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Tokens of (Un)appreciation in Radiology


Is it time to rethink the burden of applicant fees, credentialing costs and medical staff dues?

I indulge in a little check-grabbing mischief when dining with far-flung old friends and family. I have enjoyed some professional success, and it tends to make less of a mark on my finances than it would on theirs if I pay for our meals.

The mischief part comes into play because they don’t always make it easy. Folks protest good naturedly. Sometimes, they argue that I am visiting them and that guests shouldn’t be paying. When they are staying in my house and being driven around by me, etc., they maintain they should be allowed to thank me for my hospitality. In other words, guests should be paying.

I could, of course, say exactly the same things in return so that is a wash. Often, I amuse myself by sneakily advising waitstaff that the tab shall be mine although I have been outflanked from time to time by equally sneaky friends and family. It adds to the game. Whoever wins, I think it’s usually understood that those footing the bill are doing so as a token of appreciation for the others and their company.

Replace friends and family with business contacts, and there are still tokens of appreciation in play. It is a standard thing, for instance, to be fed/watered when interviewing for residency or fellowship positions. Some of that is simply a practical matter: You are spending hours together and that invariably includes a meal. There’s also a social value in that you can learn a lot about a person from how he or she comports themselves at table.

Other strategic benefits are in play, not the least of which is the phenomenon of “reciprocity.” The psychologist Robert Cialdini has put forth a lot of worthwhile material on the subject. Suffice to say that social animals as we are, humans are hard wired to react well when things are given to and done for them. There’s an instinct to return the favor and an overall strengthening of relationships.

Perhaps it was this instinct that informed me, long before hearing of Cialdini’s work, that some folks seem to have the idea backwards. Certain would-be employers inflict costs on the “talent” they are trying to bring on board. Such practices have always struck me as a penny-wise, pound-foolish way to get things off on the wrong foot.

Probably the first example most of us encounter is application fees although that is far from the worst offense. That actually makes sense to me at least in the realm of seeking admission to colleges or grad school. Applicants are asking for staff to review their materials and allocate time for tours/interviews. Fees defray those expenses and provide a small disincentive to apply so the schools aren’t buried in applications from every student in the world.

Even in that setting, the thought has occurred to me: If a school really wants to recruit a particular student, does it make the token appreciative gesture of waiving such fees? I had the flattery of a semi-aggressive recruitment from one college, way back when, but I wasn’t interested in the college, so I never went down the path of finding out. If I had though and found that the college was demanding payment for the privilege of accepting its invite, that might have been the end of it.

I have never encountered a hospital or private practice group ask for an application fee, but I have heard of it happening. I have even heard of some institutions charging annual “renewal” fees for docs in their employ. Perhaps this would make sense for an ivory tower facility in the setting of an extremely lean job market. You want us to consider you? Fine. Pay us a tribute.

What I have personally experienced is an assortment of costs that seekers are expected to bear in the name of completing an application or subsequent credentialing. These costs may come in the form of background checks, National Practitioner Data Bank (NPDB) reports, drug screenings, medical clearances, notarized documents, etc. Items rarely cost much. It is usually the legwork and time spent that grate on the applicant’s nerves. Even more obnoxious are the oft-required “medical staff dues” with costs in the hundreds.

It begs the question: Why on Earth is the hospital or rad group fobbing such things on the applicant? Between the two, the prospective employer pretty much always has far deeper pockets, and most jobs are expected to earn the employer more than is being paid out to the employee. If the employer expects to profit from the new hire, how Scrooge-like is it to chisel a little more from him or her on the hire’s way in the door?

How difficult could it be to send someone a prepaid voucher for these things if his or her application has made it far enough through processing to require it? Even a note would do: “The third-party fees required for your application/credentialing are estimated to be $X. Upon successful completion and hiring, your first paycheck will have X added in compensation.”

The argument might be made that, in addition to these costs being microscopic compared with what the employee will be earning in the job, they’re “baked in” to his or her salary. As reasonable as that might sound, it doesn’t fix the psychological blunder. The salary is relatively invisible to the employee. It is why he or she is taking the job. In the job applicant’s mind, it is a given, part of the background noise.

The nuisance fees are far more visible. The applicant hasn’t even gotten his or her first paycheck yet, and here’s an out-of-pocket demand. Further, if there are annual recurring fees, like “medical staff dues,” they are visible reminders each and every year. Each time one hits, the employee might think, “How much do you actually want me to be here?”

Throwing this stuff in the applicant’s lap is a token of unappreciation. Intentionally or no, it flings little granules of negativity in the applicant’s face, punishing his or her interest in joining the team (or remaining on it). Negativity has its psychological effect regardless of size. Dismissing it with the excuse that it’s just a little thing is an unforced error that can come back to haunt. Smart employers will actively root out such things and desirable employees will gravitate to places without them.

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