March/April 2008

The Politics of International Medicine

I enjoyed your article [MISSIONS OF MERCY, Jan/Feb 2008] on international medicine, but it was missing one key message: our government's policies are a big reason for the lack of physicians in the developing world. Our government knowingly funds positions for fewer medical students and residents than are needed (not to mention nurses and other health care professionals) to save money, because it knows that the gap will be filled by doctors from developing countries clamoring to come here to have a better lifestyle.

This puts an incredible strain on developing countries which already struggle to fund the training of their own physicians, only to see the US suck them up to fill its own void. If we really want to provide health care to the developing world instead of just tourism and adventures, we will make our voice heard as a profession that we need to train at least enough doctors to meet our own needs, or even better, an excess to be exported to the developing world (as Cuba does). This way the physicians from the developing world will be compelled to stay in their home countries, as there won't be jobs for them here, resulting in more culturally appropriate care than when we drop in for 2 weeks at a time here and there.

Dr. Bill Finn

Resident in Internal Medicine and Pediatrics

University of Rochester, NY

_______________ 

March/April 2008

Job Search "Oops":  Professionals Weigh In

I am writing in response to the “Oops, Did I Do That?” published in Unique Opportunities Jan/Feb 2008 issue. Although I agree with most of the suggestions presented to physicians in order to find the best opportunity, I would like to clarify the “Who’s Who in Recruiting?” section that explains the differences between in-house recruiters and commissioned search firms.  

Most importantly, I think physicians need to understand that both in-house recruiters and agency recruiters or physician search firms are ultimately striving for the same goal…to make a successful, long-term placement where both the hospital or group and the recruited physician and family are happy. Agency recruiters and in-house recruiters are required to build relationships with the administration and current physicians on staff in order to prove their dedication, knowledge and expertise. Yes, firms will only discuss jobs that they have contracts with, just as in-house recruiters will only discuss jobs within their system. It’s really not that different. No recruiter, whether in-house or agency is able to offer a job he or she has no knowledge of or contractual obligation.

As a retained search firm, we will not accept a search unless we are able to visit the location.  We go through the same process a physician interviewee goes through in order to understand and discuss the available positions accurately with our candidates. We tour the hospital, practice and the community and meet with all of the decision makers and colleagues the new physician will be working with. It is completely inaccurate to assume firm recruiters do not know the city, the group or the specialty politics. In many situations, we have found as an outsider more candid information may be shared. And, if we find out it is a bad practice opportunity, we will decline the search, therefore eliminating our candidates from being trapped in an awful situation.

We deal with clients nationwide, which helps provide us with a better understanding of what works in recruitment. Hospitals will hire agency recruiters for searches they are unable to handle on their own, but it does not mean that agency recruiters do not offer good, high paying and competitive jobs in metropolitan areas.  It means they do not have the time or expertise to find the right candidate who has a good reason to be in the area.  Hospitals hire top level search firms to find the best candidates for the job and to weed out those who are not superlative.  Of course, desirable metropolitan locations have physicians knocking on their door to discuss new opportunities, but do top-notch health systems want every physician who sends his or her CV?   We have clients in major metropolitan areas from San Diego, California to Boston, Massachusetts and it is

Yes, firms do require a fee for their services. In fact, high-level agency recruiters may charge fees of $50,000 or greater, not $18,000-24,000 as referenced in the article. That’s because the quality and up-front work is worth it.  I have never heard of a hospital not paying a sign-on bonus or relocation expenses because a search fee was paid. In fact, our clients pay in the top 75% because they are only recruiting the top 20% of physicians seeking new opportunities. It is critical for each and every physician to know he or she will not make less money if working with a recruiter and may earn more because as experts in our field we know what is competitive for each specialty and location.

Ultimately, every recruiter whether in-house, contingency or retained may operate differently and it is the candidate’s responsibility to determine who he or she likes working with based on personality, job expectations, family needs, geographic preference and style.

Shannon McKay, Principal,

Adkisson Consultants, Inc

_______________

I greatly enjoyed the article " Oops, Did I Do That?" by Ms. Therese Karsten [Jan/Feb 2008] . It was informative and entertaining. As I would expect, many of the lessons could be covered by the good manners that we all should learn in kindergarten. It also gave me a perspective that most physicians don't get to view. In particular, it was completely new material learning the organizational differences between in-house recruiting and independent search firms. I am happy to report that I have always enjoyed pleasant and professional rapport with recruiters who have contacted me. I am amazed by how many notices I receive every week now that my name is out there. Even though the majority of opportunities are outside of the geographic and practice parameters of my search, they often contain information I can pass on to an interested colleague. As I continue my job search, the points in the article will be a great resource.

P.S.  I followed the advice in the article and actually used my spell checker on this email!

LTC Christopher P. Coppola, USAF

Section Chief, Pediatric Surgery

Wilford Hall Medical Center

_______________  

Thank you for publishing " Oops, Did I Do That?" [Jan/Feb 2008.]  What a well written article on a subject that is long over due to be addressed. As a long time reader of Unique Opportunities who has worked in Physician Services (physician relations, recruitment and etc,) for more than twenty years, this addressed issues that physicians many times overlook.  

 As a certified medical staff recruiter and a physician services professional who has completed a fellowship in medical staff development I support Therese's article. The in-house recruiter's major responsibility is to ensure that the proper mix of medical and surgical specialists are available to meet the healthcare needs of the communities that we serve. Our job is to develop and execute the medical staff development plans of our healthcare delivery systems in such a manner as to recruit quality physicians to serve our community through a process that meets industry and "legal" standards. Most in-house recruiters are part sales person, clinician, lawyer, accountant, negotiator/mediator, medical practice manager, advertising agent, realtor, community advocate and match maker. The "stakeholders" that look to us as the "keys" to their success are truly varied. The in-house recruiters’ candidates/medical staff members bring the revenue that provides the "profit" for our institutions to be successful, so we can continue our mission. It should be noted that the in-house recruiter "lives" with his or her "placements" as opposed to a recruitment firm that moves on to the next community. Physicians need to understand how vital the interactions with the in-house recruiters are to their future. Many of us have literally built medical staffs for our communities. If doctors want to come and build successful practices many times their first contact, the in-house recruiter, will be the most vital to their short & long term success.

David Andrick, CMSR/FMSD

Director of Physician Recruitment

Wilson Memorial Hospital, Sidney,Ohio

 

September/October 2008

The importance of faith

I normally don't write to editors of magazines. However, after reading the article "Healing and Saving:  Can Religion and Medicine Get Along?" by David Goodman (July/August 2007), I felt I needed to respond to this article. I am one who is responding with some experience in medicine, for I am a family physician who has been in practice 15 years post residency, and I currently hold the position of President of the Medical Staff of my local hospital. I am also deeply rooted in my faith in Jesus Christ and committed to providing care to those in need.

 I find that my faith has had a positive impact on how I practice medicine and in no way has there been a conflict between my faith and the medicine I practice. Furthermore, the care of the sick has been carried out in the name of Christ throughout history. In my own life, it is in faith that I find the very reason to practice medicine in the first place. Hence, I take offense when people like Guadalupe Benitez make statements such as, "If you are going to provide services for one person, you have to provide them for all. If you can't accept that, maybe you shouldn't be in the medical field." Mr. Goodman placed this statement at the end of his article. Hence, he himself likely supports this statement. This statement implies that a physician's religious beliefs should have no influence in his or her practice of medicine.

 Ms. Benitez not only does not understand that in today's world of medicine everyone does not get the same service (which I know is not always fair-and that is another issue to discuss at a different time), but she also does not understand that those who do provide the care to those in need are themselves individuals with rights and freedom of thought. As for myself, I would not want to go to a physician who did not consider how God has uniquely made me, for I may not benefit from the same treatment plan as someone else may. Individuals, both patients and physicians, are uniquely created by God and require specific treatment measures. Furthermore, these treatment measures need to be provided in the light of the practitioner's own religious beliefs.

 More specifically, with regards to faith in my own practice, I find that many people's problems stem from a poor relationship with God, and that when the timing is appropriate, not only will I treat the patient's disease process, but lead them to an understanding of how much God loves them and values them and that their lives can be made whole in Christ.

 Finally, not only does religion play a large role in medicine's origins, help mold how medicine is practiced, provide the necessary backdrop on how to treat each patient as individuals, but religion provides the very reason to provide these services to those in need. People are individually valued by God and therefore I can value each patient I see individually and provide the correct service for that patient, and that service will be modified by my faith. Contrary to the above article's bias, I know that I should be in medicine and that my faith has been integral to how I practice medicine. I will state that not only can religion and medicine coexist, medicine cannot even exist without religion.

 Thank you for reading this editorial response of mine and if you feel it is appropriate, you can publish this letter, for I believe there are many in the field that would support what I have said.

Luke A. Elliott, MD
Grosse Pointe Park, MI

 

A telling response

Just wanted to write you in response to Vicki Martin's response in "Letter's From You" in the September/October issue of Unique Opportunities. I enjoyed your recent article, by the way. The fact that Dr. Martin is so adamant on her views about abortion is saddening. I would hope that most physicians practicing nowadays have enough sense and obligation to their patients that they can set aside their personal views when it comes to treating each individual person. Although many do not agree with abortion, IV drug use, smoking, or even drinking, we still do our best to treat these individuals who make these choices and attempt to do so without prejudice. By not referring someone for a legal procedure based on one's personal belief makes me wonder if she has at some point purposely withheld medical information to someone in order to maintain her own belief, thereby treating herself and not the patient. And, on a more spiteful note, I doubt that losing her subscription matters much being that she appears so closed minded.

Pedro Ramos
San Diego, CA

 

Add End-of-life Care to the Debate

Thank you for exploring the often ignored problem of health-care providers failing to provide full information, services, or even referrals to their patients if the patient seeks care which conflicts with the provider’s personal, moral, or religious views. (“Can Religion and Medicine Get Along?” by David Goodman, July/August 2007)

Your article did not discuss how this problem arises in end-of-life care. In the same study conducted by Dr. Curlin, which was discussed in the article, researchers found that a significant percent of physicians refuse to provide palliative sedation or make a referral for this care, on “conscience” grounds. (Curlin et. al., “Religion, Conscience, and Controversial Clinical Practices,” 356 New Eng. J. Med. 593 (2007)). Palliative sedation is the use of medication to induce sedation to relieve a dying patient’s severe distress that cannot be controlled despite other aggressive measures. (Z. Schuman et al, “Implementing Institutional Change:  An Institutional Case Study of Palliative Sedation,” 8 J. Palliative Med. 666 (2005)). This practice is well accepted by mainstream medicine. ( See also, B. Lo, “Palliative Sedation in Dying Patients,” 294 JAMA 1810-16(2005)); (Rousseau, “Terminal Sedation In The Care Of Dying Patients,” 156 Archives of Internal Medicine 1785 (1996)).

When a dying patient is suffering terribly in the final stages of terminal illness and chooses sedation, that option ought to be available, regardless of the provider’s personal, moral, or religious views. At a minimum, a provider unwilling to provide palliative sedation should be required to make a referral to a physician who is willing to do so, and facilitate prompt transfer of care, so that the patient’s needs are met.

Kathryn L. Tucker
Director of Legal Affairs Compassion & Choices,
Affiliate Professor of Law
Lewis & Clark School of Law, Portland, OR

ED. NOTE:  Watch for an article on palliative care in UO’s Mar/Apr 2008 issue.

 

A Different Opinion

Dear Ms. Mollie Hudson,

I saw your editorial in the July/August edition of Unique Opportunities, and I greatly disagree. A physician is one who should save life—not destroy it. He should have no part in it whatsoever, including referring a patient for an abortion. If you don’t like it, that’s your opinion. You have no right to insist (mandate) that physicians be a party to murder! Be sure to unsubscribe my name to your publication.

Vicki Martin, MD
Birmingham, AL

ED. NOTE:  I did make the point in my letter that this was my opinion. That is the nice thing about opinions—everybody is entitled to one.

M. Hudson

 

UO welcomes your responses. Letters must be signed for verification but names may be withheld for publication.

E-mail your comments to tellus@uoworks.com.