Types of Recruitment

Contingency Firms
Retainer Organizations
Hybrid Organizations
How To Choose?
Database Services

Recruiting agencies and products have evolved over the years. The standard retained search and contingency models have been supplemented by hybrid engagement fees, candidate sourcing subscriptions, database services, and total recruitment outsourcing.According to Kennedy Information, contingency firms account for almost two-thirds of professional search firms. They employ 58 percent of all recruiters, yet they only generate 50 percent of the national recruitment revenue. The vast majority of the 300 plus members of the National Association of Physician Recruiters are contingency firms who place an average of 18 physicians a year. The larger retained firms offer more job marketing resources and recruiters, thus averaging a greater percentage of candidate placements than the smaller firms.

A sourcing subscription can also produce leads on candidates who are in the market. Database services can provide you the same information that recruiters rely on to find candidates, but you will need someone internally who can devote full time to working a database pro-actively in order to justify the investment. Such investments are worthwhile if you have on-going hiring needs and personnel to handle internally.

In recent years, some large hospitals and systems have turned to outsourcing their recruiting efforts in an attempt to improve their recruitment results. Outsourcing has been driven in part by recruitment needs that far exceed an organization’s internal capabilities to meet its Community Needs Analysis and business development goals.

All recruiting firms place candidates. However, understanding the pros and cons of each recruitment firm model will help you choose which one is right for you. The best choice depends on the level of service you need, the urgency to fill a position, as well as your facilities internal capabilities. Different models provide different kinds of service and every company may not have skill set to provide the level of service you’re looking for… and paying for.

When deciding if you should use an outside agency, first determine what your needs and internal capabilities are. Make sure you understand what you can expect from the company in its recruitment efforts. Matching your needs to the company is more important than trying to work with a company whose business model won’t fulfill your needs. Also, finding a good recruiter you can work with is critical regardless of which model best suits you.

Contingency Firms

Contingency firms only charge a fee if you hire a candidate whom they referred. The contingency firm business model is candidate-centric. They work more closely with the candidates than with the hiring organizations (hospitals, medical groups, etc.). Expect that a contingency recruiter will be referring candidates they send to you to many other organizations, as well. A typical candidate will go on six interviews. If a recruiter can set up interviews with three or four organizations, their chance of a placement increases so the contingency firm may also set up other interviews for that candidate in your area. Typically Contingency firms have more jobs than they have time to work and will contact you if a candidate comes across their desk but there is no guarantee they will be promoting your opportunity either. Contingency arrangements are best suited for someone who is open to hiring the right candidate but is also OK if no one comes along. However, if you have time to do a little candidate shopping yourself this level of service may be ideal.

Retainer Organizations

There may be several reasons to hire a retainer organization including: time is of essence, there may be competition for candidates in your market, and you want a dedicated agent working on your behalf, politically you need an experienced agent to handle a sensitive situation, or you simply have a difficult situation and all other options have expired.

Make sure that the firm you select has the infrastructure to support a comprehensive search service and that they are not simply asking for money up front. You will want to be paying for a dedicated recruiter who will have both the experience and resources to contact candidates who meet your criteria. Performing due diligence by verifying both the experience of the recruiter and the resources at their disposal will ensure you are making a wise investment.

Retainer organizations come in two models. The traditional model calls for you to pay for the complete cost of the search on a monthly basis. You pay a fee each month and the organization will continue to work until your position is filled. The risk of course is that once the search is paid for, the incentive to perform will diminish over time.

Hybrid Organizations

A Hybrid Organization is between traditional search and contingency where you pay some money up front, an “engagement” fee, and the rest is “contingent” upon the position being filled. Knowing exactly what your engagement money buys will help you avoid firms whose business is really more about selling engagements with a promise to look than actually filling jobs. Ask for information regarding how they find candidates. For example, do they have sufficient internal resources and a database that you’re paying to gain access to, or are they overly reliant on external methods such as ads and mailers that you can probably produce more efficiently yourself?

One of the main advantages of an engagement fee service is the recruiter conducts a site visit to gather information, develops a report with you and therefore has a perspective not otherwise available. The other advantage is your recruiter being able to say to a candidate “I was there, this is what I saw, this is what the group is like and this is what the area is like.” Ads a credibility and weight to your practice presentation that otherwise cannot exist.

How to Choose?

Interview the recruiter who will actually be working on the job, and don’t just buy from the salesperson whose job it is to sell you the service. The salesperson may know the market very well but will not be involved in the recruiting process. Ask any recruiter specific questions about the number of candidates in their database, and how the data is maintained. One very good test is to give the recruiter the name of a candidate who has turned you down and see if they are in their system. You should expect regular reports from any retainer-based organization - at least monthly.

Ask any recruiter you’re thinking of working with a few questions before assuming he’s capable of doing the job. For example, does he know how many physicians there are in a particular specialty, how many graduates are there each year and do they ask you details about your job that only someone who knows your specialty well would know.

You want to choose an agency that demonstrates knowledge and expertise not only by the questions they ask but by the recommendations they have on addressing the unique challenges you have to attracting good prospects.

Database Services

Database services are also available. These companies gather information from candidates and offer subscriptions to access this information. If you have an in-house recruiting department this can be a supplement to your resources without the added expense of agency fees. Prices vary greatly depending on the number of candidates provided, sophistication of the software used, training involved and value added services such as broadcast email capabilities and a job listings service to be used by the candidates in the database. Utilization of the data to search and pro-actively conduct recruitment campaigns can provide a significant return on investment in the form of saved agency fees but do require staffing and expertise.


The increasing shortage of physicians is causing upper level management to decide that the answer doesn’t seem to lie in just placing another ad or hiring another recruiting firm, but that a more systemic solution is required. Outsourcing the recruiting department can lead to success for organizations whose demand for recruiting has exceeded their internal capacity to respond. Converging factors of the physician shortage, system skill level, escalating cost and decreasing results in an ever increasing competitive market, have shined a light on the need for a fresh solution. An outsourced recruitment solution jump starts results, eliminates diverse facilities duplicating efforts, addresses political issues, installs consistent recruitment protocols and standardizes recruitment messaging.

However, an outsourced program should provide long term benefits and provide more than just a source of candidates. Look for an outsourced partnership providing consulting expertise on how to improve results by identifying weaknesses and devise a strategy of improvement.

Improvements can range from training of recruitment stakeholders in more sophisticated interview techniques, implementation of recruiting software to track progress, measure cost and produce reports you can take with you to meetings. At some point the recruiting might return to be in-house so work with a company that can teach you how to establish benchmarks and measure results compared to national standards e.g. the interview to hire ratio. The best outsourced partnership will teach you the tricks of their trade and provide you with a database, tools and knowledge allowing you options over time.

The organizational and consultative skills required to handle this type of project go beyond the need to just provide recruiting skills to an organization. The process requires a true professional understanding of how to interface with the recruitment stakeholders to achieve the desired results and implement strategic planning.

Success in physician recruiting can determine the viability of a hospital system in the face of today’s physician shortage. A successful recruiting program in today’s competitive environment requires not just participation, but true commitment to continually improve internal capabilities and adapt to increased competition.

Golden Rule #4: There is no best or worst business model when it comes to physician recruitment; there are many paths to “relationship” which is the key to success.