The Job Offer Was Excellent. So Why Did the Physician Say No?

A few years ago, we had an American Board Certified Cardiologist interested in a position at one of the most prestigious hospitals in Saudi Arabia. He was well qualified, had the required experience and met all the criteria for the position.

Before making a decision about a permanent move, he agreed to spend four weeks at the hospital on a locum assignment. I thought it was a good idea. He would get to know the hospital, the people he would be working with, the city and, of course, what living and working in Saudi Arabia might be like.

The four weeks went well. He liked the city, liked the hospital and got along with his colleagues. The hospital was equally happy with him and offered him a permanent position.

But he turned it down.

The reason was something we hadn’t really considered. In his practice in the United States, this cardiologist had taken the time to develop additional skills in echocardiography. He was used to reading and interpreting his own echocardiograms, something he had invested considerable effort in learning and was very much part of his clinical practice.

At the Saudi hospital, they had their own Board Certified Echocardiologists who were responsible for interpreting the echocardiograms. So, if he accepted the position, he would no longer be doing something he had spent years learning.

He was concerned that eventually he would lose those skills. And that was enough for him to decline the offer. There was nothing wrong with the hospital or how the department was organized. In fact, he had very positive things to say about his experience. It was simply not the kind of clinical practice he wanted for himself.

I still remember this case because it raises an interesting question and mention it often while speaking to candidates. How much do physicians really know about the job they are accepting, particularly when moving to another country? We spend a great deal of time reviewing qualifications, Board certification, years of experience and whether a physician meets the hospital’s requirements. But how much time do we spend understanding what the physician actually does every day, and what he or she expects to continue doing?

A Consultant Cardiologist in one hospital may have responsibilities quite different from those of a Consultant Cardiologist in another. The same applies to many other specialties. And I am not sure a thirty-minute virtual interview, or even two, will always uncover those differences. Now imagine if this physician hadn’t done the locum. He might have resigned from his position in the United States, gone through months of licensing and visa processing, moved to Saudi Arabia and discovered within the first few weeks that the job wasn’t quite what he expected.

Some physicians may adjust. Others, depending on their circumstances, may start regretting the move almost immediately. Not every physician has the opportunity to spend four weeks at a hospital before accepting an offer. But surely there are other ways to learn more about the position. Speaking with future colleagues, asking about clinical responsibilities, procedures, patient volumes and how the department operates would be a good start.

For hospitals, recruiting an international consultant can take months of work and considerable investment. For the physician, it may mean leaving a practice and a career they have spent years building.

I think both sides have good reasons to make sure they understand each other before an offer is accepted.

Looking back, that cardiologist probably saved himself, and the hospital, a great deal of disappointment. 

He liked the hospital. The hospital wanted him. But the position wasn’t right for him. … And sometimes, that’s all there is to it.