For physician groups, hiring a new doctor is a major step that can have a long-term impact on the practice and its partners. Yet too often, the decision is made without thorough analysis or careful planning. In those cases, the results can be less than satisfactory: Specific practice needs may go unmet, group member compensation can be reduced and the new hire may decide to leave.
“Groups frequently make a seat-of-the-pants decision when it comes to hiring that has no mathematical or financial logic to it, but is based more on a feel than anything else,” said Christin Crosby, a certified public accountant and financial manager with McKesson Business Performance Services.
“A step-by-step approach to hiring that is grounded in empirical practice trends and specific group needs will generally yield a much better result for all concerned.”
According to Crosby, the hiring process is best framed by answering four key questions:
- Is the new physician necessary?
- What does the practice want or need?
- Is there an effective plan in place?
- Is the practice adequately prepared?
A committee that includes multiple partners is perhaps the most effective way to tackle these issues, she said. Putting the responsibility for a new hire solely on one person is burdensome. Furthermore, it may not produce the best result, since key input from other practice partners may be limited or non-existent.
To hire or not to hire?
Deciding whether a group really needs another physician can be determined through a detailed analysis of current volume, capacity and scheduling, coupled with an assessment of projected growth. New service lines and hospital requests for extended service should be factored in, along with physician plans for retirement. Groups should also take into account whether partners are comfortable with the current work load or are at risk for burnout.
A practice may additionally wish to develop a staffing model that tracks volume and scheduling against an established trigger point to help determine when a new hire is needed. For example, Crosby said, one large emergency medicine group in the Midwest monitored patients per physician per hour. When that metric (established by the group) exceeded a specific number of patients over a specified period of time consistently (e.g., 2.5), the decision was made to bring in an additional doctor.
Staffing models can be particularly useful for large practices that provide services in multiple locations. “When you have a lot of moving parts, you need to be monitoring your staffing on an ongoing basis to help you stay ahead of the trends,” Crosby said.
Finding a good fit
Bringing in the right skill sets to meet precise clinical requirements is clearly essential when hiring a new physician. But it is also important to consider intangibles. A useful exercise for practice partners is to consider existing organizational weaknesses and to collectively develop a list of characteristics or skills that they would like in a new hire. These can include demographic traits or soft skills, such as leadership potential and/or an aptitude for the business side of medicine, Crosby said.
It is important to remember that the expectations of younger physicians may differ significantly from those of older clinicians, Crosby added. Increasingly, younger doctors are interested in a less-punishing work-life balance as well as greater income stability. Hiring committees should therefore attempt to assess a candidate’s commitment to the practice and the profession during the interview process. Determining whether a candidate’s expectations are likely to align with the job’s realities can go a long way toward ensuring a good hire.
As part of this process, the group should discuss long-term planning issues, such as retirement and succession — particularly if one or more partners are approaching retirement age.
The hiring process
As important as it is to identify the right match for a position, it is equally necessary to develop a workable plan for the overall hiring process. That means determining how many candidates to interview, where the candidate pool should be drawn from and whether a recruiter will be necessary.
Practices should also identify who will participate in the interviews and establish a viable timeline for completing the interviews as well as making the offer. A target start date should be set. Again, a committee may offer the most effective way to establish these parameters.
Pulling the trigger
According to Crosby, groups often are ill-prepared to address a candidate’s questions or concerns regarding compensation and benefits. When developing compensation packages, groups should consider approaches that are likely to meet or exceed a candidate’s expectations. For example, some younger physicians may not be comfortable with an “eat-what-you-kill” payment model and would instead prefer the stability of a fixed salary. Along with signing bonuses and incentive pay, there may also be an opportunity to include ongoing student debt reduction as part of the deal.
Developing a package that is competitive, both regionally and nationally, may require assistance from a qualified third party. Once complete, the proposed compensation and benefits should be clearly summarized and presented to the candidate in a concise one- or two-page document. Similarly, a defined work schedule, including regular hours and call responsibilities, should also be provided so that misunderstandings are avoided. Lastly, it is important that a basic employment contract be drawn up before an offer is made, Crosby said. This document demonstrates commitment on the part of the employer and allows both parties to lock down the deal once they reach an agreement.
Groups can go a step further by assembling a recruiting package that includes information about local communities and school districts, the area housing market, perhaps a realtor contact, restaurants and other leisure activities, as well as daycare options.
Planning to succeed
By approaching the hiring process in a thoughtful and systematic manner, groups stand the best chance of success, Crosby said.
“Without this kind of preparation, you could make a hiring mistake that could have significant ramifications for the group,” she said. “Alternatively, you may miss out on a really good candidate. If you’re unable to clearly articulate the goals of practice or why you’re seeking another physician – let alone tell the candidate about their compensation – the person may decide the best thing to do is to look elsewhere.”