Make New Hires a Part of Your Team

Giving recruits the best opportunity to fit in.

BY WILLIAM B. RABOURN, JR.

You asked all of the right questions during the recruiting and hiring process and you have taken on a promising new associate. Your efforts now shift from hiring the right person to integrating the newcomer into your practice's culture. The journey to success or failure begins when the contract is signed and gains momentum when the new recruit begins seeing patients.

During the recruiting process, you both shared much the same vision of success — a signature on the dotted line. You had a position to fill with the best available person, and your recruit was looking for the best available position to fill. Both of you were clear and specific about many of your expectations, but very often the need to achieve both parties' overlapping goals tends to push discussion of day-to-day practicalities to the background. It is time for both of you to plan for success by shifting focus from the dotted line to the bottom line. This article will offer guidance on making that transition a successful one.

Welcome to the Group

Each new associate brings to the practice a suitcase packed with a unique set of strengths and interests. Ask for a honest self-assessment and take the time to carefully consider how to integrate these particular strengths into your practice to the benefit of all parties. You may discover, for example, that the refractive surgeon you hired has an interest in handling cataract cases as well, in which case everyone may benefit if you encourage established associates to transfer a number of routine cataract cases to the newcomer.

When developing an appropriate patient mix, be flexible, but help the new associate keep the end goal in mind. Having successfully negotiated the challenges of medical school and residency, your newcomer will probably be no stranger to the philosophy of short-term sacrifice for longterm gain. Encourage the crafting of a personal action plan that will meet the short-term goal of generating enough income to pay the agreed-upon salary, as well as the longterm goal of building a prosperous and professionally rewarding practice.

Keeping Score of Progress

Your negotiations no doubt included a general discussion of what services your recruit is expected to provide. Expand on that discussion and clarify the specifics, including the benchmarks against which you will be evaluating performance. These benchmarks can include your expectations as to the number of patients to be seen, or the number of procedures performed over the course of the first year. Break these expectations down into a checklist of intermediate monthly or quarterly goals. Keep an eye on the score, but don't obsess, because (as we will discuss later) these numbers form only part of the picture.

Does your contract include the possibility of moving from employee status to partnership? It is not too early to address any longer-term benchmarks and expectations that must eventually be met. Both parties no doubt want to craft an enduring, mutually rewarding partnership …"until at retirement we part"… so, approach the topic in much the same way you would approach the prospect of marriage. As a partner, your new associate will be assuming considerable responsibility, as well as undertaking a substantial financial burden. The sooner both parties articulate their financial, professional and personal expectations, the fewer misunderstandings both of you will encounter along the way.

Welcome to our Infrastructure

An organizational chart can't show a new associate how to fit in. Successful integration requires an understanding of the practice's infrastructure, which can't happen until the newcomer knows how the practice really fits together. This sort of intelligence comes from a mentor who can help to ease the transition by taking a new associate beyond the introductory handshakes of the recruiting and hiring process. Appoint a key employee (not necessarily a physician) who can bring the newcomer up to speed on "who's who" and "what's what."

A mentor can take the new associate beyond the nametags to the practice's people resources: who staff members are, what their roles and responsibilities are, and how that affects the new associate, so he or she can piece together where they will fit into the picture.

The pending arrival of a new associate may be a good time for you to evaluate the resources you are placing at the newcomer's disposal. Does the practice have appropriate support in the form of technicians and other clinical employees? Will your business infrastructure — particularly marketing — accommodate the needs of an additional associate? Have you allocated sufficient resources to marketing the newcomer? How will you evaluate the success or failure of your marketing efforts?

Initially, most newcomers will be less efficient than an established associate. Anticipate the need for additional time to see patients and complete procedures, and plan accordingly. With a lighter patient load, the new associate may not require a full complement of staff at first. Keep a careful eye on the situation, however, and add staff as volume grows. Established associates are responsible for ensuring that a staff that is loyal to them will show the same loyalty to the new member of the team.

Networking Efforts

The quality of a referral network is reflected in the practice's bottom line, but partners who are hiring a new surgeon because they are busy may not have been able to set aside time to grow that network. Delegating that duty to the newcomer helps to grow both the network and the associate.

Still, the healthiest networks are nourished by every physician in the practice. With a new associate on board, partners can transfer a number of routine cases to the new-comer and gain time themselves to devote to networking. If you did your homework during the recruiting and hiring process, your new associate should be on the same page as you are when it comes to networking strategy.

Introduction to the Community

In most cases, your new associate will be a newcomer to the community as well, and has few or no ties to it. Although selling the community was part of the recruiting process, the search for appropriate housing will probably be a newcomer's first real look around. A referral to a trusted real estate professional can be invaluable.

The more quickly the newcomer integrates into the community, the more likely he or she will be to stay. If you don't already know what types of activities interest your new associate, ask. Note how these areas of interest overlap or complement those of the practice's more established associates and identify unique interests that can extend your organization's reach within the community. Delegate each associate in the practice to do some matchmaking by introducing the newcomer to key community players within the sphere of their shared interest. Don't forget about making introductions to the medical community as well. Serving on hospital or medical society boards, or working with the local eye bank and other non-profit groups will help a newcomer forge useful ties with area physicians and optometrists.

Now is the time to make an all-out effort to immerse the recruit's entire family into life in their new neighborhood, schools and overall community. During the recruiting process, you no doubt provided the obligatory Chamber of Commerce packet with printed materials and perhaps even videos. Neglecting to follow through when the family arrives would be a serious mistake; their integration into the community has often proven to be the catalyst that ensures a newcomer's success. Don't assume you know what they like to do and what they care about … ask, ask, ask, then match the spouse, too, with a mentor who shares similar interests. Spouses who plan to look for employment may appreciate your help in quickly establishing a social network that includes influential contacts within their profession.

While it may take years to become fully integrated into the life of a community, it takes far less time to achieve an acceptable level of comfort. If, at the 6-month mark, the spouse still feels like an awkward outsider, you may very well find yourself recruiting to re-fill that position when the family moves on to friendlier skies.

It's a Balancing Act

During this first year of acclimation, should your new associate devote more attention to integrating and networking or to achieving the benchmarks you have set?

This is not an either/or situation. If your integration efforts have been successful, your new associate should not have a great deal of difficulty achieving the performance benchmarks you have set. At the very least, it would be shortsighted for a new associate to limit integration efforts because of perceived pressure to meet those benchmarks. As the associate moves into the second and third years in the practice, it will be appropriate to focus more time and energy on achieving benchmarks.

The Geometry of Scorekeeping

A performance evaluation based solely on production and patient head counts will be one-dimensional and of limited value in decision making. Pronouncing success (or lack thereof) based solely on these figures would be akin to measuring the circumference of a beachball with a ruler, when what you really need is a geometrical formula, a synergy of factors that outlines and quantifies the dimensions of accomplishment.

Consider the level of professional skill you have observed. Review a representative sampling of records to assess outcomes. Look at evidence of community involvement. Evaluate the quantity and quality of contributions to the practice's network. Who has referred patients to this associate? Are any of these referral sources new to the practice? Speak with established associates and staff to assess the degree to which the newcomer has successfully integrated into the practice, looking for evidence of goodwill. Does the associate regularly exhibit friendliness and a helpful, cooperative attitude? Do fellow associates and staff regard the newcomer as an asset to the practice? Consider patient satisfaction, using both questionnaire scores and anecdotal evidence.

When Plans Go Awry

If the situation just does not seem to be working out as anticipated, do not take action until you have taken time to carefully evaluate the situation. The practice has gone to considerable expense to sign and accommodate a new associate, an investment you should bear in mind when deciding if the relationship can be salvaged. Even if it cannot, you should learn from the experience by making it your business to determine how and why your plans went awry.

Before ascribing failure to meet benchmarks to a poor work ethic, consider whether factors outside of the newcomer's control account for the failure to thrive.
Some questions to ask:
► Did anticipated demand fail to materialize? Has the practice's competitive environment changed?
► Has the practice environment provided necessary support to the newcomer?
► Have you allocated sufficient resources to marketing the new associate?
► Did the mentor perform his or her duties as expected?
► Did the practice provide appropriate staffing to facilitate growth?

More complicated issues to take into consideration include the following:

■ What is the practice culture? How much friction and disagreement can it tolerate? Can the parties in question "agree to disagree?"

■ Does the new associate lack the negotiating skills needed to handle interpersonal conflict? If significant incompatibilities of personality or temperament cannot be resolved during the first year, the odds that you will be able to do so down the line are not all that good.

■ Determine the dimensions of the difficulty. Friction between the associate and only one other person within the practice constitutes a skirmish that can, perhaps, be mediated without too much difficulty. If more parties are involved, you may have a war on your hands, a polarizing conflict that will require considerable diplomatic skill to resolve. If your patients and the associate in question are squaring off, a conflagration may be in the offing. Termination may be the only way to limit collateral damage to the practice.

The Human Factor

Though not all recruits develop the way we would like them to, most young physicians (and most people in general) have a strong desire to do well and be accepted by their colleagues and communities. Having a well-conceived plan that is designed to serve the best interests of the practice, the recruit and the patient base is the best way to ensure that a new physician will reach his or her full potential. OM

Bill Rabourn, the founder and Managing Principal of Medical Consulting Group, LLC, based in Springfield, Mo., has a long history of sales and marketing success in the medical industry, as well as considerable experience in advertising and business strategy. He frequently speaks at regional and national meetings. MCG is a national firm specializing in consulting at both the surgical practice and corporate levels.