Transcript

- Hello, ladies and gentlemen. Welcome to another session of the AANS Operative Grand Rounds. We have a three-part series prepared. The first part discussing how to land the ideal job that you desire. Second part, we'll discuss the details of contract negotiation. And the third part, we'll review principles of business development in your new job. We thought that this series will be helpful to our graduating chief residents. Thank you again for joining us.

- Hello, ladies and gentlemen. My name is Troy Painter. I am the president of the Goodman Campbell Brain and Spine. It's odd for me to be presenting today, the topic of how to land a job, negotiate a contract, and succeed in your new practice. Our guest today is Judy Rosman. She is from the neurosurgical recruiting firm of Rosman Search, Inc. Welcome, Judy.

- Hi there, Troy. I want to thank everybody for sharing their time with me today, and I'm really excited to speak with everybody about my experience helping residents and practicing neurosurgeons through the job search process. There are a lot of things that you all probably did not learn in residency, which are really important for your job search, actually landing a job. The most important of which is how to actually be successful in your job interviews. Everybody has a very limited period of time to interview, and it's very important to make the most of each of those precious days off that you take from your chief year or your fellowship to interview for a job. There are a lot of communication issues that happen through the job search process. Sometimes you call a practice or they call you. You think you have a great conversation, and then you don't hear anything back and you might want to hear back from them and you might be anxious. Sometimes you have to tell people with whom you had a great interview that you're not interested in their job. You're not coming. Sometimes those people are friends who might've graduated before you and your residency, and you don't quite know what to tell those guys. And that can be hard. Sometimes you're not certain about a job offer. You think it's a good job offer and you like the practice, but you also want to see what else is out there and you don't want to jeopardize that offer. And at the same time, you want to be able to take a little bit of time to look. That's a really common problem. And it's often hard for people to know how to handle that. Another thing that really stumps people and can really knock your job, your job prospects off track is the contract negotiation process. A lot of people don't know how to successfully negotiate a contract. They don't know what the proper approach is for negotiating a contract and they can make mistakes that can cost them a job offer that they really want. How to choose a lawyer. That's something that most residents are not really familiar with. And it's very important that you choose a lawyer with a good approach and the right expertise and how to get started in your new practice successfully. People talk about how to take care of patients in residency, but they don't really talk usually about business development and how to make sure that you have patients to take care of.

- Judy, if we can accomplish all that in this discussion today, I think we're doing a great service for residents. So we've set out some lofty goals and I'm looking forward to this discussion.

- Terrific. Thank you very much. I actually do think that we can do that today.

- Excellent.

- So a lot of people are very much aware when they start their job search, that neurosurgeons are in very high demand. And I'd like to ask all of you listening to this webinar, what you think the purpose of an interview is? Many of you, when you call me, seem to think that the purpose of the job interview is for you to decide whether or not you like the practice opportunity. And that approach really assumes that the people that you're interviewing are going to want you. I think it's important to remember that the actual purpose of the job interview is for you to get a job offer, because although it's important for you to decide whether or not you're interested in the practice, if you're interested in the practice, but they're not interested in you because you didn't interview very well, then you don't have a chance at that job. So the first, first and foremost, the primary purpose of any job interview should be for you to bring home that winning ticket. You have to have the job offer in order for that interview to be considered successful. When you are interviewing, it's important to know that social skills are more important than your clinical skills and social skills are also just something that is usually not addressed or not addressed in a big way during residency.

- So I would certainly agree with everything you said. I think both, you know, getting the job offer, but obviously you may go on job interviews and discover that you don't want to go to that place. So it still is a two-way street.

- There's no question about that. My only point is is that if you go on the job offer, you don't want to love them and have them not love you. So my goal for candidates is when they go to interview at practices, to make sure that whatever they think of the practice, the practice definitely has a positive impression of them. At the same time, you are definitely evaluating the practice opportunity yourself. You certainly aren't going to go any place where you don't like, but you just don't want to be caught in a position where you would love to have an offer from some place and they've decided that they're not interested in you because you haven't interviewed well. That leads.

- Great.

- That leads us to our next question, which is how do you get them to love you in the job interview process? And there's a very famous book by Dale Carnegie, a very old book, called "How to Win Friends and Influence People." And if I could sum that book up in a sentence, it is really to be genuinely interested in the people that you know and the people that you're meeting. That is the best way to make friends. And it's no different when you're interviewing. The overarching rule of how to be successful in an interview for me is to, to advise you to basically be very interested in the needs of the hiring practice, regardless of what your own needs are. And I'm not saying that your needs are irrelevant, but it's important for you to be genuinely interested in the needs of the hiring practice.

- So that's a good point. I think when people interview, in general, people like to talk about themselves. And I think that it's important as you stay here, that you want to learn about them and let the group that you're interviewing with talk about themselves first and learn about their, you will learn about their practice from that discussion. And then you can talk about yourself later.

- I think that's exactly right. Of course, a lot of you have needs. Many times we deal with people with crushing debt burden, really a crushing, that burden coming out of residency. And a lot of people want to know whether or not educational loans might be able to be forgiven. People also have preferences about call and how burdensome call is. They want to make sure that they're not going to be up all night dealing with medical issues rather than neurosurgical issues. You know, you have, you have a lot of needs and it's important that you know what your needs are and especially that you know what your highest needs are, and that you're honest with yourself and the practice about them. But it's also very important that you put yourself in the shoes of the person doing the interviewing and make sure that you know that the person who's interviewing you is really looking at you and saying, "Can person meet my needs?" Until you have a job offer, it's really important to really focus on what the needs of the hiring practice are if you want to get a job offer. And once you have suitably impressed everybody, then your needs become more important and much easier to address because everybody has decided they already like you.

- That's excellent advice.

- I've listed here some questions that you might want to ask when you are on a telephone interview or in an in-person interview. And again, the theme really is for you to be interested in the needs of the practice. Ask them to just tell you a little bit about the practice. Even if you know something about the practice, ask them what they're looking for in a new hire, what's going to be important to them for somebody to make a good fit with the group or the practice. Be curious, ask a lot of questions because sometimes you think you know something, but when you ask a lot of probing questions about the needs of the practice, you may find out that there are more opportunities in different areas than you expected, or that the needs are different than what you might have seen in a job ad or what an in-house hospital recruiter had advertised to you. It's also very important that you ask about the personal characteristics of what will make an individual a successful fit with the group. And I like to think of you as interviewing the practice or the organization for a good fit with your core values and the mission of the group and the core values of the other neurosurgeons in the practice or the hospital. You know, you want to make sure that the things that you want to do and accomplish are the same things that the people that you are working with value.

- So I can tell you from personal experience, years ago when I interviewed, I went around to interview on jobs, one of the questions that I asked was tell me what your practice does for patients who have no insurance. And I think that really gets to the culture and the values and the mission of a practice. It's not something that they're going to, they're going to know exactly what, they're not going to know what you want to hear. It's not something they can just, oh, I think he's going to want me to say that we see them or that he doesn't. They're just going to have to be open and honest with you with a question like that and you will get an honest appraisal of where that group, what they're all about. Are they solely motivated by making money? Do they have a commitment to taking care of patients regardless of their needs for ability to pay? I think that's good way to get at the true culture of a practice.

- I think that is an outstanding question, Troy. I hope you don't mind if I add that to my list.

- Okay.

- Another very important question, especially as we see hospital employment increasing, is that you ask what it is you need to do in order to successfully develop a good, strong surgical volume when you come on board. Some places will have more ready-made referrals than others. Some places will expect you to do a very significant amount of marketing yourself. And it's just very important for you to know what the expectation is and what you'll really need to do in order to be able to fill your plate with patients once you arrive. A very common question that people ask is when can you ask about money and vacation and benefits? They don't know when it's appropriate, especially to ask the simple question of, well, about how much are you offering? And I would say that the first site visit, you should really focus on learning about the practice, the needs of the group, and just get to know the people. It's not that it's just a social visit, but it's really much more about getting to know the people, the core values, the mission of the group, whether or not what you want to do is what they need somebody to do and getting a good feel for people. I think that during the first interview, if the hiring practice brings up compensation, it's perfectly fine to discuss it, but I wouldn't personally bring it up on a first visit myself. At the second visit, I think it's very appropriate to ask about compensation if they haven't already told you. In my experience, most of the time they will actually bring it up. The practice will usually bring it up sometime between that first visit and the second visit, if they don't bring it up themselves on the first visit. And then sometimes people want to know, when can I ask about, you know, benefits, a vacation and the like? I think it's safe to assume that most practices will have a pretty competitive package in that regard. It's fine to ask about it. It should really become clear when you have an offer. And if it's not clear when you have an offer, then you can clarify the benefits at that time. Again, usually the people doing the hiring will bring it up somewhere along the way.

- So Judy, this might be a good time for me to get your opinion on this question, but when people ask me, how do I decide where I should, or what kind of a job I want?

- Sure.

- And I tell them that in my mind, there's three basic things you're going to consider in a job. So one is the city that you're going to practice in. So if you're a person who says, "Look, I have to work in Chicago." Then you're going to have to find a job in Chicago. And you're going to be limited by whatever is available there. So you're going to try to find the best available job in Chicago. If you're a person who's motivated by money, then you're going to have to find a job that pays the most money, regardless of where it is. If that's your sole motivation. And third, I think, is what I would say if you're motivated by the job itself, you're a person who says I want to do spine trauma, I'm going to go wherever it is. I don't care what city it is. I don't care what they pay me. I just love to do spine trauma. Then you're going to have to find that job. Or if you love to do aneurisms, then you got to find a place where you can do that. And the other factors are not just doing, when I say the job, it's not just the work you'll be doing, but also the people that you're going to work with. I want to work with guys that I really mesh with that we have common, a lot of common interests in and out of neurosurgery. So I really think for most people it's going to be a balance of all three of those things. But I think those are really the factors that you have to take into account when you're starting out looking for a job.

- Sure. In my experience, money is at the bottom of the list. I think the three things that matter most are the practice, the location, and the people that you work with. I have never ever had somebody call me and say, "I love my practice, I love where I'm living, "I'm doing exactly what I want to do, "and I love the guys that I practice with, "but I am just not making enough money. "And I need you to find a way to get me a new job." I just have not had that call in all of the years that I've been doing this. So I encourage people to really focus on those three things first. The type of practice, can you do the kind of work that you want to do? The location is tricky for me because I see people get very focused on a particular location during their residency, and they forget that they actually need to have a good job. And when I define good job in the hierarchy of needs, the first thing at the top of that list is you have to have enough surgical volume to have a successful practice. So a lot of times people say, "I want to be in Miami Beach. "It's really the only place I want to be "and I'm going to find the best available job "in Miami Beach." Or the same thing with Chicago, or the same thing with LA. And they find a job in that place and then they find the hospital's bankrupt. The referring physicians aren't referring to them, they're all referring somewhere else. There's no surgical volume to be had and then they're moving within the first six months. And typically when people are moving out of that situation, they move to much less saturated markets or much less politically contentious markets, whatever it was that caused them the problem in the first job. And they realize that the location that you live in, it does not have to be the most desirable location. It only has to be an acceptable location because even if you love the location, if you don't have a successful surgical volume, you're going to be moving. So I think location is one of the three things that I would put at the top of the list, but it's probably, you know, it's definitely below being able to have a successful surgical volume.

- I agree. And I'm encouraged that money is not the sole motivator for your clients. That's encouraging.

- Well I'll tell you this, money is often the primary motivator when people start out the job search. And a lot of times I find that's because people have a very crushing debt burden. And to me that's a very important point because I haven't, I haven't had a call where people are happy with the practice, the people, and the location, and yet they want to move because of money. But I do have a lot of people call me wanting only to look at jobs, for example, where they can make a certain amount of money guaranteed. And this always, I understand it, but I really want to encourage people to focus on the other three things. Because if you have a successful surgical volume, wherever you go, you will make enough money in your practice to pay your debt off at least over the first couple, you know, two or three years. I mean, it really will happen. Whereas if you take a really well-paying guarantee, but you don't have a successful surgical volume or the politics are terrible, or you hate the people that you're working with, you're going to be moving and you're going to wind up starting all over again. So I'd encourage people when they start their job searches to be a little less focused on money, even though it is important.

- So when asking about money, depending on the type of practice that you're looking at. So if you're looking at an independent group of neurosurgeons that you're joining.

- Right.

- I would emphasize to people that it's not so important what you're going to be getting paid in year one and two.

- That's exactly right.

- But what happens in three, four, five, 10 years down the road when you become shareholder or a partner in this group, then what are you going to be making? Because that's what you're, you're looking for a job that you plan to stay in and it's going to be a successful job. Then you're going to be there 20 or 30 years. Then you'd like to know what, where am I going to be for the rest of my career? That first and second or third year are ultimately not that important in the big picture?

- I think that's exactly right. And I will tell you that I have a lot of people on the phone these days who are very nervous about that first, second and third year because they see healthcare is changing. And a lot of people, especially those deep in debt, feel like they need to maximize this time in the market where you can still a good guarantee. People have a fear that things are going to tank, that right now things are really good, but you know, things are going to be really changing within the next five years and maybe there won't be so much gold in them there hills. So I do feel a fair amount of panic from a number of people who are looking for jobs now coming straight out of training, especially people with debt. And they're very concerned about what they're going to make in the first few years, because they don't really believe there's going to be a big pay off later on. And again.

- Well, and I imagine. I'm sorry.

- No, go ahead.

- I imagine if you're taking a job as a hospital employee, then it's a different discussion because you may only get a three-year contract and you have to renegotiate what's going to happen. They can't tell you what the long-term expectation is unlike an independent group that's already been in business for 20 years and it has an established track record.

- I think that it can, people are fearful on both fronts. Actually the people who are really afraid that the getting may not be so good in the next five years seem to be more likely to take hospital employee positions because the hospitals always pay more coming straight out of the gate. They have a much bigger pool of funds to work with than an independent private practice does because they're making money off of everything you do, not just the professional fees. So they're always the best payer when you're first starting in practice and people who are fearful about money will, you know, will really look to maximize that through a hospital employed practice. People joining an independent group are usually impressed with a track record, but I find that there's a lot of fear about the viability of small group practices into the future. And I think that's really unfortunate. In my mind, there's nothing that anybody could do better than to join a well-established independent group. I feel like if things get really bad in healthcare, the well-established group with a solid track record will be in the best position to negotiate for an employment model if they really need to do that. Whereas, you know, a group that is started by a hospital proforma, which has no experience in managing a neurosurgical practice, you know, they might write in a contract that they're going to guarantee you a certain amount of money, and they may have every intention of doing that, but if they're not successful at actually managing the business or managing the practice, you may find out that your practice is just a failure because you can't get the surgical volume or they just don't know how to run it. And that's very different and in my mind much riskier than joining a well-established group practice.

- I obviously agree with that.

- I don't want, by the way, for people to think that I think hospital employment is, is always bad. There are some very happy hospital employed groups out there. And in my experience, the best indicator of whether a hospital employed group is going to be very happy and successful, if you have a group that was at one time an independent group that used their power in the community to negotiate for employment, that is usually the most likely to be a happy hospital employed group that has retained a lot of the power and decision-making that they had when they were an independent practice. And there were other good, happy hospital employed groups, but I just, I love to see a track record one way or the other. But we will, as hospital employment develops, you know, in as an increasingly popular model, I'm sure we will find more and more hospital employed groups with a solid track record. It's like any other business. And there will be hospitals that are really good at running those groups and hospitals that are not as talented at running those groups.

- Agree.

- Well, I wanted to talk for a minute about some real-life interview blunders to avoid. It's always much more fun to talk about other people's mistakes than it is to talk about your own. And it's better to learn from other people's mistakes before you make your own. Wearing jeans is something that I have seen people do on interviews and it's not taken well. Also for the ladies wearing a low cut shirt or wearing a whole lot of jewelry, big jewelry. Those are big turnoffs, usually, to the hiring practice. It's not considered professional. I think appropriate business attire is appropriate business attire everywhere you go and that's what you should aim for. I have had candidates basically object to the hotel that the practice was thinking about putting them up in and say that they wanted to stay at a more expensive place. And the message was, boy, if you want me as a candidate, you better wine and dine me because I'm really special and I'm not going to stay in that dump. And I found it interesting that people would do that. It didn't make the best impression on the hiring practice either. Same thing, requesting a first-class ticket or saying that you want a town car or a limo to pick you up. It's hard to believe sometimes that people would do that, but they have. I know because I've seen it. And those are good things to avoid. Things that give the practice the impression that you think that you are God's gift to neurosurgery are definitely things to avoid. Sending the wine back at dinner even once is a bad idea. Just suffer through it if you don't like it, truly, and drink only a part of a glass. Sending it back twice, that's even worse. I've also had people order two dinner entrees. I heard about that from the clients after the interviews. And I've had people send back their entree sometimes multiple times because the food was not satisfactory. Sometimes people have special dietary concerns. If you're a vegetarian and you get taken out to a steak house, again, just grin and bear it. Don't make a big deal about it. You know, I think really the polite thing to do before your interview is to let them know if you have any special dietary needs, because people are really very eager to accommodate, you know, on the interview and they want to take you someplace you know, that you're going to enjoy going out for dinner. So if you have a special dietary need and you haven't made special plans in advance, just order the simplest thing that you can get and try not to make a big deal of it at the restaurant. The most common mistake that people make is bragging a lot about the other job offers they have. It's kind of like a, you know, a guy bragging to the girl that he's trying to pick up about all of the other beautiful women that he's dated and just how hot they were. It just doesn't impress the date very much. And we hear this a lot that this person was trying to puff themselves up by making themselves sound so valuable and talking about all the wonderful job offers they have from other places and how much other people love them. In which case, usually the practice that's interviewing says, "Well, if he's got so many great job offers, "he should go somewhere else." Be careful about your sense of humor just a little bit. It's good to have a sense of humor. But if you have, you know, I mean, I've had a situation where somebody thought he was being funny. He told the wife or told the surgeon in the presence of the wife at the table, that his wife looked like she was enjoying the life of the wife of a neurosurgeon. That was not that well received. Getting drunk at dinner is not a good idea. And even if you're very nervous, don't put drinks on your hotel tab. You might think that people aren't really looking at the bill, but they do. And sometimes it's the secretary that looks at it and they gossip. "Wow, you can't believe this guy put six drinks "on his hotel tab." So it's good to know that people are looking at the receipts when you turn them in for reimbursement. And what you've done will say something about you.

- That's an impressive list. I honestly can't say we've had similar experiences here. I think most people that I've interviewed have done a very good job trying to give a good impression. I think, as you talked earlier, being outgoing, asking questions about the practice is going to be the key things and obviously avoid everything on this list.

- Yes. Also avoid, even if you're in a state that is firearms friendly, it's probably not a good idea to actually bring out your firearm.

- Okay.

- We've had it happen. There are some things that people say, which are problematic during a job interview. And the most common one is to bad mouth your program. People tend to do this if they're not certain about the references that they're going to get from their program. They will try to damage the credibility of their attendings or even their chairman by telling the hiring practice all kinds of bad things about the program. Maybe in anticipation of the fact that the people at the program might not say such nice things about them. And even if it has nothing to do about with your references, even if you think that you're going to get great references, I think that it's really good to abide by the rule if you are not going to say anything nice, don't say anything at all. Sometimes people feel a lot of pressure in their job search. They might have another offer on the table and then they will put pressure on the hiring practice to give them an offer right away. And they'll say, if you don't, you know, if you don't, can't give me an offer right away, I really can't consider the job. That backfires about 100% of the time. It's really important when you're educating people about your other options that you educate, but don't, don't threaten them. Don't look demanding. Just explain really calmly that, you know, you were lucky enough to receive another offer and you don't want to put any pressure on anybody. You're hoping that you might be given an indication of whether or not the hiring practice is interested in extending a job offer to you within some kind of a reasonable timeframe so that you can get back to the other practice. And if you frame it properly, people will understand it. But it's important not to appear demanding. I've had people come up to me at my booth at a meeting and tell me all the things they don't want to do. They don't want to join a group where they're going to be on call more than one in five. They don't want to do trauma. They don't want to do this. They don't want to do that. And I think, you know, if I were hiring a housekeeper and she says, "I don't do windows, I don't do floors, "I don't do blinds, I don't like to vacuum. "I don't like all of these different things." I'd probably be a lot less likely to hire that person. Even if it's honest, I think it's more important to ask the practice, you know, what it is they want, what it is they're interested in. And if there are lots and lots of things that you don't do, you may decide that that practice is not a fit for you. But don't emphasize all of the things that you don't want to do in your job interview. Really focus on the needs of the practice and whether or not, you know, you can meet them. Making suggestions to the neurosurgeons who've been running a practice for a long time about how they should run the practice is a common mistake that people make when they're really interested in business and interested in running things in a practice. But coming out of residency, it's good to have a little bit of humility and know that you haven't run a practice yet. So it might actually appear to be a little presumptuous if you start making suggestions during the interview process about what people could do better to run a practice. Even if you do think that there are things that they could do better. And when you are asked what your ideal practice is, it's not a good idea to say that you'd like 12 weeks vacation. We have had that happen. When people talk about what is your ideal practice, they don't actually mean in a very literal sense that you would like to go practice in a place where you could work two days a week and get paid at the 90th percentile and never take trauma call. They may really, you know, are talking more about case mix and, you know, what you're looking for in partners and that kind of thing, not about a fantasy, like what would you do if you won the lottery? So it's important not to misconstrue that question.

- It's all very good advice.

- So sometimes people have something embarrassing to discuss. They might have gone through something in their residency where they were suggested to go through counseling, for example, and did that in a peer-protected kind of way. They might have switched residency programs because, you know, maybe you didn't get along with the people in the first program, or maybe, maybe you made a bad clinical error, or you had an error with respect to your judgment. And people often don't know what to do with this information. There are a couple of schools of thought about it. One is hide it. I don't adhere to that school of thought, but that is a common thing. Sometimes people say, "Well, if I just don't talk about "whatever is damaging or bad, "or if I try to hide it, once they've met me, "once they've interviewed me, "then maybe they'll be very interested in me "and then I'll break the bad news to them "and they will overlook my flaws." The problem with that approach in my mind is that you've really damaged your trustworthiness as a person, as a human being coming in. And I just don't think that anybody is going to hire somebody that they don't trust, especially for something as important as neurosurgery where you have to be trusted with sensitive situations all the time. So here's my five-step plan for dealing with sensitive situations where you have something damaging that you have to reveal about yourself, whether it was an arrest, which, hey, it happens, it always starts with let me tell you a funny story. And or whether it was just not getting along with somebody or the possibility that you're going to get a bad reference because of something you did. I suggest that you be upfront about whatever it is that went wrong. You don't have to overemphasize it, but be honest about it. Take responsibility for it. If you've messed up in the past, the most important thing to anybody considering hiring you is going to want to know is are you likely to do that again? Are you likely to repeat that mistake again? Emphasize, you know, don't dwell on the problem in the interview, focus on the needs of the practice and your ability to meet those needs. Work on convincing the interviewer that you're there to serve them, and that you can be useful to them in the way that they need and emphasize how much you have learned since the embarrassing or damaging incident, whatever it is and how you have grown from the experience. And, you know, how you can reassure the practice that that kind of thing will definitely never happen again. And then offer references who you have confidence will speak well of you. It's important if you do have something damaging in your background or embarrassing in your background, that you talk to the people that you're going to offer as references first and ask them if they are comfortable providing a good reference for you and how they will handle the embarrassing or damaging fact.

- Totally agree with what you've said. I think it is always best. Honesty's the best policy, and it certainly applies in this situation. I think if you try to hide something like this, it's going to come out later and you're only going to look bad at the, in the longterm. So I think you're best to be upfront and honest about it.

- After the interview, it's really important to thank everybody. It's okay these days to use email in order to send thank you notes. Make sure that you follow up with whoever arranged the interview process for you and ask them for all of the email addresses for all of the people that you've met. Handwritten thank you notes still happen occasionally. They're rare and I personally think that they are impressive when somebody takes the time to write one. And I think one of the most impressive things that you can do is to make sure that you recognize all of the people, including the administrative people who put the site visit together for you. Taking a couple of minutes to call the administrative assistant who probably worked for hours trying to coordinate everybody's schedule for your site visit and just tell that person how much it meant to you that they worked so hard to pull together all of the pieces of a successful interview, that makes people like you. And it lets people know that you really do appreciate the efforts of all those around you, which is really important to getting along in a group process. It's important when you are thanking people, if you are interested in the job to say so. Let them know how you feel. If you would like to receive a job offer and ask what the next steps will be and what the timeframe will be so that you'll know what to expect going forward, especially if they are interviewing multiple people.

- Again, I agree with you. I rarely receive handwritten notes, but when I do, it always stands out for just that reason, because it's a rarity.

- Well, so when you receive an offer from a practice that you like, you should treat every offer, whether you like it or not, as a gift. Of course, the first thing that you always do is say thank you. And you should express your appreciation for that opportunity even if there are some important things in the offer that you would like to change. If you like the offer, but you're not quite ready to accept it, this creates an awkward situation in a lot of people's minds. You know, they want to say thanks and sometimes the hiring practice is really eager to get moving. "Oh, I'm so glad you liked the practice. "Let's move on to the next step. "So I'm ready to send a contract your way." And you don't know how to say thanks, but I also kind of want to see what else is out there. I, you know, I'm also interviewing at other places. So it's really important at every step of the process when you're giving, when you want to make sure that the practice remains interested in you, but you're not ready to commit to them that you use some very soft social skills of making sure that the people, you know, receiving that information, understand that you're very interested in the practice and that they preserve their dignity, even if they are not your very first choice, or you're not sure whether or not they're your first choice. So make sure that you tell them all the things that you really like about the practice if you want to make sure that you preserve their goodwill. Tell them why you're so interested in the job and then tell them that, you know, you do have some other places that you're looking, but you will definitely be in touch with them throughout the process and keep them apprised of your timeline. And if you can actually give them a timeframe by which you expect to make a decision, I think it's always very much appreciated by the hiring practice that you will let them know that so that they know what to do about the other people that might express interest in the job. You know, they can decide whether or not to bring them in for an interview. So it's important to tell the practice what your next steps will be.

- So I think that communication after the interview is sometimes challenging. And I think it's important that if you are continuing to look for another job somewhere, that you just be open and honest. And as you said, if you're interested in that job, but you sincerely just want to see what the alternatives are, then I think you should say that. You know, I really like this job opportunity. These are the things I like about it. And I have already set up this interview and that interview. I just want to feel comfortable that I'm making the right choice. I think any practice that you say that to will respect you for doing that. And you may learn from other practices that you interview at things that you didn't even know. You might learn things that you like better, or you might learn that, hey, this job, first job was even better than I thought it was now that I've looked at other opportunities out there. So, but I think if, if you're honest with the practice, then I think they will wait for you and they will be very tolerant. If, on the other hand, you say, you know, "I'm interested in this practice here, "but I really want to take the time to look elsewhere," and they try to pressure you, "Oh, we need to know right away." Well, that's a red flag to you. So, you know, you don't want to join a practice that's desperate any more than they want to hire someone who's desperate. So that works both ways. And you'll learn from that discussion.

- That's exactly right. One of the things that I want to encourage everybody listening to this webinar not to do, which I have seen several people do, unfortunately, is they like a job, they want to make sure that they have, you know, that they have that job offer and they accept it, but then they're not sure and they continue interviewing. And that is always a mistake. Word always gets back. It's not something that you can keep on the QT. It's just not something that you can keep quiet. And you know, if you accept a job, you mean it. You've taken it. If you give a verbal acceptance, you tell somebody you're coming, that should take you off the market and take the job off the market. It's just not appropriate to keep looking for a job once you've told somebody that you're coming. The recommended steps for accepting an offer, this is my three-step plan for accepting an offer. It doesn't always work this way, by the way, but these are my recommendations. You should receive an offer letter or an offer summary from the practice. Sometimes people go right ahead and they send out a contract. I really prefer that people send out a summary of the offer first so that you can agree in principle to the most important terms, which should be in the contract without getting all caught up in all of the details of the contract. And you know, not 100% sure whether or not it'll work out. If all of the most relevant terms are acceptable to both parties, then you can sign a letter of intent. A letter of intent is a non-binding agreement to come to an agreement, it's or to work diligently towards coming to an agreement. It's basically a, usually a one-page letter, which says, you know, we at the hiring practice intend to offer you this position and you as a candidate intend to accept the position on the following terms. And once you both sign that, it should take you off the market and it should take the job off the market. You should stop interviewing for other jobs and they should stop interviewing other candidates while you all work on negotiating the final contract to a successful conclusion. That to me is the best process. Troy, I'd like to know what you have to say.

- So I think we have done it several ways. We have sent offer letters and we've sent letters of intent. And in some situations we have enough verbal discussion from interview process where we say verbally what we are offering on the big picture, you know, at 10,000 feet. And then we say, okay, well, here's the detail. And the first written document they may get is an actual contract. So I think we may go through steps one and two more verbally and not always put it in writing. But I think putting it in writing is probably a good idea.

- Terrific. I like to have it in writing because once I know that somebody's actually signed something that says they're coming, then I think it's very clear that they're not continuing to interview and that you can be safe not to interview other people. You know that the intention really is to move forward with that contract. But it can definitely work and often does both ways. Well, what do you do if you receive an offer that you don't like? Or if you don't think that you're going to accept the offer, but you don't know that you're going to get anything better and you're not sure that you're going to turn it down, what do you do then? I'll tell you what people usually do. Usually they don't know what to say and therefore they stop communicating. They develop a very bad case of call avoidance. If you are experiencing the symptoms of this, of this ailment, you don't communicate with the practice after the interview or the practice does not communicate with you, it usually means that one side or the other is having deep reservations, but doesn't quite want to rule out the other party entirely. And I think that's just natural because people don't want to make calls where they think that the person receiving the information on the other end is not going to want to hear what they have to say.

- I agree. So many times people just no return call and no call from the practice. I mean, sometimes it's mutual, so that makes it easy. But if you're wanting, you know, if we want to recruit somebody and he's not communicating back, or if you're in the position where you're really interested in a job, but they sent you an offer that's just completely unacceptable to you, but you really want that job, I think you should communicate right back to them and start off, "This is what I like about the offer." You find something. There's got to be something in there that you like. And then say, "These are, this is what I like. "But there's some things in here that are "just are not going to work for me. "And this is what they are." And if they're not going to work for you, then you've lost nothing by asking to have them changed because you're not going to go to that practice. And at least you give that practice an opportunity to make those changes.

- That's exactly right. In my experience, if you know, time really does kill all deals. That's a saying in recruitment and I really do believe that it's true. If you don't communicate or they don't communicate with you and a long enough period of time goes by, then one or the other party or both will just lose interest. So sometimes people think that not communicating information that the other party doesn't want to hear will preserve the opportunity to kind of be rekindled in the future. If maybe, you know, you don't get another job offer that you like better, well, you haven't sent anything bad so then all of a sudden you can call these guys back. But actually that's not the way it works. If you don't call the practice because there is bad news that you need to deliver about, you know, something that you didn't like, or some reservation that you've had about the practice, not communicating will actually kill the deal over time. And, Troy, funny that you should say say something positive then give them the bad news. And you know, and then maybe close on a positive note. This is exactly the technique that I would suggest. The cure for call avoidance is the sandwich. Pick up the phone and use the sandwich method. First, put the good stuff on top. Thank them for the offer. Tell them what you like about the position or the practice or the offer. It might be that there's not a whole lot that you like about the offer, but maybe you love the practice and you would love to practice with those people. And you would love the opportunity to do the things that you would get to do in that practice. And you would love to live there. I think that's fine. Tell them that you love all of those things. Then give them the bad news in the middle. Tell them that, you know, you're going to be continuing to interview elsewhere if that's your plan. Tell them your timeframe for making a decision. And if there are conditions under which you would love to accept the offer, but they're just not the that were given to you in the offer that they gave you, tell them that. Say, "You know what, I would love to accept this job. "You've offered me, you know, $350,000 "and I have a whole lot of debt. "And, you know, if I could find a way "to get rid of the debt, the salary wouldn't be a problem. "Or if the salary were higher, you know, then, you know, "I'd really love to pursue discussions with you." If there are conditions upon which you would like to go ahead and accept the offer, tell them in the middle of the sandwich and then close on a positive note after the so-called bad news or less than perfect news. And tell them again how much you appreciated the offer and that you hope that, you know, you all might move forward in the future.

- Agree.

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