Top 12 mistakes in physician recruiting

Ophthalmologists need to perform due diligence at an appropriate pace when making a new hire.

Issue: January 10, 2016

ByJohn B. Pinto

“Never hire someone who knows less than you do about what he’s hired to do.”
– Malcolm Forbes

“When I’m hiring a cook and I want to see what they can do, I usually ask them to make me an omelette.”
– Bobby Flay

Most doctors I know do a better job picking out a new dog than picking out a new provider for their practice.

They study prospective breeds. Consult their vet. Talk to other owners. They spend time playing with every dog in the litter and gauge the temperament of each. They make sure everyone in the family approves the choice. And then they buy all the necessary supplies and toys way before the new pup is even brought home.

Then then play with the new puppy every day to encourage its development, mold its behavior and increase its utility.

This is not so much the case in ophthalmology, where about 50% of the time a partner-track associate is fired or resigns before he or she makes partner.

We need to do better, not only for the sake of your practice, but for the sake of young and mid-career surgeons who are appointed to the wrong jobs.

1. A lack of pre-hire preparation. It is easy to overlook that the practice of ophthalmology requires a symphony of resources to be successful. You should have draft employment terms and a folio of information on your practice and community well before you start reviewing candidates. As far ahead of your new doctor’s arrival as possible, patients have to be mustered, staff trained, facilities and equipment primed, and payer contracts inked. A generation ago, with a relative abundance of dollars and ready patient access, you could take a “field of dreams” approach: hire the doc, and the patients and cash flow will come. With today’s lower profit margins, and paradoxically, much higher base salaries, you need to avoid delays in getting patients to your new doctor, claims to insurance companies and dollars back into the practice. Do not be like the pet owner who brings a new puppy home without any accessories.

2. Having a too-small candidate pool. It is a pity we cannot be like Hollywood directors, who audition hundreds of actors to fill a single role. Unfortunately, we are making new ophthalmologists at only about one-quarter the pace of demand growth for eye care. Even if you are diligent in your search for physician candidates and practice in a popular coastal market, you may have only a half-dozen CVs to consider. And if you pursue rural practice in the flyover states, a year of hard promotion may only scare up a candidate or two. Whether you practice in La Jolla or Dubuque, exert efforts sufficient to generate the largest number of potential candidates for your location. For the Iowa practice (no knock on Iowans, lovely folks), this may go beyond the usual AAO postings, ads and networking and include a multi-state letter-writing campaign or recruiting bonus loans provided to first-year residents.

3. Not using a headhunter, especially if you practice in rural America. Because there are more jobs than qualified candidates, an increasing number of ophthalmologist jobs are now being filled by search firms. This can add another $20,000 to $30,000 to your hiring costs, but consider the typical economic facts. If you are trying to find a surgeon who will generate $1 million a year and can hire someone 3 months faster through a headhunter, you are dollars ahead.

4. Not enough candidates interviewed. Screening and interviewing are draining, expensive, unfamiliar work. That is why it is easy to phone the first candidate you come across, fly through a single half-day interview and make an offer. This may rarely be obliged if you are desperate to onboard a provider or if you are in a hiring tug-of-war with another practice. But it is far more prudent to interview the widest possible candidate pool.

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5. Not disclosing your practice’s facts, figures and warts. Transparency is the watchword today. It is expected by candidates and their advisers, and it actually serves your practice’s interests, as well. Finalists for a partner-track position are typically furnished current financial statements, patient visit and surgical case volumes, and sample partnership agreements. In doing due diligence, it is reasonable for a final candidate to ask a few embarrassing questions about any doctors who have left the practice recently or about payer sanctions or contract loss.

6. Delays in progressing through the natural recruitment steps. Once you have launched a search and started collecting CVs, it is not a time to dawdle. I have seen search committees wait a couple of months for all of the CVs to arrive before commencing interviews, by which time the first CVs received are likely stale. The vetting path from candidate to new hire should be both comprehensive and brisk because you are likely competing with other practices:

Week 1: A CV arrives, and if it is in the least bit promising, you will want to call the candidate for a screening interview. Keep in mind that even speaking with weak candidates can give you clarity about who you want to hire.
Week 2: If the candidate passes the first screening call, a longer and more formal phone interview should be arranged with one or more members of your practice.
Weeks 3 to 6: If the candidate is still in the running, an on-site interview should be arranged. If the candidate is local, this interview can take place almost immediately. If the candidate has to fly in, some scheduling delays may be obliged. References should be called before going to the time and expense of travel. This on-site interview should not be less than a day (2 to 3 days would be better) and should include an opportunity for all or nearly all lay staff to meet the candidate. During this interview, you can furnish the candidate with a basic outline of prospective terms, as well as a review of the history and financial and volumetric performance stats of the practice, where appropriate.
Weeks 7 to 10: Assuming you like the candidate and the feeling is mutual, the next weeks are taken up with whatever deeper reference checks are indicated, contract negotiations and perhaps most importantly a visit by you or one of your practice colleagues to observe the candidate in clinic and live surgery.

7. Not enough quality face time with the candidate. Ophthalmologists, who are socially well-practiced and talkative in front of patients, can be shy creatures around each other when they meet for the first time. So your natural tendency might be to have the candidate shadow you for a couple of hours, go out to dinner together and call the job done. Not nearly, especially if you are hiring a partner-track physician. The first few hours that you are with a candidate, he or she is likely to be on their best behavior. Conversations will be shallow. You should no more settle for a few contact hours with a potential business partner-to-be than you should before proposing marriage. If at all possible, top candidates should be scheduled for a flexible, multi-day interview, so that if things are going well they can stick around, get to know you and your practice better, and investigate the community. Do not be shy in asking to arrange a second on-site interview. The associated travel costs are cheap compared with the cost of making a bad hire.

8. A too high or too low base salary. Thirty-five years ago, a newly minted ophthalmologist could expect a sub-$100,000 base salary. Fifteen years ago, $150,000 was a strong offer. Today that figure is $225,000 and up in most markets, and rising. It is false economy to post a job for $175,000 and wait 2 years for a third-tier candidate if you have a backlog of patients to serve today. You also do not want to overshoot and pay materially over market. Local colleagues in larger practices, headhunters and consultants have a good feel for local market rates. Learn what is fair and contemporary before you post your job.

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9. Over- or undershooting perks and benefits. Here is the current typical package of benefits for a partner-track general ophthalmologist:

Bonus compensation of 20% to 40% of collections in excess of 2× to 3.5× base compensation.
Up to $10,000 in relocation costs.
100% of full family health insurance.
$3,000 to $5,000 stipend for continuing education.
4 to 5 weeks of paid time off (combined vacation, sick leave, CE time).

10. Not disclosing partnership terms upfront. A generation and more ago, when asked about partnership, senior surgeons would pat their young associates on the head and say, “Trust me. We’ll be fair to you when the time comes.” Today, with more jobs than applicants (and much more business-savvy applicants, now often armed with a professional adviser or two), it is becoming the overwhelming norm to disclose prospective ownership terms. These terms are always subject to change, and partnership is never guaranteed (nor obliged), but frame up your good faith expectations. These terms typically include:

General guidelines and thresholds for “making” partner (number of years as an associate, revenue, case and visit volume expectations, extracurricular duties, etc.).
Elements of the practice potentially available (core practice, optical, buildings, ASC, etc.).
Percentage of each element contemplated to be shared with a new partner.
Price or pricing methodology contemplated.
Financing approaches for the buy-in.

11. Unclear standards and goals. Be clear, both verbally and in the formal contract language, about expected work hours, visit volumes, revenue productivity and surgical assertiveness. Decide before you make the hire whether you want a durably junior colleague to soak up your medical overflow and slog through postops or a fire-breathing surgeon.

12. Making a hire when there is not enough work to go around. There is no firm rule of thumb here. You may be a soloist working more than you like, willing to cannibalize your practice to have a better work-life balance. Or you may be in a group practice with a 3-month appointment backlog. Either works and substantiates bringing on a new provider. What does not work is hiring a new physician into a group of competitive, underemployed surgeons and expecting the new associate to cover his overhead in the first year.

Of course, the 13th mistake would be not properly managing a new provider once he or she been hired. Here is just a partial checklist:

Applying tough, consistent standards (for example, not letting an associate simply go home if the afternoon is light, but rather having him or her pursue outreach activities).
Making it clear who the associate reports to and matching him or her to a senior provider in the practice.
Monthly graphical performance tracking (eg, visits, collections, surgical cases, collections per visit, visits per case, etc.).
Monthly coaching meetings in the first year; quarterly in the second year.
Brisk intervention and a formal corrective action plan in the event of performance gaps.
Checking in to assure that the physician’s family is settling well into the community.

The typical well-bred dog costs around $1,500, and if he does not work out, you can take him back to the breeder and get your money back. The typical well-bred eye surgeon costs about $250,000 to recruit and employ, and even more to send back to his litter mates. Choose wisely.

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, Ophthalmic Leadership: A Practical Guide for Physicians, Administrators and Teams and a new book, Simple: The Inner Game of Ophthalmic Practice Success. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.