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Deposition Designation Station

Jack Ahern, MBA

One of the renal-related roles I had the privilege of fulfilling in the early part of my career was that of a recruiter specializing in matching nephrologist to employment opportunities.

Although the majority of the nephrologists I worked with were newly minted, post fellowship, and looking for their first "real job" several candidates I worked with were experienced, mid-to-late career nephrologists looking for a major change or a next step in career development.

During the course of my recruiting activities, I had the chance to review resumes from physicians seeking employment and to talk, on an in-depth basis, with each of these candidates about their background, goals and aspirations. I likewise gained an insider's understanding of how employment decisions are made by hospitals and group practices.

I would like to provide readers of this article with some of the insights I gained while assisting with the engagement of physicians.

The first thing that struck me as a recruiter, was that although nephrologists received intensive training in providing medical services, few nephrologists, had the benefit of professional guidance or training with respect to finding a practice situation suited to their needs. Even fewer nephrologists had formal training or professional guidance on how to optimally negotiate employment terms. As such, I heartily recommend that every nephrologist seeking a new employment opportunity obtain professional guidance to ensure that every aspect of the employment process is optimized.

Each employment opportunity presents unique challenges and it is hard to predict which aspect of the engagement process, which can span from three months to several years, may have a significant impact on the long-term success of both the candidate and the employer. So wisdom dictates to cover all the bases and ensure that not only is the most suitable opportunity located, but also that the terms of engagement are as beneficial to the candidate as possible while respecting the needs of the hiring party.

In my experience, even for high-level professionals such as nephrologists, some very basic items such as how correspondence is handled, choice of dress, quality of resume, and cultural sensitivity, can be surprisingly important make or break factors which determine who gets a job offer, or the most agreeable financial arrangement.

I cannot stress enough that cultural sensitivity is a factor to not to be overlooked or underestimated in its impact. I am not simply referring to the more general definition of culture as pertaining to a person's nationality and background, but also to the nuanced reality of the cultural variances based on geography and demographics.

De-briefing candidates and potential employers after interviews often revealed that there are significantly different ways to approaching the hiring process in different regions of the United States and at different institutions.

In particular, certain regions of the U.S. and certain institutions are must less formal than others in terms of dress, demeanor, and location for high level decision making meetings. I would advise any candidate to research not only the typical cultural elements that may affect how she is perceived, but also how business is done at the specific institution or group practice she is applying for.

As a recruiter, a trend that I noticed was that the nephrologist candidates tended to overly focus on hard-earned qualifications, such as board certification and the reputation of their respective educational institutions. Candidates however, tended to gloss over the nuanced impressions produced by overall presentation and relationship building skills, and sometimes this meant that, despite significant professional achievement, they were turned down for the position they very badly wanted.

I have been on the inside of decision making, and heard the frank, unedited, discussions of who will be given an offer, and why. Based on what I have heard I would like to remind all candidates that: when selecting from a group, Xdecisions are made on the margin. More often that not, it is what differentiates a candidate from the group that has the most impact.

Often several candidates will have more than adequate qualifications, so to get the best offer, other softer factors become determinative. For instance, if a prospective employer pays for a candidate to come visit a practice, and the candidate arrives relatively unprepared or fails to send a thank you note after the interview, some (but not all) employers will take offense and hold it against the prospect, not withstanding otherwise superb qualifications. Details I have heard discussed when making a final decision include straight forward items that all job seekers should be sensitive to such as: dress, deportment, and timeliness.

The Hidden Deal Breaker

It is not uncommon that, by the time a physician completes a nephrology fellowship the physician is married, has children in school, and his/her parents are older, perhaps in need of assistance. Notwithstanding these or similar very real family dynamics, I have seen newly minted nephrologists go through the entire recruiting process, right up to a formal offer, negotiation of salary, and terms of engagement, only to find that either they, or their spouse, cannot feel comfortable about some aspect of moving to a new location.

Demographic factors, that would have seemed self-evident from the beginning, become "November surprises" and have scuttled otherwise great opportunities. So my advice to both potential candidates and employers is to not overlook demographic or family concerns, and address demographic issues very early on in the process.

In closing, my advice to all potential candidates and employers is to present your situation as it is, if it is a match, then carefully proceed forward, but do not try to over sell, either yourself, or your practice opportunity.

As always, I invite you to send me your comments at and let me know what you think!

Jack Ahern, MBA - As a seasoned Healthcare Executive, Instructor, Author and Financial Manager, Jack Ahern brings to the table expertise gained by managing finances for an academic medical center, and providing guidance to physicians, hospitals, HMO's and major academic medical centers on issues pertaining to physician and hospital billing, hospital administration, strategic planning, renal dialysis reimbursement, HIPAA, ethics, regulatory issues and compliance.

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