Avoiding Failure: Ensuring Your Physician Recruitment Is On Track

Hiring top physicians is difficult in a good year, let alone a year with unprecedented changes and challenges. According to the Association for Advancing Physician and Provider Recruitment’s 2019 benchmarking report, the most common searches for physicians range from 92 to 227 days.(1)

In most specialties, the demand for new physicians far exceeds the number of job-seeking physicians, which means physicians can be selective when accepting a new position. Unfortunately, many recruitment efforts are doomed to failure before they start; however, the following steps guide a more successful endeavor.

Don’t Just Launch!

When your hospital administrators ask you to recruit for a position, you may be tempted to post the position immediately, but ask yourself, “Is this position ready to go on the market? Are there problems we need to address before we start recruiting? Is this a job that a high-quality candidate is likely to want in today’s competitive hiring market?”

Recruitments can fail in so many wonderfully creative ways. Launching a recruitment for a position with a fatal flaw offers all the excitement of watching a terrible football team take to the field — the question is not whether you will lose the game, but when. It might be nearing the end of the fourth quarter before the recruitment strategy fails, wasting all the time and energy you invested.

To avoid this sad fate, consider these questions:

1. Has the physician practice into which you are recruiting developed a modern practice style consistent with the needs of today’s candidates?

2. Are doctors in the practice unhappy with their jobs? Are other doctors in the practice likely to be upset that you are recruiting?

3. Is your compensation and comp structure truly competitive, given your location and the demands of the job?

4. Have you developed a recruitment team that is ready to respond to candidates quickly to keep the momentum going?

Let’s explore those issues in depth.

Is Your Practice Ready for a Makeover?

If your practice is made up of primarily senior physicians who pride themselves on being “old school,” they probably see a variety of patients and are available at all hours. When one of them retires, you may be tasked with finding someone who will fit the practice’s mold and value the opportunity to step into the practice that the partners have built.

The doctors in the group, who are all near retirement, tell you they want to hire someone young for succession planning. Do you know any such candidates: young, energetic, and “old school”? Can you find someone who will work tirelessly and efficiently, who will take call without complaining, and who wants to take “all comers” as patients?

Most younger physicians value work-life balance, and with the shortage of physicians, they can find a position that will offer just that. In highly subspecialized medical and surgical fields, young physicians want to develop the subspecialty practices for which they have trained; they also may feel understandably uncomfortable seeing patients outside of their area of subspecialty.

If a “good old-school generalist” is what your practice needs, if you don’t have enough doctors to have a subspecialized group, if your current doctors don’t want to give up their patients in an area just to attract a subspecialist, and if you really want a young but experienced doctor, recruit for precisely what you want, and maybe you will get lucky!

But you DO need a Plan B. Here are some ideas to explore:

1. Provide a J-1 visa waiver if you are eligible, and provide an H-1B visa if you can. Applying for a J-1 visa waiver can be a hassle and sometimes a risk for both you and the candidate, but if you have an “old school” practice opportunity that goes against modern trends in subspecialty training and practice, you may get a young but “old school” physician who needs a J-1 visa waiver, who treasures the opportunity to stay in the United States, and who will be flexible and eager to serve your community’s needs.
   If you believe there may be resistance in your community to welcoming someone from another culture, ask yourself whether you would prefer to transfer patients out of your community and away from their families rather than hire someone who needs visa assistance.

2. Recruit locally. Identify and reach out to every provider within an hour of your facility who may have the skills you need. Don’t assume that they would have already applied if they were interested.
   If you have had unsuccessful hiring negotiations in the past, try something new. Begin by asking candidates what it would take for them to join you, then attempt to solve sticking points. If you are offering hospital employment, this may be attractive to physicians struggling with the increased demands of private practice. If they are in the later stages of their careers, this can buy you more time to recruit the next generation of providers for your practice.

3. Use a larger health system platform to develop a modern vision for your practice as part of a health system strategic plan. As health systems are growing, so is the opportunity to establish centers of excellence at the major hubs, with large groups of subspecialized providers. This concept can be expanded to smaller community hospitals owned by the same health systems to attract critical providers.
   Imagine, for example, that your health system’s flagship hospital creates a large, subspecialized group providing sophisticated care. Your community hospital, 90 minutes away, has been served by two senior physicians who saw all comers, but one of the physicians recently retired. You need another generalist to take call and see patients; however, the candidates you find don’t want a 1:2 call schedule and they don’t want a general practice. They all have fellowships and seem to belong in academic medical centers.
   One way to solve this dilemma is to work with the practice at the main hub to develop two spots for fellowship-trained subspecialists who will serve all the patients in your community from your ZIP code and those in areas farther from the main campus who may be at risk of migrating to other health systems anyway.
   As long as you have planned for and embraced a vision to support the development of subspecialty care, candidates with subspecialty interests will often devote a certain percentage of their time to general care of patients in a community practice setting.

4. Extend your general care through APP triage clinics. Wouldn’t it be great if you could reduce your patient wait times in a physician specialty and extend the ability of your existing generalist providers in any specialty to triage patients three-fold?
   You may be able to accomplish this by asking one of your existing generalists to help set up and oversee an advanced practice provider triage clinic with three APPs. This supervisory role often works exceptionally well for experienced providers who are in the final stages of their careers, have a breadth of practical experience, and can significantly reduce your patient wait-times to see a provider.

5. Use telehealth. If you are in a mid-sized or smaller community that sometimes struggles to recruit providers, you might enlist a telehealth provider as the first stop for your patients. Suppose your practice is associated with a larger hospital in a larger city. In that case, it may be easier to recruit additional providers to the larger facility and use the expanded practice to set up a telehealth service for the health system, increasing patient access.

Might Your Doctors Speak Poorly About Your Practice?

Imagine you are a doctor on a job interview. How would you react if one of the doctors you meet with on your site visit said any of the following?

“I’m not really sure why they are recruiting you here. I don’t have enough volume myself. We may need another person for call, but there really isn’t enough volume for another physician.”

“I wish I could say the hospital was supportive. When I am on call, I get called all night over stupid little things…clarification of medication orders, leg lotion, vital signs being off….We really need a hospitalist to take care of these things, and I keep asking for more APP help, but I don’t think anyone is listening.”

“We need updated equipment so badly. Make sure you ask for everything you need and get it in your contract. They have been promising us new equipment for years, and they say they put it in the budget, but then it gets cut.”

Sometimes key stakeholders think they can avoid the adverse impact of physicians with negative feelings simply by excluding the unhappy physician from the candidate interviews. That strategy can fail miserably!

Leaders must resolve challenges with unhappy physicians before they begin to interview candidates; otherwise, they can anticipate the frustration of watching their great candidates disappear, one by one, sometimes with benign excuses such as, “I found another position through a friend.”

Is Your Compensation and Comp Structure Truly Competitive?

You may be tasked with recruiting for a position for which the compensation isn’t competitive with positions in similar locations or with similar responsibilities. There may be good reasons why you think the compensation cannot be changed:

“We have a compensation policy, and all our compensation is set using a blend of different compensation surveys….”

“If we offered more, we might have to increase the compensation for all the other doctors in the practice.”*

“The head of the practice doesn’t want to guarantee more than that because then a new person won’t be motivated to work hard.”

“The last person we recruited signed on for the salary we are offering now, so we really can’t offer more.”

Unfortunately, supply and demand for physicians determines the true “fair market value” for candidates, and if candidates have significantly better offers, they are likely to decline yours. Physicians also are not likely to tell you if compensation is the factor driving their decision to accept another job. In our experience, even if money is a significant factor in deciding which position to take, physicians will rarely admit this, even to themselves. They are service-oriented professionals whose primary goal is to help others; they chose medicine rather than banking or business for precisely that reason, but doctors still have bills to pay (and student loans to pay back).

No matter what your policy or politics surrounding compensation, figure out how much compensation good candidates are likely to be offered elsewhere and make sure your offer is at least competitive or, preferably, better than others are likely to offer.

Know the norm for the compensation structure for a particular position, regardless of your practice’s historical compensation structure. If your compensation structure is outside the norm and in any way disadvantageous to your physicians, you likely will have trouble filling the advertised position. If you are lucky enough to fill the position despite a disadvantageous compensation structure, you probably will experience retention problems.

Physicians must be fairly compensated for their time, effort, and level of responsibility. Inpatient roles, in which physicians have little control over how many patients they see, are typically compensated by salary, often with a quality bonus; therefore, call beyond the agreed-upon number of days should be compensated fairly. Outpatient roles typically are more production-oriented. How “productivity” is calculated and valued should be well-considered, fair to the physician, and in line with what most other practices are doing.

Administrative time should be protected and paid for, even though it is not clinically productive. If your institution isn’t willing to pay for administrative time for leadership roles, nobody should be surprised if you cannot recruit the talent you need for the position.

Is Your Recruitment Team Ready?

There is one sure-fire way to dramatically reduce the time it takes for you to sign a great candidate: Call your candidates immediately. That’s it! If you can’t make an initial contact the same day you get the CV, wait no more than 48 hours before contacting the candidate.

Why does this make such a difference? Put yourself in the candidate’s shoes. If you send your CV to a practice in response to an opportunity, and the practice enthusiastically calls you right away, you think, “Wow, they really like me! And they are so well-organized! I am excited to interview with them!”

On the other hand, if you send your CV to a practice and you don’t hear from them, you think, “I guess they are not interested in me. It’s okay. The job didn’t sound that great anyway.” If the practice finally calls you a month or two after you sent your CV, you might think, “Hmph. Either they aren’t very well organized, or they were just turned down by someone they liked better, and that is why they called me.” If the practice is lucky, maybe you will still consider them, but if too much time has passed, you likely have moved on to other opportunities — and you have likely moved on psychologically as well.

It is human nature to like people who like you first, or at least who like you back. If you express interest in someone and they ignore you, it is natural to justify their rudeness by thinking, “I wasn’t really interested in them anyway.” Recruiting is no different than other personal relationships in that respect.

What gets in the way of the simple goal of calling candidates promptly? See if any of these statements sound familiar:

“I have the candidate’s CV in my inbox, but I have been so busy, I have not had time to call. I’ll try to get to it next week.”

“We aren’t going to call any new candidates until we have another site visit with the one we just interviewed. I think we are going to make her an offer.”

“We just made an offer to a candidate, and we are going to wait to see if it is accepted. We can’t call anyone until we hear whether our offer has been accepted.”

“We can’t call a candidate until everyone in the group has given the CV a thumbs-up.”

“I don’t want to call any candidates until I know they are good. I want to call around to my friends who might know of the candidate and see what they say about him.”

If any of these statements sound like your organization, then you may be in for a long haul with recruitment. However, you can take steps to secure the time of busy physicians who must make calls to candidates. You can teach everyone on your recruitment team how to communicate with good candidates while actively pursuing others to maintain momentum in your recruitment process.

How to Ensure Candidates Are Called Promptly

If your stakeholders are not calling promising candidates quickly, you are at risk of losing the candidates you need to fill the open position. This is a fixable problem.

1. Identify a physician lead for recruitment activities. While it is common for all the physicians in a group to want to review a CV and give a thumbs up before anyone reaches out to the candidate, that process is far too slow for today’s competitive physician recruiting landscape. The group must deputize one person as the team lead for recruitment, and this individual needs to commit to making recruitment calls promptly after receiving a quality CV.

2. Review candidates every two weeks. The physician lead in the recruitment and the in-house physician recruiter or practice manager should meet at least once every two weeks to review the status of each CV received.

3. Help the physician lead respond quickly: When a candidate is to be called, the physician recruiter or practice manager can text the candidate’s name, current employer or training program, and cell phone number to the physician lead. That makes it easy for the physician to text the candidate regarding a time to speak. Email is also acceptable, but if the candidate does not respond to an email within a day or two, a text follow-up is essential. When competing for the attention of desirable candidates, it is more important to get a good candidate in process than to speculate about why someone may not have responded promptly.
   If schedulers are involved, ensure they recognize the importance of scheduling candidate calls within a few days. Scheduling dates that are two or three weeks away from the CV submission will not keep a candidate engaged.

4. Recruit until the ink is dry. If you don’t have a signed Letter of Intent, you do not have a deal. Rather than putting new candidates on hold until you know whether someone will accept your offer, reach out. If the candidate you have in process accepts your offer, inform any new candidates you have engaged with, but if your offer is not accepted, you will be glad you have other candidates in process.

Having had an offer accepted, a practice that continues to have other excellent interested candidates may open up a second position and hire two applicants.

Now You Are Ready!

With your on-trend practice opportunity, buy-in from all the physicians impacted by the recruitment, a competitive offer, and a recruitment team that is ready to respond to candidates quickly and enthusiastically, you are finally prepared to recruit the physician you need to your practice!

With an efficient process and all major obstacles removed, you can now actually expect success in recruiting and hiring the candidate of your dreams.

Reference

1. AAPPR. 2019 AAPPR Annual Report Summary and Highlights. AAPPR, pp. 10-14