Hiring new staff takes time and resources. A good recruitment process is the key to success for many businesses. Typically, hiring a new employee requires a couple weeks of advertising and application gathering, some interview time, and then often two weeks’ notice before this new person can actually start working. This entire process can take anywhere from a few weeks to a couple of months.
Hiring a physician, however, will generally take more time, cost more, be much more complex, and is usually more critical for business. Here are a few timing hints to keep you out of hot water.
Identify Where to Recruit
As you begin the physician recruitment process, consider whether you will be recruiting a new resident, an experienced physician from outside your community, or a physician who already has an established practice in the community.
• Recruiting a physician out of residency will generally require less compensation, the person will usually adapt to your culture easier, and there are new candidates coming out every year to choose from. New residents will need to be licensed in your state, credentialed with payers, and privileged at any participating hospitals. Most residents start looking for employment six months to a year prior to graduation. For the best applicant pool, recruitment should start at this same time. Since graduation is generally in June, the start of a new year should be the latest you start recruiting.
• An experienced physician outside your community will probably require higher initial compensation, and may or may not need state licensure and credentialing with payers. Practicing physicians are generally not constrained by a calendar unless working under a provision of a prior contract. This recruit will have more experience and often is able to begin work at a higher pace or workload.
• A physician already in the community will ideally already have a full practice (existing patients), already be licensed and credentialed, and be familiar with the community. This type of recruitment is generally the fastest and most financially beneficial to a practice. If the existing patients are maintained, full revenue streams can begin coming in immediately and there is much less cost for building up a practice. These physicians will often require higher compensation and a quick path to partnership in the practice, if available.
Required Licensure and the Credentialing Process
When considering the timing of your recruitment efforts, keep these general requirements in mind as most of them will be necessary to get paid and comply with local laws. Depending on their current situation, some recruits may already have these in place while others will still need to go through the process of acquiring them.
• State License
• National Provider Identifier (NPI)
• Hospital Privileges (some exemptions)
• DEA License
• Malpractice Insurance
Credentialing a physician with payers can take several months. This can be a complex process and one that needs to be monitored carefully. In most cases, if the provider is not credentialed prior to seeing patients, they will never get paid for their services. If a provider is employed and seeing patients for a couple months without being fully credentialed with payers, it could result in a loss of tens of thousands of dollars. Credentialing efforts should be carefully tracked in either spreadsheet or credentialing software, making sure to monitor the progress of each payer until all payers have verified enrollment.
The Employment Contract
Physician recruitment will generally include an employment contract that will protect both the practice and the physician. Key components to include in a physician’s employment contract are:
• Compensation Model (if based on productivity be specific)
• Duration of Contract
• Exclusivity Language (ability to work for other entities)
• Non-compete Language
• Malpractice Coverage Requirements
• Confidentiality of Medical Record Information
• On-call Schedules
• Buy-sell Agreement (if given ownership in the practice)
Don’t forget to include the physician’s spouse early on in the recruitment process. It can be costly and timely to go through the whole process to only find out at the very end that the spouse does not want to move to your city. Well-planned and timed physician recruitment efforts will save a lot of time and money, both of which are very valuable in doing business today.
• Require a completed credentialing packet with everything you will need to get the new recruit credentialed at the same time they sign and hand in their employment contract.
• Require a signed contract and credentialing packet at least 90 days prior to their first day of work to give you enough time to get them set up for proper payment.
• After identifying an interest from the recruit, invite them to bring their spouse and arrange for someone familiar with real estate, schools, and community to show them around.
• Don’t put all of your eggs in one basket. Talk to several candidates who may be a good fit. Remember, it can be very competitive and the process often includes last-second decisions.
• Discuss key decision points such as call requirements, culture, and compensation models early enough to know if they will be a good match. Waiting until the very end to discuss these points can be costly and risky.
Dixon Davis, MBA, MHSA, is the vice president of practice management for AAPC. Over the last 15 years, Dixon has held senior leadership positions in healthcare administration in a variety of settings including independent practices, integrated health systems, and independent physician associations (IPA). E-mail him here.