Recruiting a new doctor to your practice takes considerably more time and effort than it did in years past. A decrease in ophthalmologists and an increase in patients needing eye care is creating a perfect storm for you to navigate.
To add to the challenge, today’s candidates seem to have a widely perceived shift in the balance between their professional and personal goals as compared to earlier generations. Most hiring practices were founded by workaholic “boomer” doctors, who are only now beginning to adjust to this desire that young grads have for balance.
With a rising ratio of jobs to applicants, there is little room for recruiting errors. We find the most common errors include starting the search too late (historic 6–12-month searches can now take 2-plus years), offering an uncompetitive base salary and taking too long to move through all the steps from first meeting to final employment agreement.
According to anecdotal reports, residency programs now deliver about 450 new ophthalmologists a year, while an estimated 500 or more ophthalmologists retire annually. US Census data published in 2020 shows that the number of people who are 65 and older is growing at about three times the pace of the total population — more than 50 million seniors reside in the United States. That’s great news for the profession, but it is creating a strain not only on physician recruitment but on established providers and on your entire practice.
Below, we present our tested best practices for finding and securing much-needed new physicians.
FIRST, ASSESS YOUR REAL NEEDS
Some clients present saying they need to add a new surgeon, when what’s really needed is more internal efficiency and staff support for existing surgeons, or a shift of primary care and “medical optometry” patients from MDs to ODs.
Here are some critical steps to assessing your practice’s situation.
- Evaluate your practice’s growth strategy and future plan. Is it essential that you replace a departing provider, or would practice economics be better served by dividing the ex-associate’s patients among the remaining doctors?
- Decide whether an optometrist can handle the workload. In a recent client work-up, for a practice with four MDs — soon to be three with a retirement — and no ODs, we determined that every MD was spending about one-third of each clinic day on primary care. The simple, fast and less expensive solution was to add an optometrist, which only took 4 months of recruiting. By contrast, it would have taken more than a year to find a new surgeon for this practice.
- Determine whether your existing providers are at full capacity. This can be a loaded question. Some comprehensive ophthalmologists are just warming up at 600 visits a month; some find it challenging to transit 400 visits. As general guidance, a comprehensive ophthalmologist at 550+ visits per month (or a pediatric or retinal subspecialist at 450+ per month, or a plastics doc or optometrist at 350+) is approaching nominal full capacity. When a client is consistently running at 120+% of capacity — or is growing rapidly — these are signals to consider recruiting.
- Review productivity data and patient demand backlogs. Every practice should track the so-called “third next available appointment” metric over time. For each provider, scan their template for not the first-next available appointment, nor the second-next … but for the third. We look for the third because this smooths out the odd slot here or there that might have temporarily opened with a cancellation. If one or more of your MDs are booked out using this measurement more than 4 weeks, and this continues or grows, it may be time to start recruiting.
- Calculate the cost/benefit of adding a doctor before you launch a search. Work with your advisors to develop a month-by-month cash flow projection, out 18 months or longer. This is relatively simple. Forecast how the new doctor’s visits and collections will grow month-over-month. (Be sure to account for delays in credentialing.) Forecast expenses for the new doctor: recruitment and compensation, facility changes and staffing, insurance and other professional support. The typical forecast (or “pro forma” as this tool is called) will show an operating loss that must be carried by the partners for the first 6-12 months, and then typically a net gain after.
SECOND, PLAN AHEAD
These days, it can take well over a year to successfully recruit a comprehensive ophthalmologist, depending on where your practice is located. Subspecialists are fewer in number and more in demand. Recruiting to secondary markets takes longer than primary markets. Rural practices are even more challenging. If your shareholder documents have inches of dust on them, it is time to review the retirement notice provision. You may need to re-evaluate and extend this.
Your planning should include a “Plan B” in case you are not able to find a new MD … or if base salaries for your market have made hiring a new doctor uneconomical. Many rural solo practices are now simply closing for lack of a successor.
STEPS FOR RECRUITING
Once you have determined you need to recruit, here are steps to follow to increase your odds of success. We find that half of all newly hired, partner-track associates never make it to partnership. Hire a candidate who feels like the right choice from the start, rather than settling for a poor fit.
1. Form a recruitment committee.
In addition to practice owners, include your administrator, associate doctors and selected department managers.
CHANGES AND TRENDS IN SECURING AN ASSOCIATE
BY LAUREN SIMON
Ten years ago, it was an employer’s market. As part of the largest ophthalmic recruiting firm in the country, I saw that in larger and more popular cities, each client practice had an average of five to 10 candidates to consider, which made it very difficult for a candidate to find an opportunity in the exact city of their choice. The smaller, less desirable cities were able to attract candidates by offering higher patient volumes and incomes. This allowed for salaries to be on par with a new physician’s anticipated production and created opportunity for a candidate to hit their bonus thresholds sooner.
But various factors have resulted in a 180-degree turn: It’s now a candidate-driven market.
New market, new rules
Many factors are involved in the increasing lack of candidates in today’s market. We have not seen the necessary increase in residency and fellowship programs to accommodate the anticipated shortage, the merging of programs, the number of physician’s retiring and ultimately retiring even earlier than anticipated due to COVID. These factors have all impacted the shortage we are now experiencing.
Today, each candidate likely has multiple offers in the city of their choice. This has drastically increased base salaries for new hires. The addition of private equity practice models to the scene — and the lucrative income packages they sometimes offer — has also driven the increase in salaries. These factors mean you need to present your highest and best offer up front as many candidates are simply accepting their top bid.
Recruiting then and now
With the anticipated shortage becoming more intense, the need for recruiters will only grow. Ten years ago, practices in the larger, more attractive cities had an abundance of applicants, and they were able to recruit on their own. Rural practices were the most active clients of recruiting firms. Today, however, with candidates having so many options in every market, practices are competing on a national level.
A recruiter can assist the practice in understanding its needs and securing candidates who will meet and match those needs. In addition, a recruiter can educate the practice with details of other opportunities and offers the candidate is considering, thus allowing the practice’s offer to be more competitive.
Start the recruitment process early, as it can take much longer to find the right candidate in today’s market. Understand what the practice is looking for, and let your recruiter know as your needs change. Always put your best foot forward and remain in active communication with both the candidates and the recruiter. When setting up visits with candidates, be prepared to “wow” them with an itinerary including dinners with doctors and spouses, real estate tours and gift baskets in the hotel room with items that are personal to them (toys for their kids or pet toys for animal lovers, for example).
Balance: As valued as money
In the past, partnership track was among the three most important factors of the candidate’s job search (in addition to location and salary). In today’s market, however, work-life balance has moved into that spot. Partnership requires an enormous amount of time and commitment; today’s candidates seem to prefer more freedom and less obligation in their schedules. In lieu of full practice ownership, equity approaches may appeal to a new associate, including ASC shares or a stake in the optical shop.
With work-life balance so prized, my firm has seen a growing preference for a 4-day work week. Extended paternity leave is becoming more prevalent as a benefit. Most candidates are not interested in participating in hospital calls.
In addition to high salaries, sign-on bonuses, retention bonuses, residency and fellowship stipends, student loan repayment, car allowances, housing allowances, childcare and gym memberships are being offered.
All of this can be frustrating to typically workaholic practice founders — but it is the new reality. OM
2. Define the opportunity and your specific needs.
Make data-driven decisions. Evaluate your practice data to define what the practice needs and what the full and potentially long-term opportunity will be for the candidate.
3. Define compensation and benefits realistically.
Thanks to a relative paucity of new-ophthalmologist supply, base salaries have drastically increased. We find less salary negotiation is happening these days. Offer the highest figure your pro forma demonstrates you can pay — not the lowest figure you think you can get by with. Your mindset needs to be similar to the last few years in “hot” housing markets. If you offer under the asking price — or even the asking price! — prepare to be passed over before you have a chance to counter.
4. Define your ideal candidate.
What new services does the practice want to provide? What personal attributes of the current owners help to create the environment and success of your practice? Are you looking for more of the same or someone different? Would candidates with an interest in cataracts plus elective plastics, refractive surgery or medical retina beat out candidates who want to focus on cataracts alone?
5. Create a recruitment budget.
An often under-considered part of the recruitment process is how to make the candidates feel wanted and stay interested. It is not only about the highest salary offered. Provide your administrator with a recruitment budget to “wow” the candidates. Find ways to stand out when they are reviewing several offers, all similar in compensation. Finding and onboarding your best candidate costs a lot more than the first year’s salary. After adding up recruiting fees, signing bonuses, relocation and other perks, you may be looking at an added $50,000 or more in outlays before your new doctor’s first day at the practice.
6. Searching for and generating candidates.
Use as many avenues as possible, all concurrently. You don’t want to drag things out and ask your pharma reps for referrals … then call the local training program 3 months later … then place an Academy ad … then, after a year, get around to hiring a recruiter. Put all your chips on the table from the start. (See “Changes and trends in securing an associate”.)
7. Screening candidates.
Assign at least two members of the recruitment team (with at least one owner) for this. Respond immediately to the applicant with a phone call saying, “Thank you for expressing interest in our practice.” The days of collecting CVs in a pile and calling them at your convenience are long gone. When screening the candidates, apply the criteria you created earlier in the process.
8. Interviewing candidates.
Always put your best foot forward. Be prompt, interested in what candidates have to say and responsive to their questions and interests. It is important to do a lot of listening. Ask open-ended questions that provide the opportunity to learn what is important to the candidate. With the competitive nature of recruiting, some practices find themselves selling the benefits of their practice rather than allowing the candidate to speak. A balanced approach is needed. You need to hear what they want in order to not only recruit but retain the candidate. Otherwise, you may be surprised to discover that the new doctor plans to leave the office every Friday at noon while you expected 50 hours per week.
9. Conduct a creative site visit.
Include the candidate’s family. Make them all feel very welcome … even special. Impress upon all the practice partners that they need to at least make a friendly appearance sometime during the process. Distracted practice owners who show lukewarm interest drive away candidates.
Unfortunately, the difficulty of hiring MDs in the present environment is leading some practices to cut corners in vetting. You can accelerate the process, but don’t leave out the critical elements:
- Make sure the candidate is interviewed by the widest-possible cross-section of your practice, including any critical advisors who know your organization well.
- At the very least, review surgical videos (even better, fly to where the candidate operates).
- Check references: this is much easier for mid-career docs but tough for new grads. Go beyond talking to your candidate’s program director, who will typically over-state the young doc’s qualifications. It’s especially useful, if you can manage it, to talk to the director of nursing in the surgical facility where your candidate currently operates.
- Even at the risk of losing a candidate, don’t hire until you have spent enough face-to-face time with them to feel comfortable with their temperament fit.
11. Be prepared with a simple terms summary and an employment contract.
You will need to act quickly to stay in the game. Depending on the flow of events, it may be more appropriate to use an intermediate, non-binding “terms sheet” that spells out your offer, or to move straight to a definitive contract. Have the contract at the ready and your attorney on speed dial for changes.
12. On boarding and retention.
Keep the momentum going once the employment contract is signed. Stay in touch regularly with the new associate-to-be. Provide a detailed orientation in advance of them seeing the first day of patients (eg, EHR training, meetings with each department manager, introduction to all offices). How you welcome and prepare the new associate for future success aids retention.
We’ll close with an old recruiting adage. You’ve probably heard it before, but it still applies:
- Physicians go where they are warmly invited.
- Physicians stay where they are well treated.
- Physicians grow where they are cultivated. OM