After four years of med school and three or more of residency, you know the difference between edema and epidermis, inpatient and intravenous. But deciphering contract legalese? That’s another story.
Your training program likely didn’t cover finding a job, negotiating an agreement or sealing the deal. That lack of preparation sometimes causes candidates to stumble during the job hunt process. Thankfully, many recruiters understand such missteps are unintentional, but hiccups can still be frustrating - and may damage your new employment relationship.
The good news is you can avoid these faux pas with a little research. Here are four things job-seeking residents do that end up hurting, rather than helping: 1) starting late, 2) not understanding deadlines, 3) collecting offers and 4) not following up.
When Trish Fite, CPRP, senior physician recruiter with Holland Hospital in Holland, Michigan, begins searching for candidates, she uses a multi-pronged approach. She often starts by searching PracticeLink’s database for physicians with specific training or specialties. She’ll also canvass LinkedIn, and sometimes she’ll advertise in a specialty journal.
In a typical year, 70 percent of the candidates she interviews are residents starting their first full-time positions. Thanks to her experience, she’s familiar with questions these first-time job hunters typically have, and she tries to educate them during the selection process.
Many questions and issues arise simply because candidates aren’t familiar with the process. That’s why Fite says, "There’s not much that drives me nuts because they just don’t know." However, it’s a different story when it comes to timelines. "One of my biggest pet peeves is that they’re waiting," she adds. When doctors start the job hunt too late, they miss opportunities with employers.
Historically, says Fite, the ideal scenario has been for doctors to be close to signing six months before residency ends. In other words, residents who finish in June 2022 should try to have jobs lined up by December 2021. "They should have done all of their interviews and be ready to go by the end of the calendar year of their last year of training," she says. Employers keep this typical timeline in mind as they fill openings for the coming year.
Candidates who start late will likely find fewer opportunities, since their colleagues have already been looking and interviewing for several months - or even years. This is especially true if you have narrow criteria.
In a previous recruiting job, Fite interviewed one candidate who started looking for a specialized psychiatry position the spring before his contract ended in June. When she asked why he started his search so late, he said he thought he could put it off since he was so clear about his priorities and geographic preferences.
Unfortunately, specialized searches often take more time, not less. So if you have a strong location preference or you’re in a hard-to-place specialty, start even sooner - as early as your first or second year of residency.
As of February 2021, Fite was already interviewing applicants who will finish residency in 2022 and 2023. When it comes to candidates who start applying just a few months before the end of residency, Fite explains, "I’m always a little leery." Even with strong candidates, she tends to wonder whether other employers have already passed on them. As she says, "It raises red flags."
That said, things are a little different this year. Fite explains, "COVID has delayed everything!" Residents finishing in 2020 and 2021 were in an unprecedented situation, and it impacted scheduling across the board. Looking ahead, she says, "I am trying to decide if I need to change my own mindset going forward."
Even so, timing is a big factor in the hiring process, and it never hurts to start early. After all, the earlier you start your search, the more time you’ll have to find the right job and negotiate contract specifics.
Michael Lester, assistant dean of physician/faculty recruitment and retention at the Lewis Katz School of Medicine at Temple University in Philadelphia, understands that many residents are unfamiliar and uncomfortable with the job search and negotiation process. He invests time in educating new graduates on best practices as they explore whether Temple is the best place for them.
"It truly must be a partnership with each candidate when it comes to recruitment - and especially negotiations. The process is explained in great detail," he says. "I tell them, ’There’s an important phase of the process where you’re able to negotiate review and negotiate terms.’ It’s explained to them verbally. It’s explained to them in writing. It’s reiterated through the negotiation process."
Even so, many doctors essentially ignore that window of opportunity and try to negotiate terms after signing an offer letter. That’s frustrating to Lester. As he explains, the first stage of the offer process is a draft contract, "which basically serves as a letter of intent for us." It includes the proposed agreement.
Just after you’ve received this is the right time to review terms and request any changes. Lester says, "Any negotiations that are to take place take place during that phase in the process." After you see the draft contract, you have an opportunity to say, "Before we finalize this, would it be possible to get this?" or "Could we change that?"
"Our contracts are fairly standard, and most terms are non-negotiable," Lester says, "for anyone." The restrictive covenant is one such clause at Temple. In most cases, their candidates can only negotiate dates and dollars. "My team makes this clear early in the offer process so that faculty prospects don’t waste their time asking to change items that are considered standard," he explains.
Even so, Fite has had candidates ask about waiving the noncompete, which can’t be removed, and one attorney wanted more malpractice coverage than the hospital’s umbrella coverage provided. This was also denied.
Other terms, however, can sometimes be modified if the candidate asks before the contract is finalized. For example, one of Fite’s candidates wanted permission to moonlight at his current residency program to stay connected to teaching and research. The hospital considered it because "it does keep [doctors] sharp because [they] have to stay half a step ahead of the new residents they’re teaching," Fite says. In the end, the candidate got the accommodation.
Another candidate asked for standard student loan assistance to be redirected into a signing bonus, since she didn’t have loans. Fite’s reaction? "That’s a good ask." She took the request to her boss.
Mark Douyard, MBA, CPRP, senior physician recruiter with Bayhealth Medical Center in Dover, Delaware, encourages candidates to have an attorney look at their contract. However, he cautions: "Make sure that the attorney has a background in and understanding of health care." Otherwise, their recommendations may not be helpful.
He recalls one physician whose real estate attorney friend reviewed a proposed contract. After coming across a standard section about signing over billings and completing charts, the attorney struck out the entire section and naively advised their client: "You don’t need to do that."
When Douyard saw this, he asked the doctor, "Are you expecting to get paid?" He then explained that the hospital can only bill if doctors complete charts and allow the hospital to bill on their behalf. That language was critical. The doctor continued to argue about it, and they ended up not moving forward. Introducing a non-health care attorney effectively scuttled the deal.
Whatever and however you decide to negotiate, be sure these discussions happen right after you receive a letter of intent - and before you sign it. Lester tells physicians this is the best document to share with an attorney for review, since it will be identical to the contract. "The main difference is that the final letter is signed by the dean, and it becomes an official contract, but the terms and conditions are identical," he explains.
Some physicians create frustration by signing their letters of intent before having their attorneys review it. Their signature indicates they agree with all the terms, but since a letter of intent is non-binding, they can still legally ask for changes. Unfortunately, at that point, they’re unlikely to get accommodations. The hiring process "is bogged down a little bit," Lester says, and employers start to question the candidate’s intent and ability to follow basic instructions.
At that point, he usually responds to the physician and their attorney to explain the situation. "These questions, clarifications, negotiations, whatever it may be, have already been discussed, addressed, and we’ve come to an understanding on the terms and conditions," Lester explains. "And I make it very clear that we’re not reopening negotiations."
He’s trying to say in the friendliest way possible that the time for negotiation is up. Ideally, the candidate will choose to move forward with signing the contract as is. "At the end of the day, we have a common goal: put negotiations behind us and focus on the next steps in becoming a faculty member at Temple," Lester says.
Douyard isn’t just looking for skilled physicians. He’s also looking for the right match for Bayhealth’s workplace and culture. He wants to hire doctors who are team players "who are going to fit with the existing practice."
By the time a candidate has interviewed and perhaps even done a site visit, both the hospital and the doctor should have a general sense about the match. If the opportunity fits their priorities and they fit the facility’s hiring needs, the next step is an offer letter.
For Douyard and others, it’s frustrating when a candidate isn’t transparent about where they are in the job search. He explains: "If you interview with me in January and we let you know that we want to make an offer, I will ask, ’What’s your timetable?’" If a candidate says they’re ready to make a decision, Douyard will send the offer letter, expecting the negotiations to wrap up in the next week or so. He says, "When we make an offer, we at least think that we have the potential to fill the spot that we’re making the offer for."
Understandably, he feels exasperated if he follows up a week or so later and discovers the physician is still interviewing and has other visits scheduled over the coming months. That indicates the doctor isn’t ready to decide, despite what they said before. "It’s OK to leave things in limbo for a month or so," Douyard explains, "but not indefinitely."
In 2020, one candidate kept him waiting for almost 90 days before deciding to accept another job. Douyard doesn’t mind hearing a no, but he says the hospital "wouldn’t have sent the offer when it did if we had any clue that’s the way things were going to work out."
Sometimes, employers will rescind offers in these situations. Once, Douyard’s center issued an offer in February and didn’t hear back for several weeks. Finally, he sent the candidate an email that said: "We assume you found another job, and I would have hoped you would have notified us, but if I don’t hear from you by the close of business on March 30, we will assume you have taken a job elsewhere."
Of course, evaluating multiple offers isn’t always a bad thing. "I don’t want to give the impression that it’s not OK to get six offers," Douyard clarifies. "Depending on where you want to go and what you want to do, if you’re able to get that many, I think that’s wonderful. Just don’t space them out over a period of 120 days and leave everybody else waiting."
Employers who interview you early in your search may not be willing to wait for you to figure out where you really want to be.
The fourth mistake that frustrates recruiters has to do with communication - or the lack thereof. Recruiters generally operate under the assumption that doctors are talking to multiple facilities. "And that’s OK, we expect that," says Douyard. "It’s OK to interview at other places. It’s OK to compare offers, but let’s keep the lines of communication open."
When candidates go silent, recruiters aren’t sure where things stand. Are they on vacation or just slammed with work? Are they interviewing elsewhere? Or have they decided they don’t want the job after all? There’s no way to tell what the reality is.
After sending an offer letter, Douyard tries to follow up with candidates to see how things are going. He wants to know if they’re still considering the offer, if they need more time or if they’re waiting for other offers. In other words, he’s just trying to take a pulse. Unfortunately, some physicians seem to drop off the face of the earth once they have an offer letter in hand. Essentially, they ghost recruiters.
"If I call you a week later just to check in, it’s not necessarily that I’m calling you because I need an answer [to the offer], but I’m checking in," Douyard explains. Recruiters aren’t trying to pressure you, only to gather feedback and information. Yet many doctors ignore calls, texts and emails altogether.
"Don’t keep people in the dark," Douyard advises. Based on his experience, if he doesn’t hear back within a couple of weeks, he assumes a candidate has taken a job elsewhere, and he moves on. Sometimes he’ll find out later that Bayhealth was a candidate’s first choice, and they just needed a little more time. But if a candidate doesn’t communicate with him, Douyard has no way of knowing what’s on their mind.
For example, a couple years ago, Douyard was trying to fill a primary care spot. He found a terrific candidate and made an offer. But then, he heard crickets. "We sent the contract out in the middle of February, followed up a week later - nothing," he says. "Called, texted and emailed continuously and no response." It was surprising, given the candidate’s level of interest during the interview phase. It was also disappointing because, as Douyard recalls, "This was someone the practice really, really wanted to hire."
In fact, the practice had steered candidates elsewhere, since they thought they had filled the job. After two weeks without a response, they had to begin the search anew, never knowing what happened with the previous candidate.
"Going dark," as Douyard calls it, "is a pet peeve." He explains, "If you’re a professional person, you should have the courtesy to let people know that you’ve taken a job somewhere else, which is what I’m assuming this candidate has done."
It’s likely the doctor felt uncomfortable turning the job down. They may have cut off communication to avoid conflict. But there really wasn’t any conflict to avoid. Recruiters don’t take these things personally. As Douyard says, "My feelings aren’t hurt. It’s business. But at least be professional enough to drop an email. You don’t have to call, but drop an email and say, ’I’ve accepted another position. Thanks for your time.’ That’s the professional thing to do."
After all, unprofessional behavior can come back to haunt you during a future job search - especially if you work in a narrow subspecialty. Recruiters move around, and you might one day come face-to-face with a recruiter you ignored. That memory certainly isn’t going to help you land that next job.
Making your way through the job hunt process is no small feat. But finishing strong is just as important as starting strong. As you wrap up interviews and start to receive offers, be sure you maintain a good impression by avoiding these faux pas that frustrate recruiters. After all, you may run into them again.
"It’s a relationship-building business and chances are the recruiter you’re talking to has relationships with people throughout the organization, so never burn a bridge," Douyard advises. "Be reasonable, be likeable and keep the lines of communication open."