questions to see if you had the training, skills and interest in the job.

After returning home, you’ll probably have additional conversations to tie up loose ends. But this is your opportunity to dig deeply. Because there’s a lot at stake clinically, financially and emotionally, it’s important to steer the discussion toward topics that could make or break your success. The reassuring news is that anything important to you is fair game.

Selah suggests that your goal should be to fill three information-gathering buckets before the visit ends. The first includes questions related to any aspect of the job that affects your daily ability to see patients. The second focuses on inquiries about the culture or potential fit with other physicians, support staff and the greater medical community. The third concerns geography. Will the area meet your family’s social needs?

“You need to come away with more than just information about the nuts and bolts of the job,” says Selah. “You want to see if it’s the right culture, the right team, the right infrastructure and the right place. Everything should align with your professional and personal priorities.”

So what should you explore? Although there are many plum areas, the following subjects are ripe for the picking:

Position

Why is there an opening and how long has the organization been recruiting? Given today’s physician demographics, it’s easy to assume that you’re filling a retiring colleague’s shoes when there may be other things afoot. You want to know if you’re part of a succession/expansion plan—or simply walking through a revolving door.

Kelvin Shaw, M.D., learned from a spate of interviews how important it is to keep digging until you hear the full story. He nixed one small opportunity after getting the physician-owner to finally admit that she’d retain 51 percent control; he’d never be a full and equal partner.

His persistence eventually landed more conducive buy-in arrangements in Dallas and then Houston, where he’s now part of Allergy & Asthma Associates, a 40-member allergist and ENT team.

“You have to know structure upfront,” says Shaw. “It doesn’t do any good to work for several years and then realize, ‘Oh, I’m never going to be a full partner.’ Then you have to leave and start over again—or stay and be bitter.”

Clinical expectations

What will be required of you, and does it match your expectations? Be sure to get an accurate picture of day-to-day life. How many patients will you be seeing? How much time can you allot for each one? And what’s the competition? Knowing who’s out there is especially important if you’ll need referrals to build volume and stay busy.

Practice dynamics

How collegial is the group? Since surveys repeatedly show that a poor cultural fit is the major reason people leave their jobs, focusing on the work environment should be front and center. Who makes decisions? How are disagreements handled? Who are potential mentors?

Even though you can gauge dynamics by watching and listening, asking will fill in the blanks.

When Vanessa Wear, M.D., was interviewing for a diagnostic radiology position in 2010, it was important to her to know the parameters of the job, including the daily workload, call schedule and weekend coverage.

So when interviewing at Chicago-based Wellington Radiology, a private-academic practice servicing two Advocate Health Care Center hospitals, she zeroed in on questions that would give her the best idea of what would be expected of her.

Also, since culture was key, Wear was very interested in how happy her potential colleagues seemed in their jobs and how well everyone got along in the office. For instance, although many factors entered into her decision about Wellington as a great place to use her breast imaging expertise, it registered over lunch with co-workers that they seemed to enjoy one another and were genuinely interested in each other’s lives.

“I think it’s very obvious if people are happy or not in their jobs,” Wear says. “Yes, everyone can fake it for a little bit, but people’s true feelings come out…whether it’s a frustrated eye roll during the interview or everyone having a great time at lunch.”

Structural support

Can you deliver quality care with the nurses, ancillary services and systems in place? It’s appropriate to ask about anything that could impact a flourishing practice. Do you have to share nurses? Does the group encourage advance practice providers? What bureaucratic hoops exist to alter equipment?

You want evidence that the organization has both infrastructure and flexibility.

Wear says she didn’t ask too many questions about the radiology equipment during her interview. She just assumed any successful practice would have quality scanners necessary to diagnose patients and navigate their breast biopsies. But in retrospect, she’d be more pointed in her equipment inquiries, especially about the ability to make modifications.

Fortunately, Wear had flexibility in changing some technology. Besides bringing new expertise to the practice, she benefited from the relatively small size of the group (20 physicians), which made it easier to accomplish her goals than it may be in a larger organization.

“I was fortunate that everyone was OK with the changes that we made,” she says. “There was some hesitation, but they understood that I had specialized in breast imaging and knew what I was doing.”

Compensation

What will your package include? It’s important to learn how your salary and buy-in will be structured. What are bonuses based on? What’s the mix of payers?

Be thorough in your inquiries, but don’t make financials your lead-in.

“We all work for money,” says Craig Fowler, vice president of recruiting at Atlanta-based Pinnacle Health Group and president of the National Association of Physician Recruiters. “But you need to ask about compensation in the right way at the right time. You don’t want to be the person who obsesses about it. That sends the wrong message.”

Shaw entered the interview fray in 2003 eager to find an ideal allergy position either in Chicago, where he had completed fellowship training, or in Texas, his home turf. Since he needed to know that he’d have a patient base to support his practice, he asked how full his potential colleagues’ schedules were and how far into the future they were booked.

Confident enough in the answers to accept a position in Dallas, Shaw used similar inquiries two years ago when relocating for a faster growing Houston opportunity. “If you’re fighting over the same pool of patients with 10 other physicians, you need to know that the pool will be big enough,” says Shaw.

“Some people can come into a crowded situation and make something of it, but for others it may not be acceptable to grow slowly. So you have to figure out, ‘Is this is really a good situation?’”

Future and family

No one can predict the future, particularly with an ever-evolving health care system. Yet having a feel for the organization’s challenges and plans might help you minimize surprises.

Also, because your personal and professional lives are bound to intersect, getting a handle on work/life balance is critical. What’s the call schedule really like? Will you be home for dinner? Is there time for a healthy family life?

Check with the practice’s younger doctors to gauge their experience.

During her first job search in 2007, Kisha Davis, M.D., had an obvious reason to address a topic often tricky to navigate during a site visit. Because she was in the late stages of pregnancy, talking frankly about family for this family medicine graduate was very pertinent. She needed to know that the Maryland-based community health center’s administrators were open to a delayed start date.

Delighted by the answer, Davis took the job, even though she eventually moved on to a White House fellowship before her current position as medical director of Gaithersburg, Maryland-based Casey Health Institute. She now urges young physicians to inquire about any policy that could impact their personal choices, parenting or family life.

“When it gets to the point that you’re strongly considering a practice and a practice is strongly considering you,” she says, “it’s better for both sides if you ask, ‘How can you accommodate me?’”

Should You Buy or Rent?

Although a community tour will help you get a feel for various neighborhoods, you’ll eventually be looking for a house in one of them. Whether you purchase immediately or rent to get a lay of the land, there are pros and cons to both options.

Renting, for instance, offers the financial flexibility you may need if you still have property to sell elsewhere or you just find the current market wanting.

By not having the upkeep of ownership, you also free up money to take care of student loans or other debt. But most of all, renting buys you time to acclimate to a new community. That includes learning traffic patterns plus housing prices and other factors that could influence your ultimate purchase.

Mona Amini, M.D., attending psychiatrist for Phoenix-based Oasis Behavioral Health, grew up and trained in the area so when she decided to stay there after her psychiatry residency, she didn’t have to learn about neighborhoods or travel times. She and her internist husband already owned a home, so they had experience with the commute.

Even though renting wasn’t on their radar, Amini agrees it may be smart for outsiders to scope out the community, especially a metropolitan area. “The mistake people commonly make is that they don’t appreciate how spread out everything is,” she says. “They think that living 30 minutes from the hospital won’t be a big deal. But they might have to spend an hour and a half in traffic just to get home.”

Then again, you might find big pluses in becoming a homeowner immediately. You’re not only building equity, but you’re reassuring your new colleagues that you’re eager to establish roots in the community and are invested in its future.

Although buying a house is certainly not a prerequisite for taking any job, it frees you up to organize other aspects of your new life knowing that you have a permanent address.

By their house-hunting trip, Allan Sison, M.D., and his wife, Amy, determined that they had enough information to purchase rather than rent. They had learned the neighborhood pros and cons from friends who had relocated to Houston along with Baylor faculty members who lived in diverse areas.

They piggybacked those experiences atop their own research, which included the requisite realtor tour during a second site visit along with time on their own with two children to explore interesting places and things Houstonians like to do.

“Renting makes total sense for some people,” says Sison. “But we knew that we wanted to live in the suburbs, on a cul de sac with a big yard, a good public school system and recreational options. If we had rented, we’d probably just be spinning our wheels.”

If you make the cut, you may participate in a follow-up phone interview with someone higher in the administrative or medical food chain.

For instance, since Baylor’s position involved a three-year National Institutes of Health grant, Sison had to apply for funding. That meant several phone conversations with the division chief in addition to the screening interview prior to his visit.

The final lap

Once the heavy lifting is done, you’ll likely close off your visit with dinner. Even though social events are usually for decompressing, you can still learn about the company you’ll be keeping.

One Connecticut gastroenterologist, for instance, was impressed when eight of 10 physicians in the practice he eventually joined showed up for a Monday evening meal. “It really spoke volumes about how much they prioritized bringing someone new into the practice.”

No matter how well everything goes, however, it’s unlikely that you’ll leave your site visit with an offer. You may have every indication that the group wants to pursue talks further, yet administrators rarely put an agreement on the table before the close of business that day. They’ll likely want to assemble input from all relevant parties first.

“Our philosophy is that if we’re going to ask people to be involved in interviewing,” says Mike Krier, senior physician integration specialist for Milwaukee-based Aurora Health Care, “we better get their thoughts and feelings about a candidate to make a determination. That’s unlikely to occur before the candidate leaves.”

Because you also want to evaluate the opportunity, it’s to your advantage that other steps must occur. In fact, you may want a second visit to confirm your initial findings. Whether or not you anticipate another face-to-face, make sure you understand what happens next.

You may be fortunate in that someone is assigned to walk you through the process. If not, don’t be afraid to get specific about timelines and variables that might affect your search. Also, if you perceive a great possibility, stay in touch.

McDonald didn’t have to wait long to know that her Augusta, Maine, primary care practice wanted her. During the site visit, administrators signaled their interest, even mentioning the pay structure. Within a week, she had an offer. Even though the scale was largely set in stone, the practice sweetened the pot by agreeing to loan repayment and a sign-on bonus.

It was just enough to close the deal with a group that had been on McDonald’s radar since before training. “The culture just struck me as my tribe of people,” she says. “I really admire the physicians and staff. I love the way medicine is practiced and want to be a part of it. I can imagine being here for the rest of my career.”

As for Sison, he wasn’t anxious that he didn’t receive an immediate offer after either his first or second site visit since he was interviewing at two other institutions and assumed Baylor administrators were talking to other candidates too. He just kept in contact until the division chief made an official offer to join the institution’s academic hematology community.

Sison accepted, confident that this position would offer the promotion potential that had eluded him in his prior job because of senior colleagues on the same career path. At Baylor he met physicians who arrived as fellows or young faculty and stayed long enough to be promoted. Sison’s takeaway? Leaders there valued promising researchers and made their progress a priority.

“It proved to me that my development as a junior faculty member was important and that I would have a long-term future here.”

 

Follow up with class

No matter what the final outcome, closing the loop gracefully with interviewers is important. Here are a few pointers.

Be timely

A follow-up phone call when you get home is an immediate way to express your enthusiasm and thanks. But because connecting with busy people can be difficult, emailing is likely your next best option. It’s not only timely, but it won’t get lost in the mailroom.

Also, if you’ve met and spent scant time with a variety of people, CC’ing everyone may be efficient, but you still need to single out the lead people. One final note: Save the texting for follow-up questions with the recruiter. It’s too casual for a formal thank you.

Be professional

Even though your normal style might be very informal, you don’t want your letters to be too breezy. They should be customized and appropriate in tone. “They don’t have to be written in a 1940s business manuscript style,” says Craig Fowler of Pinnacle Health Group, “but you’re usually communicating with more seasoned doctors, so you should be professional.”

Be meticulous

If you want to make a lasting impression, pen a handwritten thank you. Expressing your appreciation on real stationery says something about your attention to detail. “A formal letter stands out because it’s not very common anymore,” says Fowler. “Is it necessary? No, but if you want to be viewed as going the extra mile, mailing a note sends that message. It will be very well received.”

As a psychiatrist affiliated with several Phoenix mental health organizations, Mona Amini, M.D., knows how to close the loop with site visit hosts. Since graduating in September 2013, she has not only served as an attending inpatient psychiatrist, but also as a consultant to various other mental health organizations.

Amini individualized her message to each contact via a personal note. “I’m a firm believer in handwritten thank yous,” she says. “We’re in a very respected field and we should act like professionals. If the opportunity is something that you really want, it shows that you took the time and effort because you really care.”

Be in contact regardless

You may not be interested in the opportunity, yet it’s important to leave a footprint. Keep in mind that the organization is just as interested in finding the best person as you are in finding the best place.

So if you don’t feel the right vibe, thank the key players and let the recruiter know it’s not for you. “It’s hard for some candidates to say, ‘You know, I don’t see myself there,’” says Kathryn Norby. “But it’s OK to be honest if it’s not the right fit.”

Osteopathic family physician Julia McDonald, D.O., MPH, knew what she wanted her practice to look like. So when administrators at Maine Dartmouth Family Medicine Residency in Augusta invited her for a site visit, she targeted questions that would clarify whether or not the physician-faculty opening mirrored her requirements.

By the time McDonald finished, she believed that she’d be a good faculty preceptor fit. Moreover, the private practice and clinical patient care roles were to her liking.

“They didn’t provide 100 percent of what I was looking for, but since I’m new to medicine, I’m certainly open to different ways of doing things,” she says. “The fact that they were even considering things I was considering made me excited to work here.”