Set priorities strategically, pre-screen opportunities, and be prepared to answer tough questions

By Bonnie Darves

When physicians start looking for their second practice opportunity, most expect the process to be easier than the first time because they’re older, more experienced and, presumably, a bit wiser than they were when they left residency. That’s usually the case, recruiters report. These job-seeking physicians usually have a pretty good sense of what they want and don’t want the second time around, at least in terms of practice setting, cultural environment, compensation structure, or responsibilities and schedule.

Ideally, that better-informed, more selective approach translates into a more orderly search process and the right job choice. That’s something that hiring organizations hope, too, and it’s one reason that “second-timers” are desirable candidates, Regina Levison, president of the national recruiting firm Levison Search Associates in El Dorado, California, explained.

“Today, many organizations are looking for these kinds of candidates — early-career physicians who plan to leave their first practice position,” Ms. Levison said. “They know, based on experience, that these physicians make a better choice the second time — and that they’re more likely to stay with the practice or hospital they join.” The other appeal for prospective employers, she added, is that they’re hiring experienced physicians who “know their way around EHRs and can hit the ground running.”

For physicians, one key challenge in that second job search is finding enough time to devote to research, phone interviews, and site visits. But it’s essential to make that time, by starting as far ahead of the desired move as possible, advises Wanda Parker, a principal with the HealthField Alliance, a recruiting and consulting firm in Danbury, Connecticut. “Unless something falls into their lap, physicians should ideally plan on taking up to a year to find the practice opportunity they really want, especially if they will move their family or go to another state,” Ms. Parker said. “We’re seeing that insurance company empanelment, licensing, and credentialing take longer now than they used to. And it can be challenging for busy practicing physicians to find the time for site visits.”

Structuring the job search
Physicians who have had disappointing or unpleasant experiences in their first position might be inclined to target jobs that appear to be the antithesis of what didn’t work out — whether that was stressful political dynamics, unrealistic productivity expectations, or simply the wrong city, community, or practice model. That’s an understandable response. But it’s important to keep those factors in perspective, rather than letting them drive the job search, cautioned Troy Fowler, divisional vice president at the national recruiting firm Merritt Hawkins.

“Physicians certainly should look at what was wrong with their first position and learn from that. But then they should focus more on the positives that they want in their next job, not just on what they want to avoid,” said Mr. Fowler. If the community was a poor fit, for example, physicians should do extensive personal research on the places they are considering, he said, and they should involve their families heavily in that process. They should also reach out to physicians and health industry professionals in the area, to learn about the services market and environment, he advised. For instance, a desirable urban area on the East or West coast might be so oversupplied with physicians in their specialty or generally that compensation could be stagnant and competition for patients stiff.

“Some physicians are willing to go to ‘over-doctored’ areas the second time around, to satisfy their lifestyle objectives. However, they should understand that there will be costs and tradeoffs,” Ms. Levison said. “I have seen physicians choose to move to San Francisco, for instance, even though they will earn far less there than they would in other markets.” She added that lifestyle has become “the number one deciding factor” for physicians, even for highly paid specialists, who seek their second opportunity.

Sorting “needs and wants”
How should physicians pursue the practical aspects of their job search? They should start by creating thoughtfully compiled lists of wants, needs, and “never-agains,” all sources concurred. While that’s good advice for preparing for any career or life decision, it’s a particularly important activity for physicians because second practice opportunities should, ideally, be positions they stay in for several years.

“I encourage physicians to first sit down alone to develop these lists — being careful to distinguish wants from needs — and then review the lists again with their spouse or partner,” said Patrice Streicher, associate director of the VISTA Staffing Solutions’ Physician Search and Consulting Division. “Then physicians should establish a priority order for those needs and wants.”

That sorting process helps avoid the “decision paralysis” that can set in when the stakes surrounding a major life change such as a new practice position are very high, Ms. Streicher explained. “This exercise also helps to tighten up the search.”

Ohio internist Peng E. Wang, DO, focused on prioritizing his criteria in earnest before he started looking for his second job. He worked as a hospitalist out of residency and had expected to pursue a fellowship, but then changed gears. “I wanted the exposure I knew I would get as a hospitalist in a large medical center,” Dr. Wang said. “When the fellowship didn’t work out, I decided I wanted to focus on outpatient practice and work in a smaller environment.”

Dr. Wang will soon join Licking Memorial Internal Medicine, a five-physician practice in Newark, Ohio, in an opportunity that satisfies his top three priorities: remaining in Ohio, working in a practice where he participates actively in decision making, and spending some of his work week in medical informatics. “I looked at four opportunities, and this one was the best fit,” he said, “because I was pretty clear about what I wanted.” He added that because he wasn’t moving out of state, he planned on taking six months to find his next job — and that proved ample time.

Jacqueline Hampton, MD, a Mississippi internist who recently sought another practice opportunity because of a combination of family, personal, and professional considerations, urges her job-seeking counterparts to allow ample time to find the ideal opportunity. “I decided that I wasn’t going to rush into a decision — and I think that can happen when you’re in primary care because there’s so much demand,” she said. Even though she could have landed a new opportunity a few weeks after she started looking last winter, Dr. Hampton allocated about six months for her search.

There were several good opportunities that fit most of Dr. Hampton’s criteria, even in the relatively rural region of Mississippi where she wanted to practice. In the end, she chose the position at Clarksdale Internal Medicine because it offered the key criteria from her wish list: proximity to her parents, a small town (population 17,000) with a rich cultural history, and an attractive work life-style that includes a relatively predictable schedule in office-based practice, in an established group. “It’s just what I was looking for, and if I’d rushed this, I might not have found it,” she said.

The job search should be tighter the second time, all sources agreed, to ensure that it’s efficient and effective. That might entail spending far more time in early “pre-screening” phone conversations with prospective hiring entities than the physician did when he or she looked for a first job. At this juncture, it’s helpful to engage a recruiter to identify opportunities that meet most of the physician’s needs and a reasonable number of the wants, so that physicians don’t go on site visits unnecessarily. “It’s important to narrow the choices from the start, as much as possible,” Ms. Parker said.

She recommends that physicians talk in depth with key individuals — the in-house or retained recruiter, one or two potential physician colleagues, and the vice president of planning or other organization leader — before choosing to visit the practice. Ms. Parker and other recruiters say that it’s appropriate, for example, for the physician to request and receive fairly detailed information early on about the practice’s market position and financial underpinning.

Mr. Fowler said that in today’s data-driven health care services environment, physician candidates should expect “the numbers to be available” on practice revenues, and procedure and encounter volumes, among other key indicators of practice performance and realities. “It should be a red flag if any organization can’t or appears unwilling to provide these data,” he said.

If asking hard questions sounds daunting to physicians who aren’t used to being assertive, the good news, Ms. Levison reported, is that most hiring organizations not only expect but truly welcome pointed inquiries.

“These are all important considerations that will help candidates gauge the potential for a good fit, and ensure that physicians make a well-informed decision. Organizations recognize that,” Ms. Levison said. “It’s appropriate to ask early on about work hours, patient volumes, and call schedule — and even how the patient care breaks down between inpatient and outpatient settings, if that’s important.”

She added that these early discussions also offer an opportunity to prospective candidates to talk about what they would seek in the way of internal support. “If physicians feel that they would benefit from continued mentoring, they should ask if that’s available, and ask who their go-to person might be,” Ms. Levison said. On the practical, business side, if it’s a private practice, physicians should request the specifics about the partnership track and buy-in amounts, she added.

The sources offered the following as additional issues that physicians should explore with prospective hiring organizations, early in their second job search:

• Known or potential downsides of the position. Recruiters should be forthcoming about any divulged or suspected problems in the organization, and physicians should consider the potential ramifications, Mr. Fowler said. “If there’s serious contention in the group, or a partner is going to leave because of unresolvable differences, physicians should know these things going in to interviews,” he said. “It doesn’t mean the physician should avoid the job, if it’s a good fit, because these things can and do occur and get resolved in practices that are otherwise strong.”
• Potential for professional development and advancement over time. Physicians seeking their second job should be thinking 10 to 15 years ahead, Ms. Parker advised, by finding out if there are a leadership track and associated resources. Ask if the organization supports and rewards physicians who pursue further education such as an MBA, MHA, or MPH degree. Likewise, ask about potential for teaching or research, if those activities are of interest.
• The practice or organization’s growth plans and vision for the decade ahead. Physicians should ask about concrete growth plans or new clinical directions that the organization might pursue. In particular, physicians should ask directly if there are any near-term possibilities that the practice or group will be sold or will merge with another organization. “These are things that could affect job satisfaction, and physicians should ask about them specifically,” Ms. Levison said.

Culture assessment key during site visit
By obtaining the particulars of the position in initial phone discussions, and deciding whether there’s enough interest to warrant face-to-face meetings, physicians can devote most of the site visit to exploring the culture and practice environment.

“Culture and practice dynamics are critical with a second practice position, physicians soon discover, so physicians need to find out as much as they can and meet with as many people as possible during that visit,” Ms. Streicher advised. For example, if the physician would have to split her time among three practice locations, and that’s a source of stress among prospective colleagues, it’s important to know about.

“I often tell physicians that if they think they will get everything on their wish list — a top salary, a sought-after community or organization, and a desirable lifestyle, there probably will be a price attached,” such as sky-high expected productivity or an untenable call schedule, she said.

Answering tough interview questions
Physicians should ask serious questions when they’re on a site visit, but they also should expect some to come their way. Understandably, prospective colleagues, department heads, or hospital leaders will want to know why the physician plans to leave the current position.

The challenge is to answer the question candidly without coming across as disgruntled, entitled, unwilling to work hard, or resistant to change. That might entail some careful “pre-scripting,” all sources said, to ensure that the responses are credible and professional, and that there’s no suggestion of “trashing the organization or the individuals,” Ms. Levison advised.

For instance, if the physician is leaving because the current job involves seeing 45 patients a day, when the physician was initially told it would be 30, the response might go something like this:

“I am committed to working hard and putting in the expected 50 hours a week, but at those volumes, I felt that I couldn’t provide high-quality care. And that there was no plan to address the situation.”

When extremely unpleasant office politics prompt the physician’s decision to seek another practice opportunity, she might articulate the problem this way:

“The two partners didn’t see eye to eye on many issues, and that caused a lot of unrest in the practice, which eventually interfered with patient care.”

If the reason for the contemplated move is unmet practice-scope or organization-support expectations, it’s probably OK to be fairly straightforward, sources agreed, by articulating that along these lines:

“When I joined the practice, I was told that my case volume would increase at least 40% in my second year, and that the department would purchase the equipment I thought we needed to deliver cutting-edge care. Unfortunately, neither happened, and I saw no indication that it would.”

Some things don’t change much from the initial job search to the second one. Professionalism and courtesy to all individuals who assist with the search — from recruiters to potential colleagues to department assistants at practices or clinical departments — are musts. Even physicians who are highly sought after because of their specialty, expertise, or particular skills should keep in mind that they still must make a good impression, particularly from the standpoint of their ability to work collaboratively and courteously.

Making a good impression means using good manners, and that includes being very responsible via email and phone with recruiters or staff at the interested organization who make contact. “Physicians should keep in mind that everyone is busy, and that if they’re not interested in an opportunity, it’s best to let people know right away,” Ms. Parker said. “Thank them for their interest, but let them know that you won’t pursue further discussions. Don’t waste other people’s time, or yours.”

Finally, it’s vitally important for physicians to fully include and, ideally, obtain the support of their spouse and family in any final job choice, before accepting the position. “That should be a current, continuing discussion along the way,” Ms. Levison urged. “I have seen candidates talk to a hospital administrator about a contract before they’ve ensured that their spouse is OK with the move, on the basis that ‘we talked about moving to Chicago last year.’ Keep the family discussion active throughout the search process, and ensure everyone has an opportunity to weigh in.”

Recruiters who shared their views also concurred on when and how physicians should curtail their search, when they’ve identified one or two good opportunities that meet most of their criteria. They agreed that it’s best to pre-screen extensively, and then limit site visits to two or three promising opportunities. “That’s where the tipping point begins. If you’ve done your research and asked the right questions, you should be ready to make your choice,” Ms. Streicher said.

“If you find 80 percent to 85 percent of what you’re looking for in an opportunity, it’s probably time to stop your search,” Mr. Fowler said.