Physician Recruiting: Finding the Keepers

Recruiting physicians these days is a lot like running a marathon. It takes stamina, preparation, and a willingness to press on in the face of insurmountable odds. It’s also akin to selling real estate, where location, location, location matters greatly.

Just ask Jason Marker. The family practice physician in rural Indiana has been actively seeking a second physician to join his solo practice for nearly two years, putting the word out to recent graduates at the residency programs where he teaches. He also networks regularly with colleagues through the American Academy of Family Physicians.

So far, he’s come up dry.

“It’s a slow process,” admits Marker, who says he can handle his heavy workload for a few more years. “These days, recruiting is a multi-year prospect. If I don’t find someone in the next one to three years, I’ll have to step up my efforts.” That would likely include advertising in professional journals and working together with his local hospital to cast a wider net.

If recruiting trends among his peers are any indication, Marker may ultimately have to sweeten the pot with a larger sign-on bonus, more flexible hours, or a fatter salary - a proportionately bigger challenge for small practices. “It’s become difficult for everyone in the industry to recruit, especially small practices, which have fewer resources,” says Brian McCartie, regional vice president for Cejka Search, a St. Louis, Mo.-based healthcare recruiting firm. “Smaller group practices are not able to regenerate themselves as easily anymore because of the physician shortage. The supply [of doctors] and demand [for healthcare services] is out of balance.”

Many variables

What’s causing this imbalance?

For one, record numbers of older physicians are reaching retirement age - backlash from the post-war baby boom.

For another, many younger doctors are decreasing their hours or leaving the profession for nonclinical settings, citing dissatisfaction with their career, declining reimbursement, malpractice pressures and increasing managed-care restraints. In a 2007 survey by physician placement firm Merritt Hawkins & Associates of Irving, Texas, in fact, 44 percent of doctors ages 50 to 65 indicated they would not choose medicine as a career if they were starting out today.

Gender plays a role as well. The growing number of women entering the field, who tend to work fewer hours and select specialties that better balance work and family, has thinned the ranks of full-time physicians further still. According to the Association of American Medical Colleges, there are now an equal number of men and women enrolled in medical schools nationwide.

Most pronounced in internal and family medicine, pediatrics and psychiatry, the physician shortage couldn’t come at a worse time. The nation’s 78 million baby boomers, now reaching their 60s, are already demanding an unprecedented level of healthcare services. As medical advances push life expectancies ever higher, that demand is expected to grow.

For patients, the shrinking pool of trained physicians may result in more restricted access to quality healthcare services. For a practice looking to replace an outgoing member of its team or bring new doctors into its fold, it means more competition for top talent.

“It’s really a buyer’s market in terms of physicians being the buyers,” says Phil Miller, vice president of communications for Merritt Hawkins. “You have to create conditions that are attractive to today’s doctors and focus nationally. Physicians are hearing about opportunities all over the country.”

Do your homework

Ask yourself what skills you truly need and what compensation package you’re willing to offer before you approach the market. “You need to be organized on the front end or word gets around that you don’t have your act together,” says Craig Fowler, vice president for Pinnacle Health Group in Atlanta, a physician recruiting firm. Top candidates these days, he adds, will disdain a practice that has a reputation for sloppy interviews.

To avoid such shunning, draft a wish list of ideal candidate qualities, but be realistic about your expectations. “In the old days, physicians looking to recruit were usually looking for a clone of themselves - someone willing to take risk and help them build the practice,” says McCartie. “You have to be more educated about the market today.”

The bulk of Generation X and Y physicians - regardless of gender - are far less interested in an ownership track, more often opting to collect a paycheck, punch the clock, and get home in time for their kids’ soccer game.

Set your budget

Before you begin advertising, of course, you’ll also need to build recruiting costs into your budget. That doesn’t come cheap, by the way. To recruit a single family physician today, Merritt, Hawkins & Associates reports that practices spend, on average, $10,000 for advertising (e.g., direct mail marketing, professional trade journals, employment Web sites), plus another $3,000 per interview (if you have to fly them in). Thinking of using a recruiting firm? Expect to drop another $25,000 or so in fees.

Once the physician accepts the position, you’ll face another $10,000 for relocation costs, $3,000 for internal marketing (to announce the new doc’s arrival to patients), plus an average of $40,000 in benefits and perks. Then, of course, there’s the issue of salary - $170,000 for today’s family physician, give or take.

All told, you’re looking at roughly $260,000 per family physician. And that’s not including the opportunity cost of lost revenue while you’re recruiting. However, you can git ’er done for less. Here are some ways to trim down the cost of recruiting:

• Touch base with your local hospital. If a true community need exists, the hospital may be willing to cover the recruiting costs and guarantee the new physician’s income for the first few years. “Physicians are a conduit to the hospital, since they are the ones who admit patients,” says Miller. “Without physicians, hospitals are just an empty hotel with bad food.”

For his part, Marker does plan to work with his local hospital to find qualified candidates if his own recruiting efforts fail to deliver. “It’s much less of a strain on my finances to have my candidate go through the hospital,” he says.

• Participate in local residency programs to get a ringside seat to all the new talent coming through the pipeline. “Hospital-based programs will send residents out to my practice to do rotations,” says Marker. “That gives me a chance to talk to them and get to know them one-on-one. What could be better than a month-long interview with a candidate? I think that’s a great recruiting tool.”

• Look to your professional association. Many associations will help you publicize your need by providing a free electronic mailing list to members, or listserv, through which they’ll forward electronic employment ads nationwide. Several, including the AAFP’s, allow you to target ads for various specialties and parts of the country.

Far and wide

Considering how global our economy has become, you’d be wise to pan out your radar when searching for a new physician. Most recruiting firms these days use a combination of direct mail marketing and mailing lists, along with ads on physician job boards, employment Web sites such as mdjobs.com and mdsearch.com, and in trade publications.

“Right now, the key is getting the word out,” says Fowler. “It’s got to be a year-round approach rather than the traditional strategy of searching in spring when all the residents are graduating. You should be advertising to both passive and active candidates.”

Although your compensation package must be competitive to even pique the interest of those you seek, Fowler says it’s flexibility that will prompt potential candidates to pick up the phone. Shorter work weeks (4.5 days instead of five, for example), reduced call schedules, and part-time positions are big carrots for younger doctors who tend to eschew sacrificing their personal life for their careers.

Remember, offering flexible hours can also work to your advantage, since physicians are often willing to work a few hours on Saturdays in return. That allows your practice to offer weekend hours to patients.

To sweeten your job offer, consider taking call duty off the table entirely by using hospitalists to treat your nighttime hospital-admitted patients. “The hospitalist movement is huge right now,” says Fowler. “Even smaller hospitals in more rural America are putting programs in place, which creates an opportunity for the primary-care physicians in their community to not have to take call.”

An offer they can’t refuse

Once you’ve narrowed the field and decided which candidates you’d like to interview, it’s up to you to sell your practice. “Make sure the right doctors on your team are going to be available during the interview to ask relevant questions and interact with your candidates while they’re in town, wining and dining them,” says Fowler. “Show them you’re excited about [the future of your practice] and you want them on board. You need to roll out the red carpet.”

And don’t forget the little things: If you’ve flown the candidate in, says Fowler, have a welcome basket waiting in the hotel room and follow up after every interview with a letter thanking them for visiting your office.

During the interview, accentuate your strong suits and your uniqueness, particularly if you’re located in a less desirable part of the country. “It should be something that’s exciting to young physicians,” says Marker. “For me, it’s the ease with which I can practice patient-centered care. In a rural setting, if I decide I want to make changes, I can do it. No approval. No big committees. That’s very empowering for physicians who are looking to provide first-class medical care without the hassles of a big system to work within.”

Even the most successful interview, however, will be for naught if you’re not prepared to tender an offer quickly. Remember, top physicians are courted heavily. “If you have a lot of bureaucratic red tape and it takes you too long to extend offers, that’s giving the candidate an open door to find another job,” says Fowler. Once you’ve identified your top choice - and don’t take too long to do that - put an offer on the table within two weeks.

Don’t settle

If you’re having trouble hiring a new physician and your practice has an immediate need for an extra hand, you may be tempted to hire the first “good enough” candidate who comes along. Miller’s advice? Resist this urge. “That’s a bad idea for physicians in particular,” he says. “For one thing, it’s expensive to bring someone in. But you also raise credibility issues.” Think of the impression a quick-to-start but quick-to-leave physician will make on your patients. Likely, they will question the commitment to quality for the entire practice, says Miller.

Instead, fill the need for immediate help while searching for a permanent solution by hiring a locum tenens physician. But beware, cautions McCartie, as that strategy can be pricey. “Locum tenens physicians are absolutely a solution when you have a short-term absence, but at $1,500 to $1,600 a day for a basic specialist it’s not a long-term solution.”

Depending on the needs of your practice, you may in fact be able to get by without even hiring an extra physician. Would a much less costly nonphysician provider, such as a physician assistant or nurse practitioner, serve as an adequate solution? “Mid-level providers can free up the physicians to focus on the patients, performing much of the initial patient work-ups,” says Fowler. “If you have a group of four or five FTEs (full-time equivalent physicians) you might be able to just hire an extra PA.”

As the physician shortage deepens across the country, private practices increasingly face an uphill battle when it comes to attracting new talent. You’ll land the right candidate faster, however, by determining your needs upfront, using multiple channels to spread the word, and crafting an incentive package that speaks to today’s family-focused workforce.

Shelly K. Schwartz, BA, is a freelance writer in Maplewood, N.J., who has covered personal finance, technology, and healthcare for 12 years. Her work has appeared on CNNMoney.com, Bankrate.com, and Healthy Family magazine. She can be reached via editor@physicianspractice.com.

This article originally appeared in the September 2008 issue of Physicians Practice.