The Best Opportunity May Not Be Hiring Yet

The job that would fit you best was probably never advertised, because a posting only exists once somebody else has a staffing emergency.

A posting is evidence of somebody else's problem

I spent 20 years as a physician recruiter, and the most common mistake I watched physicians make was treating the job boards as the market itself. What reaches a board is a narrow and late slice of that market: a seat that came open at one specific moment, in an organization that had already secured the budget to fill the role.

The group that would have valued you most might be one retirement away from needing somebody, or chronically overstretched and not yet organized enough to advertise, or simply not in the habit of posting at all. None of those groups appear on a page you refresh.

Why it matters: A search that starts with the listings lets other organizations' timing decide where you spend the next 10 years.

What you are building comes first

A physician search works better when it begins with a written description of the work and the life you want, not with a list of what happens to be available. Your specialty is settled by the time you reach this point, so the open questions are about how you practice, where you live, and what the schedule does to the rest of your life.

Most physicians never write that description down, and the jobs that happen to be advertised end up defining what they look for. The order should run the other way. Write the description first, then measure the postings against what you wrote.

The reversal is hard to notice while it happens. You read what is listed, nothing quite matches, and rather than concluding that the listings are incomplete, you conclude that what you wanted was unrealistic. Usually it was realistic and simply not advertised the week you looked.

4 questions to answer before you open a job board

These four are worth answering on paper before you open a single listing.

• How much call can you live with for the next decade? Almost anyone can absorb a hard year, so the decade is the full question and the one that decides whether you are still there when it matters.
• Do you want to build a practice or join a machine? Both are respectable answers, they are not the same job, and they rarely turn up on the same list.
• What has to be true about where you live for your family to be glad you moved? Write it down before you start trading it away against a number.
• What do you want this career to make possible? This is the one that reorders everything above it, and the one most physicians never get around to answering on paper.

Where your specialty is hardest to recruit

Regional demand for your specialty moves independently of what is posted. Some regions have been trying and failing to fill a seat like yours for a year, and some systems are expanding a service line that will need you before anyone writes a job description.

That information exists, and it is a far better guide than whatever happens to be advertised the week you start looking. It also shows you where you have leverage, which is something no job board can report. 

Contacting a practice before it advertises

Once you know where you would thrive, you can approach groups that have nothing posted. Physicians tend to find this step uncomfortable, and the people who hire physicians find it completely ordinary.

A short, specific note to a group you admire, naming why them and not just anyone, lands differently than an application. So does a warm introduction through someone you trained with.

The worst case is a polite "not right now," which costs you an afternoon. The best case is a conversation that turns into a role built partly around you, which almost never happens through a posting.

I watched a hospitalist do exactly this. She had no interest in the two openings in her city and had decided the region was a dead end. Instead of applying to either, she wrote to the medical director of a group 30 minutes out that was not hiring at all, and told him plainly what she wanted to build. They were four months from losing someone and had not said so publicly. She walked into a role that was never advertised, with a schedule built around the part of the work she cared about most, and she got there several months before the group would have written a job description. 

Arriving early changes who has options

The moment a job is posted, you are one of many, the terms are already set, and the group is negotiating from a position of "we have options."

When you arrive earlier, through your own read of the market, you are often the only person in the room, and the conversation is about fit rather than competition. That is where the questions worth asking tend to get real answers, because nobody is managing a queue of other candidates at the same time. 

The bottom line

Before you sort listings by location and salary, do the slower work first. It is the same diligence you would apply before buying a house.

Decide what you want your career to make possible, learn where in the country that is in demand, then go find the organizations that need you, including the ones that do not know it yet.

A job board will always be there and it costs nothing to watch. It is a notice board for problems other people are having this month, and most of the market never appears there.

Questions physicians ask about unposted opportunities

How do I find physician jobs that aren't advertised?

You go looking for the organizations rather than the openings. Decide what you want the work and the life to look like, learn where your specialty is genuinely limited, then build a short list of groups in those places and approach them directly or through someone you trained with. This might take longer than filtering a job board but it reaches a part of the market the board never shows you.

Is it strange to contact a practice that isn't hiring?

Not at all, and it is far more common than physicians think. Groups are frequently aware of a coming gap months before they are allowed to discuss it publicly, and a candidate who arrives before the posting is a relief, not an intrusion. The worst outcome is a polite no, and a polite no costs you an afternoon.

What should a cold note to a group actually say?

Say why them specifically and what you're trying to build. The note that works names something real about that group and connects it to the practice you want to have, so it does not read as a mass mailing. Keep it short, and make it easy to reply with a single sentence.

How do I know where my specialty is in demand?

Look for the places that have been trying to fill a seat like yours for a long time, and for the systems building out a service line that will need you. A region that has struggled to fill a seat like yours for a year may still have nothing advertised, because the need arrives well before the budget approval and the formal posting do. Someone who watches that market daily can shorten the search considerably. 

Should I stop looking at job boards entirely?

No. Watch them, apply where something genuinely fits, and stop letting them set the boundaries of the search. The mistake is treating the list of postings as the full list of possibilities. Physicians who do that lower their expectations before the search has properly started.