How to recruit the right physician for your practice
To find a good fit, you need to devote staff to the task and ask the right questions
By Phyllis Maguire
Chicago—A practice executive from northern Maine complained that her region is too remote to recruit top-notch physicians. A physician from a small academic hospital in west Texas keeps losing doctors to community practices. And the manager of a Seattle medical center has problems paying physicians enough so they can afford the Northwest's high cost of living.
At a time when the nation is supposedly awash in physicians, groups everywhere are having a tough time finding good doctors. Those recruiting problems, may get much worse explained Nelson A. Tilden, PhD, president of Medical Search Institute in Kansas City, Kan.
During a Medical Group Management Association Center for Education conference, Dr. Tilden challenged what he called "the myth" of surplus physicians. Workforce estimates make the mistake of "counting noses," he said, instead of identifying practice patterns. As a result, the pool of working physicians is much smaller than many think.
One-third of the nation's 750,000 physicians, for instance, are nearing retirement age, Dr, Tilden said. One-sixth are women who often work part time, while younger physicians often work fewer hours than their older colleagues. And more physicians are choosing administrative jobs over clinical practice.
Before you begin recruiting, sketch out the credentials and characteristics of your ideal recruit
Many medical groups and hospitals make a tough hiring climate even worse, Dr. Tilden said, by underestimating the complexity of recruiting and failing to spend enough time or money searching for new physicians. With some planning, however, he said that even small practices can improve their odds of attracting—and hiring—the best physicians for them. Dr. Tilden outlined the following steps to improve your recruiting efforts:
Lay the ground work. If your group hasn't already created a staff development plan, form a committee to write one. Does the practice want to expand into new subspecialties or sites? What are your community's demographic needs? Do some physicians want to reduce their hours or retire?
A staff development plan helps prevent a recruiting crisis if a physician unexpectedly leaves the practice or dies. It also helps convince candidates that you have a handle on staffing needs and local market conditions.
Dedicate time to recruiting. All too often, practices leave recruiting to administrators or physicians who try to squeeze a few phone calls into an already overcrowded week. If your practice hires more than one physician a year, Dr. Tilden recommended dedicating 20 hours a week of a staff member's time to recruiting. If you hire several physicians a year, he said, you should hire a full-time recruiter.
Make a good first impression. Invest in quality promotional materials. Dr. Tilden said he prefers Web sites and full-color brochures to videos or interactive CD-ROMs because they produce a more immediate impact. Your Web site should allow candidates to e-mail your practice directly and offer links to chamber of commerce, school district and local real estate agent sites.
Hammer out the details. Work out rough contract parameters, including how many hours your new physician will spend on office visits, hospital rounds, hospice and nursing home care. If your compensation plan relies heavily on productivity, don't set a low base salary. No matter how much you reassure candidates that they'll make more money through productivity, you'll scare off good candidates. Set a higher base rate and ease new physicians into the productivity formula.
Decide what benefits and perks you're going to offer. Most practices pay for malpractice and family health insurance, moving expenses, several weeks of vacation and CME stipends. Debt assistance and signing bonus can sweeten the deal.
Before you begin recruiting, decide who will make the final decision about candidates. Also, sketch out the credentials and characteristics your ideal recruit will have in terms of board certifications, fellowships, age and personality.
Cast a wide net. Recruiters today favor advertisements and direct mail over telephone calls. Place ads in journals and newsletters related to your specialty and geographic area. If you're interested in direct mail, you can buy the names and addresses of physicians and program directors. Personalize direct mail by hand-addressing envelopes and including a physician's name in the return address.
Keep your eyes and ears open at CME meetings and conferences. If you meet a physician who is unhappy in her current practice, give her your business card. Consider giving a finder's fee to practice members who help recruit new hires.
Screen over the phone. Your recruiter should make several screening calls before inviting candidates for an on-site visit. During the first call, find out if the candidate is interested in your location and compensation.
Also ask candidates about their likes and dislikes in medical practice and if they have any special economic or practice needs. This last question will indicate whether the candidate has a service requirement in another state and is ineligible for your job. If the candidate seems promising, ask her to send a CV while you send her promotional material by priority mail. Schedule a follow-up phone call in a few days.
During the follow-up call, the recruiter should spend about 10 minutes fielding the candidate's questions and discussing her CV. Many candidates eliminate themselves at this stage. You may find some gap in the candidate's CV—a lack of board certification, for instance—that kills your interest.
If you want to proceed, schedule a 30-minute in-depth telephone interview. Assume that a candidate who puts off scheduling the interview isn't interested in the position.
Ask personal questions carefully. While it is illegal to ask about family and lifestyle issues head-on, you want to make sure that the candidate is a good fit. If candidates don't volunteer personal information--and most do--Dr. Tilden suggested asking, "Are there any needs that you or a member of your family may have that might be difficult for us to meet?" This type of question allows candidates to mention that a child needs special schooling or that their family wants a particular faith community. If you can't meet those needs, say so now.
Also tell candidates about practice or community problems such as a struggling school system or a clinic's location in a marginal neighborhood. "Surprises," Dr. Tilden warned, "are usually fatal."
Check credentials. Your recruiter should ask about malpractice suits and let the candidate know that the practice intends to run background checks. (Have candidates sign a release before you start checks.)
Dr. Tilden recommended checking a candidate's education, certification, licensure, work history, hospital affiliations, legal and credit history and references. A trained staff person can do most of these checks in a few hours.
Look for falsified credentials, chronological gaps in dates of employment, arrests and convictions, and discrepancies between addresses listed on candidates' CVs and their credit records.
Finally, check personal references. Ask references about a candidate's clinical competence, scope of knowledge and ability to get along with peers, staff and patients.
Be a good host. Always include a candidate's spouse during an on-site visit. "They will make this decision as a couple," Dr. Tilden said, "so include them both from the beginning."
Contact candidates a week before the visit and ask about special dietary needs or specific activities they may be interested in. (Don't assume that a spouse wants to be bundled off on a tour.) Let candidates know what activities you have planned so they can dress appropriately.
Put candidates up in the town's best accommodations and have a fruit basket waiting. Give them the home phone number of someone from the practice in case they hit a snag in their travels. (Residents have been known to try to rent a car with a maxed-out credit card.)
Don't pack their agenda too tightly, and don't overwhelm them with too many people. Coordinate schedules so that several physicians from the practice get to interact with candidates during the on-site visit.
Follow up quickly. If you're not interested in a candidate after a visit, write a letter thanking her for her time and move on to other candidates. If you are interested, let her know within 48 hours that you plan to offer a contract.
Offer the contract within five days, and deliver it either in person or by overnight mail. A 30-day signing deadline is standard.
Suggest a second visit if the candidate is having a hard time deciding. A short-term subscription to a local newspaper might help; a signing bonus may be even more effective. Bonuses typically range from $1,000 to $20,000.
Don't pay large bonuses in one lump sum. Dr. Tilden said. For a $14,000 bonus, for instance, he suggested giving $2,000 upon signing the contract, $6,000 when the recruit starts work and the balance six months later.
Once you've made an offer, don't cancel other candidates' interviews or planned visits, because the first may not sign on. And if you find another candidate that you like even better, withdraw your offer to the first one with a written notice.
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