Dear Miss Deed, 

I am befuddled as to my course of action regarding a potential new client to whom I am speaking.

The client is in a great location and most of the details of the practice situation are good.However, the money they are offering is woeful. They want to pay me a $10,000 retainer to find an OB/GYN but are only willing to pay $100,000 to the doctor. They said they want the new doctor to work hard and they think $100,000 will do the trick. Should I take the $10,000 retainer even though I know no one will take the practice?

Very truly yours,

Dear Befuddled:

My first inclination is to tell you to take the money and run; after all $10,000 is $10,000! However, after my momentary lapse into gluttony, I have recovered enough to advise you to turn the search down if you cannot get your future client to increase the compensation. As painful as that may be, you have little choice. Your experience correctly tells you that no OB/GYN in this day and age will accept a salary/income guarantee in that amount particularly with a call schedule of every other night and weekend. If you take on the search, knowing you are doomed to fail, you will be in violation of the Code of Ethics Section IV, A., 7., C. which states: "A member shall not initiate the performance of services for a client if: (c) the condition prevents the Member from performing full and fair services for a Client." The temptation is enticing but I think you need to leave this client for a non-NAPR member.

Miss Deed


Dear Miss Deed, 

I am an in-house recruiter and pride myself on keeping accurate records about candidates referred to me by recruiting firms. Recently a firm called to ask if anyone had referred Dr. Jones (not her real name). I said no one had referred the name. The recruiter said she would get back to me with the CV. Two weeks later, a recruiter from another firm called to clear the name and I told her Dr. Jones had already been presented two weeks ago. The recruiter got angry that I would not accept the referral. Was I wrong by not accepting it?

Yours truly,
Trying Hard

Dear Trying:

The shortest answer is yes! But there is more to it. From a straight factual perspective, the referring recruiter who initially cleared the name with you was required at that time to present the candidate’s address and/or CV as well. Since the recruiter did not include this information, it was an invalid referral which therefore entitled the second firm to have the opportunity to validate their referral. The NAPR Code of Ethics requires that all referrals contain complete information about the candidate in order for the client to act upon referral at their earliest convenience.

Most importantly, the first firm subverted the spirit of the Code by clearing a name without being in possession of the candidate’s CV. By condoning the first recruiter’s “clearing” of the name in this fashion, you thwarted all future proper referrals. Allowing this to happen only encourages less scrupulous firms to call their clients, make a “name-only” referral, and lock out all other firms. It is incumbent on you to question the recruiter to make sure they interviewed the candidate, have the candidate’s CV, have described your practice to the doctor, and have received the doctor’s permission to submit him or her to you for consideration.

Like it or not, as an in-house recruiter, you are the “gatekeeper” and as such can significantly influence in a positive way not only recruiting firms’ adherence to the Code, but also assure that those firms who properly earn their fees in fact get them. That is not to say that you should shoulder the full burden of Code adherence. Certainly, the firms should share equally. In a perfect world, it would be nice to know that both hiring entities and recruiting firms are walking tall and arm-in-arm in upholding the tenets of our Code of Ethics.

Miss Deed






Dear Miss Deed, 

I am new to the business of physician recruiting and started my own firm. I am a trusting soul (I realize I may have to alter this outlook somewhat). When I was “marketing” a doctor who wanted Arizona I called a number of hospitals to see if they needed my candidate (who was an FP who does obstetrics).

I contacted this hospital which I had not worked with previously and the in-house person said he needed an FP who does deliveries. We talked about the candidate. I told him my fee which he said was okay and I sent him the CV. (My candidate told me that if I found anything in Arizona, I could send his CV.)

Things went well. My candidate visited and took the job. I sent my invoice, but never got paid. I called numerous times and e-mailed as well and finally got the recruiter on the phone. He told me he had no reason to pay my fee because we never had a signed contract.

I am . . . 


Dear Flabbergasted, 

There are a number of issues here. First, I think you encountered an anomaly as it relates to in-house recruiters. They are, in the vast, vast majority, honest, accommodating, highly ethical and very supportive in the utilization of recruiting firms.

Second, regardless of your trust in humanity, you are in business and good business protocol requires that all agreements be memorialized in writing.

Third, there are circumstances in which oral agreements are valid. If you do not know someone and cannot vouch for their integrity, you need things in writing. If you have been working with a given client on an ongoing oral-agreement basis, then there is a far greater reliability that you will be paid. The key is that a valid oral agreement requires irrefutable proof. This can only be demonstrated through pervious fulfillment of the
terms of the oral agreement. In essence, if the client paid in the past, that is, they have a history of activities, it is proof that you have a valid oral agreement between you and the client.

Fourth, did your client do something unethical? Probably. Can you prove you had an oral agreement? Maybe. Should you file an Ethics Complaint? Yes, but the client of course must be an NAPR member or there will be no jurisdictional authority by the NAPR.

Fifth, your best bet is to obtain the services of an attorney. With their help you are likely to recover something. But as a former President of the US once said, “Trust but verify.” Leave the trust to others and get things in writing. Everyone will be better off.

Yours truly,
Miss Deed





Dear Miss Deed, 

I know it’s summer and you like to cut back on your enormous workload but I feel a compelling need to have you clarify a situation I encountered.

I called a hospital I had been in contact with over the last several months but never previously sent a contingency contract because I did not have a qualified candidate to refer. Several days ago, I identified a candidate who was both qualified and interested in one of the jobs the in-house recruiter listed. I called the in-house recruiter and asked if I could send my contract. He agreed, so I sent it and when it was signed I called him, disclosed my candidate’s name (I already had permission from my candidate) which he accepted and then sent the candidate’s CV.

Five days later, the in-house recruiter called and, while apologizing profusely, told me he found my candidate’s name in his database and could not pay a fee if the candidate accepted.

I am angry and think the in-house recruiter violated the Ethics Code (not to mention he cost me a lot of money).

Seeking Restitution

Dear Seeking:

Thank you for caring about my summer; it is very busy but still quite enjoyable. My husband and I have had some time to get away, but I am never too busy to answer your questions.

Unfortunately your situation is quite ugly with a very small portion of the blame attributable to you. The problem is that your client (who I know is a NAPR member) had an obligation under the Code of Ethics to tell you he used a database, match or list service before he signed your contract. This part of the Code was added to alert recruiting firms that they should ask whether the client used a database as well as to require clients to be forthright in their dealings with firms.

The key operative phrase is that an in-house recruiter must, “Inform the recruiter prior to establishing a formal working relationship that they subscribe to a databank…” Unfortunately you did not think to ask about the databank (as I am sure most recruiters also forget) when you initiated contract discussions. The bottom line however is that the in-house recruiter had an obligation to inform you which he clearly did not. Maybe some gentle berating by you of him will make you feel a little better, but it is still a very long way from offsetting the loss of all that fee money. You should file a complaint with the Ethics Committee.

Yours truly,
Miss Deed





Dear Miss Deed, 

I had (another) disturbing experience today and I'd like your thoughts.

I called a physician who registered with the NAPR World Job Bank. I told her about a practice in Utah in which, it turns out, she was very interested. I, of course, asked whether she already knew about it. Not only hadn't she heard about it, she replied, "You are the first and only recruiter I've spoken to." She then e-mailed me her curriculum vitae and gave me permission to submit it to my client.

I called my client, cleared the candidate's name and made the referral. A short time later my client said he already had her name and curriculum vitae from another firm. I was upset and somewhat incredulous as to how this could occur.

Several days later I called the same candidate regarding another practice opportunity. After some discussion, my candidate revealed she was going on an interview at the place to which I first referred her. I called that client again and he was kind enough to reveal the name of the firm whose referral he accepted. I called them, talked to the recruiter and asked how he made the referral. What he told me was astonishing and disconcerting.

He told me it is so competitive in our field that when he gets a candidate response from the World Job Bank which contains the candidate's curriculum vitae he immediately sends it to his clients in the geographic area indicated on the forms. He proudly told me in this way he is able to get the curriculum vitae in first. If the client expresses an interest in the candidate, he then contacts the candidate and presents the practice to the candidate. If the candidate is interested he follows through doing everything necessary to establish himself as the "procuring cause." This doesn't seem right to me.

Yours truly,
What's Going On?

Dear What's, 

You have run into a cunning and unscrupulous recruiter who is attempting to circumvent the Ethics Code while simultaneously conning the candidate and the client.

Clearly when the other firm sent your candidate's curriculum vitae without her knowledge or permission, he violated sections IV., A., 4., 5.; B., 3., 4., 7., 10.; B., 7.; and E. 24. and 25 of the Ethics Code.  All the foregoing refer to improper referrals or rusing (trickery).

Firms belong to the NAPR in significant part because they want the peace of mind that all members will be playing by the same rules and that fair business practices will prevail. The business practice you have uncovered threatens the very core of the NAPR and the agreed upon standards for competition.

Under the Ethics Code, if you are aware of a Code violation, you are required to file a complaint (which I'm sure you will do). The Ethics Committee will investigate and if the facts support what you say, a sanction could be imposed. If the imposed sanction (after any allowable appeal) is Probation of six months or more, when contacted by an outside Entity or Member of the NAPR, the NAPR will give the Membership status of a Member and, if asked, will disclose that Member is or has ever been in violation of the Code of Ethics that has resulted in Probation of six (6) months or more, Suspension or Expulsion. 

I have two other suggestions for you. First, show this communication to your client to expose the other firm's underhanded practice as well as to lay appropriate claim to your fee; and second, should your client not support your claim, consider litigation .

Thanks for bringing this to me. You done good.

Miss Deed





Dear Miss Deed, 

I spoke with a doctor who was interested in one of my practice opportunities, so I asked her to send her CV to me. When I received her CV I thought it was good enough to send to two other clients of mine. When the doctor found out I sent her CV to the two other practices she got very upset with me and told me she never gave me permission to send her CV to the other two practices.

I thought that by sending me her CV she was giving me her consent to send it anywhere. Am I wrong?

Yours truly,
In The Dark

Dear In:

As I see it you have two major problems. The first is that unless a candidate expressly gives you permission, a CV cannot be sent to any client.

The second is that when you joined the NAPR there is a statement on the Active Membership Application which states in part "I have read and agree to abide by the Code of Ethics of the National Association of Physician Recruiters (NAPR) and acknowledge the violation of any section will subject my organization to appropriate sanctions as defined in the Code of Ethics up to and including expulsion by the NAPR Board of Directors as provided by the Bylaws."

The fact that you didn’t know is unfortunately not a valid excuse for inadvertently violating a section of the Code.

Receiving a candidate’s permission to release their CV to a client is one of the fundamental protections afforded a candidate under the Code of Ethics. It protects the candidates’ confidentiality, helps to avoid any unnecessary activity with a client which the candidate has no interest and helps to enhance the quality of a recruiter’s referrals by submitting only candidates who are truly interested in the practice opportunity. 

Also, I suspect that you have not read the Code of Ethics in the entirety. Granted, it did not make the New York Times’ Bestseller List, but it only takes about 15 minutes to read. You might be pleasantly surprised how clearly the rules for recruiting are spelled out. Try it you actually may like it and most importantly you will then know what NAPR’s “founding fathers” had in mind when they started the Association 30+ long years ago.

Miss Deed





Dear Miss Deed, 

I have been working with foreign medical school trained physicians and wondered if my client can reject a candidate based on the fact that the medical school was completed in a foreign county? If so, can I inform the candidate of that decision?


Dear Wondering, 

The NAPR Code of Ethics states in Section IV, A., 8. "A member shall comply with all federal, state and local laws."

In short, the answer to your question is yes, your client can reject a candidate on the basis of the medical school. HOWEVER, this can only be done if it has nothing to do with the nationality or race of the applicant. Advertisers who state medical school and gender preferences seem to have, at the heart of the matter, a desire to selectively eliminate those candidates who are not American. In essence, if an advertiser truly is not attempting to discriminate illegally against a group of candidates, it is far safer to simply eliminate any reference to the discriminating issues. The ad is then placed, the innuendo is eliminated and your client reviews all responses and selects the best overall individual.

The candidate can be informed of your client's selection criteria, but unless the candidate was born in the South Pole, was blinded at birth and lost their hearing shortly thereafter, I would suspect that he or she might think there was a little bit of discrimination going on. If you could prove to the candidate that all or most of the patients in your client's community had a rare genetic illness, the cure for which was taught only in certain medical schools, then you can tell your candidate why he or she was rejected.

Miss Deed





Dear Miss Deed, 

I believe I was the procuring cause for a placement, but Sky Blue Recruiting claimed the candidate because they had him sign a Right of Representation letter. Does Sky Blue Recruiting have a legitimate right to the placement?

Desperate for a Fee

Dear Desperate:

Procuring Cause is an action which sets a series of events in motion that ultimately leads to a placement. If you made a valid referral (got the candidate's permission and cleared the name with the client), then your claim for the fee is valid.

Sky Blue Recruiting's strategy was clever but unethical. A Right of Representation letter signed by a candidate simply asserts that the recruiting firm has been granted formal approval to represent the doctor, usually just to the specific client(s) discussed. It is a helpful tool when
making your case for a valid initial referral when the client has received an unsolicited curriculum vitae on that candidate from another firm.

However, when a valid referral has been made, as in your case, and Sky Blue Recruiting attempts to undermine that valid referral by inducing the candidate to sign a Right of Representation, they have in fact, violated the Code of Ethics, Standards of Practice and Procedures, Section IV. Ethical Rules, A. Relations with Clients and Potential Clients, 16: “A Member shall not utilize a Right of Representation document to supersede another organization’s properly made prior Referral.”

Having the candidate sign a Right of Representation after the fact to create the firm's case for their fee entitlement is clearly underhanded and violates the Code.

Good luck and go collect your fee!





Dear Miss Deed,

I just got my pocket picked. It wasn’t just some loose change, it was $20,000. Here’s what happened.

I talked to a doctor about one of my clients. The doctor liked what I told her and agreed to let me submit her CV. I excitedly called my client, described the candidate’s background and revealed her name. Then came the crushing words from my client, “I already have her name from another firm.”

When I spoke to my candidate, I was very specific in asking whether she knew of the practice and even revealed the name of the town to her. No other firm had described the opportunity to her and she had not given permission to any other firm to send out her CV.

Twenty thousand dollars is a huge amount of money to me. Can I get even? Can this be stopped? Can I make a claim for the $20,000 if the doctor takes the job? I am…

Fit To Be Tied

Dear Fit:

The quick answers to your questions are: No, Yes and Maybe. For these somewhat abstruse issues, I will elucidate.

First, getting even might make you feel good and, while many of us have longingly wished for some cleverly disguised way of doing this, it is not an avenue you should consider. (See my answer to your third question for possible relief.)

Second, stopping this practice is certainly possible, but cooperation is essential (in a perfect world). The culprits in this nasty game are the recruiters who choose to abandon their conscience and commitment to their pride in their profession and in-house people who do not understand the impact of the money at stake and who choose to allow recruiters to abandon the basics of the industry.

Ending this execrable practice can in part be accomplished by more aggressive reporting of the incidents to the Ethics Committee for investigation and possible action. Another deterrent is for the in-house professionals to ask the recruiter, “Has the physician clearly given permission to present this CV?” Clearly the in-housers are the gatekeepers and enforcers who, through aggressive diligence, can make significant progress in shutting out these unprincipled recruiters.

Third, you cannot per se make a claim for the money, but you can seek resolution through arbitration if the offending recruiting firm is a member of NAPR and they are willing to consent to both the arbitration process and the outcome. Unfortunately, these reprobates are rarely willing to do the honorable thing.

I am sorry, there is no sure-fire solution with a quick, feel-good outcome; however, I do know some people in New York…

Yours truly,
Miss Deed





Dear Miss Deed, 

I have a signed contingency agreement. Recently, I spoke to a candidate I thought would be a good fit for my client. The doctor gave me permission to release his CV, so I emailed it to my client. When I called to follow-up, my client was upset with me for sending the CV without calling first. I was upset and surprised because, although this was the first time I did this (honestly), I had a valid contract in place which I thought allowed me to send qualified candidates. I am not sure whether I am more angry or hurt.

Yours truly,
Offended For Sure

Dear Offended, 

You should be neither angry nor hurt, rather you should count your lucky stars that your client did not file an ethics complaint against you.

A signed contract with a client does not allow indiscriminate and extemporaneous referrals to them. You may think the “get ‘em and send ‘em” approach may be cool and harmless, but it is clearly against the rules.

According to the Code, a client must first request the referral so the name can be “cleared.” This protects the client from becoming embroiled in a fee dispute between two firms or more. We would have anarchy if all the firms who have a legitimate contract in force randomly sent candidate names and did not first call the client to “clear” the name. I know there are clients who prefer that you send the name with the understanding that you will politely wait for their acknowledgement that you have indeed found a candidate not previously known to them. Easier for them and you maybe, but not kosher.

Calling the client and verbally presenting the name to consummate an approved referral may be slower, but it is the NAPR way, which makes it the only valid way. Contracts only create the opportunity to make the referral; verbally contacting the client to “clear” the name legitimizes the referral.

The Code of Ethics does not allow for “illegal” shortcuts. This is still a people-to-people business and talking on the phone, at least for the initial referral, is the best way to be sure your referral is valid. I think you dodged a bullet, so mending your errant ways will not only make me so very proud of you, but it will also save you considerable grief from your fellow recruiters who may have been inadvertently thwarted by your illicit referral.

Miss Deed





Dear Miss Deed, 

I filed an ethics complaint against a NAPR firm. It was a straightforward violation in which the candidate neither gave permission, nor was aware the offending firm presented her curriculum vitae to a client. To top it off, the curriculum vitae was sent to the client without first clearing the name. Both the doctor and the client will corroborate the facts.

I am 100 percent sure the Ethics Committee will find against the firm; however, I just learned that, rather than respond, the firm resigned from NAPR before the Ethics Committee rendered a decision.

What happens to the complaint now? If anyone calls NAPR Headquarters in the future to find out about the firm, what is their status and what will Headquarters say?

Yours truly,
No Satisfaction

Dear No Satisfaction, 

Good question! In fact, what you raise here is addressed in the Code which requires the Ethics Committee to continue its investigation and render a decision. If the Committee finds that the infraction of the Code warrants a sanction of probation of six months or more or either suspension or expulsion then NAPR Headquarters must state the organization "resigned , not a member in good standing." 

I had a more vivid and poetic response, but Headquarters mentioned something to me about not compromising the exalted level of adulation I receive, so I'll go with what the Code dictates.

Yours truly, 
Miss Deed



Dear Miss Deed, 

I thought I'd seen it all, but how about this one?!

My contingency client, a hospital, sent me a memo telling me they will pay our fee, BUT I must get the candidate to agree that the amount of the fee will be considered income to him and a 1099 issued to him in his name if he accepts their position.

The Code of Ethics says that it is a violation if a candidate pays the fee. Am I in trouble?


Dear Stunned, 

Good grief! I have never seen this before.

Good news! You are not in violation of the Code because the candidate is not, in fact, paying the fee. He is only responsible for any income taxes that could result from the additional income being added to his gross income.

I must add if your doctor takes this job under these conditions he is either the most desperate candidate in the Western Hemisphere or you are a smoother talking son-of-a-gun than that good-looking fella heading up Ethics at the NAPR.

Love ya, 
Miss Deed





Dear Miss Deed,

I am with a recruiting firm and I have successfully worked with a group practice for several years. We have an excellent relationship, but I may have made a serious mistake.

I recruited an internist to join another in the group. They did not get along. The internist I just recruited called me to say he was unhappy and could I help him find another job.

The group administrator found out and called me. She was angry because I was helping the dissatisfied doctor find a job. I had a good relationship with the doctor and was only trying to help him.

What did I do wrong? I am . . . 


Dear Baffled,

Where should I start? I call this “back door” recruiting. It is a great concept. While you are making placements with a client, you secretly recruit doctors away from the client. Theoretically if you play your cards right, you will only need one client because if you keep the timing right for each doctor placed, you can recruit one away. It is like perpetual motion.

The problem is, clients tend to get upset and more importantly NAPR strictly frowns on this activity.

In fact, the Code of Ethics is very clear about not allowing this. Basically as long as you have a financial relationship with your client (defined as having made a placement on a contingency basis within the past 12-month period) you cannot recruit a doctor away from them. (If you have a retained relationship, the same applies.)

However, there is one loophole. That is, if the doctor has publicly announced that he or she is resigning, then you are immune from this section of the Code of Ethics. Obviously the doctor you were working with was confidentially seeking another job. This puts you in significant trouble.

I think we need to talk.

Yours Truly, 
Miss Deed





Dear Miss Deed,

I work diligently to screen my candidates. I am careful and conscientious in obtaining information about my clients so I can clearly and accurately portray the opportunity to my candidate. I identify my client's name and location and ask the candidate if anyone has spoken to him or her before I call my clients.

Recently, and in ever-increasing frequency, when I call my client to clear the name, I am told they already have the CV. Sometimes the client reveals the other firm's identity. I am frustrated and disgruntled.

Yours truly,

Dear Disgruntled,

As you know, physicians in the scarce specialties are being overwhelmed with calls from recruiters and often do not pay much attention to the recruiter who gives minimal information and then sends their CV out to one client or several for that matter. (We do know that some recruiters send CVs first, get the client's confirmation of a need, and then call the client.) Clearly the latter is a violation of the Ethics Code, Section IV, A., 4. regarding unsolicited referrals. This section, however, allows for multiple CV send-outs if the candidate has given permission.

In terms of the candidate's lack of knowledge or failure to remember that his or her CV has been sent, the Ethics Code has little jurisdictional authority without smoking-gun proof that the offending firm sent the CV without the candidate's knowledge or permission. Unfortunately, because physicians are not individually members of the NAPR, the Ethics Code has no jurisdiction. 

I realize this may not be the answer you are seeking honey, but it is the best I can do until we can get those son of a guns to join the NAPR.

Miss Deed





Dear Miss Deed,

I spoke to a doctor, told him about my client's job opportunity, got his permission to submit his curriculum vitae, prepared the email and called my client to let her know the good news that I had a candidate for her only to find out she already had him. Since the doctor didn't know anything about my client, I asked how this could happen. My client said that she has worked with the referring firm a long time and the recruiter just sends in the CVs.

Does a long-term relationship with a client change the rules?


Dear Unclear:

No! While it's nice to have the kind of relationship you described the other firm has with your mutual client, it is definitely a violation of the Ethics Code and unfair to other recruiters (such as yourself).

The Code is very specific in Section III. A., 4. that unsolicited CVs are verboten (and also unethical). The relationship one has with one's client can never supplant the fact and spirit of the Code. Many firms have long-standing relationships with clients. If the Code allowed for exceptions based on longevity, situations like yours would continuously arise causing chaos and serious ill-will with the offending firms.

Send your client the Code, point out the applicable section and ask her to require all firms to clear the name(s) with her before submitting the candidate. When you've done all this, go out and have a few beers. You done good!

Miss Deed



Dear Miss Deed,

I am a physician and listed my curriculum vitae on the World Job Bank. I received the following e-mail from a recruiting firm: "We have great practices for you around the country. Please tell me where you want to go."

I am annoyed because I took the time to spell out my geographic preference and don't have time to read silly, non-specific e-mails. Do I have any recourse with this firm? 

Yours truly, 
Expected Moore, MD 

Dear Dr. Moore: 

Yes, you do! In Section III, Ethical Rules, subsection D. 4. a., the NAPR Code of Ethics states "additionally, no candidate registered with the World Job Bank, Cooperative Mailing Program or any future member service may be contacted for any purpose other than to present practice opportunities (jobs)". In other words, the firm who contacted you should have described a practice(s) or in some way given you details about a job. Because the e-mail failed to describe any aspect of a practice/job, the firm has violated this section of the Code. 

The Code allows the Ethics Committee a choice of several disciplinary actions. Although your annoyance is significant, removing a digit from the right hand of the firm's owner is not one of them. Because this is both a first-time offense and a new section of the Code, the firm will be cautioned against committing future similar violations. 

Miss Deed