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Is Anybody Out There?

From: The Hospitalist, June 2009

Constant struggle to hire forces HM groups to adjust recruiting tactics

by Richard Quinn

In a tale all too familiar to HM group leaders, whether they head two- or three-physician services or the large, multistate hospitalist companies, Heather Bellow, MD, FAAP, is trying to recruit a pediatric hospitalist to her midsize Midwest town.

Her sales pitch, though, seems to focus more on the bounties of Lansing, Mich., rather than the work to be done as the fourth full-time member of Sparrow Hospital Inpatient Pediatric Services. Dr. Bellow often talks up the culture, lifestyle, and the vibrant atmosphere Michigan State University provides the community. And yet, she struggles to find new hires.

Her story is the new norm: Group directors outside the nation’s largest markets agree that they often work for months at a time to recruit hospitalists. Some relent and hire a steady string of residents from nearby institutions. Others throw money at the problem, only to lose those well-paid hospitalists to other groups that throw more money at the problem. The problem is particularly acute in secondary- and tertiary-population areas, where hiring managers often find themselves battling each other for the same hospitalists.

Who’s Hiring Whom?

Recruitment is a two-way street. Groups need to have a clear hiring plan before they start interviewing, and candidates should take ownership of their job search. Inpatient Management Inc. of St. Louis offers these tips:

  • Employers should have a clear understanding of their practice culture, the work-life balance it affords, practice style, and patient volumes.
  • HMGs need to target “the” candidate, not “a” candidate. Type-A personalities might not be the best fit for HMGs with a business-casual approach.
  • Directors need to do their homework. Pre-interview assessments, review resumes for red flags, follow through on reference checks: All are basic and effective tools.
  • Hospitalists need to know their boundaries. Determine your perfect situation, then decide the parameters of employment. Know the things you are willing to compromise on and the things that are deal-breakers.
  • Job-seekers, do your homework, too. Research the practice you are interviewing with; check out patient volume; talk to the potential employer’s physicians.
  • Money isn’t everything. A signing bonus is nice, but if the fit isn’t right, it probably won’t be worthwhile to uproot and move across the country. If the job is right, the money tends to be less of a factor.—RQ

“That’s the million-dollar question,” Dr. Bellow says. “How do you find that outside person that’s willing to come to small-town USA? I really don’t know.”

One possible answer: A focused recruitment strategy should be considered its own subspecialty. Highlighting the growing importance of recruitment and retention issues, SHM offered its first recruitment course last month at HM09 in Chicago. More than 300 people attended the session, which looked at the hiring process from both perspectives. In anticipation of high demand, the presentation was one of only a handful of sessions that were held twice during the meeting, allowing those who missed the first-day session to attend the same session on the final day.

“It’s a crazy time in some ways,” says Kirk Mathews, co-founder and CEO of Inpatient Management Inc. in St. Louis. “In challenging times, people often abandon the fundamentals because they feel they’re in desperation mode. Just bring someone in, get a body in there—anything with an MD behind their name.”

Hospitalists looking to recruit to smaller markets say times are getting tougher. The job posting board at HM09—always a popular gathering site—was littered with fliers for practices in smaller markets: Albuquerque, N.M.; Coeur d’Alene, Idaho; Murphy, N.C. Most of the announcements focused on the natural beauty of an area, proximity to surf or sand, or the peaceful lifestyle a community affords. Few focused on compensation, rotation schedules, or whether malpractice insurance and continuing medical education would be reimbursed.

“These ads try to appeal to your life other than medicine,” says Cecelia Wong, MD, a hospitalist with Med One Hospitalist Physicians in Columbus, Ohio.

Rohit Uppal, MD, medical director of the hospitalist program at Grant Medical Center, also in Columbus, says job hopefuls now know they can be picky when it comes to looking at positions in markets struggling to maintain a job candidate pipeline. Dr. Uppal uses a fellowship program as a recruitment tool, but he concedes he’s not in a power position when it comes to negotiation. “We’re not saying ‘Here’s our great hospitalist group, move to Columbus,’ ” he says. “We’re hearing ‘I’m moving to Columbus ... looking to be a hospitalist.’ ”

The Ideal Hospitalist?

A short list of traits hiring managers look for in their job candidates:

  • Personality: Some groups take a candidate to lunch with the whole group to see how they interact outside of the office.
  • Skills: Never forget that clinical care is the bulk of the job.
  • Communication: Will this person speak clearly and effectively with patients, colleagues, and hospital administrators?
  • Entrepreneurial spirit: Hospitalists are tasked with pushing quality and finding cost efficiencies. Does this candidate have the vision and drive to seek out those opportunities?

Source: Hospitalist Management Resources

Sweeten the Pot

Another potential recruiting tool some groups might overlook is physical office space. While many groups search for cost savings by moving to a “virtual office,” don’t underestimate the value a candidate might place in having a nice office to do their paperwork, says Joseph Ming-Wah Li, MD, FHM, SHM board member, director of the hospital medicine program at Harvard Medical School and associate chief of the division of general medicine and primary care at Beth Israel Deaconess Medical Center in Boston. “What does that say to a hospitalist?” Dr. Li asks. “I take them to this nice suite with outside-looking windows—it sends a nice message of how you’re valued at your institution.”

Just don’t tilt too far toward fancy offices and big salaries. Mathews cautions clients not to focus solely on compensation, because it doesn’t solve long-term recruitment issues and might attract candidates only interested in short-term commitments. “It’s not wise to buy loyalty, because then you never know when it’s paid for,” Mathews says. “I’m going to throw a $40,000 signing bonus at this doctor. … Two years from now, somebody else can throw $50,000 at them and they’re gone. It’s not the candidate’s fault. They’re at the smorgasbord table.” TH

Richard Quinn is a freelance writer based in New Jersey.


This copy is for your personal, noncommercial use only. No part of this article can be reproduced without the written permission of the publisher. Order presentation-ready copies for distribution to your colleagues, clients, or customers by contacting our reprints department at reprints@wiley.com. Copyright © 2009 Society of Hospital Medicine, administered by John Wiley & Sons Inc.

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