An insider's look at recruiters and recruiting.

The right job can lead a physician executive to wealth and happiness; however, even the perfect position in the wrong organization can make a physician executive miserable.

On the surface, recruiters look for that special 'fit' between the best of the candidate pool and the organization to achieve mutual satisfaction. Unfortunately, recruiters do not have special powers of intuition or observation to always match the right candidate with the perfect organization. In the real world, neither the candidate pool nor the organization is ideal and that frequently creates unrealistic expectations.

Recruiters are business people. This simple fact can help the candidate understand the real priorities and issues of the recruiter. All businesses must have income and, for the headhunter, revenue is earned by selling search assignments.

While doing good search work may lead to more sales, a major portion of any search professional's time is spent cultivating relationships with people who might be in the position to purchase search work. The trustees, the chief executive officer and the vice president for human resources typically purchase search work. Recruiters look for any opportunity to develop a personal relationship with these key individuals and make a sale.

Candidates need to be aware of specific recruiters who seem to get the majority of the business for the type of position and organization that is desired. A candidate who is looking to be placed in a large academic health system should be aware of the top recruiters in this area. Similarly, a physician executive focused on a job in the managed care industry may look for a different recruiter.

Know your recruiter

Recruiting firms may have dozens (or hundreds) of recruiters. It is the relationship with the recruiter that is key. While sending a well-prepared resume and curriculum vitae to a firm will get you into the database, the candidate needs to be known by a specific recruiter.

With any new search assignment, recruiters often take a quick personal inventory and identify people who may be perfect for the job they are hired to fill. Top recruiters can normally generate a list of a dozen or so candidates in less than 10 minutes of considering a new position. Of course, recruiters use their databases and other means to identify other candidates; however, 'top-of-mind' candidates have an advantage in the recruiting process.

It is rare that a candidate responding to an advertisement will get serious consideration for the position. It is true that advertisements are commonly posted on Web sites and in professional journals; however, the ads are not necessarily placed in these media to find top candidates. Rather, these ads are used to keep the recruiter's name in print for future search sales or to get the position in the public view for other organizational needs.

Top recruiters make it their business to know the target candidate pool. In fact, given the aggressive timeline of a typical search process, by the time an ad is printed, the search is well under way (and sometimes completed) which eliminates any real chance of being considered for that particular search.

While there are thousands of recruiters in the United States, very few do any significant work in recruiting physician executives. Some firms recruit for everything from physician to financial to manufacturing executives. Other firms are very specialized in only recruiting managed care physician executives.

Even the generalist firms tend to have recruiters who specialize in health care and physician executive placement. Get to know these health care specialists. It is rare that a recruiter who specializes in financial services will conduct a health care search--these projects are handed off to one of the firms specialists.

Look for reasons to build a relationship with recruiters when you are not necessarily looking for a job. They can be contacted at recruiting fairs or by phone or e-mail for specific positions and most will talk with people interested in limited career coaching on how to identify the next position.

Warning: Don't be a pest

A big caution: Candidates must be very thoughtful in each contact with recruiters. Endless e-mails and frequent contacts may not serve the candidate well. It requires a careful balance of getting to know the recruiter without appearing to be a pest.

A candidate who responds to every position posted indicates desperation or a lack of an understanding of his or her own goals. I had a candidate who responded to literally all posted positions at least once and frequently two to three times. The candidate responded to an executive vice president for medical affairs position at a top 10 health system that required substantial academic and management experience.

The same candidate said being a medical director of a small rural multi-specialty clinic was his dream job. It was obvious that the candidate had no directed goals beyond the plea "get me a job, any job and now!"

Even worse, the candidate's resume was unorganized, full of mistakes and had significant unexplained gaps. Needless to say, this candidate will probably not get a position through a recruiter.

Understanding your own goals is critical in the recruitment game. I have witnessed several excellent physician executives taking jobs that didn't seem to make sense when considering their long term goals and the family situation.

A candidate who had been a vice president for medical affairs at a small hospital in the New York City area was looking for that next move. He and his wife were born, educated and lived in New York City their entire lives. He actively pursed a VPMA position at a medium-sized hospital in rural Tennessee because of the role's added responsibility and complexity of the organization. He was ultimately hired by the hospital.

Unfortunately, within three months of the start date, the newly hired VPMA called the recruiter to say he needed to find a new job back in NYC. His wife couldn't live in this tiny town and his children had experienced a drug trade that exceeded that of the toughest areas in NYC.

This situation presented two big problems. First, the recruiter guaranteed the placement for two years, so he was required to start working again on this search. Redoing a search is one of the headhunter's least favorite tasks. It shows the client that something went seriously wrong and it requires the recruiter to start from scratch on the search that will take several months of additional work.

Secondly, for the candidate, this may be a career-ending move. Future employers will always look to why a position only lasted a few months. In addition, recruiters are even more leery of the candidate who is placed and leaves shortly thereafter.

Headhunters don't like risky placements and try to identify candidates who have a very high probability of staying in the position at least through the guarantee of one to three years. Recruiters will almost never tell these candidates that they are damaged goods; however, individuals who leave a job shortly after starting are nearly always considered risky recruits at best.

Organizational fit

Finding the right organization for the candidate is a challenge. Recruiters often have difficulties placing good candidates in small organizations and rural areas. In addition, knowledgeable candidates often overlook organizations that have a history of conflict. Some recruiters will try to sell the wrong organization to the candidate so he can fill the job.

Recruiters appreciate the thoughtfulness of the candidate who does not want to be considered for a position or organization that doesn't have the right fit. The candidate should withdrawal from the search as early as possible in the process to eliminate any false expectations by the organization and recruiter.

It is too late to withdrawal after the recruiter has presented your name to the organization. This places the headhunter in a difficult situation with the client and it could harm your chances of being considered for the next perfect job that comes his way.

Further, providing the recruiter with names of other possible candidates is a great way to foster the relationship. This encourages future communication from the recruiter and leaves a positive impression.

Scott Ransom, DO, MBA, MPH, CPE, FACPE is the director of the Program for Healthcare Improvement and Leadership Development and an associate professor in obstetrics, gynecology, health management and policy at the University of Michigan, Ann Arbor. He is also president of the American College of Physician Executives. He can be reached by phone at 734-615-4575 or by e-mail at [e-mail].