Recruiting: Hiring Young

When Thomas Z. Pineo completed his residency and was hunting for a job five years ago, money wasn't all that mattered to him. Sure, the family practitioner wanted a competitive starting salary and a nice benefits package, but he also wanted to find a practice where he could fit in and be treated with respect by the other physicians regardless of his age.

Pineo had heard of practices in which more senior docs abuse the younger ones, dumping "problem" patients on them or sticking them with an impossible call schedule. He wanted none of that.

From the nearly 200 practices he investigated, Pineo chose Greenville Medical Center in Pennsylvania. There he found a supportive and egalitarian environment that suited him just fine.

In fact, rather than being caught in a generational crossfire, Pineo benefited from being the youngest physician. He joined the practice just as another doctor was retiring, and he took on many of the elder doctor's patients.

When the soon-to-be retired doctor was out of the office, "I started taking his overflow patients and covering for him," Pineo recalls. The doctor had also stopped taking new patients, so he sent them on to Pineo as well.

But the retiring doc didn't give up call until he left. And all the physicians in Pineo's practice share call equally among others in their specialty, regardless of their age or seniority.

Chicago-based orthopedic surgeon Steven Mash believes in hiring physicians across the age spectrum.

In practice since 1978, Mash is the managing partner of M & M Orthopaedics as well as the practice's primary physician recruiter. Mash's practice has roughly 20 physicians at five locations.

Mash hires both physicians who are fresh out of residency as well as those who are seasoned practitioners.

"I am a big believer that these [younger] individuals need to be at parity" with more senior physicians, says Mash. Some practices limit incomes among their younger doctors by denying them equal shares in large assets, such as an MRI machine. That's just wrong, says Mash, because it makes "the junior guy feel used and abused."

Pairing younger and older docs, evenly distributing their responsibilities, and offering all physicians equal financial opportunities are some methods that can successfully bridge the age gap among junior and senior physicians. Recruiters and medical employment experts say such strategies also work to make a practice attractive to younger workers without ruffling the feathers of more established staffers.

"As you grow, unless you are able to keep everyone feeling integrated, needed, and wanted, you run the risk of polarizing into camps," says Michael Parshall, vice president of the Health Care Group, a consulting firm in Plymouth Meeting, Pa. "If you break [policies] among the young folks or old folks and don't allow those policies to cross the divide, you will fracture and split. There are a lot of practices that have come apart because they did not deal with these things effectively."

In fact, incorporating physicians across the age spectrum may be the best thing a practice can do to ensure its continuity. "Having a spacing of doctors allows for good succession and an infusion of new ideas and new techniques," says Parshall. He adds that this factor does not necessarily mean younger doctors are always the first to adopt new technologies. "But fresh training can open up new avenues." he adds.

Mash has hired a lot of young physicians, and nowadays he is contending with a "demographic bubble" of physicians all aged around 40. "We need to further balance the age spread so we don't have a problem in 15 or 20 years when they all retire close to each other," Mash says.

FLEXIBLE HOURS CAN BE A DRAW

But hiring and retaining good staff - particularly physicians - is a difficult endeavor, especially in regions and specialties with shortages. These days, practices are finding they must be more flexible and creative than in years past to attract younger talent, whether they are physicians or administrative staff.

The cost of recruiting and training also makes it imperative to be able to keep younger as well as older practice members happy, thus lowering turnover rates.

The physicians and administrators at Greenville Medical Center understand the importance of offering flexible schedules. Several physicians have job-share arrangements, as do administrative staff members. In addition, the entire 24-person billing department is on flex scheduling, an arrangement that appeals to both younger and older employees.

Available working hours range from 6 a.m. to 8 p.m., although the office is open from 8 a.m. to 4:30 p.m.

One woman comes in at noon, while several others work four 10-hour days per week.

"One woman has a grandchild she's taking care of one day a week," says Thora Jackson, Greenville's clinic administrator. She says employees requested the flex schedule arrangement now in place.

When workers join the billing office, they can choose the hours that "fit their lifestyle," says Jackson.

Lifestyle issues are also important to physicians. "I think a lot of young physicians are very concerned about their ability to balance home life and professional life," Pineo says.

Younger doctors interested in joining the practice "ask different questions than they did 10 years ago," says Jackson. "The reason they join groups is they want less call and more time with their families. Ten years ago it just didn't come up."

"Most of the physicians here take a half-day off a week so they can do something with their kids after school if they want," Jackson adds.

Parshall recommends that practices consider adapting worker hours from 7 a.m. to 3 p.m. for employees with school-aged children. 

A NEW GENERATION

Of course, flexible working hours are just one way practices can attract younger physicians. Moving expenses, signing bonuses, salary advances, and other financial incentives may also catch the attention of new physicians who are saddled with student debt and just starting out.

For example, a physician may want to assume a position within a year of being offered it in order to complete a fellowship. The practice could pay the physician a stipend during that time, suggests Steve Harris, a partner at the Chicago law firm, Harris, Kessler & Goldstein.

Harris says these generational issues are not unique to physicians' practices: "You have a lot of younger people, including physicians, who are into immediate gratification, and need it now ... and don't subscribe to the long-term play, that if I pay my dues, at the end of the day the growth and equity will be there," he says. "A lot of physicians are moving to jobs or taking jobs based on salary, more than any other factor, which I think is a big mistake."

Harris urges younger physicians not to be short-sighted: "You can be much better off leaving some immediate money on the table in exchange for long-term growth at an established practice."

At the same time, says Harris, times have changed, and practices need to stop pining for the "old days" and looking for physicians and workers who are more like themselves.

An older physician recently complained to Harris that one of the younger doctors in the practice had turned down three recent speaking engagements, which the group has always valued as a way to gain new patients.

"Younger doctors do less and less marketing, less outreach. We are seeing a general reluctance to do that, and why? Because it cuts into the physician's personal time," Harris says.

What to do? For the sake of cultivating harmony among doctors in a practice, Harris counsels them not to judge today's job candidates by yesterday's standards.

Although it no longer surprises him, Mash continues to be dismayed at young physicians' lack of business knowledge. "I have not found one [candidate] who even asks intelligent questions" about running a practice, says Mash.

"They all want to know how long it takes to become a partner, and how much I am going to pay them, but they have little interest in other things, like balance sheets, the ratio of salaries to revenue growth, what the practice does for public relations, patient satisfaction," and other business matters, says Mash.

Harris says it's still a good idea to keep looking for physician candidates who possess some measure of business or managerial acumen. "Otherwise, you can fail," he says.

Physicians who simply pick up your overflow or referral patients aren't going to be the ones to help you build your practice, adds Harris. In that scenario, a senior physician may find in a few years that he or she is less busy while the junior doctor is busier, even though there has been no net gain of patients.

When structuring employment arrangements, Parshall warns established physicians to be careful not to bend too far for any one person. Once you have a well-established policy in place, "It's very hard to undo," Parshall says.

Mash agrees. His general approach is to make decisions "based on what is best for the business, not necessarily what is best for the individual."

PUTTING THE GROUP FIRST

Parshall and Harris stress that what works best is for a practice to maintain policies that address the needs of both younger and older practice members. "It becomes very difficult when you start favoring one subset over the other," Parshall says.

For example, Harris says he tries to negotiate agreements that divide call duty equally among all physicians - regardless of tenure - rather than making it a collective decision in the practice. And he makes a point of making a clear distinction between "equal," meaning all physicians have the same obligation, and "equitable," which is more subjective and can lead to the unfair treatment of younger docs.

Mash regularly updates his partners about their recruitment needs and the offers he is making. "I try to communicate with my partners, young and old, what the economics are" of a job offer, Mash says. "We have been looking for a spine surgeon for a long time. I will go to the board and say, `It is going to take XYZ to hire a spine doctor, I hope you all know that.' You've got to pay them more money. The older guys understand that."

Allowing all physicians as much participation as possible within the practice's governance structure can also foster a sense of collegiality, Parshall says.

"If you want to ensure that everyone is being heard, you should have a structure that allows representation of all the voices," he says. You could, for example, allow non-board members to attend board meetings and to express themselves.

Having such a forum was important to Pineo.

"I was in meetings - you don't have a vote until you are a partner, but in no way did I feel my opinion was not valued," Pineo recalls.

"You really have to mentor young doctors," says Mash. "The advantages are they don't come with bad habits, and you kind of get to mold them in your own image."

What Pineo also likes about the practice he joined is the physicians' "willingness to share their experiences and to communicate openly about problem-solving," he says. The way the practice treated him made him feel as if he were receiving "more of a preceptorship into the world," rather than simply the opportunity to practice medicine.

"One of the keys to success is a sense of respectfulness between physicians and pride in the practice," Pineo says. "From the moment I arrived I felt welcomed. In no way was I hazed or mistreated."

Theresa Defino, an editor for Physicians Practice, can be reached at tdefino@physicianspractice.com.

This article originally appeared in the March 2006 issue of Physicians Practice.