When Hiring a New Physician, Get an ‘Entrance Strategy’

Two years ago, I fielded a call from a surgeon I knew of but had not met. Raised locally, she had left the state for undergraduate school, returning to her home state for medical school and staying for her fellowship. Heavily recruited, she wanted to stay close to home and her family, and accepted a position with a group of surgeons practicing at one of the area’s stellar hospitals.

Two years into a three-year employment agreement she was unhappy. In fact, she was angry, frustrated, worried, and greatly concerned about her future.

The genesis of her story is almost a cliché in the problems that frequently crop up after a physician has been recruited by a group. And it’s easy to see where things went wrong. It all involves what I call the “failed entrance strategy.”

This doctor had been pursued by this group, pitching a great future, good salary, moving expenses, and even a signing bonus.  Two visits to her soon-to-be employer focused on where to live, meetings with all of the group members, a hospital administrator or two (representing her surgical sites), and a real estate agent to look at homes. Everybody seemed nice and she liked what she had seen.

A contract arrived shortly after the second visit. A lawyer was hired and they focused on the "eight things a medical employment contract must have," taken from a random google search. Her lawyer followed her lead. Within weeks the contract was signed and she returned her focus to her final year, relieved of the pressures of finding a job.

Barely two years later, she was miserable. What could have happened?

From my perspective, the group that hired her didn’t provide her with a complete analysis of what the job entailed, what they were going to do to help her build her practice, how her work would be evaluated, or a host of other things that should have been explored and explained up front.

You can’t expect a new med school grad to come ready with a complete list of operational questions. From my perspective, it’s a requirement that the hiring group provide much more than a “look-see” at the way the practice runs and provides data to its physicians.

Most of her complaints were around issues that should have been discussed and/or documented before any contracts were assembled, much less negotiated.

For example, she never saw examples of the reports provided to each physician that outlined patient counts, charges and revenue. These turned out to be woefully inadequate, and belied some serious issues with the group’s billing practices. The practice had policies and procedures, but they only applied to the staff - there were no rules for the doctors. Governance was not in place. She was assured overflow, but as soon as she arrived everyone got very protective of their patient base and the overflow was far less that what had been promised.

Mentoring her in certain procedures was quickly abandoned, and she was left alone to do surgeries where she needed guidance (her surgical times on these cases were excessive as a result, which made the hospital unhappy). When the group decided to start taking call at another facility, she was included but not consulted, creating issues with her family. When the practice’s payer mix changed, she was given no notice about the financial impact this would have on her collections.

And why did patients with badly reimbursing insurance always seemed to appear on her schedule? This list wasn’t even half of the problems she recited. All of them could have been addressed, and many included as terms of her contract.

But this requires two things: First, that the practice is organized enough to provide this kind of data. Second, that they are able to communicate the full scope of the job requirements and how they will provide support and data to make the new hire a success.

Entrance Strategy

In short: The hiring group had no “entrance strategy" and now conditions had become toxic, beyond repair. (Ironically, her contract set out, in great detail, every issue imaginable related to leaving the practice, termination, etc.!)

The first step a graduate takes after leaving med school/residency/fellowship may be the most important they take outside of their academic career. In this ever-changing health care environment, graduates need to take the time to look at both the clinical and business environment they are entering. If necessary, they need to seek guidance to help them navigate these issues (which are woefully under-addressed in training), to make sure they ask the right questions.

But a hiring group can make things easier by going to great lengths to explain some of the following, providing documentation where available:

1. Practice governance. Most importantly, who does the new physician talk to about problems-both clinical and operational issues.

2. The business model that was assembled for the new physician for the first two years.

3. The practice’s revenue cycle. And any anticipated changes thereto because of market forces.

4. Reports the new physician will see that will track his practice performance.

5. His role in marketing his practice and the plan to do so.

6. Mentoring.

7. Non reimbursable requirements, like committee memberships, meetings, marketing efforts, etc.

At the bare minimum, both parties need to be on the same page on these topics. Hiring practices need to understand that a new grad isn’t going to have perspective on many of these topics, at least not at first. But new grads learn quickly, and questions on all of these topics will be forthcoming. Better to get as much on the table at the outset as you can. A lot of practices budget for a consultant to come in and help a new hire navigate all of this.

Remember: When you hire a new doctor, you’re investing a lot more than money in them. Turnover is expensive and highly disruptive to a practice.

The new grad left the practice and for the past few years has been happily working for another group at another hospital. Not so for the group she left. They have hired and lost two surgeons, repeating the same mistakes.

As the availability of med school grads lessens, the recruiting process becomes extremely critical both as a key to attract new physicians and keep them in place.

Tom Ellis III, has been a healthcare consultant in the North Texas area for over twenty years, and has worked with a variety of clients, focusing on physicians. More information on Tom can be found at www.ellisandassoc.com.