Authors: Kriss Barlow and Allison McCarthy
While the specifics and the specialty may change, messages like this are being heard and felt by many organizations. Physician recruitment is becoming a central challenge for healthcare experts, and the issue is affecting strategies and marketing opportunities across the board. A recent HealthLeaders Media CEO study found that physician recruitment was their second priority — behind quality/patient safety — for the next three years. If marketing has yet to feel that pressure then they will soon.
When demand is high, physicians have their pick of opportunities. But even with attractive lures and potential perks, many say they’re less willing to “hang in there” and face today’s challenges. Increased paperwork, rising malpractice costs, and more hassle in general are but a few reasons why practitioners say they’re eyeing early retirement, or at least downsizing their practices and hours.
With nearly 90% of hospitals actively recruiting, according to recent surveys, recruiting and retaining quality physicians is a strategic issue at the center of organizational growth. Recruitment has become a longer and more difficult process, given the competition from other organizations to hire away current staff.
Staffing needs. In every aspect of healthcare today, competition is intense. Organizations that have been through the cost-cutting process are now looking to develop strategies to grow patient volumes. Increasing patient loads means increasing the staff to care for them. A great deal of attention has been given to the workforce shortage in nursing, technical/radiology staff, and pharmacy. But there’s no doubt that having adequate physicians is becoming an ever-present challenge as well. A 2008 survey by Merritt, Hawkins & Associates shows that, while more hospitals are looking for family medicine physicians, general internists and hospitalists, there are also significant challenges in the specialties of ob/gyn, orthopedics, general surgery, radiology, and psychiatry.
Physician-level market dynamics. As an organization frames its business strategy, several agenda items are likely to take center stage. These include the hospital’s desire for expanded specialty offerings, growth of subspecialty niche areas of expertise, retirement, increased lifestyle expectations of many physicians, and the wealth of opportunities and dollar offers before them. Planning and marketing professionals need to be keenly aware of the physician’s capacity to take on more patients and the strategic implications when the practices are full.
Medical staff development. Planning a recruitment strategy requires a clear roadmap. You’ll need to make informed decisions about the realities of the marketplace, consumer demand in your area, and legal guidelines worth noting. When doing your medical staff development plan, beyond the quantitative ratios, talk with members of the medical staff and complete a qualitative assessment. In some cases, mystery shopping of area practices might be in order to confirm or dispute the numbers. Together, these factors will help determine the true physician need in the market. This information then needs to be converted into annual objectives — prioritizing the total number to recruit in the coming year versus the year after and beyond. From there, an assessment can be made as to whether the right internal resources are in place to manage that recruitment load or if additional sources need to be identified to ensure the annual objectives are achieved.
Rules and regulations. In addition to Stark legislation (ethics in patient referrals), inurement issues, and federal mandates, recruitment is also affected by state-level regulations. When we assisted in recruiting a cardiac surgeon to a new hospital program in Massachusetts, we knew the commonwealth was still a Certificate/Department of Need — regulated state — a condition that made it extremely attractive to cardiac surgeons in deregulated and extremely competitive markets. This particular physician was eager to consider relocating to another area where he would be more likely to build a thriving practice.
Location, location. Recognize that physicians typically make recruitment decisions based on their geographic preferences. And every locale has pros and cons that must be considered when you launch a recruitment search. An organization needs to know and understand what implications these preferences will have on the specific search. For some specialties, like the pediatric subspecialties, the total number of physicians is so small that a national search is obvious. In other areas such as primary care, it is helpful to refine the search criteria to create a manageable pool. Share this with the internal decision makers so they understand the decisions made and the potential. For example, internal medical search criteria that rules out international medical graduates can significantly reduce the number of physicians available. Then if the criterion further refines the search by gender, age, etc, .the prospect pool can become too small to be realistic. Beyond helping the organization understand the competition they would face in conducting the search, this framework will also help the organization be prepared to do the following:
- Respond to candidates’ questions
- Identify the best methods for sourcing candidates
- Set clear expectations about the timeframe needed for the search
- Energize the recruiters, practice partners and others charged with creating a practice development and/or retention strategy that post-recruitment efforts are just as vital to retain that newly acquired provider
Ingredients for Success
The formula for finding a good fit requires close examination of your organization, warts and all. The following elements can help you assess your environment, tailor your recruitment process, and better ensure that your hires will be a good match.
Practice opportunity. To attract quality candidates, an organization needs to offer an attractive practice environment. This is the time to take a close look at what you offer. Prospects are looking for sound financial practices and positions, existing demand for physicians in that specialty, strong operational support systems, and a balanced call schedule.
Market-competitive package. Compensation today includes not only a base salary but an entire package. Review the local and national markets to ensure you’re competitive. Specialty areas are growing rapidly with demand outpacing supply. Don’t assume the financial package you put together a couple of years ago is still relevant.
There are many resources available that benchmark physician compensation. Do your homework before starting the search. Signing bonuses are becoming quite popular, and paid relocation is a given in today’s market. If you’re competing with other hospitals or groups that offer insurance and retirement benefits, make sure these package elements are competitive as well. Anecdotally, B/Mc is also hearing an increasing number of organizations offering monthly stipends for residents, provided during training, in return for early contract signatures. This helps the residents during their financial crunch while the hospital expects the search is completed and the resident in locked into a position post-training.
Good sales and communication skills. While no one likes to talk about the “s” word, selling is a critical element to the recruitment process. Your recruitment team is selling the benefits of your organization in every email, every phone call, and every communication — but without overwhelming your prospects. Strong interpersonal skills include the ability to ask thoughtful questions and listen carefully to responses. Marketers can help with the right messages and background on the organization and the community offerings. The group also needs to use developed criteria and its instincts to find candidates who would fit with the organization, the community, and the medical staff. Designate individuals who are skilled in doing the “close” at the right time.
Internal commitment to the process. Assess what resources are available to support the recruitment process. This is a team effort and everyone, including current physicians and administration, needs to work in tandem to demonstrate their commitment to the effort. This means being available for conference calls, site visits, social events, tours, and administrative meetings. Marketing and planning provide a great deal of support in many programs and add value to the process. The key is in understanding the role of each team member, how the process works, and how the system can be positioned for the prospective physician.
Once you’ve completed an internal assessment and have a good understanding of the practice opportunity, approach you’ll use, timeline, and accountabilities, it’s time to ensure the internal team is prepared to show the practice or organization in its very best light. The team that works on the internal assessment often is involved in the actual recruitment process as well. The group should include practice partners and other physicians the candidate may work with, administrators who will provide the business side, and hospital/group members. Generally, an in-house recruiter leads the group. If your organization doesn’t have one, however, marketing may play a more active part in the process.
The group will also need to be actively involved in efforts to retain a candidate that begins practicing in the organization. The group’s role doesn’t end when the candidate becomes a new hire. Actually, it’s just the beginning of making sure the new hire feels comfortable, finds a collegial environment, and has the resources to get the job done.
The Prospect’s Perspective
As you work through the process and begin interviewing candidates, step away from your role and look at things through the prospect’s eyes. Observe the messages the practice, prospective partners, and the organization is sending to candidates. Even what’s not being said can be telling. Remember that candidates select their opportunities, in large part, on first impressions — just as you do with them.
Physicians expect flaws in every organization. But they pay particular attention to how honestly and sincerely the organization communicates with them — and they’ll see through those who aren’t being candid. Don’t be afraid to admit a few shortcomings in your organization. Your prospects will appreciate knowing the truth up front, which may tip the scales in your favor in the long run.
In highly competitive searches, it’s a challenge to keep the funnel full. Our best advice for making sure you can be selective is to continue to make contacts and continue the recruiting process, no matter what your immediate needs.
Remember that this is a team effort and it takes everyone’s commitment to make it work. It would be great if we could wave a magic wand and have the perfect candidate appear before us. But in the absence of that, do your best to nurture an environment where discipline, diligence, and diplomacy come together to bring the desired results.
Sourcing, the process of searching for candidates that match your practice opportunity is unique to each recruitment effort. Marketing and the recruitment team should consider these factors when determining how to develop the best approach for finding the right candidates
- Urgency. If the group needs someone within a short time frame, the best option may be to target local physicians already licensed to practice in that state and possibly adjust your budget accordingly. The other option is to use more resources to expose the opportunity to more candidates in a shorter period of time.
- Experience required. This factor will determine whether you approach only physicians with a certain amount or type of experience or whether you can expand to residents and fellows just completing training.
- Geographic appeal. Know how to use the organization’s location to appeal to the physician’s lifestyle and professional interests.
- Support systems. Enlist the group’s administration and medical staff to make recommendations. Network with area training program leadership or academic/tertiary affiliates to help generate leads. Offer residency rotations to expose trainees to the local hospital and practices. Be sure to work those leads hard when you have them.
- Financial picture. Your recruiting budget can vary, depending on several factors. Will you use a search firm, pay for a resource person to source candidates, or use recruitment databases, direct mail or print advertising? Remember, if there’s less geographic appeal, more experience, or more urgency involved in your search, figure extra dollars into your budget.
Each individual search should have its own recruitment plan. A customized plan will help you strategically identify the best tactics, organize the process, establish clear timetables, and highlight issues that need to be addressed before you begin the search.