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The Wrong Physician Reference Can Hurt You

Be careful whom you ask to sing your praises. That "ideal" person might do more harm than good.

To compete for a physician job, you need to list three references on your CV. But how important are these people, really? The truth is: It depends.

The better the job, the more professional the organization, and the stiffer the competition, the more likely that references will be contacted. And if you’re being screened by a physician recruiter, expect your references to be called -- and thorough feedback elicited.

Pick medical personnel who know your work and have credibility

You lose points in the competition for a job if your references aren’t solid. Attending physicians, nurses, and medical staff you’ve worked with are your best bets. The ideal reference for a primary care physician is another primary who has known you for more than two years, has worked with you in the past five, and is willing to discuss your work candidly.

A specialist is unlikely to fit the bill. The neurologist you golf with regularly—but have referred to only occasionally—isn’t apt to provide a reference checker with the detailed replies needed to give you an edge on the competition. And if you’re a resident, forget about using your fellow residents. A reference checker will assume they’re friends doing you a favor. Instead, be sure to list your program director.

Expect whomever you choose to be asked about:

  • Your clinical judgment, including use of consultants and knowledge of your field
  • The practice environment you’re best suited to
  • Your leadership skills and ability to work as part of a team
  • Your personality traits, reputation, and work ethic
  • Your oral and written communication skills
  • Your ability to adapt to new situations and handle stress
  • Any problems with your professional competence
  • Any malpractice suits or judgments against you
  • How you compare with other doctors the reference has worked with
  • How comfortable the reference would be referring a family member to you
  • Whether the reference would hire you himself, and in what capacity

Find out in advance what your references will say

Not only should your references know the answers to the list of questions above, they should be willing to talk candidly. Some individuals who agree to be references won’t go beyond basic information, because they fear liability for saying the wrong thing. A reference doesn’t need to know the answer to every question, and he/she may choose not answer some. But if they consistently lack the knowledge or the willingness to offer candid replies to a reference checker’s inquiries, their effectiveness on your behalf will be undermined.

So, ask the people who consent to give you a reference how they’ll respond to the list of questions mentioned above. Yes, hearing the truth about yourself can be awkward, but it’s even more awkward to use a reference who has nothing good to say about you.

Asking a prospective reference how they’ll respond can also influence him/her to tone down a negative answer. Say you’re leaving a group because you lost a political battle. Unfortunately, you have to give one of your partners as a reference if you want to avoid raising eyebrows. If that doctor were to first articulate his/her feelings about you to the reference checker, he/she might feel free to trash you. But they’ll blunt their criticism if they have to tell you face-to-face. And once a person verbalizes what they’ll say about you, they generally stick to that version when the reference checker calls.

You can’t use this approach with every reference, however. If you’re a resident who wants to name your residency director, it would be impolitic to ask them what they plan to say about you. So before you place them on your reference list, think hard about how they’re apt to respond. Some residency directors are masters of understatement. They tell reference checkers that a candidate is "adequate" or "acceptable" or that he "met our standards." In your residency program, those may be words of high praise, but to a prospective employer expecting unabashed enthusiasm, they can be the kiss of death. If you’re not sure your residency director will say, without circumlocution, that you’re an excellent doctor, don’t use them as a reference.

Coach references on how to respond and on how to be responsive

For your references, walking the line between being candid and being helpful to you can be difficult at times. So a little coaching is both permissible and advisable. Some questions may be tricky for a reference to field without cues from you. For instance, a prospective employer may ask your reference whether you’d be a good fit with the practice’s culture. A friendly reference won’t hesitate to say yes. But what she doesn’t realize is that when you interviewed for the job, you learned that the organization doesn’t want a good cultural fit. As the interviewer explained to you, the practice is a warm, friendly, collaborative group of low-producing doctors in an increasingly competitive managed care environment. What the practice needs is a dynamic rainmaker to shake things up. Unless your references are psychic, the only way they can know how to respond appropriately is from you.

You also need to coach references on how to handle questions about your challenges. The reference may be tempted to dream up "phony" weaknesses (you work too hard or you’re just too nice), thinking that he/she’s doing you a favor. But prospective employers aren’t naive. Tell your references to give employers the real thing—with limits. For example, a reference could say that you’re slow to turn in charts or that you spend too much time with patients. On the other hand, a potentially job-losing challenge is that you never kept a physician assistant for longer than six months.

Speak with your references about the best way to cooperate with prospective employers. For instance, a reference may offer to write you a letter of recommendation so that she can avoid fielding phone calls. You’ll need to explain that employers know that references will rarely be as candid on paper as they are in a phone conversation. Not only may a letter of recommendation be disregarded, it could raise a suspicion that you have something to hide, weakening your competitiveness.

References should also know that while it may be inconvenient to take an employer’s phone call in the middle of a hectic workday, it’s imperative that they schedule a mutually convenient time to chat. A reference checker will generally make three attempts to reach someone before throwing in the towel. It doesn’t reflect well on you if your references are consistently unavailable to speak on your behalf.