AAOS Bulletin - June, 2005

Successful recruiting for your practice

Six steps to ensure you retain your newly hired surgeon

By Steven E. Fisher, MBA

The decision to add a surgeon to your practice is a major step.

A recent survey found that more than half of physicians who leave their initial practices do so within the first five years. Moreover, the physician’s decision to leave is made within the first three to five months. Finally, overall turnover in medical offices is 9 percent, which is nearly double what the surveyed offices believed to be the case.

Although there is no way of ensuring that a newly recruited physician will remain with your practice forever, there are several things you can do to encourage this outcome.

1. Define your practice

Before you even begin recruiting, you need to have a formal governance structure. Even a solo practitioner intent on engaging a new partner needs to look at governance because when the new person is on board, it’s a group practice, not a one-person office anymore.

Group practices need to establish consensus on several issues: behavior standards, work ethic, income distribution methodology, buy-in and buy-out arrangements, decision-making protocols and resolving disagreements.

Be sure to work through and document these issues before initiating any discussions with potential new hires. A new person who is uninformed or uncomfortable with a practice’s culture may quickly decide to leave. In fact, “practice issues” may account for up to 30 percent of physician separations.

2. Define what you need

Now think about what characteristics you’re looking for in a new surgeon, both professionally and personally. Does the office need a generalist, a generalist with a subspecialty interest or a true subspecialist? Do you want someone with a strong work ethic or someone who wants a balance between personal and professional lives? An individualist or a team player? Someone who does not mind spirited arguments or a person who prefers calm, reasoned deliberation?

Most practices can tolerate some personality differences. However, people whose personalities are polar opposites rarely enjoy one another’s company, and this can make for long, unproductive meetings. It could ultimately paralyze the future growth and development of the practice.

David Nyman, a physician recruiter at the Prevea Clinic/St. Vincent Hospital in Green Bay, Wis., and an active member of the Association of Staff Physician Recruiters, emphasizes the importance of bilateral communication during the interview process. “It’s critical,” he says, “for both sides to be honest and candid. The practice needs to state very clearly what it can offer the new doctor to make him or her a success. By the same token, candidates need to share their expectations of the practice as well as their and their families’ expectations of the community where the practice is located.”

3. Check candidates thoroughly

Investigate all candidates thoroughly using every means possible. Verify credentials and personal and professional letters of recommendation, call department chairs and schedule at least two face-to-face interviews.

Be sure to develop and use a position description during the interview. One important question is whether the candidate can perform the essential functions of the position, with or without accommodation. This question is legal under the Americans with Disability Act and the candidates’ answers will give the practice important input to make the best choice.

To minimize the risk of a discrimination charge, interviewers must comply with federal and state laws and be consistent in the questions they pose to candidates. When in doubt, contact your legal counsel because some states have laws that are more restrictive than federal legislation.

Don’t forget that interviews are two-sided. The practice should provide each candidate with the information necessary for the candidate to make an informed decision if a job offer is extended. The practice also should be soliciting information from the candidates to help it determine which candidate has the best clinical skills and the most compatible personality.

4. Build a win-win agreement

When you’ve finally selected a candidate, be sure to negotiate a win-win employment agreement. The agreement should be written in clear and unambiguous language. State the salary up-front, together with benefits (health insurance, life insurance, disability insurance, vacation). Specify the circumstances and timing for any bonus payments. About one in five separations result from disagreements over compensation.

Ideally, the agreement should include terms and conditions of the buy-out as well as internal financing options for the buy-in. As addenda, include any corporate contract or partnership agreement and any documents that specify the practice’s expectations for work load, call, time-off, mutual support, administrative duties, standards of practice and behavior. This helps eliminate “surprises” and “broken promises.”

If you include a non-compete clause, be sure to obtain legal counsel. Not only do state laws differ, state courts have often come to different conclusions about their enforceability.

Consider including a clause that mandates arbitration rather than litigation in the event of a disagreement. Arbitration typically results in a faster, less costly settlement than litigation, and with far less antagonism.

5. Support newcomers

Once the new surgeon is on board, provide active support to give him or her every opportunity to be successful. A thorough initial orientation to the practice, area hospitals, referring doctors, and the community in general is critical. Other practice doctors can steer business toward the new person for the first six months or so and actively promote the surgeon in the community. For example, if existing doctors reduce their office hours by a certain percent, many new patients will automatically be funneled to the new person.

Some larger offices have developed a formal protocol and checklist with deadlines linked to the doctor’s first day seeing patients. The checklist should include applying for the doctor’s medical license, Medicare number and hospital privileges, as well as executing various agreements with private payers and other basics. Barbara J. Kiel, CEO of OAD Orthopaedics in Warrenville, Ill., uses such a checklist and swears by it. “We’re in the process of working through our checklist right now in connection with a new doctor, a hand specialist, who will be joining us in the near future. It covers everything from managed care contract credentialing through parking assignments,” she says.

Training should cover ICD-9/CPT coding (especially complying with the law as far as unbundling is concerned), the practice’s billing and collections protocols, Stark II, anti-kickback and the Privacy and Security regulations under the Health Insurance Portability and Accountability Act.

Make arrangements for the new surgeon to meet with a current practice principal and/or the business manager on a regular basis for several months to deal with issues as they arise so they do not become serious. These meetings will help the new doctor learn whom to contact when a problem arises.

6. Establish evaluation protocols

Finally, the practice and the new surgeon need to agree on the evaluation protocol. What are the measures of success? (Billing? Collections? New patient volume? Results of patient satisfaction surveys? Some combination of these?) How are different elements weighted? When will the evaluation take place? Who will be doing the evaluation from the practice’s end? What input will the new doctor have to the evaluation process?

There may be no certain way to predict that any affiliation will be permanent. However, following these steps will maximize the chances of a good match and minimize the chances of a debacle. For more information and a sample recruiting checklist, visit the Practice Transitions section of the AAOS Practice Management Center Web site.

Steven E. Fisher, MBA, is the manager of practice management affairs at AAOS. He is also staff liaison to the Academic Business and Practice Management Committee. He may be contacted at (847) 384-4331 or sfisher@aaos.org

(1) AMGA Press Release; February 15, 2005. “Preventive Measures Key to Physician Retention.” See also http://amga.org/MediaAlerts/article_mediaAlerts.asp?k=127

Other resources:

1. Moore, P. The Art and Science of Physician Recruitment. Shands Healthcare: http://shands.org/professional/ppd/practice_article.asp?ID=81

2. Grimshaw, R. Tailoring New Physicians to Meet your Practice. Family Practice Management; April, 2001. http://www.aafp.org/fpm/20010400/39tail.html

3. The Physicians Guide to Employment Contracts and Job Search.

4. AMA Young Physicians Section (YPS): http://www.ama-assn.org/ama/pub/category/16.html

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