Reel in the Best Hires

Deciding to hire a new physician is a complex process for most medical practices. Yet it's one that must be approached deliberately. The need to bring on a new physician is generally a good thing -- new hires may be part of a practice's growth strategy, for purposes of opening satellite offices, increasing referral patterns, or meeting terms of new managed care contracts.

Avoiding hiring a needed physician -- or recruiting in a disorganized manner --  can be very costly.

The financial impact of a vacant position varies by the type of practice and number of office locations. To illustrate, the American Medical Group Practice Association lists an internist's gross annual productivity (professional charges) at the 90th percentile as $596,377, with a median productivity of $392,430.

The average potential monthly income related to the open position should also be considered. On a monthly basis, lost physician professional charges for an internist would be $49,695 at the 90th percentile and $32,702 at the average productivity level. Other factors that affect the bottom line include lost referrals and the financial risk of failing to meet terms of a managed-care contract.

Bringing a candidate to the practice for an on-site interview generally costs about $3,000 --  not including the cost of time spent by each member of the practice who interviews the candidate. Be certain each candidate brought in is truly a viable new hire in order to make the most of your recruitment budget.

Pre-screening by phone

Once the decision is made to hire, you need to ensure that new physicians will be happy working in your organization for a long time. The process of keeping a candidate "sold" on your organization begins at the pre-screening stage, and it continues during interviewing, at the offer stage, and after the new hire is on board. Remember, at every stage, you are competing with other practices in the market to fill positions. 

Screening candidates before bringing them on-site for interviews will help you decide who is a good match for your organization. If you work with a search firm, its senior recruiters should handle some or all pre-screening for you and provide detailed assessments of their pre-screening conversations. If you are handling this task yourself, it is essential to have thorough discussions by phone with the candidate and conduct reference checks.  

Ask the candidate open-ended questions that will elicit substantive responses, such as:

• How would you describe your clinical strengths?
• What is the ideal position for you, and why?
• What type of practice would best suit you, and why?
• What do you like and dislike about your current position, if applicable? 
• What type of practice and patient volume are you accustomed to, including number of patients per day?

Discuss the income range for the position, benefits, typical living costs in the area, schools, and lifestyle amenities. This information should be shared with the candidate's spouse. Partnership criteria, including productivity expectations, timeline, and buy-in should also be shared with the candidate at this point in the process.

Similarly, discussions with references will help you determine whether the candidate is a good fit. Again, ask open-ended questions designed to gather detailed information, such as:

• How would you describe his work habits?
• What are her greatest strengths?
• What kind of first impression does he make on patients?
• How would you describe her communication style?
• How does he handle stress?
• How would you describe her perspective on ethical issues?

Keep in mind that all comments from references are voluntary. In some cases, former employers may only be willing to confirm that the physician was employed by their organization during a specified time period. Other employers may provide additional factual information but be unwilling to address subjective questions.

Watch for red flags that may help you decide to eliminate some candidates: changing positions frequently, a history of dissatisfaction with work environments, low productivity patterns, and long-term goals or preferences for communities that do not match what your practice can offer.

As top candidates are identified during pre-screening, the continued process of selling them on the practice is key. Setting a pattern of responsiveness is essential --  return calls from all candidates promptly. If you are using a search consultant, follow up promptly with each candidate presented by the search firm. Send additional information about the practice and the community, along with career summaries of physicians on staff to show the candidate that your organization's interest is sincere. This will make an excellent first impression on candidates, reducing the chance that they will become interested in other employers while waiting to hear from you. And candidates who have a good impression of your practice will talk with others about it.
 
On-site interviewing

If no significant red flags appear as a result of telephone pre-screening, schedule an on-site interview, preferably to last one to two days.  

Because it is essential for a candidate to understand the vision and strategic initiatives of the practice, senior leadership should take part in the interview. The administrator, human resources representative, or physician who can best explain compensation should also meet with each candidate.  

Make certain that each interviewer has as much information as possible about the candidate, including the curriculum vitae, a career summary, and copies of information generated from pre-screening interviews and discussions with references.

Again, emphasize open-ended questions when interviewing, such as:

• What do you see yourself bringing to this practice that would be different from what we have now?
• How would you describe the way you work with support staff?
• How would this organization fit with your professional goals?

Discuss openly any negative aspects of the practice or candidate preferences that conflict with what your organization can offer. These might include the reason the previous physician left the practice, a starting salary that is lower than the market average, or a less-than-stellar local school system. To ensure a consistent message, designate one interviewer to discuss such issues; this should be the physician or practice administrator who can best talk honestly about issues that may be perceived negatively and respond to the candidate's concerns. 

Dinners and lunches with prospective colleagues and their spouses should be part of the interview itinerary. Time with the candidate's spouse may include tours of the community with real estate agents, visits to local schools, meetings with prospective employers in his or her field, or visits to area attractions. 

Sweeten the pot

If it is likely that your organization will make an offer, ask the candidate at the end of the interview, "If we extend an offer to you, would you accept it?" Reinforcing in the candidate's mind your strong interest will help sell him or her on your organization.
Many practices are looking at lifestyle benefits as a hiring incentive. Flex time or job-sharing opportunities and limited evening and weekend call hours are strong draws. Buy-in and partnership opportunities remain among the most popular incentives for physician hires and can be valuable tools for retention.

The income potential of a partnership and the opportunity to be part of management decisions can be hard to pass up. A typical base salary for a practicing internist is $140,000 to $150,000. If the opportunity exists to enter into a partnership after two years, his or her income would likely increase to $155,000 to $180,000, and as much as $250,000 if the physician is highly procedure-oriented.

Working with a search firm

A search firm can educate candidates about the job market, help them to assess their priorities, provide reality checks on salary, benefits, and other issues, and increase the likelihood that they will respond favorably to offers from organizations that match their highest priorities. If you are using a search firm, give them in-depth, honest information about your organization and your ideal candidate. They need to have a thorough understanding of the practice's profile, including:

• caseload
• call coverage
• referral patterns
• payer mix
• billings, collections, and overhead
• compensation plan and production bonuses
• partnership qualifying factors and buy-in formulas
• required clinical qualifications
• community advantages and barriers to recruitment
• information about each stakeholder's commitment to the hire

If you have many openings to fill on an ongoing basis, consider an outsourcing arrangement with the search firm. One option is for the firm to send one of its senior recruiters to work on-site at your facility. The on-site search consultant can help organize and streamline recruitment processes, and serve as a buffer between internal departments and managers involved in recruitment to ensure that everyone's expectations are met.

Offer orientation

Once the new hire is signed on, an effective orientation program will ease the transition for a new physician, encourage longevity in employment, and continue to sell the candidate on the practice. 
Appoint a mentor to check with the new hire about how their move is going, and if there is any other support the practice can offer. The mentor should be a physician in the same specialty as the new hire, and have thorough knowledge of how the practice operates.

The mentor provides the new hire with a sounding board for questions or concerns, whether they are work-related or involve personal or family acclimation to the community. Part of the mentor's role should be to introduce the new physician to other local doctors, especially those in the same and related specialties. 
Make certain that new hires know whom to work with in the practice for everyday activities, from ordering medical supplies to insurance coding. Schedule monthly review sessions with supervisors to receive feedback on how their practices are developing. Productivity standards should be thoroughly explained to the new hire, not only during the interview process, but again after he or she starts, in order to reduce misunderstandings.

Most important, with every new hire, ensure that your organization is keeping all promises made during the recruitment and hiring processes. Honoring commitments is key to developing loyalty in employees.

This article originally appeared in the November/December 2003 issue of Physicians Practice.