The Best Time to Create Leverage Is Before You Want to Leave

Leverage is the number of people who would be glad to have you, and whether you can name them on a day when nothing is wrong.

Leverage gets built in the years you are not looking

I spent 20 years on the recruiting side of physician job searches, and physicians with real leverage were never the ones who had recently developed a taste for negotiation. They were people who had kept a few ordinary things up to date for years, during stretches when leaving had not crossed their minds.

The trouble is the timing. Building leverage takes time, calm and no particular urgency, and those three conditions vanish on the day a physician decides to go. After that the work has to be done under pressure, which is exactly when it is hardest to do well.

Why it matters: By the time a physician needs options, the window for creating them has closed, and the search proceeds on whatever was already in place.

What a search looks like without the groundwork

Most physician job searches begin on a single bad day. Something at work becomes intolerable, and by that afternoon there is a browser open and a list of postings on the screen. The problem has usually been building for months, but the decision arrives all at once, and nothing has been prepared in advance.

The search then has to be built from scratch, by someone who is upset, against a clock that is emotional but feels entirely real. The CV is four years out of date. The market rate for the specialty is unknown, so the first number anyone names becomes the anchor for everything that follows.

There are two people outside the institution who could be called, and the entire read on the market is whatever happens to be advertised that month. Assertiveness at that point changes very little, because there is no alternative in reserve.

4 habits that cost about an hour a quarter

Four habits do nearly all of the work, and none of them requires a project.

• Keep your CV current. The reason is not that you are leaving. Physicians delay searches for months because rebuilding a CV from memory is miserable, and a CV updated once a year is more accurate than one reconstructed under pressure.
• Know your own numbers. Your volume, your collections where you can see them, your panel, your call burden, whatever your specialty is measured on. Physicians who can describe their own production in specifics have a different conversation from physicians who can only describe how hard they work, and that holds in a compensation review as much as in an interview.
• Know roughly what the market pays, continuously. A rough sense of the range, refreshed as you go, is enough. The point is to avoid learning the range and evaluating an offer in the same week.
• Keep the relationships alive. This habit does the most work and gets the least attention, so it is worth more detail than the others.

Take the occasional call from a recruiter you have no interest in, be pleasant, and ask what they are seeing in the market. Most will tell you at length, because the market is the part of the job they find interesting.

Stay in touch with the people you trained with, who by now are scattered across the groups you might one day want to join. Attend the meeting you would otherwise skip, and accept an invitation now and then.

None of this is networking in the transactional sense that makes physicians recoil. It amounts to staying visible enough that people can still picture you, so that on the day you need to make several calls, there are several people worth calling.

The advantage shows up as speed

A physician who has kept these habits running for three years decides to look, and within two weeks she has three real conversations under way, because she knew who to call and the people she called already knew who she was.

That speed is what lets her be unhurried, and an unhurried physician can ask the uncomfortable question, decline the exploding deadline, and say truthfully that she is comparing options.

She negotiated no differently from the way she would have three years earlier. What changed was that she had somewhere else to go.

The hospitalist with 11 names

A hospitalist I worked with kept a running note on his phone: groups he liked, people he had met, and a line about anything he heard concerning a system in his region.

He did not think of it as a strategy. It was a habit that took him about 20 minutes a month.

When his hospital was acquired and the schedule changed under him, he had 11 names in that note. He made six calls in a week and had two serious conversations going before most of his colleagues had finished absorbing the news.

He was no smarter than the people around him, and the only difference was that he had done one small thing repeatedly across years when nothing was wrong.

The bottom line

Leverage is cheapest to build in the years when a physician has no reason to think about it, and it cannot be bought at all in the week it is wanted. Nobody schedules an hour for a problem they do not have, which is why physicians who have options on the day they need them look, from outside, like they got lucky.

An hour a quarter, spread across a year in which you have no intention of leaving, is worth more than every hour you could spend on the search itself.

None of this is preparation for quitting. It means that when the day comes, the decision is still yours to make.

Questions physicians ask about building leverage

When should I start building leverage if I am happy where I am?

Now, and being happy is the reason to start rather than a reason to wait. These habits only work if they have been running for a while before you need them, and physicians who start in the month they decide to leave are assembling a market read, a CV and a contact list under the worst conditions available. Starting early is cheap because none of it feels urgent.

Does keeping my CV updated mean I am planning to leave?

No, and treating it that way is what leaves physicians stuck. A current CV is a record of what you have actually done, and the person it serves most is you, in your own compensation review. Update it once a year on a date you choose, not on a day when something has gone wrong. A version written in a calm week is simply more accurate.

Should I take recruiter calls when I am not looking?

Take some of them, and be straightforward that you are not looking. The job being pitched is rarely the point. What the recruiter can tell you about what is moving in your market is information you have no other easy way to get. Be pleasant and brief, and you end up with a relationship and a data point instead of a deleted voicemail. Remember throughout that the recruiter is working for the organization, not for you.

What should I actually be tracking about my own practice?

Whatever your specialty gets measured on, in specifics rather than impressions. Volume, collections where you can see them, panel size, call burden, and the figures that appear in a compensation conversation. This does not require a spreadsheet project. It requires being able to answer without guessing. Being able to name these figures changes the terms of any compensation conversation.

How do I know what my specialty pays without doing a full market analysis?

Keep a rough sense of the range and refresh it as you go, instead of setting aside time for a one-time deep dive. Ask recruiters what they are seeing and compare notes with the people you trained with. What you are protecting against is one specific situation: hearing a number for the first time in the conversation where you also have to judge whether it is any good. With no comparison available, that number becomes the reference point for the rest of the negotiation.