Last month I wrote the candidate half of this: what account executives need to prove to get hired. This is the other half, written for the people doing the hiring. It is the same market seen from the opposite side of the table, and the gap between the two sides is where most of the bad hires come from.
I run the US medical sales desk here, which means I spend my week talking to account executives in home infusion, respiratory and home health, and to the leaders trying to hire them. What follows is what I would tell you on a first call about a live vacancy.
A weak account executive hire in this market does not simply miss target for a year. They spend that year in front of your referral sources. Discharge planners, case managers and physician practices form a view of your organization through the person who calls on them, and repairing that view takes far longer than the twelve months you spent finding out. The cost of the wrong hire is not the salary. It is the referral base you have to win back.
What this guide covers
01What you are actually buying
In home infusion, respiratory and home health you are not buying a closer. Almost nothing here is won by a pitch to a purchasing committee. Revenue arrives through referral relationships: discharge planners and case managers in the hospitals across your territory, pulmonology, sleep and allergy practices, skilled nursing and assisted living leadership, care managers inside physician groups and ACOs, and depending on your therapy mix, wound care, infectious disease and oncology practices.
So the thing you are hiring is access and credibility with those specific people, plus the discipline to build more of it. That is a different assessment from the one most interview panels run. Three questions get you most of the way there.
- Which referral sources have you built rather than inherited, and how did the first one start?
- Which of your relationships would survive you changing employer, and which would not?
- Where is your current coverage thin, and what would you do about it in ninety days?
The third question is the one that separates people. Strong candidates answer it immediately, because they already think that way. Weaker ones treat it as a trick.
If a candidate offers you a referral list, patient information or a pipeline export from their current employer, that is not enthusiasm. It is a preview of what they would do to you on their way out, and in this sector it can carry compliance consequences for you as well as for them. We screen for it before you ever meet them.
02How to read the numbers on a resume
Every account executive resume carries a percentage. The percentage is not the assessment. Whether they can take it apart is the assessment, and these are the follow-up questions that do it.
| What the resume says | What to ask | What a good answer sounds like |
|---|---|---|
| 118 percent of quota | Who set the quota and what was it built on? | They know the basis, and say plainly whether it was a stretch or a formality. |
| Grew the territory year over year | From what base, and what else changed that year? | They volunteer the launch, the competitor exit or the payer win before you ask. |
| Top performer | Ranked where, out of how many? | A number, not an adjective. |
| Record quarter | How much came from your top two or three referral sources? | They know the concentration and can say what they did to reduce it. |
| Consistent delivery | What did month on month look like across the year? | They describe a normal month, not just the good ones. |
| Managed a book worth X | Inherited or built? | Honest either way. Inherited and grown is a perfectly good answer. |
The candidate you want is rarely the one with the biggest figure. It is the one whose account of their own performance survives three consecutive questions without changing shape. We do this screen before submission, and the notes come to you with the resume rather than being something you have to reconstruct in a first interview.
03Five ways these searches go wrong
- Hiring the biggest number in the pile. Attainment without context is the least reliable predictor in this market. Ask what the number rested on before you fall in love with it.
- Hiring a competitor's rep for their book. Some relationships travel and some do not, and the ones that travel usually take longer than the candidate suggests. Hire for how they build, not for what you hope walks through the door with them.
- A compensation plan nobody can explain. If the split, the caps and the accelerators cannot be described in two sentences, experienced candidates assume the worst and go quiet. We pressure test the plan with you before we go to market.
- Interviewing without selling. Good account executives are being approached constantly. A panel that only assesses, and never explains the therapy mix, the payer position or the growth plan, loses people who were genuinely interested.
- Ignoring the operational story. Candidates want to know that intake, pharmacy, nursing and billing can deliver what they sell. If your service levels are strong, say so, with detail. It is one of the most persuasive things you own and most employers never mention it.
04Speed, and why it decides this market
The account executives worth hiring are not on the market for long. They are usually in work, quietly looking, talking to two or three organizations at once, and the process that moves first tends to win them even when it is not the largest offer on the table.
A search that stalls does not simply take longer. It changes who is available. The strongest people drop out first, because they have options and no particular need to wait. What you are left with after six weeks of silence is not the same shortlist you started with.
What works: a confirmed two-stage process agreed before we advertise anything, interview slots held in advance rather than found later, feedback inside forty eight hours, and an offer that is ready to go the day the second interview finishes. None of that is exotic. It simply has to be decided at the start, and it is the part of the brief we are most insistent about, because it is the part that decides whether you get your first choice or your third.
It is the same argument we make on the pharmacy side, set out in how a recruitment agency fills a role, and the reason offers fall over late is covered in why great interviews still end in declined offers.
05What they are asking about you
This is the half of the conversation you never hear. Before an experienced account executive agrees to interview, they ask us five things, every time. Have your answers ready, because vague ones lose you candidates at the first call.
- Is the compensation plan real? Base to variable split, caps, accelerators, how often the plan has been rewritten, and whether the people currently in seat are hitting it.
- Why is the territory open? The single most revealing answer you give. A promotion is a good story. A third vacancy in two years is a story too, and they will find out either way.
- Can operations deliver what I sell? Intake turnaround, nursing capacity, billing accuracy. Service failures cost them referral relationships personally.
- What is the payer position? Contracts and network status set the ceiling on what any account executive can do in a territory.
- Who will I report to and what is expected at three, six and twelve months? Leadership stability matters more than most employers realize.
We put those questions to you at the briefing stage rather than leaving them to surface mid-process, which is why our first conversation about a vacancy takes longer than you might expect and the rest of it takes less.
06How we run an account executive search
A small number of the right people
We send a short list of candidates we would stand behind rather than a large batch of near misses. That is the team's standard here, and it is why our shortlists are read rather than skimmed.
Coverage across all fifty states
We recruit these roles nationwide, so we can tell you how your package and territory compare with the markets you are competing against for the same person.
Discreet where it matters
Replacing someone still in post, or opening a territory you would rather competitors did not hear about yet, is handled as a confidential search.
Alongside that we brief candidates properly, prepare and debrief them at every stage, and establish what it would take to move them before you interview, so your offer is built to survive their resignation conversation rather than to open a negotiation.
If pharmacy leadership sits alongside your commercial hiring, the clinical side of this market is covered on our specialty infusion and specialty pharmacy pages, with the wider picture on the US specialisms hub and the background on why those roles are so hard to fill in specialty and infusion recruitment in 2026.
Frequently asked questions
Should I hire an account executive from a direct competitor?
Often yes, but hire them for how they build referral relationships rather than for the book you hope arrives with them. Some relationships transfer, many do not, and anything that depends on them bringing confidential information from a previous employer is a risk to you as well as to them.
How long should an account executive search take?
With a confirmed two-stage process, held interview slots and feedback inside forty eight hours, this is usually weeks rather than months. The variable is rarely candidate availability. It is how quickly decisions get made once the shortlist lands.
Is it better to hire someone with therapy knowledge or with referral relationships?
Relationships and the discipline to build them, in most cases. Therapy and reimbursement knowledge is learnable by a capable person in a few months. The ability to open a cold referral source is not, and people either have a method for it or they do not.
What should we prepare before going to market?
A compensation plan you can explain in two sentences, an honest answer to why the territory is open, your payer and network position, your intake and service levels, and the interview slots. We work through all five at the briefing stage.
Can you run the search confidentially?
Yes. Replacing someone still in post or opening a new territory quietly are both routine for us, and neither the vacancy nor your organization is named until a candidate is ready to be introduced properly.
Hiring an account executive this quarter?
Tell me the territory, the therapy mix and what the plan pays. I will tell you what that role looks like against the rest of the market, who is realistically available, and what it will take to land them. If the honest answer is that the package will not get you the person you have described, you will hear that first rather than after three months of searching.
Are you an account executive rather than a hiring manager? Part one of this pair, what actually gets you hired, was written for you.