Bringing on a New Physician

This practice has a method to select “Dr. Right.”

BY AMIR ARBISSER, M.D.

When we recruit a new physician into our practice, we implement one of the most critical decisions we will ever make. Our practice’s reputation for superior performance is an immediate endorsement of the new doctor to both patients and professional colleagues. Because we expect to work side-by-side with our newby for decades, we devote extra time, effort and expense to the recruiting and hiring process. Our multi-faceted goal is to hire a colleague talented and caring enough to care for our own parents, spouses and children. In the following article I’ll summarize how we recruit new physicians. Though some of our strategies may be tailored to our midwestern location and our specific practice, you should find concepts to apply to your own recruitment process.

Understand the Goal

Recruiting begins with the partners’ strategic decision to give this process the highest priority. They must share common understandings concerning the proposed position and goal. Each must be able to clearly explain the plan to managers, staff and recruits.

• Are we replacing a phasing-out senior associate, or are we enlarging our service line?
• Is there a target population of patients or referrers, or are we focusing on a certain geographic market or a specific hospital or insurance plan?
• Is the goal a cornea specialist to deepen a refractive surgery service, or is the group seeking relief by spreading out call responsibilities with a new generalist?

Classic business issues need to be resolved before serious recruiting can begin. Newer partners frequently expect more immediate returns for their corporate stock investment, whereas mid-career ophthalmologists often adopt a lengthier investment time frame. To recruit successfully, everyone in the practice needs to understand exactly what the process involves and everyone must be on the same page.

Take a Long-Term View

We have never suffered a long-term loss by employing a new doctor. However, do anticipate serious front-end investment during the recruiting process and until the new physician hits his or her stride. These outlays may adversely affect cash flow for months. In addition to the obvious time and expense of recruiting visits, including the candidates’ visits to your practice as well as yours to selected recruits, your practice must prepare resource space and equipment, as well as sufficient staff to serve both current and future doctors’ needs.

We are experienced recruiters, but we also selectively engage professional headhunters, which can easily add another $25,000 to your recruiting investment. That is money wisely spent if you can shorten your search by 6 to 12 months.

Be prepared to introduce your new doctor to both patients and the community with announcements in the media, personal visits and multiple welcoming dinners. We invest close to 2 months’ executive secretary time to simply credential each new associate. As a bi-state group, we currently file three dozen applications per new physician. Four months typically elapse before state licensing occurs in some locales, and Medicare, insurance panel enrollment and clinical privileges may be predicated upon the state license. In other words, your executive secretary will often be working for the still-out-of-town future associate while postponing tasks normally performed for you and your partners.

Bottom line: It is important to recognize that successful recruiting combines short- and medium-term investments to achieve longer-term goals.

Have A Lead Recruiter

Once the group commits, a designated equity physician member leads the charge with data support and able assistance from our group’s executive director. I’m biased about recruits and believe they respond more positively and attentively to experienced partners than to employed staff. The lead recruiter role requires serious commitment, including attendance at national meetings, plus massive telephone time at night, on weekends and even on holidays. An understanding and supportive spouse is a definite advantage here. Our group gives the recruiter partner a bonus when the new recruit starts. That is psychologically important to both the recruiting partner and to those who have been spared the effort.

The lead recruiter organizes the search and identifies internal team members who need to be actively engaged in the process. This includes the executive director, our executive secretary, corporate attorney and selected staff members. He reports developments in brief summaries presented at appropriate intervals, via e-mail or during otherwise scheduled meetings.

Our long-term recruiter partner is a mid-career ophthalmologist. Having achieved specific personal goals and experienced the practice’s progress through multiple annual cycles, he has a better long-term “investment” perspective than a newly minted partner. In this role, he has also identified and successfully resolved contractual inequities that evolved over 25 plus years of our growing corporate practice. He will hopefully conclude his career with the successful recruits as his long-term associates — and future lead recruiters.

When Recruits Visit

Recruits must sort out multiple opportunities, just as practices strive to shorten their candidate list to optimize the precious time available. It is difficult to arrange weekend visits when you have to match the schedules of busy residents or fellows with a multi-speciality group in which all the equity members are committed to spending time with each candidate.

Invite the spouse to the initial recruiting visit to your practice. It is fruitless to “sell” the doc, raise the group’s hopes and then lose valuable time and/or other candidates should a spouse later deem the community unappealing.

The recruit deserves the privacy of a quality hotel or bed and breakfast. This is not the place to save $50 to $100 per night, given the thousands of dollars worth of time investment you will be making. Nor should you house recruits at the Ritz if you have a more vanilla-flavored practice. Because we “import” most recruits from other parts of the country, we try to provide a gift basket containing area goodies: a matchbox model John Deere tractor (the company’s world headquarters is in our town), corn candle, regional dessert wine, a sample of local specialty mustard, a regional day trip book by a local columnist and an area map. Your gift basket should highlight the most appealing aspects of your locale.

A bouquet of cut flowers improves every visitor’s mood during personal site visits. A rental or borrowed car appeals to some adventurous visitors, while others prefer a tour guide — typically one of the partners or spouses, our executive director or a seasoned manager. While the recruit physician tours your office(s), be sure to offer the spouse a parallel schedule appropriate to his or her interests and needs. This is the time to highlight schools, cultural activities and sightseeing options in addition to pre-planned occupation-related interviews. Remember that windowless ophthalmic lanes are quite similar in Bettendorf, Iowa; Bangor, Maine, or Boise, Idaho. It is the spouse who interacts daily in the community and in the schools. In our experience, failed relationships are more often the result of disappointed spouses than doctors.

Employ Technology

Using today’s easily available information technology is another tool in expediting data collection regarding potential new hires. “Google” candidates’ names and peruse the search results. Recruits’ voluntary contributions to social network sites such as Myspace.com also deserve your time.

Perhaps useful information appears on doctors’ college, medical school or post-graduate Web sites. Background checks can be easily conducted. In today’s world, it is critical to consider whether state licensing, clinical privileges, insurance panel applications or referral relationships will prove challenging if the electronic history reveals chemical indiscretion. Better to find out sooner than later.

Make it a Quality Visit

The office visits emphasize our basic site of service, the exam lane, as well as the clinic’s layout and facilities. We insist upon scheduling part of each recruit’s visit during working hours. I want them to observe patient treatment, patient flow and how the various staff divisions interact with patients and each other. We believe in keeping staff in the loop about most matters — including new associates. If time permits, we try to introduce our managers and frontline staff from each division so that they can personally respond to any visitor queries. We are proud of our talented staff and respect their opinions. We seek their impressions about the outstanding candidates we consider.

Although recruits typically view their tour schedule prior to arrival, the final schedule awaits them upon check-in. The schedule details their daily activities and the practice associates who will be spending time with them, both in the office and during each meal. We include contact information containing practice doctors’ personal phone numbers and the exec’s home and cell phones to facilitate communication. One could certainly add information such as spouses’ names, children’s ages and school districts, as well as e-mail addresses.

Each lunch or dinner with the recruit typically includes several individuals who are part of the practice, often accompanied by their spouses. The practice representatives include a mixture of partners, non-partners, employed optometrists, managers and the executive director. This format enables all of us to meet and personally converse with the candidate or couple.

We all provide immediate feedback to the lead recruiting physician should we feel that any issues or loose ends need attention in subsequent sessions with the candidate. Though phone messages and e-mail facilitate these communications, practice voicemail may be particularly well suited to this task. Text messages are also terrific for this. Our system signals the doc when a message is received so that it may be retrieved unheard by the visitors if, for example, they might be touring with the recruiter partner.

Ambience Counts

For years we have preferred recruiting dinners at homes over more traditional restaurant and country club venues. I believe the home setting gives the visitors an important opportunity to assess our members’ values and interests. They typically appreciate the serious interest we are expressing by opening our homes. The privacy of a home facilitates frank discussion of core values. I cannot even imagine a comfortable, spirited discussion of Medicare issues in a public commercial space. (When circumstances force us to meet in a restaurant, we request a private dining room.) The formal confines of a restaurant also limit much of the discussion to one’s immediate elbow partners. The home enables folks to move around and converse with diverse partners. At a restaurant, everyone usually departs simultaneously, but in the living room people can comfortably linger for hours. Closing time is typically more flexible at one’s home, too.

Another note on the recruiting dinners: it’s a good idea to ask the recruit in advance if there are any dietary considerations that should be taken into account in planning the menu. This type of concern for detail shows your sensitivity and flexibility, while also eliminating the chance of serving prime rib to a vegetarian.

Help with House-Hunting

With the exception of our founding partners, “pioneers” to the area who were then unfamiliar with any local resources, nearly all of our recruited physician associates have toured and purchased homes courtesy of one highly knowledgeable realtor. Her firm developed an excellent executive relocation package used by several large local industrial employers. She mails this package to our recruits to acquaint them with our community prior to their visits. Our realtor enjoys genuine friendship with several partners’ families and provides additional but appropriate input to the group about recruits and spouses, as well as offering honest insights about us to the visitors.

An active listener, she uncovers candidates’ personality traits that may fail to surface in recruiting and cocktail chat. She shares our goal of successful long-term recruitment, which supercedes any immediate real estate transaction. Though scheduled by the group’s executive secretary, the realtor keeps in touch throughout visits with the lead recruiting partner. If you can find a realtor like this in your community, consider yourself fortunate.

Once we have signed a recruit, we will often provide a mailed subscription to the daily paper to facilitate integration into the community. The newspaper also helps a recruit follow real estate ads long distance. Our trusty realtor can pursue new leads from the paper in direct communication with the recruit.

Why We Visit Recruits

Over the years, several of us have site-visited individual recruits. Seriously, we really do this.

Although rendering an equity partner non-productive and on the road for a day or more seems costly, change your perspective and view this as an important investment opportunity. In some practices, the loss of a productive specialist such as a vitreoretinologist can easily result in a six- or seven-figure practice income deficiency, plus an adverse negotiating position in searching for a replacement. We know, we’ve been there.

The social repartee of a recruiting weekend seems as unreal as the weekend dates at my initially all-male alma mater, Princeton. Neither resembles a real-world experience. Everyone shines their shoes, brushes their teeth and generally acts politely. Also, have you ever received a less-than-forthcoming appraisal from a recruit’s program director, faculty member, colleague mentor or friend? If the source is directed, can one ever be sure of the veracity of the reference? Also, given these litigious times, some references purposely provide vague information.

For the long haul, observing the recruit at work and evaluating his or her human chemistry is truly more important than 2 days’ of a partner’s productivity. The recruit’s video demonstrates a selected case or two, but it cannot adequately represent how a novice surgeon approaches challenges under fire, or interacts with patients and staff on his or her own familiar turf.

Visiting recruits at their workplaces requires delicacy on your part. Not every program director rolls out the welcome mat. Some refuse and seem offended that I might not believe every laudatory comment they proffer about a candidate. Certainly, our approach is not mainstream, and the appearance within a residency or fellowship of an out-of-town practitioner could be disruptive from the chairman’s point of view.

More problematic is visiting the practicing ophthalmologist who wishes to depart his or her current position for greener pastures. Subterfuge may be required here, such as: “This is Doctor X, an old friend from medical school … college … our fraternity.” Granted, visits to recruits may be uncomfortable, but the information gained is invaluable.

I like to shadow recruits in both clinics and operating room settings. Cocktail chitchat and phone conversations fail to accurately demonstrate how the recruit treats diverse patients and families. A weekend date cannot replace seeing the OR and clinic staffs either happily seeking out a greeting from the doctor recruit, or averting their gaze as he or she strides down the hall. It is priceless stuff. In this wacky world, we don’t expect trainees to operate like seasoned partners, however our patients deserve properly educated new associates with effective communications skills. We expect that they be steeped in good surgical principles and respectful of tissue. Having a sense of humor is a definite plus as well.

A final thought on this tactic: More than once, I have visited previously reluctant candidates on their home turf who then became willing to consider and visit our practice. Several of these individuals subsequently joined our group. I doubt there is a more convincing strategy at communicating your sincere interest than traveling away from your practice to visit a recruit.

It is Worth the Effort

Sound like a lot of work? It is. But I still haven’t covered all aspects of recruiting, such as contract negotiations, for example. It was my purpose here to concentrate on identifying the right mutual fit for recruit and practice.

It is inappropriate and unfair to move a candidate, much less a family, to your practice and community without performing due diligence — internally and externally. You need to identify an associate outstanding enough to care for your own mother, or your own patients. Someone whose skill and empathy allows you to feel relaxed, knowing that the practice’s patients are in good hands. A doctor whose competence you will respect as a colleague and hopefully as a friend. You may enjoy literally decades of satisfaction from a well-conducted recruiting effort. OM

Amir Arbisser, M.D., is a pediatric and medical ophthalmologist and co-founder of Eye Surgeons Associates, PC, with main offices in Bettendorf, Iowa, and Rock Island and Silvis, Ill. The practice’s long-term lead recruiting member is William Benevento, M.D. Dr. Arbisser may be reached at yayinmaven@aol.com.