Recruit to Retain: Successfully integrating newly recruited physicians to your medical team.

Submitted by:

Richard N Tate, FACMPE

This professional paper manuscript is being submitted in partial fulfillment of the requirement for ACMPE Fellowship

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Introduction

Every practice executive has at least one physician they consider their lead

physician. This physician exemplifies all that is noble about the medical profession

and can be counted on for both clinical and administrative advice. This physician

carries the respect of his or her peers and is willing to participate on their behalf

during early morning or evening meetings to make strategic decisions about the

direction and state of the group. He or she is an ethical leader and embodies the

organization’s mission and values and incorporates them into his daily practice. If

there’s not currently a physician like this on the medical team, it’s time to utilize

new strategies or ideas to recruit, onboard, and retain one to lead the team toward

becoming a high performance medical group.

Facing health care reform and uncertain changes in local healthcare markets that

will inevitably affect physicians and physician groups, the need to have strong

physician leadership is more important now than ever before. Groups are weighing

decisions to become employed by hospitals or health systems, become part of an

Accountable Care Organization (ACO) or Clinically Integrated Network (CIN), or

positioning themselves with insurers for future reimbursement. These are just a few

challenges but very important decisions nonetheless. The challenge addressed in

this paper is helping physician groups determine for themselves the best strategy to

recruit the right medical team to tackle these issues head on.

The need for physician recruitment is usually due to two things. One is the

strategy to add a new physician due to community need and the other is the need to

replace a departing physician from the group. In a Guide to Physician Recruiting by

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Merritt Hawkins & Associates, “every phase of physician recruitment – from

retention, to cost considerations, to the candidate you ultimately select – must be

based on the fundamental understanding that the U.S. has too few doctors.”1 With

this concept in mind, be diligent in how recruitment is handled. It is essential that

the group picks the right candidate regardless of the reason for the physician

vacancy. How any physician is recruited and integrated in the practice will play a

huge factor in whether he or she can be successfully recruited and retained. Being

successful in all aspects of the process could very well land a new lead physician the

medical team can get excited about.

Recruiting the “right” physician adds significant value to the medical team, yet

on-boarding the physician with effective tools and orientation processes will more

effectively integrate him or her into the new practice. Through published books,

surveys, journal articles, industry professionals’ testimonials, and personal

experience, this paper will explore and present industry ideals and stepping stones

for greater success toward the practice of recruiting and hiring new physicians.

Informed decision making about how to recruit a new physician and a well thought-

out onboarding process will assist medical groups with successfully integrating the

right physicians to their medical team.

Background Information on Physician Recruitment

Physician recruitment is not an exact science. It can be done internally by the

physician group or it can be done via assistance from outside recruitment firms.

There are resources available to do both effectively and an executive or physician

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recruiter can use both methods simultaneously. The more options used will likely

lead to more resumes or curriculum vitaes (CVs) for the practice to review.

Reviewing the CVs that come in, carefully sourcing the candidates and matching

their qualifications with the group’s needs will determine the best fit for an

organization.

As if recruiting physicians isn’t hard enough, there is increasing pressure to fill

vacancies in shorter time frames, often within 90 days. Add the cost it takes to

recruit a physician from start to finish, and recruiters find themselves carefully

weighing the decision to recruit internally or seek help from the outside. According

to the ASPR 2012 In-House Physician Recruitment Benchmarking Report, “the

median “Days to Fill” a vacancy was 155 across all physician specialties (222 days

on average) compared to a median of 120 days (208 days on average) in the

previous year.”2 That’s an average of over seven months to fill a vacancy! From the

financial angle, a cost estimate it takes to recruit an Interventional Cardiologist in

2009 is provided in Table 1 below:3

TABLE 1 The Typical Cost of Identifying, Interviewing and Relocating a Physician

Interventional Cardiologist Recruitment

Direct costs of recruiting: Advertising (Internet, print ads and mailings) $4,500

Site visit (travel, lodging, car rental, meals) $2,000

Second visit for home search* $2,000

Relocation costs $15,000

Signing bonus $40,000

Search firm fee $30,000

Total $93,500

* Not including expense for family members’ travel

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The cost and time it takes to fill a physician vacancy present a challenge. These

challenges can be overcome if work is performed smarter and more efficiently.

Don’t be afraid to know limits. There are people out there who recruit for a living

and when the situation presents itself, ask for help. As physician recruitment is

explored in greater detail, a closer look at in-house and outside recruitment options

and the potential advantages and disadvantages of both will be discussed.

In-house Physician Recruitment

In-house physician recruitment is the internal approach to physician recruiting.

While it is typically the most inexpensive way to recruit, it also is the most time

consuming. If the plan is to recruit this way, the recruiter needs time to formulate

ads, post them via media sources in print, web, or paper, and source candidates

during phone interviews and site visits. An essential understanding of the position

and specialty being recruited is a must. Interested candidates will have many

questions to ask and it is important that the recruiter be able to address the

questions quickly and accurately. Do the homework prior to placing the ads for the

job opportunity to prevent the “I’m not sure” and “Let me find out and get back to

you” responses. These answers can scare away interested candidates.

There are several ways to get the job opportunity to the physician community.

Posting ads on the internet through various sources is a good way to get the job out

there. Job boards like HEALTHeCAREERS (www.healthecareers.com) can post the

opportunity to the internet but also to hundreds of additional independent job

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boards who affiliate with their service. Juliane Marino, former Account Manager

with HEALTHeCAREERS, said in 2013:

“HEALTHeCAREERS Network delivers the most qualified candidates, which allows

in-house recruiters to spend less time having to sort through applicants, freeing up time

to invest in the highest quality candidates. Also, the direct relationship you have with

your Account Manager here at HEALTHeCAREERS Network gives you another

professional to bounce ideas off of and to help build a recruitment strategy. These are

significant differentiators from some of the larger non-niche job boards.”4 In addition to the large job boards like HEALTHeCAREERS, professional medical

societies for each specialty have websites that allow recruiters to post vacancies for

society members. For example, when recruiting a gynecologic oncologist, the Society

of Gynecologic Oncology (www.sgo.org) provides the opportunity to post the

position to members of the society. Most physicians in specialties where the

candidate pool is smaller will be members of these types of societies enabling the

recruiter to reach a specific target audience without giving recruits the feeling of

being “recruited.” This allows the active job seeking candidate to find the

opportunity on his own terms.

Other web based recruiting applications allow clients to post their jobs on their

web site job board, but also provide the client with a candidate databank to send e-

mails directly to physicians. One of these services is PracticeMatch. In late 2012,

Mark O’Bryan, Customer Service Representative with PracticeMatch said,

“… the best reason to use a tool like PracticeMatch would be the money you could save versus using a firm where you are paying for each physician you recruit. You can recruit multiple physicians out of PracticeMatch for a flat subscription fee.”5

This allows an in-house recruiter to get the job posted on the internet and also

actively target multiple physician candidates that may be interested in the

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opportunity. The recruiter can be a little more aggressive in his own marketing

approach for lesser fees.

Print advertisements typically accompany job board postings on physician

society websites. The cost of posting a job in physician periodicals and journals is

significantly increased when posting to print. Additional costs come in the form of

ad design and formatting of the ad to be posted. Journals and magazines have

different size specifications and forms of acceptable media. The help of an outside

graphic designer will likely be needed to format the ad to specifications before it can

be sent to the publisher. The graphic design costs will be incurred prior to running

the ad in print. Each print publication then provides different cost structures

depending on the size of the ad and the number of months it is published.

Professional organizations like the Association of Staff Physician Recruiters

(www.aspr.org), a society devoted to in-house recruiters, and the Medical Group

Management Association (www.mgma.com) can prove useful for in-house

recruitment. These organizations provide a wealth of information, continuing

education, conferences, networking opportunities, and written tools to assist

recruiters with new ideas, industry trends, and developments in the marketplace.

They also provide forums for those wishing to achieve a higher level of certification

that demonstrates a commitment to excellence in their health profession.

In all, the cost of in-house recruiting is relatively inexpensive if there are enough

interested candidates. Job boards and print ads will cast a broad net for your

opportunity but are a more passive approach to recruiting. If the need is more

aggressive, services like PracticeMatch could be more appropriate.

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Physician Recruitment Firms

There are essentially two types of recruitment firms, retained firms and

contingent firms. Both offer the client access to candidate CVs without having to use

the job board or print advertising. Both also come with a significant fee as a result of

a successful placement of a candidate they present to the group. For those

executives and recruiters who don’t have the time to do the recruitment in-house or

are having extreme difficulty placing a specific specialty, the cost of using an outside

firm may be worth the investment. These firms specialize in speaking with

physicians day in and day out across all specialties. They have access to the same

physician contact databases and job boards, as well as their own websites and

resume pools. If the preference is for someone else to find candidates and present

them for the opportunity, seeking help from a recruitment firm is a good idea. The

differences between retained and contingent firms will be discussed in further

detail.

A retained recruitment firm is a company that accepts a small recruitment fee up

front, or “retainer,” to provide physician recruitment services on behalf of the

physician group or client. It is a lot like hiring a third-party consultant to examine

the current physician vacancy, develop the recruitment plan, and present interested

candidates to the client. A single recruiter is typically assigned to each new client

search. The recruiter works one-on-one with the physician group to be the point of

contact for the recruitment process. During recruitment, the recruiter will be

actively engaged in filtering interested candidates down to only those who meet the

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criteria established by the group, assisting with on-site interview arrangements for

selected site interviews, and even assisting in the negotiation process with the

candidate if an offer is to be made. Cody Hall, Vice President and Partner with

Arthur Marshall, Inc., a retained recruitment firm, offered in December 2012 the

following description regarding the benefits of using a firm like his:

“First, we view working together as a true partnership; our success & growth greatly relies on us being successful for you, the client. Second, we work for you and are contractually but more importantly, ethically obligated to work in the best interest of our client as opposed to working for the candidate. We serve as an extension of your office.

At any given time, 85% of the practices & hospitals in the country are recruiting and we work as a consultant and partner to our clients. Our strategy & meticulous process take our clients opportunity to the national level while helping them separate their opportunity and highlight its true selling points. Candidates view our recruiters as an outside, independent 3rd party which affords our recruiter a certain credibility that hospital employees may not have (because candidates expect hospital employees will have an automatic bias for their employer).”6

The cost structure of this type of arrangement tends to be the most expensive

approach to physician recruitment. In addition to the retainer fee, the client will be

expected to pay a variation of, but not limited to, the following: site-visit fees, travel

expense reimbursement for candidate visits, marketing expenses for web or print

advertisements, a subsequent larger placement fee if the vacancy is filled, and a

possible early completion bonus if the position is filled within 180 days. These fees

will be negotiated and determined up front in a contractual relationship between

the selected firm and client. Though the cost of using this type of physician search is

higher, the benefits described by Cody Hall, such as having a professional recruiter

continually search for candidates, and the trade-off of having time to focus on

operational issues rather than candidate sourcing, are big reasons groups choose

this recruitment strategy.

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Another type of physician search is a contingent search. According to Webster’s

Dictionary, contingent can mean “that may or may not happen; possible.”7 That’s

precisely how a contingency search works. A practice can engage a contingent

search firm to solicit candidates on their behalf. If they “happen” to produce a

candidate that is subsequently signed by the group, a placement fee is paid. If they

don’t produce an ideal candidate and subsequent signing, there are no obligations

for payment to the search firm. In essence, the signing of a physician is possible and

it truly may or may not happen with this type of search. Whether it happens or not

dictates the cost to the physician group or client.

The advantages of this type of search can be fairly clear: no upfront costs and the

ability to use multiple contingent firms simultaneously. Eric Rubin, co-founder and

VP of Physician Recruiting, with National Health Partners provides the following

statement from 2013 of why a group should chose a contingent search firm like his:

“Practices or hospitals can work with either retained or contingency firms. It is better to work with a contingency based recruiter rather than a retained search because a fee is only paid once a successful placement is made with contingency agencies. Retained firms charge an up-front fee, typically require exclusivity with the search, in general (in my opinion) have little accountability, and there are typically no guarantees of their performance – your money is at risk. Many times retained firms do deliver, but more often than not the position goes unfilled. Finally, the recruiter who is selling you the retained search is not always the recruiter who services your account. Furthermore, since there is no risk to the practices to use a contingency firm, multiple firms can work on the same opening, which often means the position is filled sooner than it would be if only one retained firm is utilized. It is always better to use three recruitment firms who have a proven track record. National Health Partners is been in business since 1997 with a proven track record in the industry. We are more of a boutique firm who believes in customer service and integrity. We believe in not taking a job order unless we are confident we can deliver.”8

Even though Eric’s search firm has a different approach than the retained model, the

recruiters are equally knowledgeable about the physician recruitment industry and

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can assist with travel arrangements for candidates and even contract negotiations. If

the group doesn’t want the exclusivity of using one retained search, perhaps a

contingent search will better suit their needs.

Selecting a Recruitment Firm

It’s extremely important to an organization to find the right physician for their

medical team. The selection of this new team member begins with the decision to do

it in-house or use a firm. If the decision is made to use a firm to help with the

recruitment, there are several factors to consider when choosing a firm to do

business with. According to Pinnacle Health Group, ten factors to consider when

choosing a partner are:

1. How long has the company been in business? 2. What is the company's reputation? 3. Do their services extend nationally or are they limited to a particular region? 4. Do they recruit for all specialties? 5. How much industry experience and expertise do its search consultants have? 6. By what means are candidate references and background checks verified? 7. Does the company have a list of satisfied clients they can give you? 8. What is their success rate in placing quality physicians? 9. What strategies and processes do they use in their searches? 10. Is the company a member of the National Association of Physician Recruiters (NAPR)?9 Asking these questions will generally narrow down search partners to those that

can tailor to the specific physician need and marketing methods. In January 2013,

Kevin Perpetua, former Managing Partner with The Medicus Firm, offered the

additional insight into the selection process of using a firm like The Medicus Firm:

“I'd say the key factors a group should consider when selecting a retained search firm are the experience level and success of the recruiting consulting that will be represented the practice. The use of the Internet has increased competition for the active job seeks. Therefore, it's important to know the type candidate sourcing is

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utilized and that "passive" seekers are being reached as well. Finally, the group needs to be comfortable that the firm will provide a level of service that makes it easier for the group. Understanding the total fee structure before the search is initiated helps as well in order to avoid surprises down the road.”10

Kevin’s point about understanding the fee structure before the search is a very

good one. Notice that neither Pinnacle nor Kevin point out the importance of “how

much” a firm costs. Most firms are generally competitive with their rates and are

why the focus is not pointed there. The difference may lie in where the group gets

billed for them. To Kevin’s point, it is important to know where and what the group

will be charged for along the way. Also, be sure the search partner carries some

flexibility during the search and communication remains constant throughout the

search. The recruitment need today may not be the exact need 30 days from now.

Having a firm that can alter their recruitment strategies and efforts midstream to

meet changing criteria is of the utmost importance. Equally important is the

communication of those changing needs to the search partner.

The Recruitment Process

Once the business plan and recruitment details have been solidified and the

decision is made to proceed with the physician recruitment, it’s time to source the

opportunity to potential candidates. The group may have decided to go with a

recruitment firm or do it in-house, or possibly both. Whichever is chosen, in a Guide

to Physician Recruiting, Merritt, Hawkins & Associates suggest remembering three

key sourcing principles.

“The first key sourcing principle to consider is that physician recruiting is not an event, it is a process, and the process never ends… Another key sourcing principle is that you should not rely too heavily on any one particular method of contacting

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candidates… The third principle is what we broadly refer to as the “boots on the ground.” Regardless of how many ads you run, jobs you post online, or letters you send, at some point someone must get on the phone and talk to candidates.”11

Keeping all of these principles in mind, the recruitment process should begin to

unfold. CV’s begin to present themselves as potential candidates for the opportunity

and the group will walk their way through the recruitment process, from screening

new candidates to signing the contracts. These steps in the recruitment process will

be examined in more detail starting with screening new candidates.

Screening the Candidate

Perhaps the most important step in the recruitment process is screening the new

candidates. Ask the right questions up front, gauge the candidate’s true interest in

the opportunity, and determine if any potential spouse is also interested in making

the move. If these are not done, it could end up using significant time and

unnecessary resources on a bad candidate. Alternatively, great candidates and

physicians can be selected by good screening techniques. The proper selection of

which candidates could potentially work for the group could ensure the right talent,

culture, and fit that will best position the group for future success.

Prior to making the first phone call to screen the candidate, the recruiter should

carefully review the candidate’s CV and background. The training and work

experience should be commensurate with the group’s expectations of a prospective

partner before proceeding. It is equally important to determine if the candidate has

any familiarity with the community being served. They may list hobbies that could

be a particular niche the community provides or they could have trained or worked

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nearby and may already be familiar with what the community has to offer. Being

fully prepared prior to making contact with the candidate will make the screening

process much smoother from the outset and will set a positive tone with the

candidate.

The initial screen should be done via telephone. As Merritt, Hawkins &

Associates suggested, this is the “boots on the ground” method of screening

candidates. Having pre-set questions will provide consistency to the interview

process as well as keep the conversation moving. Possible questions to consider

when performing the phone screen with a prospective candidate may include:

What attracted you to our opportunity? How did you find out about this position? What do you know about our practice and community? What information would you like to learn about our practice? What information would you like to learn about our community? What is your motivation for leaving your current practice? Do you have any special interests/techniques to offer the group? How would you describe your bedside manner? What is your ideal practice opportunity look like? Where do you see yourself in the next 3-5 years? What is your timeframe for making a decision? Are you currently interviewing with other opportunities? Is there any information we can provide your spouse?

Always remember to follow the traditional human resources policies regarding

what is legal to ask candidates. By staying legal, asking appropriate questions, and

making a point to truly listen to the candidate’s responses, great insight into a

potential fit for the opportunity can be achieved. Paint a great picture of the

opportunity for the candidate, don’t do all of the talking, and always ask “What other

questions do you have for me at this time?” before leaving the phone screen. If the

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candidate meets the qualifications at this point and training background is

satisfactory, it is time to move to the next step in the recruitment process.

Background Checks

Organizations typically handle background checks in different ways. Some like to

perform these prior to a candidate’s site visit while others prefer to handle it during

their hospital privileging process. It is generally safer to handle these on the front

end to avoid the expense and time of a site visit if the candidate has a potentially

negative mark on their records. Candidates with negative background checks could

cause major issues with insurance payors, hospital privileges, and even derail

potential employment of the candidate. Candidates who are interested in the

opportunity generally will be happy to complete the release forms to authorize

these checks if there is nothing to hide regarding potential issues.

The two background checks most organizations prefer to complete are the

National Practitioner Databank (NPDB) and a criminal background check. It is

important to be familiar with hospital or group bylaws after completing these

checks to ensure a candidate’s ability to gain employment and grant facility

privileges.

Site Visit

If the candidate reaches the site visit stage of the recruitment process, the group

should already be aware of the candidate’s qualifications and potential fit for the

opportunity. Likewise, the candidate should be well versed in the position he’s

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looking at, the compensation structure, and the job requirements the opportunity

has to offer. Therefore, the site interview becomes more of an opportunity to

confirm both parties’ assumptions and allow for more exploration of the practice,

hospital, and community.

Merritt, Hawkins & Associates suggest using “The ‘70/30’ Rule” when setting up

a site visit.

“… we believe the candidate interview should be structured to be 70% social and 30% professional. The goal is to allow the candidate and his or her spouse to walk through the practice and the community and to visualize living and working there.”12

If the spouse is not included on the candidate’s initial visit, be prepared to bring the

candidate back for another visit. The spouse could be the ultimate decision maker

on a new practice opportunity so it is imperative to get their approval. The visit

should last no longer than 24-48 hours to ensure the candidate has enough time to

explore the opportunity but also motivate them to work towards a decision on the

opportunity.

The first step of the site visit involves travel arrangements. The recruiter should

verify with the candidate the most convenient way to travel and coordinate details

accordingly. If the candidate wants to fly, ask if they have a preferred airport they

like to fly out of or if they have a preferred airline. Do they prefer a window or aisle

seat? Be flexible regarding flight departures and arrivals. Remember, the ability to

adjust based on both parties’ schedules will translate into an impression on how the

organization acts in general towards someone who comes to work there. If the

candidate requires transportation from the airport, accommodations should be

made in advance to prevent surprises upon arrival to the community.

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Overnight accommodations are also important. Based on the screening

interviews, the recruiter may be able to determine the type of hotel needed. If the

candidate is single, he may prefer a trendier hotel in a busier downtown area. If the

candidate is visiting with a spouse, a nice quiet bed and breakfast may be more

suitable. Effective planning for their arrival and lodging preferences sets a positive

tone for the interview. There is never a second chance to make a first impression.

Making the travel arrangements as seamless and comfortable as possible will keep

any potential distractions from disrupting the visit and allow the candidate and

spouse to focus on the main reason for the visit, the job opportunity and community.

The visit itinerary needs to be well thought out. As mentioned previously, there

is a 24-48 hour window to squeeze in a lot of tours, meetings, meals, and

conversations. Key stakeholders in the recruitment process need to be well

informed of any visit plans and have any potential meetings or meals on their

calendars well before the candidate’s arrival. These stakeholders might include: the

CEO of the physician group, hospital, or health system, potential physician practice

partners, physicians of the same specialty, key referring physicians, supporting

specialist physicians, service line administrators, and physicians with the same age

or interests as the candidate. It’s generally easier for these stakeholders to

rearrange their work and personal schedules if they have adequate notice of their

participation prior to the candidate’s visit. In many cases, these stakeholders can be

called to duty during their allotted visit times so it is imperative to be flexible and

have a back-up plan in place should this happen. A tour of a facility or brief meeting

with another potential stakeholder can fill any downtime created.

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When planning the visit itinerary, customize the candidate’s day around people

and places that are either passionate about or unique to the community. Merritt,

Hawkins & Associates say “Physicians have told us on countless occasions that they

selected a particular practice based mostly on the attitude of the people recruiting

them.”13 Stakeholders who care about the community they live in, as well as

restaurants with a distinct flavor for the city, go a long way towards making positive

impressions on candidates and spouses.

Never underestimate the role of the community tour. Most organizations require

the use of a local realtor to escort candidates on a “window tour” of the community.

While most of the key stakeholders spend an hour with the candidate during the

visit, the realtor will likely spend at least three hours with the candidate. For this

reason, the realtor needs to be part of the recruitment team. During their three hour

tour, candidates tend to open up about their job search and community interest if

the realtor is doing their job correctly. They can provide valuable feedback and tools

the recruiter can use to tailor the remainder of the candidate visit.

It is imperative that the right realtor is chosen as a partner for recruitment visit.

The role of the realtor should be clearly defined prior to any visit. Their primary role

is not to sell a house during the visit, but rather act as an ambassador to the

community. They should provide unique insight into the community’s history,

present school information for candidates with children, arrange a possible visit to a

swim league or church, and provide a comprehensive overview of the many housing

options the community provides. Do not select a realtor interested only in showing

his or her current property listings.

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Spouses who accompany the physician candidates during their visit will likely

not be interested in clinic or hospital tours and meetings throughout the day.

Consider providing an additional itinerary for the spouse which may include more

time with the realtor or social time with another physician’s spouse. If they bring

children along for the visit, provide tickets to a local aquarium or city attraction that

adds value to their visit. Keep them busy learning about the community rather than

sitting in a hotel room.

Consider the value of providing additional items for the candidates and their

families to set your visit apart from other opportunities. Show them their time is

valued by leaving a gift basket in the hotel room, introduce them to a local soccer

coach, or use signage to welcome them to the city. The more things that differentiate

the group from the competition typically “win over” the candidate and land them in

the open opportunity.

The Offer Letter

The offer letter is good faith document that shows the organization’s

commitment to the candidate and outlines the terms discussed in the recruitment

process. Conversely, the offer letter also serves as the candidate’s acceptance of

these terms as each side works toward the employment contract. An example of an

effective offer letter can be found in Exhibit A (see attached).

Assuming the site visit goes well and the group wants to make an offer, the

candidate should not leave town without an offer letter in hand. This solidifies the

belief by the candidate that the group is serious about his candidacy and is 100%

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committed to bringing him to town. In many cases, this is the impetus the candidate

needs to be able to give notice to their current employer.

Contracting

Once the offer letter has been executed by both parties, the group’s legal counsel

should get involved to begin drawing up a draft agreement for the candidate to

review. The offer letter will provide the platform for the legal team to begin

incorporating terms of the agreement into the official contract. Contracts may vary

depending on specialty and the size of the group. Depending on how large the group

is, there will likely be contract templates already in place. Different specialties may

have different compensation models or duties so this should help speed the process

along.

Be prepared to negotiate. Candidates typically have a lawyer review the draft

agreement provided to them. The candidate’s lawyer will be trying to protect the

candidate’s best interest, much the same way the group’s lawyer will be focused on

theirs. Being familiar with the agreements allows the group to know which terms

they are willing to compromise on and which ones should remain firm in the

agreement. Knowing what can and can’t be done while being flexible with

candidate’s requests will expedite the process. Filling a physician vacancy is a leap

of faith by both parties so showing the candidate the willingness to be flexible

confirms what work will be like with the group and assures them they made the

right decision.

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Communication

Good communication is critical throughout the entire recruitment process and

will remain that way through the next phase of physician onboarding. Recruiting is

analogous to a long-distance relationship. The more communication between the

parties, the more secure both feel about their commitment to each other. Learning

the candidate’s favorite method of communication is vital to taking the relationship

to the next level. Whether text, phone calls, or e-mail, continue to shepherd the

process along and make sure the candidate is informed every step of the way. All

communication doesn’t need to be lengthy, but merely enough to ensure the

candidate that the group is moving the process along. Be sincere in the commitment

to the candidate and all of the hard work put into the recruitment process will likely

pay dividends for the group in the form of a signed contract.

Physician Onboarding

Congratulations! Contracts have been successfully completed and now it is time

to get the candidate relocated and seeing patients. The final phase of the

recruitment process is known as “onboarding.”

According to Collins English Dictionary, onboarding in a noun meaning “the

induction and assimilation of a new employee into a company or organization.”14 A

Business Today story written in August 2011 explains that the origin of the term

came into existence in the 1970’s. It gained popularity only in the last decade as

companies began putting emphasis on preliminary training for new hires.15

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In the physician onboarding realm, integrating new physicians requires a lot of

moving parts. There are many departments that will need to work cooperatively

and simultaneously to make the onboarding process go smoothly. The medical staff

office, marketing, human resources, facilities, information technology, office

managers, recruiters, and administration must work together to make the new

provider’s integration as seamless as possible. No piece of the onboarding process is

any more important than the other. One will undoubtedly affect the outcome of

another. At the end of the day, the candidate sees everyone as one organization so if

one department drops the ball, everyone looks equally bad when things don’t go as

planned.

Donna Ecclestone addressed a few key points to remember regarding physician

onboarding and retention in her article written for the Journal of ASPR in the Fall of

2012:

“Change and communication go hand in hand – Stay alert to what is happening within your organization and share that information with new physicians and those involved with their onboarding

One plan does not fit all – Ensure each new hire has the appropriate training and tools to do his or her job

Know the rules of the game – Re-evaluate your program annually and make adjustments as needed

Proper orientation is a JCAHO standard Measure success based on the organization’s goals – Find out what

your organization values most and make those standards a top priority”16

Remembering these points when organizing the onboarding strategy will help refine

the process over time and allow the departments mentioned earlier to work

simultaneously with each other and the candidate. Staying fresh with new trends

and ideas and using today’s media to network or learn new techniques can serve as

a powerful tool for the organization and onboarding program.

23

Exhibit B (see attached) provides a generic example of an onboarding checklist.

Of course, each onboarding program will create their own personalized checklist to

match their organization’s particular needs, but this sample provides a good

reference point if starting from the ground up. Organizations like CHI Franciscan

Health System in Tacoma, WA use the term “central air traffic controller” to describe

the keeper of their checklist. It becomes the controller’s job to make sure each

stakeholder from the different departments is doing their part and in turn, the

central air traffic controller is communicating back to the new provider what needs

to be done on their end. Making sure that information, both arriving and departing

the hub, reaches its intended destination in a timely manner, is paramount to the

physician onboarding success.

Credentialing and Licensure

The first order of business after executing the employment agreement is for the

provider to get a medical license to practice medicine in the state(s) the

organization serves. Most contracts have anywhere from 90-day to 180-day

termination notice. If it is the former, this doesn’t allow much time to get a new

medical license, since the length of time necessary can vary. Everything hinges on

the medical license, so completing this requirement is the foremost concern. No

license, no practice.

Once the licensure is complete and approved by the appropriate state medical

license board, applications can be submitted to the group’s participating insurance

payers. Payers generally take anywhere from 30-180 days to complete the

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credentialing process and begin accepting and paying claims for the new provider.

Getting the paperwork in quickly and correctly will save the group money if the

payors can approve the new applications without delays.

Facilities & Equipment

Facilities and equipment involves several components. It can include things like:

build-out of new exam space, computers and phones, office furniture, lab coats,

business cards, and parking passes. As Ms. Ecclestone pointed out earlier, making

sure the physician has the tools and training to do their job is a key focus of the

onboarding process. Include members of the various departments such as facilities,

information technology (IT), and administration when examining building and

supplies. Reference the sample checklist in Exhibit B for more examples of items

needed to get the provider up and running.

Human Resources

One of the most valuable teams in the onboarding process is the human

resources team. In many organizations, human resources drive the onboarding and

orientation process. By onboarding and orienting tens to thousands of employees

each year, they are able to customize their process and tailor it to physicians very

easily. Never underestimate the power of a well-driven human resources program.

Human resources may also play a vital role in the relocation process if the

provider is moving from out of the community. As one of the more unsettling pieces

to the recruitment process for the new provider, it is vital that the relocation

25

process work very quickly and easily. Among other things, human resources will be

a key player in coordinating benefits for the new provider, as well as ensuring his or

her orientation process is tailored to adequately train the new recruit.

Marketing

Every organization intends to get their new provider up and running as soon as

possible. Time truly is money when it comes to bringing on board a new provider. In

the Summer of 2011, Ann Mololey writes:

“We know that the ultimate goal should be to build a foundation that allows the physician to be efficient and busy as soon as possible, which is why a discussion about marketing and positioning strategies with the new physician should take place prior to their arrival. With the objective to drive patients to the practice, an action plan of introductions and relationship-building activities should launch immediately after the physician is in place.”17

Organizations have found many ways to be creative in marketing their physicians

and some methods are purely dependent on the culture and environment they are

located in. Some of these methods include print ads in newspapers, local

publications, direct patient mail, radio broadcasts, YouTube physician bios,

Facebook, twitter, billboard signage, newspaper articles, the phone book, and health

fairs. These are the tip of the iceberg but might help to get a marketing plan headed

in the right direction. Trial and error of several marketing methods will help

determine what works best for each community and new physician. Ultimately, a

strong provider will create word-of-mouth advertising which is the best

advertisement a group can receive.

Orientation

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Physician orientation is the first opportunity to introduce the new physician to

the organization. It allows the ability to convey the organization’s vision, strategy,

and culture at the same time while requiring dedicated communication and face

time with existing physicians. Dr. Stephen Beeson describes the physician

orientation process in his book Engaging Physicians: A Manual to Physician

Partnership as follows:

“A vision-rich, dedicated orientation can provide tremendous impact and clarify the vision and goals of the system and the physician role in the system’s effort… The orientation is a means to provide system information, but it is also an opportunity to create a powerful impression of ‘who we are.’ There will be only one opportunity to do this, and the first blush with the system must exceed physician expectations.”18

It is very important to cover everything the physician needs to practice comfortably

and efficiently during the orientation process. Items needing to be addressed

include introductions to key leaders, contact information for all leaders and support

personnel, facility tours, and any systems, dictation, or electronic health record

training. Depending on the specialty, the new physician will be working in the clinic

as well as the hospital. Clinic and hospital systems and culture can differ slightly, so

it’s important that both are covered thoroughly.

Practice orientation involves acclimating the new physician to his outpatient

practice environment. By now he should have met his new partners during the

recruitment process, so this is a great opportunity to assign a mentor. The mentor is

a physician partner who the new physician can look to for guidance on day-to-day

situations and also seek advice. A portion of the practice orientation should be

designed for shadowing opportunities between the new physician and his or her

mentor. This will help ease the stress of transitioning into a new practice while

27

familiarizing the new physician with the longtime culture of the group. As

mentioned before, additional orientation strategies will include training for any

practice management system, EHR, dictation software, or e-mail. Introductions to

staff and the practice manager will round out the support structure the new

physician needs to be successful in the outpatient realm.

Hospital orientation involves introducing the physician to more than just the

clinic setting. It should be conducted by high-performing staff members that have

the ability to introduce and portray the medical community from a broader

perspective. Physician members of the medical staff should present quality

initiatives and components that could quickly impact the new physician’s credibility

with existing medical staff members and possible referring physicians. It should

convey physician partnership and collaboration, support, and involvement. The

most important function to cover during hospital orientation involves

differentiating the hospital’s performance, vision, culture, and tactics used to help

this new physician become successful as quickly as possible. This is the hospital’s

opportunity to emphasize ethics and support for the physician and further cement

the decision to join the medical team. Additional items covered during hospital

orientation include hospital software systems or electronic health records (EHR)

training, parking and security access, facility tours, support staff introductions, Joint

Commission (JCAHO) and Occupational Safety and Health Administration (OSHA)

training, and marketing opportunities to name a few.

By the time orientation is complete for the clinic and the hospital, the new

physician should feel comfortable picking up the ball and running with it. He or she

28

has now been provided with the platform to become successful in their day-to-day

practice of medicine.

Conclusion

In conclusion, recruiting a new physician leader is a process, not an event.

Recruitment plans, effective recruitment strategies, and comprehensive onboarding

techniques must be well thought out into one streamlined process that ultimately

leads to the right fit for the group. No one part of the process serves greater

importance than the other. They overlap and intersect in every aspect along the

way.

Understanding the business plan and recruitment model will help source the

right candidates for the opportunity. Anticipating questions and feedback, providing

honest and transparent answers to the candidate, and following up quickly on

outstanding items will ultimately work in the group’s favor towards landing the

candidate. The subsequent onboarding process then becomes a platform to

differentiate the group from the rest and introduce the very values that were sought

out when the search began for the new physician leader.

Tackle healthcare changes and physician turnover as an opportunity to

transition the group into a high performance medical group. More and more

emphasis is now being placed on strong physician leadership that can instill a

culture of change in the healthcare environment. Take the time to get recruitment

and onboarding strategies right and deliver the community a new physician leader

they can embrace for years to come. Be steadfast in commitment to the industry, be

29

true to beliefs as an organization, and foster the very resources who keep us in

business, the physicians.

30

Bibliography Advisory Board Company, “2009 Advisory Board Physician Engagement Survey,” The Advisory Board Company, 2009. Advisory Board Company, “Medical Staff Engagement Benchmark Report: 2012: Insights from the Physician Engagement Initiative National Database,” The Advisory Board Company, 2012. Advisory Board Company, “The High-Performance Medical Group: From Aggregations of Employed Practices to an Integrated Clinical Enterprise,” The Advisory Board Company, 2011. American Medical Group Association [AMGA], “Physician Turnover Rates Mirror Economic Conditions and Housing Market: Medical Groups Report Increased Turnover as Economy Recovers According to AMGA and Cejka Search Survey,” Virginia, April 18, 2011, accessed November 29, 2012, (http://www.amga.org/AboutAMGA/News/article_news.asp?k=508). American Medical Group Association [AMGA], “The Recession and the Three R’s of Healthcare: Reform, Recruitment, and Retention: Medical Groups Are Adjusting to Meet Economic Challenges Reports Cejka Search and AMGA Survey,” published March 30, 2010, accessed November 29, 2012, (http://www.amga.org/AboutAMGA/News/article_news.asp?k=365). Association of Staff Physician Recruiters [ASPR], “ASPR In-House Physician Recruitment Benchmarking Report; Executive Summary,” (http://www.aspr.org/displaycommon.cfm?an=1&subarticlenbr=720). Bauer, T. N., & Erdogan, B. (2011). Organizational socialization: The effective onboarding of new employees. In S. Zedeck (Ed.), APA handbook of industrial and organizational psychology, Vol 3: Maintaining, expanding, and contracting the organization, APA Handbooks in Psychology (pp. 51–64). Washington, DC, US: American Psychological Association. Beeson M.D., Stephen C., Engaging Physicians: A Manual to Physician Partnership. Florida, Fire Starter, 2009, 45-53. Broxterman, Michael P., and Abdo, Wendy, “How to Choose a Physician Recruitment Firm Part II: Making the Right Choice,” accessed January 4, 2012. (http://www.phg.com/article_a049.htm).

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Business Today, “Wordsmith: Onboarding,” published August 21, 2011, accessed May 30, 2014, (http://businesstoday.intoday.in/story/meaning-of-word-onboarding/1/17632.html). Cody Hall, e-mail message to author, December 20, 2012. Collins English Dictionary, “onboarding,” accessed May 30, 3014. (http://www.collinsdictionary.com/dictionary/english/onboarding). Ecclestone, Donna, “Onboarding and Retention: Key Areas of Focus Gleaned from 2012 ASPR Annual Conference,” Journal of ASPR, Fall 2012, (http://www.aspr.org/displaycommon.cfm?an=1&subarticlenbr=757). Eric Rubin, e-mail message to author, January 4, 2013. Erra, Drew, & Hogue M.D., Michael, “Creating a Cost-Effective Process for Physician Recruitment,” Human Resource Strategy Third Quarter (2009): 57-63, accessed November 29, 2012. (http://www.stratfordfidelity.com/wordpress/wp-content/uploads/2011/06/Creating-a-Cost-Effective-Process-for-Physician-Recruitment.pdf). Giovino, MD, James M., “You Should See My Doctor”: Cost Effective Marketing Ideas for Your Practice,” Family Practice Management, January 2002, accessed May 30, 2014. (http://www.aafp.org/fpm/2002/0100/p33.html). Juliane Marino, e-mail message to author, January 7, 2013. Kevin Perpetua, e-mail message to author, January 4, 2013. Maloley, Ann, “Marketing Your New Physicians: A Critical Stage in the Onboarding Process,” ASPR Journal, Summer 2011, accessed May 30, 2014. (http://www.aspr.org/?468). Mark O’Bryan, e-mail message to author, December 19, 2012. Merritt Hawkins, 2011 Review of Physician Recruiting Incentives: An Overview of the Salaries, Bonuses, and Other Incentives Customarily Used to Recruit Physicians. Texas, Merritt Hawkins, 2011. Merritt Hawkins, on behalf of The Physicians Foundation, Health Reform and the Decline of Physician Private Practice: A White Paper Examining the Effects of The Patient Protection and Affordable Care Act On Physician Practices in the United States. Physicians Foundation, 2010, 43-46.

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Merritt, James, Hawkins, Joseph, and Miller, Phillip, Merritt, Hawkins & Associates: Guide to Physician Recruiting. Third Edition. Missouri, Practice Support Resources, 2009, 9-10, 91-92, 107-108. Tawoda, Taryn, “5 Strategies for Physician Recruitment in Competitive Markets From ASC Administrator Christy Franck,” Becker’s Hospital Review, March 21, 2012, accessed November 29, 2012, (http://www.beckershospitalreview.com/asc/5-strategies-for-physician-recruitment-in-competitive-markets-from-asc-administrator-christy-franck.html). Vitale, M.Ed., Ed.S., J.D., Joe, “Cleveland Clinic: A Guide to Physician Recruitment,” accessed November 29, 2012, (http://my.clevelandclinic.org/Documents/Alumni/A_Guide_To_Physician_Recruitment.pdf). Webster’s New World Dictionary of American English, Third College Edition. Macmillan, USA, 1994, 301.

33

EXHIBIT A

LETTER OF ACCEPTANCE [Date] [Name], MD/DO [Address] [City], [State] [Zip] [Phone Number] Dear Dr. _________: We are pleased to make you an offer to join the physicians of (Organization Name) and (Hospital/Health System Name) as a [Specialty] physician in (City, State). We know you will be an excellent fit and a welcome addition to the community and medical staff. Terms of Offer The terms of your agreement shall commence on or about __________, 20__ or as soon as you are 1) licensed to practice medicine in the state of _________, 2) credentialed through the medical staff offices at (Hospital/Health System Name), 3) are approved for malpractice coverage and 4) are on insurance company panels . As part of that agreement you will be supported with the following: 1. Base guarantee salary of $[Salary] 2. $________ sign-on bonus 3. $_,000 for CME 4. $_,000 for Dues, Licensure, & Certification 5. Malpractice Insurance 6. Full Benefits Eligibility 7. Relocation Assistance in the amount of $_________ Offer Letter, Credentialing and Agreement We request your assistance and cooperation by promptly completing the necessary applications, including the credentialing packet, which will be provided to you. This letter of acceptance is contingent upon the satisfactory completion of all references, credentialing, and approval by all applicable committees. This letter of acceptance must be signed prior to the release of the formal agreement. Your signature below accepts the terms and conditions of this letter of acceptance, and the intent of (Organization Name) to cease recruiting efforts for this position, while both parties work in good faith towards the completion of the final agreement. __________________________________________ ______________________________ ___________________, M.D. Date __________________________________________ ______________________________ _______________________, President & CEO Date (Organization Name)

34

EXHIBIT B

Action Item OwnerDate

Complete

On-Boarding Plan Checkl i s t Generated

Current CV - obta ined and sent out

Noti fy team of new practi tioner contract incl . W-9

Letter of Intent Received

Executed Contract scanned to database

Firs t week orientation schedule prepared

Requested Department number (i f s tart-up)

Mentor ass ignment

Med Staff - Packet of documents sent to phys ician

Med Staff - Completed packet & required

documentation received from phys ician & sent to Med

Staff

Med Staff - Approval Received

Med Staff- CMO Approval

Med Staff - Board of Directors ' Approval

Background Release Form

Medica l License Issued

Profess ional Reference Questionnaires mai led

Letter from Phys ician requesting temporary privi leges

Card access , parking, dictation #, card

CAQH Login & Password received

NPI Number, Login & Password received

Case log his tory received

Malpractice Insurance in Place

Notice of Privacy Practices

CLIA Certi ficate

OSHA & LEARN

Qual i ty (as needed - PCPs)

Phys ician Signing Bonus Pa id (i f necessary)

Sa lary

Financia ls

Proforma Created

TALEO - Entered into system

TALEO - Completed to hi re

Local address obta ined & updated in HR/Payrol l

Pos i tion # created

Benefi ts Information

I-9

Relocation (i f needed)

FINANCE

NEW PHYSICIAN ON-BOARDING CHECKLIST

PHYSICIAN DETAILS

Full Name: Specialty:

Home Mailing Address:

New Practice Name: Department No.: Start Date:

New Practice Address: Phone/Fax:

Covering Physician:

Notes

RECRUITMENT

Phone No.: Email Address:

CREDENTIALING

HUMAN RESOURCES

35

CRP Education

LEARN Ass ignment

OIG Roadmap for New Phys icians

Key Referra l Network Introductions

Bio Card Profi le Sheets

Photo Shoot Coordinated

Upcoming Marketing Events

Ad in Newspaper

Phys ician Newsletter

Intranet Introduction

Employee Newsletter

Hospita l Orientation / Introductions

Office Phone

Cel l Phone

Wireless

Copier, Fax, Printer

Identi ty Management Request

Computer profi le - set up /emai l / outlook

Remote Access

PPMS

ePrescribe

Meditech Tra ining / Password

Charttmaxx Tra ining / Password

Dictation Tra ining

Phys ician Coding Education

Compl iant Documentation Management

Faci l i ties need assessment

Exam Room Equipment

Office Furniture Ordered / Received

Office Suppl ies Ordered / Received

Cl inica l Suppl ies Ordered / Received

Lease Created

Lease Signed

Cl inic Signage Ordered / Received

Phys ician Coding Education

Bus iness Cards ordered

Benefi ts Enrol lment/Direct Depos i t

Provider Appointment Schedule

Staffing Needs

OS Forms/ Fee Tickets

Tra ining and on-boarding for s taff

Schedule PPMS Tra ining / Password

Lab Coat

Surgica l Preference Cards (for surgeons)

Block Time

Scrub fi tting / card

COMPLIANCE & SAFETY

MARKETING

MEDICAL RECORDS / HEALTH INFORMATION SERVICES

FACILITIES

TECHNOLOGY AND INFORMATION SERVICES

OFFICE MANAGER

CODING

OTHER

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Endnote

1 Merritt, James, Hawkins, Joseph, and Miller, Phillip, Merritt, Hawkins & Associates: Guide to Physician Recruiting. Third Edition. Missouri, Practice Support Resources, 2009, 9-10. 2 Association of Staff Physician Recruiters [ASPR], “ASPR In-House Physician Recruitment Benchmarking Report; Executive Summary,” (http://www.aspr.org/displaycommon.cfm?an=1&subarticlenbr=720). 3 Erra, Drew, & Hogue M.D., Michael, “Creating a Cost-Effective Process for Physician Recruitment,” Human Resource Strategy Third Quarter (2009): 57-63, accessed November 29, 2012. (http://www.stratfordfidelity.com/wordpress/wp-content/uploads/2011/06/Creating-a-Cost-Effective-Process-for-Physician-Recruitment.pdf). 4 Juliane Marino, e-mail message to author, January 7, 2013.

5 Mark O’Bryan, e-mail message to author, December 19, 2012.

6 Cody Hall, e-mail message to author, December 20, 2012.

7 Webster’s New World Dictionary of American English, Third College Edition. Macmillan, USA, 1994, 301. 8 Eric Rubin, e-mail message to author, January 4, 2013.

9 Broxterman, Michael P., and Abdo, Wendy, “How to Choose a Physician Recruitment Firm Part II: Making the Right Choice,” accessed January 4, 2012. (http://www.phg.com/article_a049.htm). 10 Kevin Perpetua, e-mail message to author, January 4, 2013.

11 Merritt, James, Hawkins, Joseph, and Miller, Phillip, Merritt, Hawkins & Associates: Guide to Physician Recruiting. Third Edition. Missouri, Practice Support Resources, 2009, 91-92. 12 Merritt, James, Hawkins, Joseph, and Miller, Phillip, Merritt, Hawkins & Associates: Guide to Physician Recruiting. Third Edition. Missouri, Practice Support Resources, 2009, 107-108. 13 Ibid.

37

14 Collins English Dictionary, “onboarding,” accessed May 30, 3014. (http://www.collinsdictionary.com/dictionary/english/onboarding). 15 Business Today, “Wordsmith: Onboarding,” published August 21, 2011, accessed May 30, 2014, (http://businesstoday.intoday.in/story/meaning-of-word-onboarding/1/17632.html). 16 Ecclestone, Donna, “Onboarding and Retention: Key Areas of Focus Gleaned from 2012 ASPR Annual Conference,” Journal of ASPR, Fall 2012, (http://www.aspr.org/displaycommon.cfm?an=1&subarticlenbr=757). 17 Maloley, Ann, “Marketing Your New Physicians: A Critical Stage in the Onboarding Process,” ASPR Journal, Summer 2011, accessed May 30, 2014. (http://www.aspr.org/?468). 18 Beeson M.D., Stephen C., Engaging Physicians: A Manual to Physician Partnership. Florida, Fire Starter, 2009, 45-53.