Successful Physician Search Process for Health Care Organizations

By Martin H. Osinski and Michael J. Kirschner

Conducting a comprehensive search is an extensive, time-consuming process when you are seeking a quality physician to fit your organizational goals. You should evaluate the situation carefully. Before you initiate a search, it is critical that you are methodical, organized and efficient since the process takes commitment and is costly. This article will explain 10 steps to identify quality physicians in a reasonable time frame.

One: Evaluate the need.
It is critical that you care-fully evaluate your medical staff needs before initiating the physician search process. Depending on the size of your organization, this could be a formal, comprehensive medical staff development study performed by a consulting firm, or a brief, internal evaluation conducted by your organization. Make sure it is an accurate and honest attempt to evaluate your current physician situation. This evaluation will ensure you are heading in the right direction, implementing this process at the right time, searching for the right type of physician(s) and receiving proper support from your organization.

Two: Analyze practice opportunity
Investigate each practice opportunity and discuss its strengths and weaknesses. Are there ways to reduce the weaknesses? How can we make this opportunity as attractive as possible? Is adequate office space available for the new physician? Are contracts developed for candidates and have they been reviewed by contract experts? This is important because you need to understand the obstacles and have a strategy to overcome them. All the key individuals involved with the recruitment process must be committed. Recognize that you are competing against others for the same quality physicians.

Three: Describe practice opportunity
Have a clear understanding of the opportunity. Describe the key features of the practice and the required criteria for the physician candidates. Make sure the medical staff approves the description - this will help staff perform the recruitment and minimize misunderstandings.

Four: Physician search sourcing methods
Numerous sourcing methods are available to identify quality physicians. We recommend using several methods simultaneously. Organization is extremely important- the more sources you use, the more confusing the search could become. The recommended sourcing methods to perform comprehensive searches are:

• Networking - Notify all physicians and other personal contacts and inform them of the search, assuming it
is not confidential. Attempt to receive refer-i~a1s from these individuals, and confirm they have a basic under-standing of your needs so they are not referring inappropriate physicians. If recent graduates are on the medical staff, have them follow-up with their residency or fellowship programs for potential candidates.
• Specialty societies/associations, conventions and training pro-grams - Notify the national, state or local organizations appropriate to the specialists you are recruiting. A majority of these organizations have job opportunity lists. Attend annual specialty conventions and dev el-op an exhibit to further promote your opportunities (if recruiting is going to be a continual process). If possible, arrange interviews with potential candidates in advance. Visit residency and/or fellowship programs with physicians appropriate for your opportunity.
• Advertisements - Opportunities may be advertised in general medical publications, such as the New England Journal of Medicine and Journal of the American Medical Association. They also can be directed to a specific specialty, such as the Journal of Orthopedics, Journal of Neurosurgery and Journal of Urology. Highlight key aspects of the practice opportunity and requirements to attract qualified physicians.
• Targeted direct mail campaign - Design a letter explaining the details of the opportunity and forward it to a target population in that specialty. For best results, send it to the "right" audience to hit the hot buttons of particular physicians. For example, a letter for a medical director position should be sent only to physicians that have administrative experience and appropriate clinical training. The unique and key features of the position should be clearly stated.
Use certifications, geography and year of transition as selections in targeting your mailer. Verify that a system is established to handle responses effectively.
• Database - Automating your candidate profiles will increase efficiency and organization. If you develop your database, make sure it is designed to meet all of your needs. Purchasing a database could be an adventure since there are numerous types; however, gain a thorough under-standing of the quality of the data and how the systems work.
• Physician search firm- Contact a limited number of recruitment organizations after you know your needs. These firms provide different services, and you want to make sure your specific needs are going to be met. You can contact various national recruitment associations to receive lists of firms, recommendations and referrals. Understand what each search firm will provide and its fee structure. The services are critical because you want to keep the process organized, focused and, most importantly, successful. Evaluate fees according to your priorities to insure search activity and increased potential for search success. We highly recommend that you interview (by telephone) each firm and the recruiter managing. Discuss strategies, methods and costs prior to selecting the firm. The relationship you want to develop with a firm will decide if you work with one or more.

Five: Decide on an approach
After evaluating your needs, ana-lying and describing the practice opportunities and determining which sourcing methods to use, you can select the approach. If your organization has a recruitment office, will they manage the entire search process, or receive assistance from a search firm? If you do not have an established recruitment office, are the physicians to seek an associate on their own or receive assistance from a search firm? Do not assume the recruitment office or search firms will meet all your needs. Ask several questions before making a decision: How does the recruitment office plan to proceed? Will they do it all alone or use search firms as well? Will they use one or several firms? How do they plan to keep the process organized if they are using several firms? If the physician recruits on his or her own, how much time will it take away from their practice? What is the strategy of the search firm? Can it guarantee activity? Will it represent your spec if-ic practice opportunity? Each approach has financial implications. Analyze the cost benefit, and make sure everyone knows their role in this process.

Six: Initiate search process
Be fully committed to the process. The candidates must be thoroughly screened, and the qualified candidates must be contacted in a timely manner. We recommend contacting presented candidates within two days to make sure they stay available. The next steps are just as important as the first five steps in order to achieve success.

Seven: Interviewing
Two interviews should take place - by telephone and an on-site visit.

Telephone interview - The tee-phone interview should consist of the recruiter, Administrator and/or appropriate physicians speaking with the candidate. Anyone speaking with the candidates must be able to specifically explain the opportunity in a professional manner. Ask the candidates their desires, motivation-al factors, priorities, clinical style and philosophy. Prior to the tee-phone interview, prepare to provide potential site visit dates.

On-site visit interview - After the telephone interview, if the candidates remain viable, an on-site interview should be arranged and references received. The references should include physicians who can com-met on the quality of the candidates' medical skills and their personality within the last two years. It also would be appropriate to include administrators, nurses and referring physicians as references. The visit should provide the candidate and spouse/significant other (if appropriate) a comprehensive view of the opportunity. This is your chance to learn as much as possible about the candidate and show off your practice opportunity. The visit, which should include a tour of the practice, hospital and community, must be well organized - individuals involved should be well versed on the opportunity and professional. Plan adequate time for the candidates to meet with the administrator(s), physicians with whom they will be practicing and referring physicians. Depending on the specialty or opportunity, it may be appropriate to meet with the operating room staff, board members and/or chief of services.

Social functions may be planned throughout the visit, as well as meetings for spouses. The educational system and religious facilities also may be investigated. A comprehensive visit may take two or three days. Before the candidates leave, have all your questions answered. If the visit is proceeding well, a sample contract (after it has been reviewed by a contract expert) should be pro-vided to a candidate or be reviewed with the Candidate before concluding the visit.

Case example: Group Practice B had an internist candidate visit for a job position. Throughout the visit, the candidate waited to meet the physicians in the group in between patient office visits. During the interview, the physicians were interrupted by telephone calls. The candidate did not have time to ask important questions and get information about the opportunity since the key physician had to leave early. In addition, the financial aspects were not is-cussed, and the candidate did not have time to tour the hospital. Other key people were on vacation. The recommendation is to plan a comprehensive visit and establish an appropriate itinerary.

Eight: Post-interview
Gain feedback on the candidate as soon as possible after the visit. If you decide to not pursue the candidate further, inform him or her promptly in a professional manner. However, if your organization has decided to pursue things further, re-contact the candidate within a few days of the visit or wait to hear back from the candidate if they wanted time to think it over. Either way, you should re-contact the candidate within one week.

Nine: Present and negotiate contract
First and most importantly, make sure the contract has been reviewed by a physician contract expert (usually an attorney) before presenting the agreement to the candidate. This is critical because if an inappropriate or unfair contract is presented, you run the risk of permanently damaging the relationship and destroying the candidate search process you worked so hard to develop. There may be flexibility with the contract. If the candidate requests some changes and you are strongly in favor of the physician's candidacy, you may choose to modify the con-tract. Prior to giving a final response to candidate on the contract requests, evaluate the overall importance of the requests. Decide if the contract changes requested by the candidate are significant enough for you to reject the candidate. Timing is important in negotiations. If too many delays occur, the candidate may perceive that you are not interested or too disorganized. If the contract needs to be reviewed, make sure the new contract is forwarded to the candidate within two to three days of the conversation.

It is important that you use your attorney as an advisor, not as a spokesperson who speaks directly with the candidates. Remember to demonstrate your effective communication abilities - clear and timely communication between you and the candidate is essential for a success-fully negotiated contract. Decide on the most important issues, using your attorney's guidance.

Case Example: A physician employment agreement was forward-ed to an obstetrician/gynecologist candidate by Group Practice C. The candidate has various questions and leaves messages for the point-of-con-tact person at the practice. The call is returned seven days later, and the candidate receives some answers to the questions. A revised contract is to be sent to the candidate within four to five days. It is received 17 days later with only some revisions. The candidate then waits for a call back after two messages. The point-of-contact at the practice calls the candidate, and the final contract is not received by the candidate in two more weeks. The candidate decides to accept another offer. The recommendation is to respond to the candidate in an organized and timely manner.

Ten: Decision
Listen to your feelings and recognize their impact on organizational goals. Consider input from your professional colleagues and perhaps family members (if they were involved in the process) - they could provide objective points with their perspectives on the candidate.

Reprinted with permission from MGM Journal. Vol. 44, No. 6.
Copyright 1997. Medical Group Management Association.