Eight pearls when hiring a new ophthalmologist

Strong candidates are harder to secure today than in the past.

Issue: October 10, 2014

ByJohn B. Pinto

“One cannot hire a hand; the whole man always comes with it.”
– Peter Drucker

“If you think it’s expensive to hire a professional to do the job, wait until you hire an amateur.”
– Red Adair

“The secret of my success is that we have gone to exceptional lengths to hire the best people in the world.”
– Steve Jobs

The human resources motto “Hire hard, manage easy” applies to all levels of staff recruitment, but nowhere more critically than in hiring new doctors to join your practice. Ophthalmologists are your most expensive employees. With a drop in residency training slots, candidates are getting much harder to secure, particularly in non-coastal, non-urban markets.

In addition, there are fewer A-level job candidates. After more than 35 years in the field, I can attest that the young MD and DO candidate base is less uniformly superior. They need to be sifted through, screened and vetted more thoroughly than in the past.

Three decades ago, most newly minted surgeons were workaholic careerists at the top of their undergraduate class. Now? Not so much. Some of the most intellectually gifted and ambitious students have chosen careers in information technology, law and business. While most of the medical students who remain are smart enough to come and work for you, they tend to have a bit of “beta” mixed in with their “alpha” characteristics. This can be especially frustrating for older surgeons, whose idea of work-life balance is to add an exercise room to their clinic.

This month’s discussion can be seen through the lens of either the hiring practice or the physician being hired — both have a critical stake in how things turn out. But what follows is written from the perspective of a surgeon or administrator who is recruiting a new doctor. Here are eight pearls.

Pearls for hiring a new doctor

Be clear about what you want. This sounds obvious but is often overlooked. New, unplanned hires are often made just because “somebody nice” walked through the front door. Write a draft position description and a draft employment contract, which will force you to think about the priorities. Do you need full time or will part time do? Is this a partner-track position? What will the buy-in terms be? If you are looking for a medical retina or glaucoma subspecialist, would you also like him to handle comprehensive ophthalmology part of the time?
Be clear about the desired surgical and medical (and business) aggressiveness of your new doctor. Is she inheriting a full practice from a retiring doctor, or must she build a satellite office from the first patient chart? Have frank surgeon-to-surgeon discussions about care pathways and what constitutes an operable cataract. If you are interviewing a mid-career surgeon, ask him to supply a copy of his CPT report for the last several months — it is a wonderful snapshot of where he sets the bar.
It is obvious that you want to review the largest-possible candidate pool, which is getting tougher and more expensive all the time. Professional society listings are just a start. Mailings regionally and nationally are often obliged. An increasing number of positions are being filled by recruitment firms.
Hiring can be a tremendously subjective process. It helps to objectify this, even if artificially. Before you start to interview, make up a prioritized scorecard of the desired attributes of your new doctor. After each interview, try to score your candidate. This will help you remember each candidate you speak with and force you to be disciplined in your final choice.
Be clear about your work intensity expectations. Some surgeons live to work, but an increasing number today merely work to live. Both approaches are perfectly honorable ways to conduct a life, but take care that you do not match a low-key surgeon with a workaholic practice owner. Both will be profoundly disappointed.
Always hire collaboratively. When a new position opens, nominate a search committee; the typical composition would be a physician, a senior tech and the administrator. In a larger practice, the HR director will likely lead the process. However many people you have on the search committee, make sure that any final candidate has spent time with the widest possible cross-section of lay staff. Even the most junior front desk clerk may give you insights that you have overlooked. Ask one or two important referral sources to your practice to interview your finalist; they will be flattered to be asked and be more likely to support the new doctor when she arrives.
There are hundreds of potential interview questions. Here are two that are often overlooked:
- "Tell me a little bit about your first paying job." In my experience, the earlier that one works, the better and more reliable worker he is as an adult. You want an answer like, "I babysat when I was 13.” You do not want an answer like, “Well, I guess your job would be my first ever."
- "Imagine this situation … ." Posing hypothetical questions such as, "What would you do if you noticed a patient had stolen a dropper bottle in the exam room?" forces a candidate to think on her feet and reveal a bit of her moral compass.
Because it can be so costly to make the wrong hiring decision, an increasing number of practices are taking supplemental measures to gauge their final candidate’s fitness for employment and eventual partnership. These include:
- An interview with an industrial psychologist. Difficult personality traits can compound as one goes up the subspecialty and intelligence ladder.
- Visiting the candidate on site in his present job or training site to see him operate and work up patients.
- A much wider round of reference checks — not just talking to her department chair, but also to her head tech, the RN who runs the ASC and a couple of doctors who refer patients to her.
- An executive physical to rule out any occult problems.
- A criminal background check.
- A financial background check. Obviously this will be weak for a debt-burdened student, but a weak credit score for a mid-life surgeon can unmask problems that could affect his effectiveness on the job.

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Following up after the hire

Once the hire is made, it is critical to actively manage your new provider. You should coach all providers in your practice toward higher volumes and economic efficiency. Hold monthly performance review meetings, which should be largely upbeat, with new doctors. Make sure that partner-track doctors know what the hurdles will be to make partner.

Few associate providers or partner-track associate providers are “naturals” when it comes to practice building. Selling involves vulnerability to rejection, which is an anathema for most surgeons. You have to be specific about outreach duties:

Expected hours per week spent doing outreach lunches, screenings, etc.
Documentation and follow-up after each contact.
Tracking of results — at 6 and 12 months, are practice-building efforts working?
It helps to bond the young, shy associate to a lay staffer who can stay on top of him and help make appointments in the community, and to make sure the associate is not just touching each lead once but staying in longitudinal contact.

For more information:

John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. John is the country’s most-published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement, Cashflow: The Practical Art of Earning More From Your Ophthalmology Practice, The Efficient Ophthalmologist, The Women of Ophthalmology, Legal Issues in Ophthalmology and a new book, Ophthalmic Leadership: A Practical Guide for Physicians, Administrators and Teams. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.