Best Midlevel Provider Hiring Practices

Know What You’re Looking For

Many medical practices mistakenly assume that because the role of healthcare providers in a specific setting remains relatively consistent across employers, they simply must find a candidate for the job who is certified, licensed, and capable of performing the designated skill set. While this may partially be the case, there are a number of problems with this approach.

First, it is difficult to assess clinical skills in the interview setting. You can’t ask job applicants to demonstrate on patients. Your best bet when it comes to clinical competency is to rely on candidate self-assessment, references, and the amount of prior experience. However, this doesn’t always translate into performing the required clinical skills efficiently and proficiently.

Second, it is essential to identify a provider who fits your practice culture. The new member on your team must work well with existing employees within the practice environment. If your practice values volume, you’ll need a hard-working, efficient provider who can achieve this outcome. If your practice is more relational and emphasizes patient experience, you’ll need a midlevel provider capable of delivering this style of care.

The importance of identifying a midlevel provider who fits your practice culture cannot be overstated. It’s easier to teach a provider who works well with your existing team and is motivated to learn, than one with the required clinical skills who isn’t a natural fit for the group. Think critically about the characteristics of the provider you’re looking for before you start the interview process. Don’t fall into the trap of hiring the wrong person for the job simply because you need to fill the position or because the individual looks good on paper.

Screening Resumes

The number of resumes you can expect to receive for a midlevel provider opening varies widely. In a rural, medically underserved community, you may be crossing your fingers and praying to receive one partially qualified applicant. Major health systems or large academic health centers may receive hundreds of applicants for a single position. Regardless of the camp you fall into, the basic principles are the same when it comes to sorting through resumes.

Resumes share notoriously little information about a candidate. So, they are more useful for identifying negatives. Resumes with sloppy formatting, poor grammar, and multiple misspellings, for example, absolutely must be screened out, no matter how desperate you are to hire for the position. If the provider didn’t take the time to format the resume or proofread the document, you can imagine how his or her patient charts will hold up if ever called into question by a court of law.

Develop a set of objective measures by which you score resumes. This scoring system can also help you decide in which order to interview candidates. You may choose to look at some of the following measures:

• Background—While clinical experience is certainly worth considering, applicants with backgrounds in other professional areas also bring valuable perspective to your practice. A former human resources manager turned nurse practitioner, for example, may be helpful when it comes to hiring and making other managerial decisions in the future. A former IT professional may be invaluable when the practice implements a new EHR system.

• Accomplishments—Your applicant may not have attended an Ivy League graduate program, but does he or she have other impressive accomplishments listed on the resume? Military experience, for example, shows evidence of hard work and dedication. Such accomplishments, even if not clinically related, should be weighted highly in the resume screening process.

• Organizational Interest—Does it appear that the applicant has submitted hundreds of resumes to various practices across the country on websites like CareerBuilder? Or, was the resume submitted with a well-written cover letter based on interest specifically in your practice? Applicants who submit resumes based on some sort of selection criteria and with a specific interest in your practice are more worth your time.

• Paperwork—The certification of the provider must match up with the patient population you’re hiring to treat. An adult-gerontology nurse practitioner, for example, may not be the best fit for a family practice, as this NP won’t be able to see kids. Make sure the qualifications listed on the resume logistically line up with the position you’re trying to fill.

Remember, these are simply the criteria by which you’re deciding whether to toss the resume in the paper shredder or to stick it under the paperweight on your desk for a call back. These are not the criteria by which you’re hiring. Resumes that you deem worthy make it to the next step in the process: the phone interview.

The Phone Interview

Even if you receive a resume from a candidate who lives two miles away from your practice, you’ll want to start the interview process with a phone interview. This serves as a screening process, saves time and money, and allows you to hone in on some important qualities of the candidate before meeting in person. It allows you to talk with candidates who look good on paper, screening out those who don’t live up to their paper persona in conversation.

Try breaking your phone screen into three parts:

1. Candidate introduces him/herself (10 minutes);

2. Interviewer introduces him/herself (10 minutes); and

3. Q&A: Candidate asks questions (10 minutes).

Start the call by letting the candidates know how the interview will be structured. While there is a structure to your call, allow conversation to flow. If the candidates struggle with spending more than a few minutes talking about themselves, ask questions about what they have told you so far or that appear on their resumes. You might ask, for example, why the candidate decided to become a nurse practitioner, or how he/she selected a graduate program.

As you listen and talk, assess the candidates’ qualities. Do they speak with poise? Do they seem intelligent? Is there evidence that they have done due diligence and researched your practice before the call? Red flags such as a failure to do one’s homework when it comes to learning about your practice, or speaking in a manner you wouldn’t feel comfortable putting in front of patients in your practice, allows you to eliminate unqualified applicants.

If your candidate seems to have promise, offer an in-person interview at the end of the call. Avoid making hiring decisions until you have met the individual and conducted a formal in-person interview.

The In-Person Interview

The final stage of the hiring process is the in-person interview. You should have an idea as to your candidate’s qualifications and fit for the practice by this stage, but keep an open mind as you enter the face-to-face interview. You want to be able to identify red flags, and green flags as well, throughout the course of your interaction.

Ideally, the candidate will interview in a similar manner with multiple individuals in your practice. At the very least, the candidate should also interview with one individual who would work alongside the candidate in the clinical setting—another physician, nurse practitioner, or physician assistant. Clinicians will have different takeaways from an interview than the HR department or administrators and vice versa. By having the candidate interview with multiple parties, you get a well-rounded view of the provider and, most importantly, the approval of the candidate’s future colleagues for the new addition.

Don’t forget that in the interview process, the candidate is interviewing you as an employer as well. It is important that the interaction is mutually beneficial and that the candidate comes away with a sense of the culture of your practice. As the one conducting the interview, it is your responsibility to make sure the candidate understands the responsibilities of the job as well as who he or she will be working with.

Good candidates are likely looking at a number of different employment options, so show what distinguishes your practice from others. Setting the tone for transparency when it comes to job expectations and responsibilities starts early, and you should share this in the interview process. It will be part of what helps you stand out from other employment options the candidate might have.

Starting the Interview

To start the in-person interview, take five minutes or so to chat with the candidate. This creates a relaxed, conversational atmosphere. It ensures that you see the “real” candidate for the job. Ask where the candidate is from or what he/she likes to do for fun. Show interest and let the conversation flow naturally.

Begin the focused part of the interview by asking something along the lines of, “To get started, why don’t you tell me about your understanding of this position.” This allows you to clear up any misconceptions of the job and describe it in more detail. You will also get an idea as to how well the candidate prepared for the interview by researching your practice in advance.

Continuing the Interview

Have the candidate’s resume handy and ask him/her to walk you through the resume. Start with college, and continue with a recap of each job held thereafter. While this may seem redundant, given that the information has already been presented to you in writing, it can reveal several important characteristics of the candidate. Joel Spolsky, CEO of Stack Overflow, suggests paying attention to three particular aspects of the candidate:2

1. Whether he/she is driven;

2. Whether he/she has passion; and

3. How he/she makes decisions.

While these items may not correlate directly with the candidate’s current skill set, they do reveal motivation to learn and become an effective, efficient team player. They also show you how the candidate might apply clinical knowledge.

Consider asking questions similar the following to hone in on these aspects.

1.      How have you made major life decisions?

• Why did you pick that school?

• How did you decide on that major?

• How did you decide to take/leave that job?

2.       What were some of your achievements at that job?

3.      What are some examples of mistakes you’ve made? How would you have done things differently now?

4.      What were some of your favorite parts of that position?

5.      What were some of the challenges with each job?

6.      What were you hired to do in each job?

7.    What would your boss say about you?

8.      Who were the people you worked most closely with? How would they describe you?

Follow your Q&A of the candidate by giving him/her some time to ask his/her own questions. If you think this is a candidate you want to move forward with, you may also want to take time at this point to show him/her around the clinical area where he/she would be working and introduce him/her to potential coworkers.

Ending the Interview

If you haven’t ruled out the candidate, end the interview by asking permission to check his/her references. Ask if there is anyone your candidate would like you not to contact, such as the candidate’s current employer. You may also wish to ask the candidate to connect you via email with the references he/she suggests you contact.

Making a Decision

Throughout the interview conversation, you will notice red flags—a warning the candidate may not be the right hire—or green flags—assurance the candidate is a fit for the position. Note that red flags and green flags aren’t set in stone. While being late to an interview is certainly a red flag, calling in advance to explain that he/she is stuck in traffic may be more of a green flag. Another example might be that the candidate’s ability to talk about prior experiences could be a green flag, however, talking far too much and dominating the conversation is a red flag.

Red flags might include:

1. Being late or unprepared for the interview. The candidate should bring a resume and be familiar with the details of the position and your practice, especially those that are readily available online or that were discussed in the phone screen.

2. Complaints about previous employers. A candidate who complains about a previous employer suggests that he/she blames others in the face of challenge. Ideally, the culture of your practice is not one in which complaining is a match.

3. Vague answers as to why the candidate left previous employers. Litigation or disputes with former employers are a major red flag. In some cases, vague answers can mean the candidate is trying to be respectful. If this is the case, the candidate will not give the same reason for each job he/she left.

4. Lack of appropriate references. Candidates who list personal friends as references and who cannot name a supervisor he/she has had within the last five years as a reference likely has a reason. Proceed with caution. Make sure the candidate provides a reference from at least one individual who has supervised the candidate in the clinical setting.

5. Inconsistencies or discomfort around a particular topic. If the candidate becomes visibly uncomfortable when you ask about a job he/she has held, for example, this suggests something is suspicious. The candidate may be covering up a negative experience or lying on his/her resume.

6. The candidate does not have any questions at the end of the interview. If a candidate has been paying attention and engaged during the interview process, he/she should naturally have at least a few questions about the job or the practice. Asking only questions centered around compensation and benefits is also a bad sign, as this can mean a paycheck is the only reason the candidate is considering the job. Many candidates know they will be expected to ask questions and prepare them in advance, which is a good sign. If the candidate lets you know that he/she had questions prepared but these have been covered over the course of the interview, this should not be seen as a red flag.

On the flip side, green flags are signs that the midlevel provider is likely a good fit for the position. Green flags might include:

You have a good conversation with the applicant during the icebreaker portion of the interview. The candidate relaxes and naturally keeps up with the flow of the conversation throughout the interview. Use caution here, as you do want to maintain objectivity. If you like the applicant as a person based on your conversation, it can be difficult to maintain a balanced view of him/her as an applicant.

The provider came prepared with copies of his/her resume and a list of questions to ask during the interview. And, the questions the candidate asks are intelligent and insightful. A list of questions that could have been answered with a quick glance at your practice’s website may be a red flag because they indicate lack of preparation.

The candidate presents a balanced picture of him/herself. While the candidate appropriately touts accomplishments, achievements, or rave recommendations, he/she is also able to discuss areas of weakness.

A candidate may reveal something about his or her personal circumstances that might affect his/her employment. Appreciate this level of honesty, as it allows you to accurately assess the provider’s fit for the position. Even if these circumstances may be prohibitive now, there is a chance you will be able to hire the prospect later, provided the interview goes well.

Checking References

Recently, I spoke with an applicant to Midlevels for the Medically Underserved, my company’s residency-like program for nurse practitioners. Throughout the phone interview, the applicant’s pet canary squawked loudly. To me, this was an off-putting professional snafu. However, I didn’t feel I could decline the applicant a spot in the program based on this alone, as she was otherwise qualified on paper. Then, the applicant’s references arrived in our mailbox. Both references checked the spot for “Average” in the professionalism category on the reference form. Most of our applicants receive “Excellent” ratings across the board. So, this low rating caught my eye, affirming my initial impression. Ultimately, we declined to give the applicant a spot in the program.

Over the course of the next few months, the applicant continued to interact with our company’s staff, harassing them over calls and unprofessional emails about the rejection decision. The reference saved us from matching her with a practice who would have undoubtedly been dissatisfied with her level of professionalism.

I’ve personally talked with hundreds of applicants to this program. While these interview conversations certainly reveal a lot about our applicants, the compliment of a reference to supplement the interview is a powerful combination.

Some applicants may list friends as references, calling into question their workplace abilities or, at very least, their professionalism. Others list references who have directly observed the applicant in the clinical setting who may even take the time to write or call our company to advocate for the applicant’s acceptance based on stellar performance. This, of course, speaks volumes and assures we can have confidence sending the nurse practitioner out to work for a partnering facility with our company’s name behind them.

While keeping up with references for each applicant isn’t always easy, experience shows us it’s one of the most important pieces of our interview process.

Reference checks are far too often neglected by healthcare employers. Desperation to fill a provider position may lead employers to cut corners. Or, the mistaken belief that a provider’s level of success depends solely on clinical decision-making ability deems them unnecessary.

Checking references is a must before bringing on a new provider. Even if these individuals share very little information about the prospect, simply looking at the individuals the provider lists as potential contacts is helpful. A provider who cannot name any qualified professional references should be a major red flag.

A background check is never a substitute for a reference check. There are plenty of providers out there with clean professional and criminal records who are terrible to work with. Taking the time to talk with multiple references can save you the even more time-consuming pain of hiring the wrong person for the job.

When you call to speak with a candidate’s reference, consider structuring the call in the following manner to get as much information as possible without overstepping any boundaries.

1.       Introduce yourself, thank the individual for taking the time to talk with you.

2.      Ask some or all of the following questions:

• “In what context have you worked with the candidate and for how long?”

• “Can you describe the candidate’s general responsibilities?”

• “What were the standards of successful performance in the candidate’s role? How did he/she measure up to these standards?”

• “What would you say are his/her strengths and weaknesses in the clinical setting?”

• “Would you work with him/her again?”

• “How would his/her coworkers and/or patients describe him/her?”

3.      Thank the reference for their time and wrap up the conversation.

In addition to speaking with at least two references, you must also do your own research on the applicant. Look him/her up on LinkedIn and Facebook. What do you find? Is the candidate’s public representation of him/herself something you would feel comfortable with your practice’s customers seeing?

In doing your own background research, you might also find out that your professional circles overlap. If you have connections in common, reach out to common contacts. These connections may not be individuals who have observed the provider directly in the workplace, but can still speak to his/her character and accomplishments. Keep in mind the candidate’s requests as to who you not contact, such as a current employer. Never check a reference without the candidate’s consent and avoid asking for any information that could be used to discriminate against the candidate. Stick to questions about the individual’s ability to perform functions relevant to the job.

When you speak with individuals you and the candidate know in common, you are looking for information that helps you decide if the candidate is a good fit for your practice’s culture. Consider using the following conversation format when contacting a personal reference:

1. “It looks like you went to school with [the Candidate], is that accurate?”

2. “How did you two meet?”

3. “How long have you known each other?”

4. “Have you been in touch since that time?”

5. “How would his/her peers/coworkers/superiors describe him/her?”

6. “What were some of his/her favorite things to do at [company]? What were some of the things that [the Candidate] didn’t enjoy doing?”

Lastly, and most importantly, ask “Who else do you know that I should speak with about [the Candidate]?” Some people may not be willing to share openly about a candidate, but they are willing to connect you with someone who will.

References

1.    Weber L. What do workers want from the boss? The Wall Street Journal. April 2, 2015. Retrieved August 10, 2017, from https://blogs.wsj.com/atwork/2015/04/02what-do-workers-want-from-the-boss/?mod=e2tw .

2.    Spolsky J. The guerrilla guide to interviewing (version 3.0). Available at
www.joelonsoftware.com/2006/10/25/the-guerrilla-guide-to-interviewing-version-30.
October 25, 2006. Accessed March 1, 2017.