Recruiting GenX physicians.

IN THIS ARTICLE ...

Making the right hiring decisions with GenX physicians can be a challenge. Learn some strategies for recruiting and retaining young practitioners.

Demographics in the United States are changing dramatically as the large block of baby boomers continue to age, creating an increase in demand for health care services. Many hospitals and physician groups report that it is very challenging to recruit and retain physicians.

It's also expensive and time consuming. Sometimes candidates are hired to practice even if they don't fit well in the organization's culture. Later, when the match appoints both parties, another recruitment cycle is launched.

Cultural divide

The personal and professional goals of younger physicians and upcoming graduates are significantly different from those that have been in practice for years. Generally, the new crop of younger physicians is seeking:

* High income, but they show less desire to sacrifice personal time to build a practice or pay a "buy-in" fee

* Two- to three-year income guarantees whereas recruiting entities would prefer to offer a one-year guarantee with specific performance targets

* Extra pay for living in undesirable areas.

Physicians are not geographically disbursed proportionally throughout the United States with a large number of rural areas and smaller communities find it difficult to meet the income requirements of new physicians. Although it may be less expensive to live in rural or smaller communities, physicians are demanding wages exceeding industry norms in exchange for living in a less culturally diverse community.

* Accommodating hours

According to Dave Gans, MSHA, FACMPE of the Medical Group Management Association, 41 percent of physicians under the age of 35 are women and 48 percent of medical students are female.

The aggregate survey data from MGMA, when com paring male to female, show that hours worked, visits and relative value units are generally lower for females than males. The changing demographics of this group of younger physicians take a different attitude to career and family than those who preceded them.

Women are an asset to a practice, but their priorities are often different during the early stages of their careers. Young doctors, both male and female, also are greatly impacted by malpractice expenses.

In an article recently published on the MassMed.org Web page, one OB/Gyn physician decided to work three days per week in California because her malpractice costs are $7,000 whereas they would have been $72,000 in Massachusetts. This is just one example of what is prevalent throughout the country.

Recruiting factors to consider

As your hospital or practice discusses the possibility of recruiting one or several physicians, there are certain questions that you need to consider before making the commitment. These include:

* Make sure that there is a true demand for the physician or specialty. If the practice is not operating at optimal efficiency, hiring an additional physician to meet a perceived, but not quantifiable increase in demand, only serves to add more expenses to the practice. The added revenue of having existing physicians contribute an incremental amount of time to the current practice often has a greater positive return than adding a new physician.

* What goals are you trying to accomplish? Is this succession planning? Are you trying to offer new or expanded services?

* Whom can you attract? Be realistic in terms of whom yon think will come to work in your community and fit in with the culture of the practice or the hospital medical staff.

* Why would someone want this opportunity? Even though you and your partners are satisfied with your situation, others may not view your group from the same perspective.

* What will you do to attract a candidate? Going through the interview process, checking on the candidate's background and making a job offer is not always sufficient incentive to get a qualified candidate to accept an offer. Housing, education, relocation, income potential, family situation and personal time are all factors of importance to GenX candidates.

* What is your competition doing? Do you run the risk of losing a portion of your business if your competition is able to bring physicians into your service area?

Profile the position

Take the time to work with your physician partners to put all of the critical components of your practice down on paper. Make sure you're all on the same page and are able to present a cohesive and positive impression to candidates. Critical elements include:

* Express in both a qualitative and quantitative manner the mission and values of your practice. What do you stand for and will you be able to objectively determine if your candidates meet those criteria?

* Be up front with your candidates regarding the culture and work ethic of your practice. Do not sugarcoat productivity expectations, salary support and non-clinical work just to get the candidate to accept the position. Misunderstandings are much too difficult to work out after-the-fact and are extremely disruptive to the practice.

* Take the time to prepare a job description for each physician specialty in the practice. This is often buried in a contract, but a better approach is to have a separate document detailing all expectations and position responsibilities.

* Tell the candidate how you plan to evaluate his or her performance and what types of support that you or your partners will provide the new physician to ensure a reasonable opportunity to be successful in the practice.

* Lay out all of the qualitative expectations in advance. These include practice guidelines, disease management protocols, documentation requirements and coding proficiency.

How do you find candidates?

It is essential that all of the physicians in the practice are involved in the recruitment process. Recruiting a new physician to a practice is a significant decision and has the potential to either increase value to all of the practice partners, or become a quagmire that can lead to contractual disputes, disruption and the expense of discharging a physician.

Methods for identifying candidates include:

* Current physicians When physicians interact with other physicians in the community, at educational conferences ant other industry functions, they should actively network with their colleagues to identify potential candidates.

* Residency programs Each physician should keep in active contact with his or her residency program. Take the time to interact with the academic medical staff and keep them apprised of opportunities in your practice and community.

* Recruitment firms Although there is a cost to this, when quantified, it may be less than the cost of your time and the cost of making a poor hiring decision. Professionals in this area can focus on bringing you only qualified candidates through a sophisticated screen and selection process.

* Professional organizations Man physicians belong to their specialty academy or professional development organizations such as the American College of Physician Executives. These organizations provide excellent networking opportunities.

* Ads There are many industry publications that carry ads for physician positions. These may attract a large number of candidates for a reasonable price. However, all of the work of qualifying candidates, performing initial telephone interviews and setting up on-site interviews falls to the physician group.

* Hospitals Hospitals have a huge incentive to work with medical staff to ensure that there is an adequate supply of physicians in their community. Hospitals often have the staff and resources to identify qualified candidates.

Timeline

The physician recruitment process can be long, laborious and a significant time burden on existing physicians who are already straggling to meet the needs of their practice. The key to staying out of this situation is to plan and be proactive towards physician recruitment. The practice should:

* Identify and quantify the need for a new physician nine to 12 months before the anticipated start date. For physicians who plan to retire, a 24-month time frame is recommended to allow for a meaningful transition period between the retiring physician and the new recruit.

* Irrespective of the method that the practice or hospital uses to identify and qualify candidates, it will take at least two to three months to get enough responses to allow the group to have a large enough pool to consider. In some less populated areas of the United States, the time frame may be extended as you may require the assistance of a hospital to demonstrate financial stability to the candidates.

* Make sure you have three or tour acceptable candidates and that each goes through the exact same screening and selection process. This will allow for a factual and unbiased decision to ensure that the best candidate is offered the position.

* Get the physician signed and under contract 90 to 120 days before his or her start date. This will allow the practice to start the credentialing process with payers and make sure that licensing requirements are met.

* If it does not feel right, do not be afraid to start over. It is more important in the long run to pick someone who will fit into your practice's culture than it is to fill a void.

It continues to be difficult to attract physicians to certain geographic areas. Specialties that are frequently mentioned in short supply include:

* OB/Gyn

* Dermatology 

* Rheumatology 

* Neurology 

* Cardiology 

* Anesthesia

* Gastroenterology 

Rural areas and smaller communities especially straggle with attracting orthopedic surgeons, neurosurgeons, cardiac specialists and vascular surgeons at a level that meets the income requirements of these physicians.

Competition for physicians is fierce and it is critical for those who wish to recruit to be proactive, innovative and willing to devote the time and resources necessary to make a successful hire.

Managing the conflicting goals, objectives and characteristics of a divergent group of individuals is an extreme challenge, but one that has to be effectively addressed to ensure continual success of existing practices.

Red Flags To Watch Out For When Recruiting Generation X

Overly anxious to interview

Multiple hospital changes within a single community

Suspicious time intervals on CV

Unwilling to provide current references

Discovering omissions, discrepancies and inconsistencies

Board eligible for a long time, not board certified 

Multiple moves and short stays

Undue anxiety about licensing malpractice at new location

Doing something other than trained to do

Rick E. Weymier, MBA, FACMPE, is director of clinical consulting and physician services at VHA, Inc., a nationwide network of community-owned health care organizations and physicians. He is based in Irving, Texas and can be reached at 972-830-0298 or at [e-mail].