Practices generally find themselves recruiting a new surgeon for one of two reasons: either an established surgeon has vacated a position, or the practice has an eye for growing their market share and wants to expand services. Regardless, practice growth requires success in both recruiting and keeping young and talented surgeons. This article will discuss some important factors to consider as you begin your journey to adding a new ophthalmic surgeon.
Define Your Identity
To successfully attract like-minded surgeons, you must first define your practice identity. In other words, what type of surgical practice are you — academic vs private practice, primary eye care vs surgical referral center? If your practice is at an academic center, you will typically receive applicants who self-select for a practice environment that includes an employed position, usually with administrative time set aside for research endeavors, and potentially involving teaching of residents or medical students. If you are a private practice, consider whether your center is a primary eye care provider offering routine eye exams or a surgical referral center participating in co-management. Modern private practices can be split into these two categories and each setting is likely to attract different types of young surgeons.
To start, it is important to identify which category best fits your practice, and then highlight the benefits of your practice’s structure and focus. If you practice primary eye care, do you own an optical and would your recruit be able to buy in to that revenue stream? Do you have a large returning patient base (for example, patients being followed for glaucoma or other conditions) that will provide yearly, if not more frequent, comprehensive exams for your new provider?
If you are primarily a surgical referral center, do you have a robust network of referring doctors to support a new and likely hungry surgeon? What is your market share of surgeries, and what is the trajectory? If you do not know those details, local industry reps who usually have their finger on the pulse of the market can be a solid resource to help you better understand where your practice fits and how it compares to others in the area.
Define the Surgeon You Are Seeking
Obviously, within ophthalmology there are various subspecialties, and looking for a glaucoma specialist vs. a comprehensive ophthalmologist will drastically change your applicant pool. Assuming you already know what type of care this surgeon will provide patients, you want to drill down deeper to less obvious differentiators among applicants. When asking young recruits where they place importance when evaluating a practice, they typically cite these characteristics (listed loosely here in descending order):
- Practice culture/values
- Geographical location
- Practice/ASC ownership potential
- Projected surgical volume
- Overhead sharing method
- Starting salary
- Practice call
The order of importance can vary by individual, so understanding what each recruit values the highest will help you identify what aspects of your practice to highlight. The best way to do this is to listen carefully to the types of questions they ask at the very beginning of recruiting talks. For example, if they ask about overhead sharing, partnership structure and ASC ownership, they are likely hungry for business partnership and looking to grow and retain value. If they are most curious about starting salary, call sharing, and paid time-off, they may be a surgeon more accepting of an employed position and seeking work-life balance. Still others may be more curious about where their surgical volume will come from and may be a better fit for a practice looking to replace a surgeon than a practice seeking to grow their market share.
Outside of business mindset, you want to determine the style of surgeon you are after and direct your recruiting efforts there. Do you have a retiring glaucoma specialist who has a large glaucoma patient base in need of management? You will likely seek a glaucoma specialist who is well versed in conventional incisional glaucoma surgery and bleb management, so look for young recruits from traditional glaucoma fellowship programs.
Or are you looking to expand your glaucoma offerings to include more minimally invasive and cutting-edge technology? In this case, look to the training programs with an emphasis on surgical volume and experience with a variety of MIGS procedures. You want someone who is forward thinking and willing to evolve their surgical practice over time.
Highlight Your Values to Find the Right Fit
Outside of marriage, finding practice partners is one of the weightiest decisions you make in life. If you think about it, making sure you have alignment in a few core areas such as finance, religion and family size is essential in a marriage, and it is not that different in a medical practice. Finance: Where will we put our resources to help grow our family (or practice)? Religion: What are our foundational values upon which we will raise our family (or grow our practice culture)? And equally important is family size: How many children (or associates) do we want to bring into our house, and how do we want to pass the torch to them? As was the case with us and generations before, this next generation of young surgeons is different than we are and values different things than we did.
Start discussions with your why —your mission statement or your organizational “just cause.” It is more important than ever that recruits understand who you are as a practice to understand how to expect the practice to behave in new situations such as decisions on who and when to hire next, or how to handle being approached by an equity firm, among others. The more information you can share about organizational history with important decisions can help an applicant determine if they align with your practice. If they do not, it is better to lose out on a recruit than to have an associate, or worse a partner, who does not match your position on key issues.
For a lasting relationship, the recruit needs to see a long-term future at your location (or at least one of them if there are multiple locations). A “rooted recruit,” or someone who has connections either personally or through their spouse to the geographic region of your practice, is worth a lot. The only thing worse than an unhappy associate is an unhappy associate’s spouse.
Retaining Talent in a Competitive Market
Nebraska football coach Matt Rhule believes the key to success in the age of the transfer portal — where players can leave for the greener pastures of another school without losing eligibility to play college football — is to spend significant time and energy recruiting the players in your own locker room. In other words, the courtship does not end once a player commits to you. The same is true in the practice of recruiting and keeping young ophthalmologists.
When you land a new associate surgeon, both sides are already committed to each other in a significant way and it is likely in the best interest of both sides to maintain the relationship. Certainly, from the practice’s perspective, it is best to have associates who grow to become partners. But just as in a marriage, it takes time, effort, and yes, even some sacrifice to make sure your future partners feel heard, loved, and cared for. That means spending real time building and maintaining open communication, understanding their “love language” or how they like to feel appreciated, and identifying areas where existing partners are willing to compromise when associates inevitably ask for something new or outside of what is typical from the practice’s past.
Associates must believe you have their best interest at heart, and that means believing you want them to succeed even if that comes at a cost to you personally. Usually, this cost takes the form of sharing overhead or patient volume. Unless you are replacing a departing surgeon, the growth in volume that prompted the recruitment of another surgeon will be a delicate subject. Surgeons entering the job market with prior experience will value available surgical volume more than someone who is just coming out of training. They will also, whether coming out of another practice or academics, have already been through a practice-building phase of their own. Having a well-planned and realistic ramp up of surgical volume for them will be important. Put in the effort to budget their volume correctly and set expectations early.
How much should you give up to your new associate rather than encouraging them to build their own volume? The right approach is likely a balanced one, and provided you structured your overhead sharing model appropriately, everyone should win in the long run as associates get busier.
A good rule of thumb is to aim for the associate to handle your historical year-over-year growth plus 10% of your current volume. So, for example, if you are a solo surgeon who performed 2,000 cataracts last year, and 1,800 cataracts the year before, a reasonable year one goal for a new associate would be 400 cataracts. Anything above that could then be attributable to the work they put in to build the practice in that first year. There may be some early opportunity cost of giving up some of your hard-earned volume, but what you gain is a partner who sees your compromise and partnership mindset at the heart of important decisions.
A Final Note: How to Bait the Line
The best recruits are typically found via word-of-mouth or mutual contacts. Put the word out to friends in the field who often know of a trainee or existing surgeon who is looking to make a move. Headhunters and advertisements or job postings are typically less fruitful for the practice looking for partners or someone to take over as part of a succession plan. Another option is to get in touch with training program coordinators or directors (residency or fellowship depending on what you are looking for, and you can tailor which programs based on the style of surgeon you are after) who can share your opportunity with their trainees. OM
