Hiring a Young Gun

When Lauren Hughes was only 4 years old, she knew she was going to be a doctor. As a child she recalls being interested in science and loved being around people, so it seemed like a natural goal. Now at age 29, she has a master’s degree in public health, is in her fourth year of medical school at the University of Iowa, and wants to specialize in family medicine.

“I really love all ages … primary care offers,” explains Hughes. “Plus there’s lots of flexibility and I really like to keep my options open.”

But as altruistic as her outlook may seem, Hughes has a few requirements of her own. What does she want? A big paycheck? A fancy house? No, what she wants most is time. Her dream job, she says, is a position in family practice that offers enough scheduling flexibility so she can pursue her passion of healthcare policy advocacy. “Of course I want a comparable salary to wherever I’m living - heck, right now it would just be nice to have a paycheck,” Hughes says, chuckling. “But really my top priority is finding a job that is flexible and interesting to me. I need to have a job that allows me to pursue an outside life.”

She hasn’t yet fielded her first offer, but she’s not concerned: “I’ve always been the kind of person who, if I don’t see what I want, I’ll figure it out. I know there are ways to craft what I want to do.”

Hughes is not alone in her pursuit of work-life balance. In fact, as a member of the newest generation of physicians, she typifies this changing attitude - one that might take some getting used to. Unlike generations past, today’s new physician work force (a combination of Generations X and Y) approach the work place very differently. They aren’t motivated by the traditional carrots, like promotions or money and, instead, are seeking balance between their work and personal lives.

“This generation is more in the employee mindset,” explains Pam McKemie, senior vice president of Locum Tenens recruitment firm. “The last few generations graduated from medical school and hung out a shingle on Main Street. Unless someone is a strong, capable entrepreneur, you’re not going to see that as much today. Generation X/Y says ‘Ya know, I’m not willing to give up the next 30 years of my life to this.’”

So what’s a practice that has positions to fill to do? First you may want to make sure you really need a new physician. Is it possible to fill the demand with a nonphysician provider? Or is there a way to expand the practice’s current hours? If not and once you’ve determined that your need is real, start by looking at things from their perspective. They are coming into practice at just the right time - for them. As the physician shortage gets worse, these new doctors are courting attractive offers from practices and hospitals of all sizes, cultures, and locations.

And it’s not just money that’s being dangled before them - it’s time and lifestyle as well. So as much as you may be eyeing young potential doctors to help you build a practice and give you some relief, realize they also are sizing you up to see how their lives will be better by joining you.

Time is on their side

Of course time is important. The older half of today’s young doctors - those born between 1961-1978, known collectively as Generation X - watched their parents endure long hours to climb their respective ladders of success. Growing up, Generation X, more than any other, came home to empty houses after school and missed time with their parents. It was a lifestyle that, apparently, didn’t hold much appeal.

“Their parents worked long hours, and the divorce rate soared in the 1970s. In turn, Gen Xers said ‘We’re not gonna do that’ and came into the work force introducing the idea of work-life balance,” explains Amy Lynch, consultant, author, and Generation Y specialist. And while it may have been a struggle for Generation X to pave the way, notes Lynch, for Generation Y (those born between 1979 and 1994) seeking balance is a no-brainer. “It’s an evolution about attitudes about time. For [younger generations] personal time is money. They would rather live with debt than not have time with their family and friends.”

Indeed, work-life balance has been cited as one of the most important considerations among young physicians. According to the 2007 Physician Retention Survey by Cejka Search and the American Medical Group Association (AMGA), the number of physicians who choose to work part-time increased from 13 percent in 2005 to 19 percent in 2007. More of these young doctors are likely to be women who, historically and statistically speaking, will be more likely to seek part-time or flex-time work arrangements.

“These women are … talented [doctors]. They’re nurturing and caring, but when it comes to families, mothers are still the primary caregivers,” explains Brian McCartie of Cejka. “You’ve got a gender shift and have to remember the [doctors] coming out today are planning families.”

So recruiters, practices, and hospitals are responding. Joanne Johnson, the director of recruitment for the Adirondack Medical Center in Saranac Lake, N.Y., reports that almost 5 percent of its more than 50-physician staff work part-time and three of its current open positions offer that flexibility, whereas 20 or even 10 years ago it was unheard of for the medical center.

“This generation is looking for a different quality of life,” says Johnson. They want lighter schedules, a balanced life, and more time with their families. We have to respect that.”

But how do you actually provide that type of flexibility and stay on top of the workload?

There’s no single answer but here are some solutions that practices have successfully adopted:

• Two for one. Hire two part-time physicians to fill one position. This works well with husband/wife teams of the same specialty or if you have two people who really know they only want part-time.

• Make use of the semiretired. Consider hiring older doctors who want to reduce their work schedule. They can come in a day or two a week, or perhaps work Saturdays. These physicians are often less interested in big salaries than in pleasant work environments and the chance to stay involved. If you have older doctors on staff now, create a schedule where they work heavier schedules during summer or school vacation months, assuming they don’t have school-age children. Reverse the schedule during the school year.

• Safety net. Use a hospitalist to care for your inpatients, giving you more time to focus on your office-based practice.

“Flexibility can be a curse - you can’t just leave it wide open for an individual to decide,” advises Tommy Bohannon, senior director for Merritt Hawkins & Associates, a national physician-recruitment firm. “The members of the practice have to sit down and decide collectively what they are comfortable with.”

Show ’em the money

But as much as this young work force craves balance, money still talks. And it’s actually more important than ever. Not only has the price of, well, everything gone up, but the price for medical training has become downright beastly. According to the Association of American Medical Colleges, the average educational debt of 2007 medical students is almost $140,000, up 6.9 percent from 2006. In light of the soaring debts of these young doctors, not surprisingly many enticing recruiting pitches include “loan forgiveness.” In fact 40 percent of the respondents to Merritt Hawkins 2008 Survey of Final Year Residents said loan forgiveness programs would have a “great effect” on their decision to join a practice compared to only 13 percent who felt that way in 2003.

McKemie, of Locum Tenens, can attest to this trend. She recalls a surgeon she placed in a rural community in West Virginia (a “very tough” placement, she says) and although the physician was originally from the area, what sealed the deal was the loan repayment aspect of the offer.

“This guy was around 30 and was starting a family and had all this debt from school,” she says. “They work all these hours and have young families and all this debt - it’s exhausting.”

Krystal Johnston scoffs at the notion that people go into medicine for the money. The 34-year-old pediatrician is running a practice in a Medicaid-heavy area of northern Michigan, while trying to pay off her student loans.

“The interest [on student loans] is pretty significant. If you pay a little over the minimum each month, you still don’t pay much of the premium,” she says. “Plus there’s payroll, health insurance, which has gone up 20 percent just this year, and immunizations that insurance doesn’t cover. It all adds up. I can only speak for myself and my friends, but I don’t see any of us buying islands.”

So aside from offering a competitive salary (check out our physician compensation survey “Getting More” for detailed physician salary information), and possibly student loan forgiveness, how can you add financial punch to an offer? Here are some ways:

• Practice transition allowances. According to Bohannon, more practices are offering sums of money that function like a combination of a relocation package and a signing bonus. But instead of handing over a lump sum at the beginning, the money is divided up and doled out monthly (sometimes for up to a year) to assist with mortgage payments and living expenses until the new physician is up and running. Be sure to check with your attorney or CPA before offering this perk.

• Stipends. Offer a recruited resident a living allowance before they actually start work. “You take a resident who’s making at most $40,000 a year and offer to pay them a stipend while they finish their training. It’s a time when they are really strapped for cash, and that can go over big,” Bohannon attests.

• Cover inconvenient expenses. Offer to cover other burdens such as malpractice insurance or CME. Although it’s not as glamorous, it’s all necessary, all expensive, and would be considered a perk to any young doc.

Culture club

And finally, you have to make them happy. While time and money can create an attractive offer, you have to make sure they’re comfortable with your practice’s culture, too. That’s why it’s not surprising that mentoring programs are gaining in popularity - not only to recruit new talent, but to keep it. According to the Cejka and AMGA 2007 Physician Recruitment Survey, 95 percent of the respondents agreed that mentoring programs increase retention and overall happiness.

“[Younger doctors] want a cultural fit within the practice,” explains Cejka’s McCartie. “It’s about respect, relationships, being valued - all the intangibles. Mentoring is the first step and teaches what the group is like. Not only does it teach the administrative nuances of the office and where to park your car, but it also is the fastest way to assimilate into a practice.”

Signature Healthcare in Brockton, Mass., implemented its mentoring program in 2005. Marc Greenwald, the practice’s chief of medicine, believes it has decreased turnover from 10 percent to 5 percent, and has increased physician satisfaction overall.

“The goal is to make the new physicians feel a part of the organization, to behave as empowered participants rather than salaried employees,” explains Greenwald. “If the physicians feel like participants, physicians who are interviewing will sense that and want to join us.”

The program includes open communication of expectations from both sides, a shadowing arrangement with physicians in all specialties, and assigning a coach (rather than a “mentor”) to each new physician. They’ve even implemented a spouse welcome wagon to make sure that a physician’s family also feels comfortable with the practice.

“A lot of these spouses have careers or have small children,” says Greenwald. “The more members of the family who feel attached to the organization, the less likely the physician is to leave.”

But if you’re not quite ready to roll out an on-paper mentoring program, or even if you are seriously thinking about it, there are some basic building blocks that could help put your new recruits at ease. Nancy Smit, president of SHR Associates, has a few recommendations:

• Define yourself. “Go on an internal retreat and define your mission. How do you know what qualities are important if you don’t even know your own mission?” asks Smit.

• Pick your team. Identify two or three personable physicians for a buddy system and have them meet routinely with the new doctors until they are comfortable.

• Create a list of known community resources. Compiling a list of realtors other doctors have used, schools their children have attended, or other resources that you have used and can recommend can add an extra level of comfort for a doctor new to an area.

Do we really have to change?

Well, no, not entirely - but you should still know what you’re up against. All signs point to a sea change that the healthcare industry simply can’t ignore. So even if you’re wondering “Can they really ask for all of this?” consider McKemie’s observation:

“I think they can - the reality is that they can. They can say ‘I can offer you a 30-hour week, work every other weekend with Fridays off,’ and [many practices will] accept it. I’m 20 years into watching this trend and unless there’s a huge shakeup in healthcare reform, I don’t see this changing.”

Kellie Rowden-Racette is an associate editor for Physicians Practice. She can be reached at kellie.rowden-racette@cmpmedica.com.

This article originally appeared in the February 2009 issue of Physicians Practice.