Published in the July 2018 issue of Today’s Hospitalist
CORPORATE LEADERS in business journals always offer this formula for success: Hire the right people and the rest will be easy.
“Once I became a group director, I realized that was really true,” said John Nelson, MD, during a practice management precourse at this spring’s Society of Hospital Medicine annual meeting. “As director, it’s your job to manage your program’s performance, and the foundation is hiring the right people.” Even when short-staffed groups are desperate to find doctors to cover shifts, programs should still aim to find recruits who are the right fit.
But how do you find them? And once you sign them, how do you keep them? Dr. Nelson—a hospitalist at Overlake Medical Center in Bellevue, Wash., who for years directed the hospitalist program there, and a principal with Nelson Flores Hospital Medicine Consultants, a national consulting firm—offered his take on innovative recruitment strategies.
Here’s a common recruiting mistake: Groups don’t spend enough time thinking about how to sell their program as an opportunity.
“I want candidates to like us so we have the option to hire them if we like them.”
~ John Nelson, MD
Overlake Medical Center
“Everyone focuses on schedule, compensation and workload, and those are important,” Dr. Nelson pointed out. “But what you really need to convey is what it’s like to work within your group.” While programs generally have very similar approaches to treating heart failure, “the experience of working with different doctors really varies from group to group.”
Is the culture of your group all about maximizing lifestyle and your time off? If so, communicate that clearly to potential recruits. What about the culture of your medical staff and hospital? Those (if they’re positives) are what you need to sell.
“I never want to go to a hospital and find out I’m the smartest doctor,” he said, noting that groups should stress the expertise found among other medical staff members. He also finds it important to be honest.
“We’re very thin in our hospital on rheumatology, which isn’t an issue often, but I’ve told recruits that sometimes they’ll get stuck,” says Dr. Nelson. “I’ve also noted that there are a couple of docs we don’t really like working with, but a whole bunch we do.”
Get in the game
But fine-tuning your pitch won’t help if you don’t attract recruits. According to Dr. Nelson, programs shouldn’t make the mistake of not considering physicians trained in family medicine. They should also look to convert local primary care doctors to hospital medicine, even though this may not be as fruitful an option as it was 10 years ago.
And programs should actively recruit doctors who want to work only a gap year or two before a fellowship. One member of his group planned to work as a hospitalist only a year before a GI fellowship.
“That was 14 years ago, and he’s still with us,” Dr. Nelson said. “I was going to be a hospitalist for only a year before an endocrine fellowship. Someone who’s willing to commit to two years is the same as physicians who insist they want to stay with your program their entire career.”
While traditional recruiting forums—e-mails, print ads, job fairs—are a start, everyone in your group needs to take on recruiting as a personal responsibility.
“Staffing a hospitalist program is hugely important to supporting successful performance,” he said. “Everyone should be working his or her personal connections from where they used to work or where they trained.”
And if you don’t have residents already training in your hospital, plan to go where they are, even if the closest residency program is 50 or 100 miles away. And plan to do so year after year.
According to Dr. Nelson, groups should consider holding a dinner every year that’s open to every second- and third-year resident in a residency program. “Anyone can attend, even doctors who already have fellowships lined up,” he said. “One of you could talk for five minutes about your hospital, but the rest of the time should be just social.” Once your group makes such an event an annual tradition, “everyone will remember your program.”
And if you’re among that small group of practices that doesn’t have any openings right now, keep recruiting anyway. “If someone is in town and they’re planning to move here in a year or two, try to meet them in person and spend some time.”
That helps keep you informed about what people are looking for in practice opportunities. And “if those people are in the market in a year or two,” Dr. Nelson says, “they’re going to think about your place and probably call.”
Talk to references
You also need to respond—and quickly—to any query from a hospitalist.
“That person should get a phone call back, ideally from your lead hospitalist, within a couple of hours of hitting the send button on his or her e-mail,” said Dr. Nelson. “When a physician responds right away, candidates have the impression of a well-run group.” If you’re busy, he advised calling the candidate just to set up a better time to call back.
As for references that candidates supply, recruiters typically send references a written form. But “I think that’s not very valuable,” he said. What can yield meaningful information from a reference is a phone call.
“Everyone always says positive things,” he noted, “so just before you end the conversation, say something like, ‘We all could do something a bit better. What do you think this doctor should work on?’ That’s when you hear that a doctor could do a better job coming to work on time or being nicer to staff.”
If you know someone at the hospital where the candidate is now working who’s not listed as a reference, Dr. Nelson said you can consider making that call as well. But be careful, he warned, not to tip off someone the candidate wouldn’t want to know about his or her job search.
The right way to interview
The interview and site visit are excellent opportunities to sell your practice. But consider these separate scenarios:
SCENARIO NO. 1: The recruiter picks the candidate up at his or her hotel for a packed morning of formal interviews, first with the CEO, then the CMO.
Human resources then details the benefits before the recruiter gives the candidate a hospital tour and sits him or her down to a boxed lunch with however many hospitalists can get away that day. Then it’s on to more interviews all afternoon with the chief of staff, the head of the ED and the chiefs of other departments before the recruiter drives the dazed candidate back to the hotel at 5 p.m.
SCENARIO NO. 2: The group’s lead hospitalist picks the candidate up at the hotel, and the two spend an informal hour and a half getting to know one another and discussing the program. The candidate then meets with the hospitalists, as well as with executives at a group meeting before a hospitalist conducts a hospital tour. They then go to lunch off-site.
The candidate is done in the afternoon, driven back to the hotel again by the lead hospitalist. Or the practice arranges for a real estate agent to take the candidate and spouse or partner on a community tour before they’re taken out to dinner with the other providers and their significant others.
So which interview would impress a recruit more? “The first one’s a grind, but an awful lot of groups interview like that,” said Dr. Nelson. He’s also taken part in interviews where people grill candidates about how they would handle some specific conflict.
“You’re just going to get a script back, what the candidate thinks you want to hear,” he said. Instead of using the site visit and interview to put possible recruits on the spot, sell yourselves, your practice and your hospital.
“I want candidates to like us so we have the option to hire them if we like them,” he said. Be sure to recruit the candidate’s spouse as well by arranging a tour of local schools or highlights.
In addition to giving candidates the group’s manual on policies and procedures, Dr. Nelson advised giving them the password to the group’s online schedule so they can see what shifts they’d be working. He also thinks it’s a good idea to hand out group members’ e-mail addresses and phone numbers in case a candidate wants to follow up with any of them.
“One doctor said that was the reason she joined our group,” he pointed out. “After the interview, she called another woman in the group and they really hit it off.”
One audience member asked Dr. Nelson how he screens for emotional intelligence. Some of that, he noted, becomes apparent during the interview and interaction with other group members.
But another member of the audience noted that the interview process in his practice always includes advanced practice clinicians as well as lower-level administrators and supervisors. It’s good, he said, to see how a candidate handles those interactions.
“That shows candidates that you value partnership and respect,” said Dr. Nelson. “It also makes it clear that your culture isn’t top down.”
The benefits of a recruiting committee
Dr. Nelson passed on this maxim he once heard from a recruiter: “Time kills all deals.” By the end of the site visit, you want to be able to hand a candidate a letter of intent if your group would like him or her to sign on. “But it’s not open-ended, so the candidate can’t just put it to the side and then check out five other options,” he explained. “Put a deadline in the letter of one or two weeks.”
And to help turbo-charge recruiting efforts, Dr. Nelson said it can be helpful to establish a recruiting committee, one that meets weekly to review where in the process the group is with any candidate. “A committee won’t suddenly produce new recruits that you wouldn’t connect with otherwise,” he said. “But it keeps hiring in front of everyone and reminds them that recruiting is one of the most important things we do in our work.”
Phyllis Maguire is Executive Editor of Today’s Hospitalist.
How to hang on to physicians
DATA INDICATE that annual hospitalist turnover is around 7%. “If your group has 20 doctors, expect to lose one a year,” said John Nelson, MD, during a practice management precourse at this spring’s Society of Hospital Medicine annual meeting. A hospitalist who for years directed the hospitalist program at Overlake Medical Center in Bellevue, Wash., Dr. Nelson is also a principal with Nelson Flores Hospital Medicine Consultants, a national consulting firm.
To retain doctors, he strongly encourages hospitalists to form social and professional connections with their entire medical staff. Too often, he pointed out, he’ll visit a hospital and see the hospitalists come into the doctors’ lounge, grab some food and head back to their office to eat by themselves.
Instead, spend time with the other physicians. “You’ll be happier as a result,” he pointed out. “And the other specialists are less likely to dump on you if they see you as a friend.”
To boost retention, pay attention to your onboarding, and consider assigning a mentor or “buddy” to new recruits for their first six months on the job. Nocturnists create group stability, as does flexible scheduling, and recognition is important, even if it’s non-monetary. He’d also like to see groups offering sabbaticals to doctors after they’ve worked there 10 years, giving them six months or a year off at half salary.
In terms of avoiding burnout, Dr. Nelson said he talks to many doctors who plan to cut back on working full time, going from 15 shifts a month to 12.
But “I’m not sure that’s very meaningful,” he said. “Those 12 shifts will be just as hard as they always were, even with three more days off a month.” A better solution might be having fewer patients every day or fewer hours each shift, even if you end up working more shifts.
Dr. Nelson also reminded the audience of what Daniel Pink in his 2009 business classic “Drive” identified as key motivators: autonomy, mastery and purpose. Too often, he said, groups cede their own autonomy and their sense of ownership.
“You need a culture of physicians seeing this as their practice, even if they’re employed,” he noted. “It’s not the CEO’s fault that the surgeons treat you poorly.” Even if the CEO could be helpful in addressing that problem, “it’s mainly your job to address it. If the default position is that someone needs to fix something for you, that’s not as healthy of a culture”—and it certainly won’t motivate people to stay.