The change in healthcare is shifting the recruiting market.
“What physicians were interested in used to be about the dollar and their salary. Now it’s about quality of life and how their partnership track is going to work,” says Helen Combs of Alabama Allergy & Asthma Center. She’s referring to a transformative shift in physician recruiting.
Combs chalks up the change to the young grads growing up in a generation where they “got medals because they were in the race, not because they won. So quality of life is important. They value their personal time, and that’s a shift.” See related story below.
Sheila McKenna, chief development officer at Brookwood Medical Center, agrees about the shift, but points to a different cause. “Look at the number of women coming out of med school. I think it’s more than 50 percent now,” she says. “It’s absolutely changing the face of medicine.”
But Combs stresses that the challenge still rests on “finding a good match for our practice.” She’s recruited five specialists for their practice in the last eight years, and estimates it absorbs about 200 hours to recruit each one, but spread over years.
That’s a common error made by practices in need of a new physician, agree both recruiters. “They assume they can start looking in January for a physician to start in June,” Combs says.
Allow about three years to find the right specialist to fit a practice. Newly graduated specialists, especially, will have jobs years before they can start. “They’re looking two years in advance,” Combs says. “They feel like they’re behind if they don’t have a job before the last year of their fellowship.” McKenna says the most difficult fields to recruit for right now are urology, endocrinology, gastroenterologist, and rheumatology.
The biggest error made by recruiters is over promising. “Give the physician all the information,” Combs says. “They will ultimately find out anyway. Yes, you have the best front desk, but you also have high nurse turnover or the smallest breakroom ever.”
Because practices can differ greatly in their culture, “You have to really listen to what the candidate is asking for and make sure it matches what the practice needs,” Combs says. Practices with a more academic and teaching slant make decisions differently than ones focused solely on providing quality patient care under a business model.
If recruitment seems daunting, practices can hire recruiters or allow hospitals to do the task for them. For Combs, “recruiting independently from a hospital allowed us a lot of flexibility and a lot of professional leeway.”
McKenna says federal restrictions limit what hospitals can offer, but the financial advantages can allay the fears of investing in a new hire. “We offset 100 percent of the incremental costs for that first year,” she says.
Under that first-year list hospitals can pay for the physician’s salary, malpractice insurance, additional support staff, EHR licenses, handheld tablets, and more. “It’s all operating dollars, not capital expenses,” McKenna says.
For hospitals, recruiting for themselves holds greater promise these days. “A much higher percentage of physicians coming out of medical school are actively considering looking into hospital employment,” says McKenna, because of the uncertainties surrounding reimbursements and healthcare in general.
A completely different aspect of recruitment lies in finding temporary replacements for physicians. “Seventy-five percent of our work is filling locum tenens,” says Karen Belk of Belk & Associates. Locum tenens literally means place-holder in Latin.
Residents form the prime recruitment pool for locum job applicants. “Residents who can moonlight are ecstatic, because it helps them with their family obligations,” Belk says.
But about fourth of the physicians Belk hires hold permanent positions elsewhere. “They pick up a Saturday shift or an after-hours shift at the walk-in clinic. It’s a great way to make extra income if the kids are going to college or their IRA is dropping.”
Surprisingly, many of the physicians Belk recruits work temp jobs only, especially emergency room physicians. The advantages include flexibility and the golden enticement of paid malpractice coverage.
“The best locums are retired from private practice,” says Belk, who estimates retirees compose about 40 percent of her locum recruitment. “They keep their license when they retire, travel for a bit, and then start missing that patient interaction. They don’t realize this option is available. Our clients need them, and we cover their malpractice.”
The struggle for Belk in recruiting, like for all recruiters, arises when searching for primary care physicians. “If I open my database, I could find someone needing a family physician or ER doctor in every county in Alabama. Probably two or three,” she says, stressing again her wish for more retired physicians. “I wish I could clone the good ones I’ve got; the need is so intense.”
Brookwood’s McKenna also hungers for more primary care physicians. “There’s such a small pool to pull from that primary cares have a lot of options,” she says. “If I had all the cash I needed, I’d hire for twenty more sites. But it’s hard to find a really good physician.”
That need prevents Belk from wanting to focus more of her business on permanent placements. She says she could call every hospital and every clinic in Alabama and get a contract to fill permanent positions. “But why do that if there’s not enough candidates to fill those contracts?” she asks. “I’m not looking for new clients; I need more physicians.”
Anecdotes from Physician Recruiters
by Jane Ehrhardt
Recruiters can see some interesting sides to physicians looking for positions. Some simply hold too high of an expectation and others don’t seem to grasp that an interview with a recruiter is still a job interview.
Sheila McKenna, chief development officer at Brookwood Medical Center, is always surprised when physicians show up with their spouses. “I wonder if I’m interviewing the spouse or the physician,” she says. “And these are experienced physicians.
“It’s not the women, and it’s not the older men, and not very often,” she says, and adds that spouses are always encouraged to come on recruitment trips. “But who brings a spouse to a job interview?”
It’s even more startling when the spouse takes a more active role in the interview or the negotiations than the applicant. ”I don’t know where they end up, but they don’t end up here on our campus,” she says.
Helen Combs of Alabama Allergy & Asthma Center says her most interesting candidates were twins who wanted to join the practice together. “In a medical practice having physicians with the same last name and same exact appearance would have been a nightmare,” she says.
“Can you imagine someone calling to make an appointment with ‘that doctor’?” she says. “You’d finally figure out it was Dr. Brown, but then what do you ask? Knowing it’s the one with brown hair doesn’t help, since they’re identical.”
Both recruiters agree that the hardest experiences they face are when they lose a good recruit. “We thought we were ready to hire, and then after we’d done our recruiting, we realized we needed to put the brakes on our growth. This was a really good candidate too, but it’s not like she could wait six months for us to be ready,” says Combs.
For McKenna, it’s recruits leaving shortly after joining. “Some have stayed only a year, some less,” she says. “It does not happen often, but when it happens, it hurts, because we’ve put a lot of time and effort, not to mention money, into finding the right person. It took a tremendous effort to prepare a practice for them to come on board.”
