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How to make the practice-fellow match

My roadmap to a productive courtship — and marriage.

Recruiting someone right out of fellowship is a lot like dating. If the candidate likes you, expect to hear back from him or her right away. However, if the candidate is considering different opportunities, you may not hear back until days or even weeks later. Before that call can occur, though, there’s a lot of talk and homework you and the candidate need to get through.

The following is what the practice needs to keep in mind to find a successful match.

DREAMING OF THE PERFECT PRACTICE

This dating game begins shortly after fellowships typically commence in July. During the first two to three months into a fellowship, candidates think about options and preferences for their post-fellowship medical careers, including geographical location, long-term goals, practice settings, income potential, partnership vs. non-partnership and research and teaching opportunities. The wild card in this equation is personal yet very relevant — a candidate’s future spouse or partner whose input affects the final decision. Potential employers need to understand these considerations when looking to hire someone right out of fellowship.

TIME FOR THE COFFEE DATE

Five to six months into your search and into the physician’s fellowship, the conversations start to pick up. Around November or December, expect your administrator to have an initial phone call with any potential candidates. A good candidate conversation includes an overview of the organization, discussion of services offered, population and whether you are offering a partnership opportunity (which is important to disclose up front). At this point, salary and incentives should not be discussed.

What do need to be addressed, though, are expectations. A fellow training at a high-volume, large academic environment may be used to another manufacturer’s diagnostic equipment that is not in your organization. The fellow may be accustomed to using a drug therapy that is cost prohibitive for a smaller practice or is not part of an organization’s formulary. Assessing the candidate’s ability to compromise on requests vs. needs is an important consideration when selecting a candidate.

I advise the candidate on what specific equipment we have in the office as well as what therapies we are using to treat and diagnose patients. The follow-up question I ask is, “Are you comfortable with our current setup of equipment and drugs?” This information helps candidate assess the scope of care provided in the office. The candidate may or may not inquire about the possibility of adding additional equipment or therapies not currently used in the office. I defer those questions to our medical director, who addresses them during the next round of interviews.

A candidate who asks about research or intellectual property rights opportunities, for instance, may not be the best fit for a smaller private practice.

IT’S GETTING SERIOUS

After these conversations, the “dating” really starts. Candidates are narrowing their choices, and so should you. I recommend talking further with your top three candidates. More than three can be time-consuming for everyone, and it is not fair to mislead a fourth-choice candidate in the process. Warning: Excellent candidates usually get employment agreements early in this process, while the negotiation processes can drag on for the safe choices — for both the organization and the candidate.

By February, your medical director should have a video conference call with out-of-state candidates and a phone call with local candidates. Following those calls, in-person interviews should be set up with local candidates, with the top two out-of-state candidates’ interviews set up as soon as possible. Some practices cover all or part of the travel expenses for candidate interviews, while others do not cover any expenses. Every area is different, so use your discretion based on norms in your city/state for recruiting.

Around March, it’s time for you to meet with the candidate. In my experience, a successful recruitment interview depends on providing clear and concise information. I generally give the candidate a tour of our offices and discuss what to expect in terms of patient volume, staffing and pathology mix. I avoid discussing reimbursement figures. Though you can make inferences into why a candidate is considering your organization, it always good to just come out and ask, “Why do you want to work for us?”

Again, be clear with your expectations. If you are hiring a retina specialist, for example, tell the candidate whether he or she would see only retina patients or comprehensive patients too. If a candidate would be working at multiple offices, discuss what his or her schedule would look like in advance. Be up front about other factors, such as office hours, operating room time and number of support staff to expect.

Additionally, I have found that having the techs share their knowledge portrays your practice in a very positive light.

Your interview day should consist of the candidate shadowing an associate doctor or partner/owner and finish with the owner or partner meeting the candidate in the office for a final discussion. If you are happy with what you see, present the candidate with a contract or send one to him or her within 24 hours of the interview.

PLANS FOR A HAPPY UNION

Now the negotiations begin. This phase of the process can be exhausting if you are not used to recruiting someone right out of fellowship. Remember that the candidate now has more confidence and more options to choose from. You should expect questions that cover termination clauses, restrictive covenants, compensation models, start dates and benefits. These factors are all fair game for a candidate to bring up at any point during the process. In the end, the organization and the candidate should view this as a business marriage.

Once both parties sign the employment agreement, it’s time discuss expectations for the day-to-day. Recent fellows like to start off strong and be busy. To facilitate this, the administrator should review these topics:

  • Patient volume. Newly trained physicians may move fast while others move slower and need to build up that confidence to schedule more than four patients an hour. You need to assess your new hire’s ability at six weeks and again at 12 weeks to see how he or she is adjusting.
  • Staff relations. Some excel in this area and immediately “get” your company culture. Other new doctors may struggle because they do not know how give or receive constructive feedback. The administrator or medical director can provide guidance to the doctor on how best to nurture a mutually beneficial working relationship with the staff.
  • Clear expectations. These should include arrival time, completing charts in a timely manner and seeing patients outside of their specialty, such as a disability patient or an ocular emergency.

HOW TO MAKE IT WORK

The transition from fellow to full-time physician is not easy. The new hire deals with a new EMR, a new schedule, new organizational culture and a new way of seeing patients.

How can this transition go well for your new recruit? Lots of communication. An administrator should check in with the new recruit every other day for the first couple of weeks and have face-to-face conversations in the office or in an exam room. Listening to the physician’s concerns early on sets the tone for your relationship for years to come. I would expect some of the recruit’s concerns to include getting operating room time and insurance panel credentialing. I always tell doctors, “My job is to make your job easier.”

Red flags that the relationship is not working include requests in the first few months to leave early/come in late and attendance issues. You want this to work, so be clear about your expectations with these areas.

What can you expect from recent fellows? Historically, being that this is their first job, keep in mind that it will very likely not be their last. My experience is that the average fellow stays at his or her first job for two years. The most common reasons given for a resignation are related to family (ie, marriage, relocation to be near family) followed by the opportunity to make more income and low patient volume.

CONCLUSION

Recent fellows brings a lot of great qualities. They are not set in their ways, so you can develop and teach them. They are very driven to do well and are methodical in their decision-making regarding patient care. Pitfalls, of course, are inevitable, so watch for these and address them right away before they become bigger issues.

A successful recruit is one who grows with your organization. Be candid about things such as partnership opportunities. Do not make income guarantees. If you view the onboarding process as a continuous improvement process, you may have this employee for life. OM

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