Recruiters
 

Around the second to last year of residency, in addition to inquiries from area practices needing fresh blood, physician recruiters', hospitals', clinics' and practices' phone numbers from all over the United States will start appearing on your pager and filling your mailbox with their recruitment packets (which I initially didn't answer because I thought I was going back to Canada, but then had to call and beg later on to see if they could place me on a J1-waiver but by then it was too late). So Canadian IMGs with minuscule chances of getting licenced in their own country had better answer back those pages.

International Medical Graduates are often the target of scammers and so allow me to point out how the ethical recruiters work.

1) Ethical recruiters will NOT ask for money from the physician being recruited, whoever needs the physician will be paying the recruiter and not the other way around, the employers will be paying them anywhere from 20 to 30% of the physicians' annual salary if they are on a contingency basis, retainers or a salary if they work exclusively for the employer. I received  flyers saying I would be guaranteed a job if I wrote somebody a cheque of anywhere from 5000 to 15000 dollars however I had heard of too many IMG residents on J1 visas being conned so I didn't fall for any of these. The fee is variously worded as a facilitation fee, finders' fee, administrative expenses, search fees, etc. but they will ask for the money up front or by installment or after you sign a contract which ethical recruiters won't do. And interview expenses like air fare for the physician and his family, accommodation expenses, car rentals and even food and gas expenses will all paid for by the prospective employer (interviewing for residency I only had 2 programs offering free accommodation and I had to pay for my own airfare, car rental, etc.)

2) It is in the  recruiters' best interest to get the physician a position where both the physician and employer will be happy since how much they get paid or whether they get paid at all depends on how much the physician is going to be paid and whether the physician will stay for a long time with the employer (i.e. if the physicians' base pay is going to be 150,000 per year the recruiter will get anywhere from 30000 to 45000 dollars once the employment contract is signed if they are getting paid on a contingency basis, which is further prorated on whether the physician stays with the employer for the length of the contract, for example if the doctor leaves before six months they get nothing and they have to look for another physician for that employer for free. If they are paid on a retainer or salary then performance bonuses depend on whether they are able to recruit competent physicians who will stay with the employer.

3) The recruiters have a rep to protect, both with the physicians and prospective employers. So they make sure the physicians they are presenting to employers are checked out and the employers aren't known for exploiting the physicians. They will ask for recommendation letters from your program and call your referees even before they tell you where you will be interviewing.

4) Ethical recruiters won't pressure you to sign a contract you don't like or ask you to go for interviews to places you don't want to. They will usually line up 3 or 4 job interviews (based on the parameters you give them) so you can make a choice as to where to go for interviews.

The NAPR is the national association self policing physician recruiters.

Contracts

Whether you are approached by a recruiter or directly by an employer once you have chosen where you want to work, a contract will have to be signed. I was never taught anything in medical school about what to look for in a contract and how to negotiate one and we only had a couple of hours during residency covering this topic (the only thing I remember from that lecture was to make sure a lawyer specializing in employment contracts looked at it first before I signed anything). But just like doing a good patient prep before surgery preparing well for these negotiations is half the battle.

1) Make a list, including input from your life partner, of what you want in a practice (if you're working with a recruiter it would save you a lot of hassle if you actually gave this list to them so they can set up your interviews based on this list).

2) It doesn't hurt at all to ask for what you want right at the outset. The other side can only say yes or no.

3) If something is not in the contract then you don't have any right to demand it.  That is, anything promised to you verbally but not written down in the contract is non binding.

4) Have a lawyer specializing in employment contracts review the contracts as soon as you receive them and follow their advice before signing it.

This model contract is available for AMA members.

Contract horror stories from the AMA.

Here's a web site about how to negotiate contracts

Here's a list of articles that will really help with job interviews and contracts

Recruiter links
Disclaimer: Having links to these recruiters on this web site does not constitute endorsement of their services nor does it imply acceptance of any liability that may be incurred as a result of surfing to their sites. As with everything else on the net buyer beware.(They were all ethical and aboveboard when I dealt with them but if they got bought out or had staff changes things might change.)

There are a lot of physician recruiters out there and the NPR web site has a list of members

Another recruiter with  experience placing IMGs in Canada and works really hard at placing you

This U.S. based recruiter specializes in placing Canadians in the U.S. and works really hard at placing you

This recruiter has experience placing IMGs in Canada

A Canada based recruiter recruiting for the U.S. and overseas
 

Immigration Issues

Here's what a Notice of Action looks like.
And here are the forms and other documentation needed when going to the U.S. consulate to get your H1b1 visa for yourself and your wife's H4.
(thanks L.B. for your questions)

The only thing I have to add is, this time around it is the employers who will pay for the H1b expenses and it doesn't hurt to ask if the employer is willing to petition you for a green card right away (during your first 3 year contract). And make sure to ask them to put this in your contract. Since September 2001 it has gotten much harder for certain nationalities to clear U.S. immigration even if they are Canadian landed immigrants (my lawyer asked for more paperwork from me, including copies of any parking or speeding tickets I may have gotten, when I had to renew my H1B than when I first applied for one and I am not even originally from any of the countries being given special attention, one of the other IMGs, at the hospital I was in had to take a day off, so he could personally appear before BCIS, just for H1B visa processing and he was already in the U.S., I don't know how long it would take for people outside the U.S.).

AMA listing of individual state requirements for licensure