Recruiting & Employing a New Doctor for Your Practice
Considerations for ensuring a successful hire.
BY JOHN B. PINTO

Unless destined for a solo practice, the most important decisions you will make in your career lifetime will be related to the doctors you choose in forming your practice. Making doctor employment decisions intelligently will have as much influence on your professional happiness, as making the right decision about whom to marry will have on the happiness of your personal life. Below are a few principles that can be applied to your hiring procedures to help identify when it is time to bring on a new doctor and to improve the chances of successfully finding, hiring and retaining an associate or partner.

Is it Time to Add Another Doctor?

The decision to add a new doctor is driven not only by patient volume and the growth pace of your practice, but also by subordinate factors:

► Do you have or want a satellite office that will require added coverage?

► Are there subspecialty services you are not willing or able to provide at present?

► Are you acquiring the practice of a retiring doctor that you will need help covering?

► Are you at a stage in your career where you simply want to slow down, but do not want your overall practice to move backward?

► Do you need an associate or partner to replace a departing, disabled or retiring surgeon?

► Does an adverse local call sharing arrangement oblige your addition of another doctor?

► Are you simply lonely or fatigued from practicing alone or in a small group?

► Are you willing to take a pay cut for extra time off?

► Are you in a competitive environment, where growth is necessary to keep up with other dominant practices?

Unless you have substantial and sustained clinical, financial or competitive motives to add a new doctor, you are unlikely to succeed in recruiting or keeping a new doctor. Bottom-line financial considerations ultimately steer the process and influence success. Your candidate eventually needs to be able to develop an economically viable book of business, and as the practice owner, ideally, you need to get a pay raise — or maintain your income, while improving your personal working environment, advancing the practice's quality of care and increasing its competitive viability.

What Kind of Doctor Do You Need and Can You Find?

Until about 20 years ago, the assumption in most ophthalmic settings was, "We need a doctor, let's find another full-time eye surgeon." Today, professional staffing choices and options are much wider and more nuanced. Instead of another general ophthalmologist, you may need a subspecialist. Although there is good reason for preserving the practice of "comprehensive" ophthalmology, in your practice it may be more appropriate to add a glaucoma, retinal or plastics subspecialist. This can vastly increase the difficulty of finding an acceptable hire.

Instead of needing a full-time doctor, a part-time physician may do. An increasing number of young, life-style-based surgeons, would like to work part-time. If you do not need a full-time doctor, you may find a candidate flexible enough to float his working hours to the demands of your practice. Instead of needing another surgical ophthalmologist, you may only require a medical ophthalmologist. It may be feasible for you to hire a 60-something, semi-retired ex-surgeon, especially if you work in a retirement community. This can be a good solution in practices with not quite enough surgery to go around, or those loathe to admitting another partner-level doctor into the practice.

It may be that your practice does not need an ophthalmologist at all. At least two options are available to increase clinical capacity without hiring a fellow M.D. First, you can hire one or more optometrists. The ratio of O.D. to M.D. eye care providers in America today is approximately 2:1. If your practice provides comprehensive care, and you are a soloist now, it may make more sense to adopt these same ratios and end up with one M.D. and two O.D.s, or two M.D.s and four O.D.s. Optometrists are less costly and often easier to recruit than physicians. If all you want to accomplish is a greater clinical capacity, a second option may be to boost your personal clinic volumes by adding more technical support, and/or working longer hours.

All of these options are going to be circumscribed not only by your practice's needs, but also by the practical availability of candidate doctors. In recent years, the search time required to find a suitable candidate has grown, and the competition for great candidates has risen sharply. As a result, base salaries have ballooned.

A Rise in Salaries

Five years ago, it was typical to offer a younger, partner-track general ophthalmologist a base wage of $110,000 to $130,000. It is not unusual today for generalists to command base wages in the $150,000+ range, particularly in less attractive markets. Partner-track retinal associates have been bid up from base wages in the $150,000 to $180,000 range, to $225,000 or more. I expect these numbers to keep going up, and predict that ophthalmology recruiting could be heading for an environment that will have a lot in common with professional sports agents.

With these escalating costs, every doctor added to your practice will lead to at least a short-term drop in profits. This is quite affordable in large practices, but less so in solo and small practices. There are several ways to blunt this pay cut if yours is a smaller practice, including building capital reserves before you hire and borrowing to sustain your personal lifestyle costs. Critically, before the hire is made, you should be sure that your practice's volume and growth are sufficient to support a new doctor.

What Will Make Your Practice Attractive to Candidates?

I interview many candidate doctors each year, both those who accept my practices' job offers and those who decline. The most common reasons doctors give for declining our job offers include:

► "The doctors don't really seem very eager to add another provider."

► "There does not seem to be enough patients to support another doctor."

► "There's been a lot of prior doctor turnover in your practice."

► "I don't really want to live in ______________."

► "My spouse doesn't want to live in ______________."

► "I'm looking for a partnership opportunity, not an associateship."

► "The buy-in cost is too high."

► "The compensation package was lower than others I was offered."

If your market, your practice or your deal is truly dreadful, you are going to have a hard time recruiting in today's tougher market. But you almost always can make your opportunity more attractive to candidates. Here is a short list of glamour and beauty tips:

1. Be prepared in advance. Make up binders or portfolios with information on your community, the history of your practice, doctor and key staff bios, and a few financial and volumetric stats. Have a basic, generic employment terms sheet prepared.

2. When offering a partnership opportunity, prepare a supplemental package to distribute to serious candidates. This should include financials, performance graphs, benchmarking statistics and a recap of the anticipated buy-in terms.

3. Anticipate the tough questions:

► "Why did your last two associates only last 1 year?"

► "How many surgical cases will I do after the first year?"

► "Are you planning to have your spouse as an office manager after I make partner?"

► "Will you be sharing your practice with me, or will I have to build from scratch?"

4. Recruit widely. Today, professional society Web site postings, wider journal ads and networking through reps and personal contacts are essential. Your search may eventually require regional cold calls and mailings to doctors, and professional recruiting firms are increasingly essential for tough markets.

5. Don't waste time in your review of curriculum vitae (CV) and first phone contacts with candidates. Review CVs as they arrive, and call every marginally acceptable candidate as soon as possible. Be sure to call those candidates who may seem a little below your standards on paper, they may actually shine on the phone and with patients.

6. Don't scrimp on reference checks. Ask questions as though you assume the worst, and hope for the best.

7. Have a formal "visit plan" for prospective physician candidates, with an itinerary and plenty of face-to-face time.

8. Make sure that everyone who is going to meet or interact with your candidate is on the same page about your practice. They need to be upbeat and able to answer questions consistently.

9. Show your candidate the highlights of your community, especially those features that will match the candidate's interests.

10. Take the lead. You are the host, and should drive the process and the eventual discussions regarding employment details.

11. Always, always trust your gut, and the guts of your staff and spouse. Even the most capable candidate who ranks low on the affability scale will never get very far as a private practitioner.

After a Position is Accepted

Once a position has been formally offered and accepted, move along briskly with the next steps:

► Make sure you have secured a source of ready funds to cover the inevitable profit lags in the early months and quarters.

► One person should be in charge of transitional details, and accountable for their completion: licensure, credentialing, special equipment needs, and in some cases, facilitating personal needs such as schools, housing and moving chores.

► Clear reporting lines should be established. A new doctor should know who their boss is, how often they'll meet and how they should proceed in the event of disputes arising between the associate and the senior doctor.

► Be clear and specific about performance expectations. Do not assume that your doctor will know how many hours they should be working, what meetings they should attend, what should be done during down time or how much time they should be dedicating to outreach or continuing education. Where appropriate, document your expectations in writing, and use this as a regular performance checklist.

► Communicate early and often with the new doctor. For the first year, the associate should be meeting with their supervising physician at least every 2 weeks, as well as every week or two with the practice administrator for ongoing coaching sessions.

► Share data with the new doctor. At the very least, he or she should receive their personal production, collection and utilization stats. For partner-track doctors, it is now common to share routine financial and volume performance statistics for the entire practice.

Most of us search for years to find a prospective spouse. For obvious reasons, a lot less scrutiny and time are available in finding a potential business partner. The tactics discussed here will increase the odds for recruitment success and long-term doctor harmony.

John Pinto is president of J. Pinto & Associates, Inc., an ophthalmic practice management consulting firm established in 1979. He can be reached at 619-223-2233, e-mailed at pintoinc@aol.com or found on the web at www.pintoinc.com.

Lauren Simon and Amelia Rogoff are principals of The Eye Group, an eye care recruiting and placement firm, located in Boca Raton, Fla. They can be reached at (561) 852-0008 or toddop@aol.com.