why the hell does it cost so much to find people like this. there's probably a few thousand people in the country at most who can do this job and there is certainly an online community or resource network they all use. Put out an ad on it, have them fly in, do some interviews and hire someone. where exactly does that 500k go?
Most people who can do this job are probably already doing it and are being well paid. Therefor, you need to go after them and present this as a better opportunity.
U of Iowa is unique in that you have to run a university and a research hospital which greatly reduces the number of people who are qualified and may be interested.
I can't remember exactly what happened but I do remember they ended up paying for two retained searches which is very rare. I think maybe they did not interview first slate of candidates in a timely fashion or something like that. Anyways, it should have only cost them about $200-$250K.
Recruiting fees do sound outrageous but trust me, organizations pay them every day. Relying on web postings only reaches about 5% of the potential candidate pool.