Avoiding Turnover: How to Hire and Retain Good Physicians

It usually starts like this: You have a need to hire a physician so you run an ad, ask your colleagues if they know of anyone, network with the interns, and start interviewing. You look at resumes and make decisions based on what you see there, and if the references check out and the person seems competent, you've got yourself a hire. Six months, a year, maybe even two years later, the physician walks out the door and you are left to start all over again.

So what went wrong and what you can do to prevent it from happening again in the future? There's no magic formula, but there are some basic steps that you can take to design a successful hire-and-retention strategy going forward.

Define your practice's culture

What keeps an employed physician from walking out the door? If the person hired is a good "fit" with the practice, then everyone is happy. But how can you determine that? First, you need to figure out the culture of practice - the personality of your group, usually based on the values upon which your practice operates.

Some practices have mission statements that help to capture the values or essence of their organizations. If you don't have one, this is a great place to start. Once you have established what your practice stands for, it becomes much easier to articulate the values you will be seeking in a great candidate. Without a set of core values, mismatches are bound to occur.

So determining what are the key factors that make your practice what it is, and being able to articulate or encapsulate those values into a solid mission statement, is the foundation to building a successful hiring strategy. Once the values have been identified, it is much easier to match candidates to a set of suitable characteristics that will "fit" with your practice's personality.

Conduct successful interviews

Working with a practice client recently whose second physician hire in two years had just departed their practice, we determined that the partners were having a difficult time truly expressing their values and what they were seeking in employed physicians (and ultimately, potential partners). The previous hires looked good on paper, did well in the interview, and seemed to work well with patients and staff. But from the very beginning in each case, they felt something was missing. "It was just a gut feeling," said one. First, you have to be able to articulate what your practice is all about (your mission) but you also have to trust your gut. That instinct is a useful tool in helping to determine whether the personality of the candidate will fit the culture (or personality) of the practice, and ultimately, whether or not things will work out for both parties.

Second, involve a number of people in the hiring process. I am routinely confronted with presenting a great candidate for hire, only to discover that half of the partners really felt negatively toward the personality, regardless of how good he or she looked on paper. Involving a team in the assessment helps to find the best candidate, the one that everyone feels will work out well. If even only one member of the team has reservations, explore why and you may uncover traits in the candidate, or scenarios imagined, that the rest of the group failed to consider.

Third, have the candidate come onsite for a day. There is no better way for both the candidate and the practice to determine if this may be a good fit. For the candidates, simply seeing your premises may seem fine but seeing firsthand how a typical day runs - from scheduling to charting - is an entirely different experience and will help them to evaluate if it's a place they are going to be comfortable with. For the hiring practice, seeing a candidate in the practice environment, and his/her reactions to the operational aspects of it, as well as how the candidate interacts with staff and patients, is an ideal way to gauge "fit" right from the start.

Define expectations in writing

Before making an offer, find out what the candidate's expectations are and what those expectations are founded upon. Even if you seem far apart on salary, being as transparent as possible as to what you are offering, and why, may be enough to have the candidate see things from your perspective. Then draft a contract that is detailed enough to spell out all the major requirements of the job, not just schedule and benefits. Don't hesitate to draft a formal job description that spells out expected performance and supply the candidate with copies of your policies and procedures. Tie these into your employee contract - something as simple as "employee is expected to conform with practice's policies and procedures, and to perform to specifications laid out in the job description" - will suffice. Often, future problems are discovered at this contracting stage, particularly if the candidate has difficulty agreeing on the terms. This is a red flag and it may be prudent to move to the next best candidate instead.

Make it a two-year contract for two reasons - one, the employee will clearly understand that these are the terms for an extended period, and two, it saves facing a renegotiation for both parties until a solid relationship has been established. Certainly you do not want to keep an unhappy hire for two years, so make sure there are provisions for both of you to terminate employment "without cause" in the event that things do not work out as well as planned.

Keep your new hire happy

Not all employees are seeking partnership, particularly part-timers, but if you have a defined partnership track, talk about that from the beginning so that your employee has something to aspire to down the line. If your track is vague, formalize what you are looking for in a potential partner. One of the best ways to do this is to formulate a "practice charter." This document spells out what is required of a partner or shareholder based on the practice's values, and acts as a commitment by each to uphold those standards. Sharing it with an employee can help ensure that there are no surprises down the line, particularly if the employee is underperforming from a partner perspective but has an expectation of making partner based on longevity alone. Make sure that the bar is set based on performance and contribution, or you will guarantee that the physician will "turn over" when her expectation is not met.

Provide plenty of opportunity to become involved in the practice. Engaging your employed physicians in operational and clinical aspects of decision making helps to give them a voice, builds teamwork, and gives them a stake in the practice's success. And tailoring involvement to areas of concern can be very productive. For example, if your employee is struggling with, say, work/life balance, have her set up a committee to determine ways those goals can be better met by everyone in the practice.

Identifying your practice's culture, hiring for fit rather than what works on paper, and creating a transparent and involved work environment will help to ensure you start right and enjoy the benefits of a great hire for years to come.

Susanne Madden, MBA, is founder and CEO of The Verden Group, a consulting and business intelligence firm that specializes in practice management, physician education, and healthcare policy. She can be reached at madden@theverdengroup.com or by visiting www.theverdengroup.com.

This article originally appeared in the June 2011 issue of Physicians Practice.