Why Pediatric Practices Lose Top Candidates?
Insights from ETS Pediatric recruiters Melissa Willis, Evyn Duff, and Jaclyn Padgett.
Time kills deals. Strong pediatric candidates are evaluating multiple opportunities at once, and a slow or disorganized hiring process is the number one reason practices lose top talent before an offer is ever signed.
At ETS Pediatric, our recruiters speak with pediatric candidates and practices every day. That gives us a direct line to what both sides are looking for and exactly where deals fall apart. This guide covers the most common reasons practices lose candidates late in the process, what a realistic hiring timeline looks like, and the best practices that keep general pediatricians, subspecialists, and APPs engaged through to a signed offer.
Why Practices Lose Strong Candidates Late in the Process
Most candidate drop-off is avoidable. The root causes come up repeatedly across private practices, FQHCs, and large health systems, and they have nothing to do with the opportunity itself.
Slow Follow-Up After a Candidate is Submitted
Strong candidates speak with multiple medical groups simultaneously and may have offers from other practices by the time they speak with you. Just as practices avoid putting all their eggs in one candidate’s basket, candidates also pursue multiple opportunities to know their options before committing. If weeks pass without interview scheduling or any feedback, candidates often accept offers elsewhere.
After weeks without a phone interview or any next steps, they accept elsewhere. We have seen candidates accept another offer while still waiting to schedule a first interview. Aim to provide feedback on a candidate presentation within 5 to 7 days – interested or not. Extended silence after a submittal leaves a negative impression that candidates carry forward. The pediatric community is smaller than most people realize, and you never know when your paths will cross again. Leaving a good impression on every candidate, even those who are not the right fit, reflects well on your practice and your team.
Lengthy or Overly Complex Interview Processes
Every round you add is another opportunity for a candidate to drop out or accept a competing offer. A phone or virtual screen followed by one onsite visit is sufficient for most roles. Four or five rounds drive candidates away and signal poor internal organization or communication challenges.
Poor or Inconsistent Communication
Going a month without any response after an interview signals a lack of interest. Even a brief weekly update during an internal approval process keeps the candidate engaged and prevents them from feeling ignored.
Delayed or Uncompetitive Offers
Waiting weeks after the onsite visit to put an offer together or presenting a low offer at the last minute kills momentum. Physicians also routinely negotiate terms and have an attorney review the final contract, which can add several more weeks to the timeline. Starting the financial conversation late stacks delay on top of delay.
It is also worth keeping perspective on the offer itself. Losing a strong candidate over a relatively small compensation gap is rarely worth it. The cost of restarting a search, the time spent, and the strain on your existing team while a position stays open will almost always outweigh a modest difference in salary. When you have the right candidate in front of you, being flexible on the final number is almost always the better business decision.
What a Realistic Pediatric Hiring Timeline Looks Like
Practices with the highest success rates follow a 4 to 6 week process from candidate presentation to signed offer. Here is what that looks like step by step.
Step 1: Review the candidate presentation and respond.
Provide feedback within 5 to 7 days – interested or not. A fast response sets the tone and tells the candidate your practice is organized and engaged.
Step 2: Schedule the phone or virtual interview.
Aim for within 2 to 3 days of expressing interest. Before that call ends, lock in the onsite date or confirm it via email within 24 hours.
Step 3: Complete the onsite interview.
Schedule within 2 weeks of the phone interview. For local candidates who are a strong fit, this can be the only in-person step.
Step 4: Present a written offer.
Do this the day of the onsite or within 3 to 5 days. Walk through compensation and schedule terms together so the candidate can ask questions and commit sooner.
Step 5: Support the candidate through negotiation and signing.
Most physicians negotiate terms and many have an attorney review the final contract. Stay in contact, answer questions quickly, and keep the process moving.
Target total timeline from presentation to signed offer: 4 to 6 weeks.
Best Practices for Interviewing and Making the Offer
Know Your Compensation Framework Before the Onsite
Going into the onsite without a clear sense of what you are prepared to offer is one of the most preventable sources of delay. Work with your recruiter to align on compensation expectations and identify deal-breakers before the candidate arrives. A candidate who shows up with unanswered questions and leaves without answers is a candidate who stalls. Make sure the following are settled and ready to discuss before they walk in the door:
- Base salary and any production or bonus structure
- Schedule and call coverage expectations
- PTO and leave policies
- Clinical responsibilities and patient volume
- Benefits including health insurance, retirement, and CME allowance
- Any non-compete or other contract terms that could affect their decision
For benchmarking base salary and production structures, Doximity’s Physician Compensation Report is one of the most widely referenced sources among physicians and ETS Pediatric can help you interpret what those numbers mean for your specific market and role.
Surprises at the offer stage are one of the most common reasons candidates walk away from a role they otherwise wanted.
Present a Written Offer at the Onsite Visit
Once the groundwork is laid, the onsite visit is your offer moment. Walking through the full offer together in person lets the candidate ask questions in real time, get everything they need to make a decision, and commit sooner. Post-visit offers that leave key questions unanswered invite delays and give competing practices room to move in.
If you need a starting point for offer documentation, ETS Pediatric can provide sample offer letter templates. All final contracts should be reviewed by an attorney.
Anticipate Negotiation
Expect candidates to negotiate. It is standard practice, and many physicians will have an attorney review the final contract before signing. Setting this expectation early prevents frustration and keeps the process moving rather than stalling at the finish line.
Setting Clear Expectations to Support Candidate Retention
Hiring is a stressful process for both sides. Candidates are making a major career decision, and practices are trying to fill a critical role without losing momentum. One of the simplest ways to ease that pressure is to define next steps clearly before every phone call or in-person visit wraps up.
When a candidate knows what to expect, they are less likely to second-guess the opportunity or go quiet. When a practice knows what to expect, they can plan internally and avoid scrambling. Before every interaction ends, the candidate should know:
- When they will hear back and in what form
- What the next step in the process looks like
- Who is involved in the final decision
Setting that expectation early is not just a good process, it is a signal to the candidate that your practice communicates well and follows through. That matters. A disorganized or slow process raises real questions about what day-to-day operations look like in the practice. A smooth, well-communicated process builds confidence and makes it easier for a candidate to say yes.
ETS Pediatric coaches both candidates and practices on next steps after every interaction. Candidates are prepared to ask the right questions, and practices are prepared to answer them. Keeping both sides informed and aligned is one of the most effective ways to protect a strong candidate from quietly accepting an offer elsewhere.
The Bottom Line
Time kills deals. Strong candidates are speaking with multiple practices at once and move toward whoever responds with the most clarity and speed. The practices that consistently secure top pediatric talent are not always the ones with the biggest budgets; they are the ones with the clearest, fastest process.
Before your next strong candidate accepts an offer somewhere else, audit your hiring timeline against these basics:
- Respond to candidate presentations within 5 to 7 days
- Limit the process to a phone interview and one onsite visit
- Align on compensation before the candidate arrives
- Present a written offer at the onsite or within 3 to 5 days
- Communicate consistently at every stage, even when nothing is final
- Plan for negotiation and attorney review from the start
If you need support getting there, ETS Pediatric works exclusively in pediatric recruiting. We pre-screen and vet candidates before a practice ever speaks to them, reach passive candidates a job posting will never find, and handle the coordination work that keeps your process moving – scheduling, communication, compensation alignment, and offer strategy. We only charge when a candidate is placed.
When your hiring process needs to move quickly, we help make sure it does.
To learn more about how we work with practices, visit etspediatric.com/practices.
If you are a candidate exploring opportunities, browse current openings at etspediatric.com/jobs.
Frequently Asked Questions
Q: How long does pediatric recruitment typically take?
A: The most successful practices follow a 4 to 6 week process from candidate presentation to signed offer. That includes feedback within 5 to 7 days of submittal, a phone interview within 2 to 3 days of expressing interest, an onsite visit within 2 weeks, and a written offer presented at the onsite or within 3 to 5 days afterward. Attorney review and contract negotiation can add additional time, so planning for it from the start keeps the process from stalling.
Q: Why do pediatric practices lose strong candidates late in the hiring process?
A: The most common reasons are slow follow-up after a candidate is submitted, too many interview rounds, inconsistent communication between steps, and offers that arrive too late or without enough detail. Strong candidates are typically speaking with multiple practices at once and move toward whoever responds with the most clarity and speed.
Q: How quickly should a practice respond after a candidate is submitted?
A: Within 5 to 7 days, whether you are moving forward or not. A fast response signals that your practice is organized and engaged. Extended silence after a submittal leaves a negative impression — even if you circle back later.
Q: How many interview rounds should a pediatric practice use?
A: Two. A phone or virtual interview followed by one onsite visit is enough to make a confident decision for most roles. Additional rounds add time and fatigue without adding meaningful insight, and they give competing practices more opportunity to move in.
Q: What should be covered before presenting an offer to a pediatric candidate?
A: Everything. Before the offer is presented, the candidate should be clear on base salary and any bonus structure, schedule and call coverage, PTO, clinical responsibilities, patient volume, benefits, and any contract terms that could affect their decision. Surprises at the offer stage are one of the most common reasons candidates walk away from a role they otherwise wanted.
Q: Should practices expect pediatric candidates to negotiate their contract?
A: Yes, and it is standard. Most physicians negotiate terms and many have an attorney review the final contract before signing, which can take several additional weeks. Planning for this from the beginning keeps it from feeling like a delay and helps both sides stay focused on reaching an agreement.
Q: How does a pediatric recruiting partner help practices move faster?
A: A specialized recruiter handles the coordination work that slows most practices down: scheduling, candidate communication, compensation alignment, and post-interview follow-up. At ETS Pediatric, we also screen and vet candidates before a practice ever speaks to them, so the process starts with qualified matches rather than a stack of resumes.