Recruiter intake

Tell me about the opportunity

I review every submission myself. A structured summary is faster for both of us than a phone screen for a role that turns out not to fit. If it does fit, we'll get on a call.

This form is for recruiters, staffing agencies, and health system or practice representatives describing a job opportunity. It collects no patient information of any kind. Fields marked * are required. Everything else is optional, but it helps me screen faster.

Who you are

So I know who to call back, and where you're placing this.

Your name *

Agency / health system Who you work for, if not the employer directly. If you work for the employer itself, write "direct".

Your email *

Your phone

The employer and role

Employer / practice name *

City *

State *

Practice setting *

Locums or permanent? *

Permanent role Locums / temporary assignment

Role summary *

Target start date *

Compensation

Structure *

Base / total comp range *

wRVU conversion factor

Call

Call frequency *

Primary or backup *

Primary Backup only Both

Restrictive covenants

This is the single most important section on this form. Describe any non-compete AND any non-solicit / non-circumvention clause in the contract, even in draft form. If you genuinely don't know yet, say so rather than guessing. "Unknown" is a valid answer. "None" is not, unless you've confirmed it.

This role has no restrictive covenants at all: no non-compete, no non-solicit, no non-circumvention clause.

Non-compete *

Non-solicit / non-circumvention *

PartnershipBuy-in, what's included, track record

Buy-in price and method

What partnership includes

Track record

Case mix and OR accessElective mix, robotics, navigation

Elective case mix

OR access, robotics, navigation

Referrals and triageWhere patients come from

External referral sources

Non-operative back pain and pre-clinic screening

Team and operationsPA/NP, MA, schedulers

Clinical and scheduling support

Local marketSaturation, tort climate, payer mix

Local market notes

Hospital and ORAnesthesia, equipment, neuromonitoring

Hospital and OR notes

LifestyleSites, meetings, weekend expectations

Lifestyle notes

Due diligenceWhat you're willing to provide in writing

Willing to provide 3-year comp by quartile, in writing Willing to provide governance / bylaws documents Willing to share contact info for the last two associates who left

Anything else

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