As a physician recruiter of prominence, a number of times during any given week I get a fair number of calls from physicians in training who, honestly, should not be calling me whatsoever and I am very frank in telling them this.  The call normally starts something like this:

“Hi Bo, my name is Dr. Doe.  I am finishing up my dermatology residency and I want to be there in Austin.”

“Ok, Dr. Doe, are you flexible on location at all?”

“No, I am only going to consider Austin.”

“Sure, I understand.  I am actually from Austin.  Great place.  But, you do realize Austin is one of the most sought after, and consequently saturated, markets for physician employment in the entire US?”

“Right, yes, I know.”

“As well, the population is very young and fit, so it is therefore not the veritable goldmine of skin cancer you probably want and could find even in a more agrarian setting just a half hour or so away from Austin.”

“I understand all that.  I am not really financially motivated.”

It’s at this point in the conversation, realizing this person’s heart is set on Austin, that I diverge from what is typical of an agency recruiter to do:

“Look, Dr. Doe. If you’re dead-set on being in Austin, you don’t want us looking into that area for you.”

“Why not?”

“Well, because I know first-hand that Austin-area practices are inundated with the CV’s of those in training and if we refer you to a practice, it’s going to put a $20-30,000 additional price tag on your head for the practice to have to deal with in hiring you.”

“Wait, what?”

“Yes, that’s right. As much as I would like to help you find a job, my wife insists that I get paid for it.”

“Well, what if I paid you?”

“That’s a bit trickier of a relationship – probably something more appropriate for an attorney – but would you actually be willing to pay us $20-30,000 in fees to find you a job?”

“Maybe I would, but I can’t. I am an indebted resident.”

Here’s the thing.  I’m a veteran physician recruiter and without being too braggadocios, I am rather good at what I do.  The physician recruitment field is very challenging and rewarding in a number of ways, but I ultimately do it because it is lucrative.  However, no amount of money is worth negatively effecting the trajectory of someone’s career.

If I get an agreement in place with an Austin-area practice in contemplation of Dr. Doe’s candidacy, it basically says that in the event Dr. Doe signs a contract for employment with said practice, I get $20,000 from them.  Now, if the practice has seven or so PGY-4 residents they are presently considering for hire, six of whom came to them on their own and one of whom – Dr. Doe – was presented by a recruiter whose services ultimately come at a hefty price, I assure you the practice is often going to focus on those other 6 candidates before they give Dr. Doe an offer.

Sure, there’s always the chance the practice will still hire Dr. Doe, the fee attached to his candidacy notwithstanding, but the chances are pretty slim and I would prefer to spend my time on other matters. I’d rather have Dr. Doe remember me with fondness for not sabotaging his job search as he entered practice, so in the event he decides he wants to get paid in something other than the charm of idyllic Austin, he will contact me about some of my job openings in other areas.

Do note that I am by no means saying, “Do not work with a recruiter.”  If a recruiter approaches you about a job you have interest in, or you see an ad of interest placed by a recruiter, then by all means you should work with them.  This means that the practice has already conceptually allocated the funds towards the process and, in some respects, your candidacy is actually bolstered by working with the recruiter (especially if the nature of the relationship the recruiter has with their client is of the “retained” variety, which is what almost all of mine are).

What I am saying, however, is do not individually approach a recruiter about being promoted in an area  of prominence.  If you encounter a recruiter less ethical than myself, you may be inadvertently harming your candidacy.  Instead, open the phone book and call every practice you can find, get their fax number or mailing address and send in your CV that way.

In other words, don’t call us, we’ll call you.  We’re recruiters and we’re very good at that.

This essay is cited in the KevinMD record on physician careers.

Bo Claypool is a physician recruiter who is the managing partner of Monroe & Weisbrod, a psychiatry-specific physician recruitment firm.