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 are ranging from 92-227 days1. In most specialties, the demand for new physicians far exceeds the number of physicians who are job searching, which means that physicians can be extremely selective when choosing a new position. Your department can’t afford big recruiting mistakes in this competitive recruiting environment. Unfortunately, many recruitment efforts are doomed to failure before they start. To prevent your critical recruitment from going up in flames, here are steps you can take to prepare for success!
Don’t Just Launch! Instead, Ask Yourself—“Is our position ready to be on the market? Or are there problems we need to address before we start recruiting?”
When a physician resigns, or when your hospital administrators ask you to recruit for a position, you may be tempted to immediately post a position. However, if you want to succeed with your recruitment, you need to look at your opportunity the way a high-quality candidate would look at it and ask yourself “Do I have a GOOD job that a high-quality candidate is likely to want in today’s competitive hiring market?” There are so many wonderfully creative ways a recruitment can fail! 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 are going to lose the game, but how far you will get your hopes up before they are dashed to the ground. You might get really close to the end of the game before the recruitment finds a way to fail, most spectacularly and creatively, wasting all the time and energy your team invested.
To avoid this sad fate, ask yourself these questions:
- Has the physician practice into which you are recruiting developed a modern practice style consistent with the needs of today’s candidates?
- Are any of the doctors in the practice unhappy with their jobs? Are any of the doctors likely to be upset that you are recruiting?
- Is your compensation and comp structure truly competitive given your location and the demands of the job?
- Is there a Recruitment Team that is ready to respond to candidates quickly to keep momentum going?
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 all kinds of patients and are available at all hours. When one of them retires, you may be tasked with finding someone who will fit the mold of the practice and value the wonderful opportunity to step into the practice that the partners have built. 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? The doctors in the group tell you they want to hire someone young for succession planning, because they are all close to retirement. Do you know any such candidates—young, energetic, and “old school”? I know a precious few, but not many! Most younger physicians value work-life balance, and with the shortage of physicians, they can find a position that will offer it. Also, seeing patients with all types of problems is less and less popular as subspecialization has increased. In highly subspecialized medical and surgical fields, young physicians want to develop the subspecialty practices for which they have trained. They may also feel understandably uncomfortable seeing patients outside of their area of subspecialty because they lack appropriate training for those patients’ problems.
“But a good old-school generalist is what my practice needs! We don’t have enough doctors to have a subspecialized group. And our current doctors don’t want to give up their patients in an area just to attract a subspecialist. And we really want someone younger, but with some experience.” I know. And I am sorry. Really. I am. I wish I could create the perfect candidate for you. You don’t need to give up on your dream candidate entirely. By all means, go recruit for exactly what you want. Maybe you will get lucky! But you DO need a Plan B. Don’t worry; I am here to help. Here are some ideas to explore:
- Provide a J-1 Visa Waiver if you are eligible, and provide an H-1B visa if you can. I know health systems often don’t want to pay the legal fees involved in providing visa assistance even when they could provide these benefits. Applying for a J-1 waiver is often a huge hassle, and sometimes a risk for both you and the candidate. But try sincerely. If you have an “old school” practice opportunity that goes against modern trends in subspecialty training and practice, you just may get a young but “old school” physician who needs a J-1 visa waiver and who treasures the opportunity to stay in the United States and create a life here, who will be flexible and eager to serve your community’s needs. If you feel 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.
- Recruit locally: Identify every provider within an hour of your facility who may have the skills you need and reach out to try to recruit them. Do not assume that just because you know of each other, they would let you know if they were interested. If you have had negotiations in the past that were unsuccessful, try to put past unpleasantries behind you. Instead, ask them what would need to happen for them to join you and see if you can problem-solve any 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.
- 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 bigger and bigger, so is the opportunity to develop 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 in order to attract critical providers to the smaller hospitals. Imagine, for example, that your health system’s flagship hospital creates a large subspecialized group providing sophisticated care, and your community hospital is 90 minutes away. Your hospital has traditionally been served by two senior physicians who saw all comers, and one has recently retired. You need another generalist to take call and see patients, but you find candidates don’t want a 1:2 call schedule and they don’t want a general practice, either. They all have fancy 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 in your community who will serve all the patients from your zip code and areas further from the main campus who may be at risk of migrating to other health systems anyway. Imagine the “Your Health System Regional Movement Disorders Neurology Clinic” and the “Your Health System Regional Cognitive Disorders Clinic” (or insert whatever the subspecialties are for which you will recruit). We have found that as long as you have enthusiastically planned for and embraced a vision to support the development of subspecialty care, candidates with subspecialty interests will often equally as enthusiastically devote a certain percentage of their time to general care of patients in a community practice setting.
- 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 3-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 3 APPs. This supervisory role often works especially well for experienced providers who are in the last stages of their career, who have a breadth of practical experience, and can significantly reduce your patient wait-times to see a provider.
- 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. If your practice is associated with a larger hospital in a larger city, 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.
Will Any of Your Doctors Likely Say Bad Things About Your Practice Opportunity to Candidates?
Imagine you are a doctor on a job interview. How would you feel if one of the doctors you meet with on your site visit says 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, vitals 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 that they can avoid the negative impact of physicians with negative feelings simply by excluding the unhappy physician from the candidate interviews. We have often seen that strategy fail miserably! Leadership is a contact sport, and your leaders will need to engage with any unhappy physicians to resolve tough challenges before candidate interviewing begins. Otherwise, you can anticipate the frustration of watching your great candidates disappear, one by one, sometimes offering convincing excuses such as “my spouse decided the location isn’t great for us” or “I found another position through a friend.” When you have unhappy doctors and the candidate turns you down ostensibly for some unrelated and benign reason, chances are, the candidate is just being polite.
Is Your Compensation and Comp Structure Truly Competitive?
You may be tasked with recruiting for a position for which the compensation really 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 blended 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 sets 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 recruiting, 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, and 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 are surrounding compensation, you need to figure out what your good candidates are likely to be offered elsewhere, and make sure that your offer is likely to be competitive (at the very least) or preferably, better than what others are likely to offer your candidate.
It is important to find out what the norm is with respect to how the compensation structure works for a particular position, no matter what your practice’s historical compensation structure is. If your compensation structure is outside the norm and in any way disadvantageous to your physicians, you will likely have trouble filling your position. If you are lucky enough to fill your position despite a disadvantageous compensation structure, you are likely to suffer retention problems. All in all, it is critical that physicians be truly 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 mostly by salary, often with a quality bonus, and call beyond the agreed-upon number of days should be compensated fairly. Outpatient roles are typically more production-oriented, and how “productivity” is calculated and valued should be thoughtful, 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, then nobody should be surprised if you are unable to recruit the talent you need for the position.
Is Your Recruitment Team Ready?
Would you like to a sure-fire way to fill your open positions as quickly as possible? If so, there is one magic trick which will dramatically reduce the time it takes for you to sign a great candidate: CALL YOUR CANDIDATES RIGHT AWAY!
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 a practice 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 maybe 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 have likely 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 very simple goal of calling candidates promptly? See if any of these statements sound familiar:
“I have the candidate’s CV in my inbox, but it has 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 or not. 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 your recruitment! However, you can take steps to secure the time of busy physicians who must make calls to candidates, and teach everyone on your recruitment team how to communicate with good candidates while you are actively pursuing others, so that you can maintain momentum in your recruitment process.
How to Ensure Candidates Are Called Promptly
If your stakeholders are not calling promising candidates right away, you are at great risk of losing the candidates you need to fill your open position. However, this is a fixable problem!
- Deputize 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, such a process is far too slow for today’s competitive physician recruiting landscape! The group must deputize one single individual as the team lead for recruitment, and this individual needs to commit to making time for recruitment calls promptly after receiving a quality CV.
- Review Candidates Every Two Weeks: The physician lead in the recruitment and the in-house physician recruiter or practice manager should have a meeting at least once every other week to review the status of each CV that was sent.
- Help Your Physicians Respond Quickly: When a candidate needs 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 asking for a time to speak. Email is also fine, 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 valuable 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, make sure that they know that it is critical to schedule calls with candidates within a few days. We have sometimes seen schedulers offer dates to talk that were two or even three weeks away from the CV submission, and that is just not fast enough to keep a candidate engaged.
- Recruit Until the Ink Is Dry: If you don’t have a signed Letter of Intent yet, then you do not have a deal! Rather than putting new candidates on hold until you know whether or not someone is going to accept your offer, reach out. If the candidate you have in process winds up accepting your offer, you will need to 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. When a practice is lucky enough to have an offer accepted and also have other excellent candidates who are interested, we have often seen practices open up a second position and hire two!
NOW you are ready!
With your on-trend practice opportunity, buy-in from all the physicians impacted by the recruitment, a truly (hopefully highly!) competitive offer and a recruitment team that is ready to respond to candidates quickly and enthusiastically, you are finally ready 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 finding and recruiting the candidate of your dreams!
References
- AAPPR. 2019 AAPPR Annual Report Summary and Highlights. AAPPR, pp.10-14
