As someone who has recruited a very large number of physicians over the years, I am quite sold on the benefit of a “letter of intent” or “LOI” as a tool for physician recruitment.

While physicians are highly familiar with medical/surgical concepts and while many are in no way intimidated by dissection within the human body, many to most are not qualified or really desirous of dissecting a complex legal document without the help of an attorney. With that in mind, let me ask you this: Do you really want to have the candidate you seek to hire tethering their decision to join your organization to deciphering substantial amounts of legalese? Or would you prefer they first reach the decision based around signing a simple, pleasant letter of intent and then allow contract negotiation to proceed after this mental milestone has been reached?

Put yourself in a physician candidate’s shoes for a moment. Imagine you have just interviewed with the Cleveland Clinic and the Mayo Clinic for essentially the same staff position. You have family in Rochester and your spouse has family in Cleveland. Both positions offer the same compensation package and benefits, not to mention they both carry the same level of prestige, as you perceive it. You also happen to like your prospective co-workers at either clinic equally. They have both made you an offer with seemingly equal tenacity and both have presented you with their standard employment contracts that are prohibitively long, ominous sounding and completely outside of your interest or capability to decipher.

However, whereas the Cleveland Clinic just presented you with a 30-page contract to review and sign, Mayo decided to first send you a letter from your prospective department Chair that first outlines the highlights of the offer and invites you to sign the letter as merely a gesture of your intent to join the team. It’s tone was pleasant and welcoming, and it indicated that a contract would be forthcoming after the letter is signed.

Which position do you already feel better about, if only slightly? Sometimes it’s the little things than can make a huge difference, and a well-written letter of intent can tip the scales in favor of your practice opportunity over another. Furthermore, the use of the LOI allows the decision making process to be more incremental and therefore less likely to be overwhelming.

A letter of intent is a non-legally binding written gesture and agreement between candidate and prospective employer that outlines the terms of employment and says that we agree in principle to pursue this proposed relationship to the best of our ability, and to the exclusion of all others, and that barring some extenuating circumstance — such as an inability to create a mutually agreeable employment contract — we will be working together.

Letters of intent are certainly not idiosyncratic of just the physician employment world, and they basically stand upon the premise that when someone makes a promise, if even just an informal, non-legally binding one, they will stick by it. Furthermore, for physician recruiters, a letter of intent is seen as a candidate reaching an enormous mental milestone within the interview process, as most candidates with integrity will not sign a letter of intent, lest they truly, truly intend to take the position. Moreover, it is generally accepted that once the letter of intent is inked, the easier it will be for the candidate to take the step of inking the contract itself.

Here are some tips when it comes to a letter of intent (“LOI”):

• Make sure there is a warm and sincere tone. Most properly drafted employment contracts are dry and unforgiving, so make the LOI serve the functioning of buffering the contract with some human sentiment. But don’t overdo it. Have someone else read it — whose opinion you value — to see if you have laid it on too thick;
• Be sure and hit all the highlights of the employment agreement, such as pay, benefits, term of contract, etc., but there is no need to include anything that could be seen as a negative, like non-competition language. Since the LOI is not a legal agreement, why would you include within it something like a non-compete which concerns termination of employment, when employment has not even been formally established?
• Notwithstanding the foregoing about being warm and heartfelt, also be as brief and succinct as possible. The candidate will probably have plenty of reading to do when it comes to the contract itself so no need to overdo it with an unnecessarily verbose LOI. A single page is adequate, and you should not exceed two pages;
• Make sure it is clearly spelled out that the LOI does NOT constitute a legally binding agreement as failure to do this will make it much less likely of getting a signed LOI;
• Have a place on the LOI for the prospective candidate to sign, but also have a place for the representative of the hiring entity to sign and make sure it is already inked by this person prior to presenting the LOI to the candidate. There is something nice about receiving an LOI already half-executed in blue ink. It makes the offer all the more real (yes, this may sound silly, but this is true);
• Most importantly, do not consider the recruitment process to be over once the LOI has been signed and that the contract negotiation period is a mere formality. While a signed LOI is encouraging and a great sign, you are a LONG way from home before you have a new addition to your organization;
• As soon as feasible after the mutual signing of the LOI, formal contract review and negotiation should begin. The longer you wait to get to a mutually agreeable the contract, the more likely you are to not ever get there. Ride this momentum created to the LOI all the way to a contractually agreed upon addition to your organization with a long tenure ahead of them.

Bo Claypool is a physician recruiter and managing partner, Monroe & Weisbrod. He can be reached on Google+.