Creating a “Gold Standard” Physician Recruitment Strategy · CREATING A “GOLD STANDARD” PHYSICIAN RECRUITMENT STRATEGY PAGE 2 I. INTRODUCTION Physician recruitment is a multi-faceted

MARKETING AND PLANNING LEADERSHIP COUNCIL

Creating a “Gold Standard” Physician Recruitment Strategy Original Inquiry Brief March 23, 2004

RESEARCH IN BRIEF

When facing physician shortages due to aging medical staff, early physician retirement, growing communities, and out-migration of physicians due to poor reimbursement or high malpractice premiums, health system administrators often develop in-house physician recruitment programs to bring physicians—both primary care physicians (PCPs) and specialists—to the medical community. Successful programs have high placement-to-recruiter ratios, low costs, and high placements-per-visit rates. The following report describes tactics for effective physician recruitment—including tailoring site visits for each candidate’s professional and personal interests, speaking at length with candidates’ spouses, and conducting thorough screenings to eliminate less viable candidates—and profiles four successful physician recruitment programs.

I. Introduction

II. Tactics for Successful Physician Recruitment

III. Profile: Recruiters conduct post-visit surveys to improve future site visits

IV. Profile: Strong recruiting program keeps medical staff apace with growing community

V. Profile: Personal attention pivotal to successful recruitment program

VI. Profile: Recruiters rely on pre-interview screening, invite only most viable candidates

MAJOR SECTIONS

THE ADVISORY BOARD COMPANY WASHINGTON, D.C.

Advisory.com

ASSOCIATE Leslie Oestreicher

MANAGER

Laura Dicker

CREATING A “GOLD STANDARD” PHYSICIAN RECRUITMENT STRATEGY PAGE 2

I. INTRODUCTION Physician recruitment is a multi-faceted undertaking that involves predicting and identifying physician need, advertising vacancies, promoting the institution and its surrounding community to candidates, ensuring that selected candidates’ personalities match well with the hospital or practice, and organizing successful site visits. Health systems that develop in-house recruiting programs often work closely with private practice and clinic administrators to bring physicians to the health system’s medical staff. Though less expensive than external recruiting firms, in-house programs remain costly

Growing physician turnover rates have led hospitals to devote more resources to recruitment efforts. An analysis of physician recruiting methods shows that hospitals spend thousands of dollars to effectively bring a physician on staff.1 Creating an in-house recruitment program can save health systems thousands of dollars per search, as an internal recruiting program costs less per search than hiring an external search firm; according to a 2003 survey, 47 percent of large hospitals (with more than 200 beds) maintain an in-house employee dedicated solely to physician recruitment.2,3 Major physician recruitment costs are listed below.4

Income guarantees: The vast majority of income guarantees are forgivable after an agreed length of time.

Staff or recruiter time and fees: In-house recruiters often receive a base salary between $35,000 and $65,000, and may receive bonuses per successfully recruited physician.

Recruiting sources: These resources include journal advertising, networking, direct mail, and Internet listings.

Site visit and interview costs: These costs include travel, food, accommodations, and entertainment, typically total between $1,500 and $3,000 per interview.

Relocation expense reimbursement: The national average relocation expense reimbursement in 2002 was $9,000.

Post-recruitment marketing: These efforts may include advertisements to announce the physician’s arrival to the community and referring physicians.

According to James Merritt, president of the Irving, Texas-based Merritt, Hawkins & Associates recruiting firm, the potential cost of a physician search—not including income guarantees—approaches $100,000.5 Needs analysis, medical staff survey inform recruitment needs

Though physician recruitment is an expensive endeavor, most health systems recruit physicians to meet demand from the community and medical staff. Health system administration can proactively identify physician needs by conducting a real-world needs assessment that combines a full range of metrics to determine accurate, optimal physician supply. Common needs assessment tools that help administrators determine which specialties to target for recruitment are listed on the following page. 6

1 Merritt, J. “Physicians: The Cost of Recruiting Physicians.” Trustee. (October 2002). 2 Advisory Board research. 3 Merritt, Hawkins & Associates. “2003 Survey of Hospital Recruitment Trends.” www.merritthawkins.com/merritthawkins/pdf/2002_hospital_trends.pdf (Accessed March 21, 2004). 4 Merritt, J. “Physicians: The Cost of Recruiting Physicians.” Trustee. (October 2002). 5 This figure includes benefits/perks, recruiters’ fees, candidate sourcing, candidate/spouse interview, physician relocation, and practice marketing; Merritt, J. “Physicians: The Cost of Recruiting Physicians.” Trustee. (October 2002). 6 Clinical Advisory Board. “Pre-Hire Checklist, Exit Interview Blunt Turnover.” Clinical Strategy Watch. Washington, DC: The Advisory Board Company. (December 2003).


Accessibility of medical services Hospital capacity and infrastructure characteristics Incidence of disease rates Marketplace trends, such as potentially practice-changing clinical innovations National physician-to-population ratios Population counts and projections Regional variances in age, gender, and socioeconomic factors

In addition to proactively determining recruitment needs, administrators can reactively recognize recruitment opportunities through medical staff survey results regarding areas of need. Furthermore, succession programs—in which hospital representatives work closely with retiring physicians to identify and hire their successors—also bring to light imminent retirements and consequent recruitment opportunities. Before commencement of a physician search, all parties involved in the hiring decision—usually a recruiter and hiring physicians—should agree on hiring criteria, salary, and incentives and create a detailed recruitment plan. Hospital administrators should also consult legal counsel regarding recruiting arrangements to ensure the legality of strategies prior to implementation. Recruiters utilize multiple media to target appropriate candidates

Recruiters use various media—including the Internet, brochures, advertisements, telephone calls, and direct mailings—to alert potential candidates of openings in the medical community. Recruiters have identified geographic preference as a major factor in physicians’ employment decision; thus, physician recruiters target physicians with ties to the area—either through family, education, or spouse—or who have indicated that they would like to relocate to the area. Recruiters believe that this search method reduces the number of no-response solicitations. A sampling of resources used to identify potential candidates is provided below.

Advertisements in medical and non-medical journals Attendance at national conferences for specialists Databases of physicians, including graduating residents and military physicians with plans to

leave the service in the next year Internet listings on recruitment websites, such as PracticeMatch.com and PracticeLink.com Listings on medical associations’ websites Local medical school rosters Medical society mailing lists Networking with residency programs Postcards sent to potential candidates Retained physician recruiters from external search firms

Once a candidate is identified, recruiters often send a direct mailing to the candidate or contact the candidate by phone. Direct mailings can be letters or postcards, often describing the opening, promoting the community, and providing contact information for the recruiter.

Pre-interview conversation includes screening, promotion of community

After being identified, but before being invited for a site visit, each candidate is thoroughly screened to create lowest possible interview-to-placement rates, which saves physicians and the health system administrators’ time and money. A well-defined screening process allows the recruiter to decide whether or not the candidate is viable while simultaneously allowing the candidate to determine whether he or she likes the community. The case study on the following page takes an in-depth look at one such successful screening process.


In addition to screening out candidates, pre-site visit conversations should “sell” the institution and its surrounding community to physicians. Recruiters may send videos and customized information packages to interested candidates. Site visit crucial to impressing candidates and their families

If the recruiter and hiring physicians are still interested in a candidate after the screening process, the candidate is invited for a site visit and interview. The most important aspect of planning these site visits is ensuring that they are highly customized to each candidate according to personal and professional interests. Recruiters also find success in accommodating the candidates’ spouse and children, who influence the candidates’ decision; recruiters can accommodate the candidates’ families by scheduling entertainment—such as trips to the zoo or museum—for family members during the candidates’ appointments at the hospital. According to James Merritt, president of Merritt, Hawkins & Associates, “the interview should be structured for confirmation, not negotiation. The client and his or her spouse should merely be confirming what they have already learned by phone, fax, and e-mail prior to the interview. The personal interview…should be 70 percent social and only 30 percent about business.”7 It is important that the candidate confirms a good impression of the medical and general community. Common site visit activities are listed on the following page.

7 Merritt, J. “Physicians: The Cost of Recruiting Physicians.” Trustee. (October 2002).

A pre-hire compatibility checklist involves a structured, in-depth phone meeting in which administrators walk the candidate through a detailed site profile, complete with data about the hospital’s practice environment, services, caseload, and community. This extra level of information ensures that candidates see an accurate portrayal of the institution. During the conversation, recruiters work from a set list of probing questions about the physician’s practice style, professional goals, and reasons for seeking a new practice setting. In addition, hospitals sometimes include a candidate’s spouse in the conversation to discuss career opportunities, housing, and other pertinent subjects. Implementing this in-depth phone meeting protocol has increased the efficiency of the interview process. Prior to the implementation of the protocol, the health system averaged 3.5 interviews per hire; after implementation, the health system averaged 2.5 interviews per hire. In addition, the percentage of interviewees hired rose from 25 percent to 49 percent. Source: Clinical Advisory Board, “Pre-Hire Checklist, Exit Interview Blunt Turnover,” Clinical Strategy Watch, Washington, DC: The Advisory Board Company, (December 2003).

Case study: Pre-hire checklists ensure good fit


Formal dinner with practice physicians Hospital tours Introduction to medical staff and health system administrators Real estate/community tours School tours

Financial incentives include income guarantees, relocation expense reimbursement

In order to attract selected candidates to the community, health systems often offer financial incentives. According to the 2003 “Review of Physician Recruitment Incentives” from Merritt, Hawkins & Associates, the following list provides common physician recruitment incentives:8

Income guarantees Relocation expense reimbursement Signing bonuses Continuing medical education (CME) payment

According to the aforementioned survey, health systems are increasingly offering income guarantees, also known as “physician recruitment agreements” and “physician practice startup assistance agreements.”9 Approximately 94 percent of these income guarantees include a forgiveness clause, which allows the income guarantee loan to be forgiven for physicians who remain in the service area for an agreed length of time.10 Trends in income guarantee prevalence are depicted in the graphic below.

8 Merritt, Hawkins & Associates. “2003 Review of Physician Staffing Incentives.” www.merrithawkins.com/merrhawkins/pdf/2003_incentive_survey.pdf (Accessed March 21, 2004). 9 Heerwagen, P. “Income Guarantee a Popular Way to Attract Physicians.” North Valley Business Journal. (August 2002); Merritt, Hawkins & Associates. “2003 Review of Physician Staffing Incentives.” www.merrithawkins.com/merrhawkins/pdf/2003_incentive_survey.pdf (Accessed March 21, 2004). 10 Merritt, Hawkins & Associates. “2003 Review of Physician Staffing Incentives.” www.merrithawkins.com/merrhawkins/pdf/2003_incentive_survey.pdf (Accessed March 21, 2004).

1999 2000 2001 2002

23%

33% 34% 38%

Income guarantees becoming more prevalent

Percentage of search assignments involving income guarantees*

* Each year represents April through March. Source: Merritt, Hawkins & Associates, “2003 Review of Physician Staffing Incentives,” www.merrithawkins.com/merrhawkins/pdf/ 2003_incentive_survey.pdf (Accessed March 21, 2004).


In addition to income guarantees, a popular financial incentive used to recruit physicians is reimbursement for relocation expenses. The Merritt, Hawkins & Associates survey indicates that 99 percent of all searches included offers to pay for relocation costs; the average relocation allowance in 2002 was $9,000. Notably, all of the recruitment programs profiled in this report offered relocation reimbursement, ranging from $4,000 to $10,000. Often, relocation reimbursement costs are split between the hiring physician practice or clinic and the health system. Another financial incentive targets the largest pool of new talent: residents. Recruiters can successfully enfranchise desirable residents by providing a loan assistance program that begins in the last year of fellowship. Health systems can also attract graduating residents by offering standard, post-graduation loan repayment assistance. The following section details tactics utilized by successful physician recruitment programs; these tactics are described in further detail in the subsequent sections of this report. II. TACTICS FOR SUCCESSFUL PHYSICIAN RECRUITMENT Tactic #1—Pre-recruitment planning: Before commencement of a physician search, all parties involved in the hiring decision—usually a recruiter and hiring physicians—should agree on hiring criteria, salary, and incentives and create a detailed recruitment plan. Hospital administrators should also consult legal counsel regarding recruiting arrangements to ensure the legality of strategies prior to implementation. Tactic #2—Candidate sourcing: To identify potential candidates for recruitment, physician recruiters find the most success with a combination of traditional resources—such as Internet listings, databases, and networking at residency programs—and innovative and highly targeted resources—such as advertisements in non-medical magazines and mailing lists from medical societies in cities where physicians face a crisis, such as uncontrolled malpractice costs. Tactic #3—Direct mailings: When contacting potential candidates through direct mailings, some physicians prefer more formal looking envelopes and letters, while others prefer easily readable glossy postcards. Regardless of the format, direct mailings usually describe the position opening and the community and are often tailored for different specialties. While providing essential information is important, recruiters warn against providing too much information about the practice and the community; too much information might encourage candidates to self-select themselves out of the candidate pool. The direct mailing should simply encourage potential candidates to contact the recruiter to obtain more information. Tactic #4—Pre-interview screening: Screening candidates before inviting them for a site visit and interview saves all parties time, money, and energy. One recruiter strongly recommends having the hiring physicians—not the recruiter—check the candidate’s references, because physicians better understand clinical qualifications. The president of the recruiting firm, Merritt, Hawkins & Associates, suggests spending between six and ten hours on the phone screening each candidate prior to the site visit, in order to reduce the number of inappropriate site visits.11

11 Merritt, J. “Physicians: The Cost of Recruiting Physicians.” Trustee. (October 2002).


Tactic #5—Conversations with spouses: During phone conversations prior to the site visit, recruiters may speak with candidates’ spouses to convince them of the community’s merits and to learn which non-medicine-related activities should be included in the site visit. Spouses play an important role in the decision-making process and should be a consideration of recruiters. Tactic #6—Site visit planning: Each site visit and interview should be carefully designed by the recruiter in collaboration with the hiring practice. Common activities include a hospital tour, real estate tour, and introductions to practice and referring physicians and hospital administrators. The site visit is a great opportunity for the health system to indicate its interest in the candidate. An interesting tactic used by several profiled recruiters is working closely with a no-pressure, knowledgeable real estate agent who is willing to report back to the recruiter any pertinent information overheard during the real estate tour, such as whether they have already made a decision about acceptance of the position. Tactic #7—Providing draft of contract: Prior to departure, physicians or recruiters may want to provide the best candidates with a draft version of a contract. By sharing the draft, the candidate learns how interested the physicians really are and starts to think about the position in concrete terms. Tactic #8—Financial incentives: Most often, the hiring physicians negotiate contracts with chosen candidates. When the health system offers financial incentives—such as income guarantees, medical school debt repayment plans, or relocation expense reimbursement—the recruiter may take part in the contract negotiation. Tactic #9—Post-recruitment support: Once physicians have been successfully recruited to the community, profiled recruiters continue to support the physicians as they transition into the medical community. Post-recruitment services include helping physicians find office space, advertising the physicians’ arrival in the local newspaper, and formally introducing the physician to the medical staff. Tactic #10—Recruitment program staffing: Having the appropriate number of recruiters and support staff strengthens the recruitment program. Total full-time equivalents (FTEs) depend on each situation; health systems in less desirable locations—because of cold weather, high malpractice premiums, and high managed care penetration, for instance—probably require more FTEs per recruit because more time and effort is invested in recruiting each physician. The remainder of this report profiles four health systems’ successful recruiting programs.


III. PROFILE: Recruiters conduct post-visit surveys to improve future site visits With a staff of two recruiters, the health system’s recruitment program helps bring between 20 and 30 physicians to the community each year. Three years ago, half of recruited physicians were PCPs. Currently, as a result of the aging of certain medical staff, 60 to 70 percent of recruited physicians are specialists. Of the approximately seven PCPs recruited each year, one is typically employed by the hospital’s primary care network and the rest join a private practice. Key factors that contribute to the success of the recruitment program include the following:12

Careful pre-site screening Close collaboration with hiring physicians Highly orchestrated site visit Offers of loan repayment and/or income

guarantees A windfall of the recruitment program’s success has been a strong and lasting relationship between recruited physicians and the health system. When recruiters help bring physicians to the community, the recruited physicians’ loyalty (and referrals) remain with the health system. The strong in-house recruiting program has also controlled the costs of recruiting and has allowed administrators to strategically and methodologically plan additions to the medical staff. Each recruiter heavily involved in up to 15 searches annually

The physician recruitment team comprises two full-time recruiters and one supporting staff member. The physician recruitment team is part of the business outreach and development department, and the recruiters report to the director of guest services and physician contracts. Each recruiter is expected to be heavily involved in between 10 and 15 searches each year, and they often participate less intensively in other recruiting efforts. The recruiters’ compensation model includes a bonus structure; recruiters’ receive most of their income from a base salary, in addition to a bonus of a set amount of money for each physician brought into the community. The director decided against placing more of recruiters’ compensation in the form of bonuses so as not to encourage recruiters to conduct faster physician searches in order to increase the number of physicians recruited to the area, which would probably lead to a drop in the quality of the searches. If the director had more resources—namely, a larger budget—he would hire more recruiters to support additional, high-quality searches. With a larger staff, each recruiter would specialize in recruiting several types of physicians to gain more focused expertise and learn the nuances of and resources for recruiting different types of specialists. Currently, the recruiters are generalists and recruit for all types of specialists.

12 These and other factors are described in more detail in the subsections to follow.

Institution type: Three-hospital, 1,000-bed, not-for-profit health system located in the East

Source: Senior Director,

Guest Services and Physician Contracts

Physicians recruited 13 specialists; annually: 7 PCPs Staff: Two recruiters

(1.8 FTEs) Recruited physicians per staff member: 10


Avoiding external firms keeps costs of recruiting low

The cost of recruiting physicians—including overhead, but excluding relocation costs—averages between $10,000 and $12,000 per physician. To keep costs low, the recruiters avoid utilizing external firms, which can cost approximately $30,000 per search. Recruiters will only use an external search firm for extremely difficult and/or urgent searches; otherwise, recruiters rely on internal resources. The hospital may also pay up to $5,000 per physician for relocation costs. On some occasions, the hiring physicians—instead of the health system—pay for the recruited physician’s relocation costs, as the recruited physicians may wish to avoid having financial obligations to the health system. Medical staff development committee determines occurrence, scope of recruiting efforts

The health system’s committee on medical staff development determines how and when the health system will contribute to a recruiting effort; this committee is composed of the health system’s board of directors, hospital chief executive officers (CEOs), vice president for medical affairs, and community members. When working with a private practice to recruit a physician, the health system uses standardized tiers of assistance. Before commencement of each search, the medical staff development committee decides which tier will be applied to each recruiting effort based on need. The tiers are listed below (in order of the most basic to the most involved).

Candidate identification Screening assistance Site visit assistance (including helping to organize the visit and paying for half of the costs) Contract negotiation Provision of income guarantees

In addition to determining the scope of the search, the medical staff development committee also determines when the health system participates in a recruiting effort. The physician recruitment program supports many recruitment efforts; however, the health system does not participate in physician searches in which a physician is interested in coming to the community to purchase a practice or if there is no demonstrated need for a physician in the community. The committee does respond to the following types of recruitment requests:

A member of a local physician practice can appeal to the committee for help recruiting a physician by submitting a letter to the committee that documents why the hospital should support the recruitment effort. This letter should include data such as wait time for appointment and physician-to-population ratios.

Medical staff members can suggest a recruitment effort. For instance, if the medical staff votes that the community needs a certain type of specialist, the committee dispatches the recruiters to bring that specialist to the area.

The recruitment office may also suggest a recruitment effort based on a need recognized through the recruiters’ succession planning, which is described on the following page.


Succession planning contributes to recruitment program

The recruitment program’s succession planning program typically entails recruiters working with physicians who have approached the recruiters for help finding their replacement. Most physicians want to see their practice survive after their retirement and understand that it will take time to recruit their replacements. Recruiters also approach physicians over the age of 55 who seem to be easing into retirement. Communication regarding succession planning is particularly successful because the medical staff and recruitment program enjoy open communication through the following channels:

Constant collection of feedback from medical staff Discussions during department meetings Medical staff newsletter

Physicians support recruitment efforts and succession planning; however, this was not always the case. In the early 1990s, physicians were leery of the health system’s physician recruiters, viewing them as bringing competitors into the medical community. Eventually—as physicians observed that the health system was recruiting in-demand physicians needed by the community and medical staff instead of competitors—physicians learned that increasing competition was not the intent of the recruiters and that the physician-recruiter relationship should really be symbiotic. Prior to start of recruiting process, recruiter explains the physician employment market

Once a recruitment effort is approved by the medical staff development committee, a recruiter is assigned to the project. Most recruitment projects are joint efforts by the health system’s recruiters and a hiring physician practice. As a first step, the dedicated recruiter meets with the private practice’s office manager and physicians to discuss the practice and the position opening. If the practice is working with the hospital’s recruiting team for the first time, the recruiter talks practice representatives through the recruitment process, outlining when the hospital will take an active role (e.g., identifying and pre-screening candidates) and when the physicians must take over (e.g., checking references and conducting interviews). The recruiter also takes the time to explain the dynamics of the physician employment market to physicians who have not participated in the recruitment process for some time. The director has observed that some physicians assume the physician employment market is the same as when they were hired, which may have been when opportunities were so rare that physicians accepted almost any position offered. The recruiter explains that physicians today have much more discretion in choosing their jobs and are more likely to turn down an offer; as such, the candidates are interviewing the physicians as much as the physicians are interviewing the candidate. Essentially, this means that that hiring physicians must make an effort to impress the candidate during the recruitment process.


Recruiters use myriad methods for identifying potential candidates

Once the recruiters have mapped out the recruitment process and delineated the physicians’ and recruiters’ role, the recruiter begins the identification of potential candidates. Strategies for identifying candidates are described below.

Advertising in non-medical journals: In this innovative tactic, recruiters place advertisements in unconventional magazines with the assumption that physicians read magazines other than medical journals. For instance, the health system successfully recruited a urologist who responded to an advertisement in a small hiking magazine; the physician was attracted to the fact that the health system is located in an area known for its hiking.

Attending national meetings for particular specialists: Recruiters will attend national meetings and notify specialists that there is an opening at the health system.

Limited advertising in medical journals: Recruiters only place a few advertisements in medical journals because there is only a limited return on investment (ROI) for this type of marketing. Recruiters have found that a lot of physicians read these journals and quite a few physicians response; however, the respondents rarely fit the profile that the recruiters are seeking.

Placing listings on the Internet: The health system places lists on PracticeMatch.com and PracticeLink.com to advertise openings.

Purchasing databases: The health system purchases databases containing information about physicians who are completing their training and looking for jobs; databases used by the health system include a military database that lists all physicians leaving the service in the next 12 months. Through the databases, recruiters query all physicians that were born in, lived, or studied in the area.

Reviewing local medical school roster: A local medical school has been a great source of candidates, particularly because of the close relationship between the faculty and medical staff and because the students have already made a connection to the community.

Targeting states with physician crises: Recruiters are always aware of crises affecting physicians, such as malpractice issues in neighboring states, and focus on identifying physician candidates in those states.

Utilizing internal networking: Members of the physician practice are encouraged to contact their residency programs and inform the directors that the health system is recruiting physicians. In addition, medical staff members are asked for names of physicians they trained with and for permission to contract those physicians on the medical staff member’s behalf.

The health system would like to increase the community’s involvement in the recruitment process. For instance, if someone had a relative just exiting a residency program, the recruiters would like to be notified. However, it is difficult to create a campaign to promote community participation without implying that the current practices were ill-equipped to care for the community, which is not a positive message to send.


Initial contact often through direct mailings

Once candidates are identified, they are sent a direct mailing that typically describes the region, health system, and practice opportunities. The intent of the letter is to pique the physician’s interest; recruiters know that physicians are inundated with mail, so they avoid long letters that physicians may not bother to read. Recruiters do not use postcards, as the director believes the more formal format of a letter and envelope makes a better impression on potential candidates. The letter opens with a “hook,” such as a reference to a current issue of development in the specialty. For instance, a letter might start with a question about how the physician has been affected by malpractice issues, and then go on to mention that the health system’s state has tort reform. Recruiters conduct screening phone interview, reference check, background check

Candidates that respond to notification of openings are informally screened during the first phone conversation with recruiters. The first conversation with potential candidates typically asks the candidate to describe the following (in approximate order of occurrence):

Reasons why the candidates want to leave their current position Expertise Location of previous positions Whether they would like the region Family characteristics Existence of personal issues

If the recruiter believes the physician is still a feasible candidate after the first conversation, the recruiter asks for the candidate’s resume and references. Recruiters only check the references of the most viable candidates so as not to irritate the physicians’ references, who have probably been contacted by several other recruiters. After the first conversation, recruiters also conduct a background check—including criminal and financial reviews—through an external company specializing in background checks to verify that the physician is a good fit for the health system. Only if the recruiter thinks the physician is a good candidate, the recruiter will forward the candidate’s resume, references, and background-check report to the hiring physicians. The hiring physicians then review the candidate’s information and decide whether or not to initiate contact with the candidate. Carefully planned site visit takes candidates’ spouses into consideration

When the hiring physicians decide to invite a candidate for an interview and site visit, the recruiter has a lengthy discussion with the physician practice’s office manager to create the itinerary for the site visit. Details of the site visit plan are so exact that they include what will be in the welcome packets that await candidates in their hotel room. Occasionally, office managers take the lead in planning the site visit; other times, the recruiters plan most of the visit. However much the recruiters contribute to the planning, they are always careful to work collaboratively with office managers, so that all parties’ input is taken into consideration. Recruiters prefer to invite the candidate’s family on the site visit, and recruiters spend a significant amount time selling the community to the candidate’s family, especially the spouse. While the practice environment may be advanced, the community is less developed; it is important to the ultimate retention of the recruited physician that the spouse feels comfortable in the community. Most candidates and their families stay two nights during their site visit; recruiters do not encourage candidates to stay longer or to consider the site visit a long-term vacation because that would be an inappropriate use of the health system and recruiter’s resources.


Upon arrival, every candidate receives a complete itinerary that is explicit as possible. The visit is tailored specifically for each candidate—adapting to their professional and personal interests. A sampling of important site visit events is provided below. Another essential part of a successful site visit is allowing the physicians free time to absorb their impression of the practice and discuss the community with their spouses. Contract draft, survey exchanged before candidates’ departure

Prior to departure, recruiters encourage the hiring physicians to place a draft contract in the hands of candidates that they are interested in hiring. Giving the candidate a draft contract expresses to the candidate whom the physicians are really interested in hiring the candidate and often starts the candidate thinking in more concrete terms about actually taking the position. Some practices have not yet developed a standard draft contract; for those practices, recruiters encourage hiring physicians to share with the candidate a document with bulleted points detailing what can be expected in a contract. Also before the candidate leaves, the recruiters give the candidates a satisfaction survey that asks the candidates about their satisfaction with the site visit. A sample set of questions is provided below.

Breakfast with the recruiter and a hospital and/or practice representative Discussions of the community with the recruiter Formal dinner with up to eight practice partners; the recruiters avoid very

large dinner parties because too many people impedes conversation; before this dinner, the recruiter tells the candidate a small piece of information about each dinner guest (such as where they physician trained and a hobby of the physician’s spouse) so that the candidate can be somewhat prepared and slightly less overwhelmed upon meeting everyone

Hospital tour Meeting with the following individuals:

Hospital executives Members of the physician practice Potential employers of the candidate’s spouse Private banker (optional) Referring physicians Representative for the chamber of congress

Real estate and community tour Visit to schools or superintendents’ offices (optional)

Source: Advisory Board research.

Site visit activities focus on both hospital, community

Do you feel like you received the right information? Do you feel like you spoke with the right individuals? What did you dislike about the visit? What did you like about the visit? What should the recruiters have done differently?

Source: Advisory Board interviews.


Not only do the results of the survey inform the recruiters on how to improve their future recruitment efforts, but they also allow the recruiters one more chance to supply the candidates with important information or put them in touch with the right people. Health system offers limited financial incentives to candidates

If a physician practice decides to hire a candidate, the physicians might let the candidate know before departing from the site visit, or within 48 hours after the site visit ends. Members of the hiring physician practice negotiate contracts with candidates; occasionally, the health system’s recruiters are involved in contract negotiation if the health system is offering a limited loan repayment or other financial incentives. The health system considers loan repayment for graduating residents, and, on rare occasions, the health system offers a stipend for residents who are finishing their residency programs. In addition, on rare occasions, the health system offers income guarantees for the hardest-to-recruit physicians; the income guarantee is typically $10,000 forgivable after four years. Also, each physician is offered up to $5,000 in relocation expenses. However, as previously noted, physicians may prefer to accept relocation cost reimbursement from the hiring private practice to avoid being financially obligated to the health system. Post-recruitment efforts mostly handled by practice managers

Once a candidate is successfully recruited to the community, the health system’s recruiters help physicians contact realtors and bankers who have standing relations with the recruitment office. Recruiters also assist newly recruited physicians through the credentialing process. While the recruiters help as much as they can, the office managers of the physician practice tend to take on most of the responsibility of helping recruits transition into the medical community. IV. PROFILE: Strong recruiting program keeps medical staff apace with growing community In response to the fact that the health system is located in one of the fastest growing counties in the nation, the health system has created a highly effective internal recruiting program to allow the medical staff to keep pace with the exploding population.13 The recruiting program has been extremely successful. With one full-time recruiter, the recruiting program doubled its 2003 goal of nine successfully recruited physicians. In addition, after only one quarter, the recruiter has brought in 14 physicians to the community on a pace that should far exceed the 2004 goal of 20 successfully recruited physicians. Two out of every three candidates who visit the hospital accept a position in the community.

13 The county is expected to grow by 300,000 residents in the next 10 years. Seventy percent of the health system’s market are Medicare patients.

Institution type: Two-hospital, 500-bed, not-for-profit health system in the West

Source: Physician Recruiter Physicians recruited 18 specialists; annually: 2 PCPs Staff: Recruiter (1 FTE),

Support Staff (1.5 FTEs), Credentialer (1 FTE)

Recruited physicians per recruiter: 20


Part of the reason the recruiting program has been so successful is that the state has malpractice tort reform, which protects physicians from high malpractice premiums, as well as an attractive climate and a quickly growing market that physicians know will support their practice. In addition to the positive attributes of the region, the health system has been particularly successful primarily due to several recruiting practices listed below.

Paying attention to spouses’ interests “Underselling” the community over the phone and over-delivering during the site visit Conducting heavy pre-screening to eliminate unnecessary site visit costs

The recruiting practices listed above are described in more detail throughout this profile. Full-time recruiter supported by 2.5 FTEs

The in-house physician recruitment program began in 2003 and is part of the physician services department. Members of the recruitment team include one full-time physician recruiter, one full-time credentialer, and one full-time and one half-time support staffers. The recruiter does not work on a bonus structure. Costs per recruit vary greatly for each search

The cost of recruiting physicians differs significantly depending on the involvement of the recruiter in the recruitment effort. The health system usually pays for travel costs for each site visit, which average $800. The health system will also pay a relocation fee of $10,000. In addition, many recruits are offered an income guarantee that is forgivable after four years. Administrators, practice members, medical staff members all identify recruitment needs

At the end of each year, the CEO and the hospital’s board of directors decide which types of physicians will be prioritized for recruitment in the upcoming year. Prioritization is determined by needs analysis and by anticipation of what each type of physician could contribute to the hospital’s bottom line. Another resource that informs the decision about which type of physicians will be recruited in the upcoming year is a manpower shortage assessment performed by an external consulting firm. Consultants study physician needs by specialty based on numbers of physicians currently in the area, expected population changes, physician ages and likelihood for retirement, and other similar factors. In addition to health system-identified recruitment needs, many recruitment efforts are initiated by requests from physician practice members who wish to replace a retiring physician or expand their practice to meet demand from the community. The health system’s administrators are happy to assist these physicians because participation in the recruitment process strengthens the relationship between physicians and the health system. Furthermore, the health system identifies opportunities to assist with physician recruitment by sending a letter to all members of the medical staff each September to ask if they have recruitment plans for the upcoming year and inquire whether they would like the health system’s assistance in recruiting efforts.


Recruiter identifies candidates through Internet, residency directors, journals

The health system recruitment efforts are driven by a commitment to provide the best health care to the community, which means that the physicians must be of the highest caliber. Consequently, the program is very selective when it comes to recruiting physicians, starting with the identification of potential candidates. For instance, recruiters only contact the residents graduating from the highest ranked programs in the country. Successful tactics for identifying the best candidates are described below. PhysicianWorks.com

One of the most successful tactics for identifying candidates has been the Internet site, PhysicianWorks.com. Currently, the health system maintains several active searches, each of which receives six hits per day. Approximately half of the health system’s recruits are identified through PhysicianWorks.com, which the director considers to be a great ROI. The recruiter noted that PhysicianWorks.com is successful because it is well-known and user-friendly. Contacting residency program directors

To identify potential candidates, the recruiter contacts directors of the highest ranked residency programs, especially those programs based on the West coast. Physicians recruited from other areas of the country tend to be less likely to enter the community because they are less comfortable with the weather and culture of the West. Journal advertisements

On occasion, the recruiter advertises practice opportunities in specialty journals and the Journal of the American Medical Association. However, the recruiter does not place advertisements in the New England Journal of Medicine because advertisements in this journal have not resulted in successful recruitment to date. When physicians are identified through PhysicianWorks.com, residency directors, or journal advertisements, the recruiters send a letter customized for each specialty that describes the opportunity for specialists to come to the community. Recruiter avoids costly, ineffective identification techniques

Interestingly, the recruiter does not use databases to identify potential candidates. The recruiter has considered purchasing a database, but, given the fact that the health system already exceeds its recruitment goals, he does not believe it is necessary to allocate recruitment funds on a database. Instead of buying a database, the recruiter would prefer to invest in hiring another physician recruiter. The health system does not use external search firms to identify candidates. The recruiter has found that retained physician searches—in which external recruiters are paid for their contribution to a physicians search—are too expensive and external recruiters do not pay enough attention to detail. The only exceptional case when the health system utilized an outside recruiter was during the search for a neurosurgeon; neurosurgeons are notoriously difficult to recruit given their scarcity and the high demand for their services throughout the country. Therefore, administrators sought additional support to recruit this specialist.


While leads from current medical staff about potential candidates are appreciated, most recruitment efforts do not originate from medical staff’s suggestions. Medical staff members often suggest that their friends and relatives should be recruited; however, their friends and relatives do not necessarily correlate with the best prospects in the country. Since the recruiter’s goal is to constantly upgrade the quality of the medical staff, he does not always pursue leads generated from the medical staff. Recruiting website in development will identify potential candidates

Another technique that the recruiter will soon use to identify potential candidates is a user-friendly, in-house physician recruitment website. This website will allow physicians to learn about opportunities to practice in the medical community and contact the recruiter directly. In addition, the website will allow physicians to apply for medical staff privileges and state licensing. In order to advertise the assets of the community, the website will have links to various city attractions, including websites for professional sports teams, the state university’s catalogue, and the city’s chamber of commerce. The website will also market the high caliber of patient care in the community and the fact that the hospital’s medical staff includes some of the finest physicians in the country, who were trained at the most prestigious research institutions. Physicians will access the recruiting page through a link on the health system’s main website. Screening process reduces number of unproductive site visits

When a prospect is identified, the recruiter contacts the candidate by phone and completes a screening form. One of the first questions the recruiter asks is why the candidate is interested in coming to the health system’s community. If the recruiter approves of the candidate after the first conversation, he will send the candidate an initial screening form, which asks for references. After checking for at least three positive references, the recruiter does more phone work, talking to the physician and the physician’s spouse about the community. The recruiter tries to sense if the candidate is viable and to design the most appropriate site visit. The recruiter encourages the candidate to be as forthcoming as possible about his background, even if the information is unattractive (such as malpractice problems or bankruptcy). The recruiter will find out this information eventually through background checks, so it saves him time to learn about these potential problems early on in the recruitment process. Candidates tend to be more forthcoming when the recruiter explains the discovery of pertinent issues is inevitable and that it behooves the physician to alert the recruiter to potential issues so that he can work with the physician to resolve any problems related to his or her background. During pre-site conversations, recruiters also speak at length with the candidates’ spouses to gain an understanding of what they are looking for in a community and what their personal and professional interests are. Winning over a spouse has proven to be one of the most effective strategies for successful recruitment of physicians because spouses often play a large role in the decision-making process. Another tactic the recruiter has found to be successful during many pre-visit talks is to “paint a picture of the community at a seven or eight” on a scale of ten so that the candidate’s expectations of the community are slightly lowered; then, once when the candidate arrives and sees that the community actually rates as a “ten,” candidates will be even more impressed and more likely to sign a contract immediately. For instance, the recruiter will warn the candidate that during three months of the summer the weather will regularly be 115 degrees; however, when the candidate arrives in August and discovers that the climate has a “dry heat” and that 115 degrees not as uncomfortable as they expected, they are even more pleased with the community than they thought they would be. The recruiter uses his discretion in deciding when to apply this strategy.


Of approximately 24 potential candidates whom the recruiter speaks with over the phone, the recruiter and the hiring physicians only invite the two or three best candidates to visit the hospital. By reducing the number of site visits to exclude unsuitable candidates, the recruiter saves the health system and hiring physicians considerable time and money. Two of every three candidates that come for an interview end up settling in the community. Intricately planned site visits result in highly impressed candidates

When the recruiter and hiring physicians invite a candidate for a site visit, the candidates are asked to make their own travel arrangements; travel costs are reimbursed by the health system. The recruiter asks the candidate to send him all original receipts, including receipts for travel costs, after the site visit; the candidates keep photocopied versions of the receipts for themselves. The recruiter ensures that the candidates receive a reimbursement check within two weeks of the site visit, as any delay beyond two weeks may upset the candidate and make that candidate less likely to accept a position in the community. Beyond the travel arrangements, the recruitment team makes all the arrangements for the site visit; the visit is detailed in an itinerary that the candidate receives before leaving for the site visit. The credentialer on the recruitment team creates the itinerary from a template designed for each specialty and further tailored for each candidate. For instance, a neurosurgeon’s itinerary will include meetings and/or interviews with the following individuals:

CEO Director of the recovery rooms Directors of the operating room (OR) Head of the emergency department (ED) Hiring physicians Local neurologists (who would be the referring physicians) Pertinent health system administrators Surgery team

Each of the individuals listed above that interview the candidate are given an electronic form that rates the candidate, providing an indication of whether or not the interviewer would hire the candidate. Each of these forms are printed by the recruiter and filed. Other important, standard site visit activities are listed below.

Real estate tour (from a no-pressure real estate agent who has been working with the hospital for two years); the real estate agent knows to report back to the recruiter any pertinent information she overhears during the real estate tour—especially information that will help during contract negotiations such as whether candidates have already decided to accept the position

School tour (if the candidate and spouse have or plan to have children) Free time for the candidates and their families to relax and discuss their impression of the

community Beyond the aforementioned activities, the recruiter tries to tailor each trip to each candidate’s interests. For instance, he may take the family to the opera, ballet, symphony, or state university’s baseball game. One strategy that the recruiter has found to be useful in creating the best possible site visit is to ask candidates to write out a list of a dozen questions they have about the area prior to their arrival; the recruiter then knows what aspects of the community are important to the candidate and what the site visit should include.


Also, special interest is paid to the details, such as having flowers and gift baskets in the hotel room, along with a tailored packet of information, which includes information from the chamber of commerce and a local realtor. Formerly, the recruiter organized a party for each visiting candidate that was attended by physicians; however, given the high volumes of recruits coming to the health system, the recruiter felt he was taxing the physicians too much by asking them to attend 30 parties per year, so he ceased throwing these parties. Before the candidates depart after the site visit, the recruiter likes to give the most desirable candidates a draft copy of a contract. The contract is clearly labeled as a draft and does not include compensation figures. By giving candidates a draft, the recruiter is expressing that the system and physicians want the candidate to become part of the health system’s “family.” Those candidates who did not give the best impression during their interviews are not given a draft of the contract. However, one may be sent in follow-up after further assessment. After the visit ends, the recruiter and candidate schedule time to talk, or the recruiter asks the candidate to call him in approximately three days. During that follow-up conversation, the recruiter can get feedback about the site visit and offer any additional information to the candidate. Financial incentives encourage physicians to join health system’s “family”

Should the hiring physicians decide to extend an offer to the candidate, those physicians negotiate the contract. If the physicians lack negotiation experience, they can ask the recruiter to sit in on the negotiation talks. As previously mentioned, the health system provides a relocation fee of $10,000 and income guarantees for many recruited physicians; these income guarantees are typically forgivable after four years. Recruitment team supports physicians even after joining the community

In addition to financial incentives, the health system encourages physicians to sign contracts to practice in the area by helping them transition in to the medical community. For instance, the recruitment office works diligently to get newly recruited physicians credentialed and enrolled in the electronic Medicare claims system so that they can file insurance claims from the first day they start practicing; helping physicians be reimbursed immediately also helps physicians transition off of the income guarantee, which saves the health system money. To help market the recruited physicians to other physicians and the community, the health system provides a graphic artist to help physicians create advertisements for brochures and business cards. The physician is also added to the call center physician referral program, which receives 100,000 hits per year. In addition, a representative from the properties division of the health system meets with the physician to discuss using the on-campus medical office building; if the recruited physician prefers, the recruiting office will also contact a commercial real estate agent on behalf of the physician.


V. PROFILE: Personal attention pivotal to successful recruitment program During 2002 and 2003, the health system’s recruiter was heavily involved in 25 and 16 recruiting efforts, respectively. On average, the health system recruits 18 physicians per year; 70 percent of recruited physicians are specialists because the hospital’s family practice residency program supplies most of the hospital’s PCPs. Seven of ten physicians who come to the hospital for a site visit end up remaining with the health system, which reflects the hard work and preparation that goes into making each site visit enjoyable for candidates and their families. In addition to effective recruiting tactics, the health system’s attractive location also facilitates physician recruitment. The health system is located in one of the state’s largest cities, which has a low penetration of managed care, and the state enjoys tort reform, which controls malpractice premiums. One recruiter (with one part-time assistant) conducts physician recruitment

The health system has one recruiter, who is the director of physician relations, and one half-time assistant. The director reports to the senior vice president of strategic planning. While the recruiter receives no bonus compensation structure based on recruiting results, all employees of the health system participate in an incentive program in which each employee receives an annual bonus if the health system achieves certain financial goals. Total cost per physician search averages $29,000, including relocation expenses

The recruiter has a budget of $19,000 per recruit, which includes half of all up-front costs; members from the hiring physician practice pay the other half. This figure includes site visit costs, including food, lodging, travel, and car rental expenses. In addition, the health system pays approximately $10,000 for relocation expenses. The health system will not, however, pay for unreasonable or excessive moving expenses, such as antique boats or jet skis. For extremely hard-to-recruit specialists, the recruiter may hire an outside firm, which adds cost to the physician search; to control costs, the recruiter set a cap on external search firms’ services per search at $15,000.

Institution type: Four-hospital, 700-bed, not-for-profit health system in the Midwest

Source: Director, Physician

Relations Physicians recruited 12 specialists; annually: 6 PCPs Staff: Recruiter (1 FTE),

Support Staff (0.5 FTE)

Recruited physicians per FTE: 12


Recruitment needs identified by needs analysis, succession planning, medical staff requests

To predict recruitment needs, the health system hires a consultant to conduct a physician needs analysis every three years. Based on that information, the physician relations director will identify those specialty areas that lack physicians, and then further identify practices in those specialties with several physicians over age 55. The recruiter approaches those physicians, asks them what their plans are, and inquires if there is anything she can do to help with succession planning. Occasionally, physicians agree to work with the recruiter to begin identifying potential candidates to take over the practice. However, many physicians are reluctant to think about their own aging and retirement, so it can be nearly impossible to involve physicians in succession planning. Employed physicians are required to participate in succession planning. The recruiter’s close relationship with the medical staff aids her in identifying when she will need to recruit physicians. Because she is so close with the medical staff, the recruiter often hears when physicians are planning on retiring before the news becomes official. For instance, if she hears that a physician has bought a house in Florida, the recruiter will suspect that physician is planning on retiring soon, and she will approach that physician and begin to work on finding that physician’s successor. The recruiter also begins a recruitment effort when the medical staff identifies a need for a certain type of physician. Current events comprise key informer of where recruiter targets candidate search

Due to the fact that the health system’s community has low managed care penetration and tort reform to minimize malpractice issues, many times physicians identify themselves as candidates and approach the recruiter in search of position openings. However, there remain specialties for which the recruiter must still actively identify and pursue candidates. Several strategies for identifying candidates are described below and on the following page. PracticeMatch.com

The recruiter has placed listings on PracticeMatch.com for six years; she averages one or two placements from practice match each year; these results, in the recruiter’s opinion, indicate that the website pays for itself. In addition to PracticeMatch.com, the recruiter advertises on several other physician employment websites. Specific leads from current events

The recruiter reads several journals and health care publications to learn about current events and issues among physicians. Based on this knowledge, she learns which cities she should target in her search for suitable physicians. For instance, the recruiter once read that a large health system in Ohio with 100+ employed family practice physicians was about to terminate the employment of these physicians and help them transition into private practice; knowing that she could take advantage of the period of transition to bring some physicians to her health system, the recruiter used an Ohio phone book to send a direct mailing to every family practice physician in the area. This effort resulted in several successfully recruited physicians.


Also, when physicians in Nevada threatened to go on strike because of malpractice issues, the recruiter used the information as a potential lead. The recruiter called the city’s medical society, purchased a mailing list of active members, and sent a direct mailing to every physician inviting them to consider moving to the community where malpractice costs were under control. Purchasing medical society mailing lists

On several occasions, the recruiter has purchased mailing lists from medical societies in areas she knows are “hot spots” for recruiting, such as areas with high managed care penetration and malpractice premiums. When purchasing one medical society’s mailing list, the recruiter was asked to send a sample of what she would be mailing so that it could be approved. Then, for a fee of approximately $200, she received a mailing list of active members. The mailing list was particularly valuable because the data was current and broken down by specialty. It also afforded her a high degree of control in choosing to whom she would be sending mailings; for instance, when the health system wanted to recruit a female obstetrician and gynecologist (OB/GYN), the recruiter went though the mailing list and selected only those OB/GYNs with female first names. Physician networks

The recruiter will often ask members of the medical staff if they have any leads for potential contacts from their medical societies or residency programs. Once the recruiter has identified potential candidates through the aforementioned resources, she sends a direct mailing to each candidate. Depending on the recipients, the recruiter may include information about the state’s tort reform. Recruiter, hiring physicians screen candidate before planning a site visit

When physicians respond to the recruiter’s letter, she first talks to the potential candidate about the position opening and about the city. If the candidate is still interested in more information, she has a member of the hiring physician practice call the potential candidate. Based on the outcome of that conversation, the recruiter and the hiring physicians may invite the candidate for a site visit. As the recruiter begins planning the site visit, she is simultaneously conducting reference checks and a thorough background check. The candidate is asked to sign a release of information so that the health system can conduct a thorough check. Issues that would prevent the health system from pursuing the recruitment of a physician may include a criminal record and bankruptcy; bankruptcy can disqualify a recruit because that physician is considered a credit risk. Whenever possible, the recruiter works with physicians to overcome problematic incidents that are uncovered during a physicians background check. Recruiter finds success in closely tailoring site visit for each candidate

Although there is no official policy, the recruiter prefers that the candidates come on their first visit to the health system without their family so that the candidate can concentrate on professional issues. However, if having their family present is important to the candidates, the recruiter makes an exception. For instance, it was important to one candidate that his high-school aged-children, who were competitive swimmers, join him on the site visit to see the local schools’ swimming programs. In this case, the candidate was allowed to have his children join him on the initial site visit.


The site visit typically includes a tour of the hospital and community and an introduction to key administrators of the health system and as many members of the medical staff as possible. A typical hospital tour is highly adapted to each physician, but usually includes the following stops:

Hospital administration office Medical staff service and credentialing office Physician’s lounge Laboratory Radiology Medical library Chapel Sleep room

Second site visit customized to candidates, their families

Only the most promising candidates are invited on a second site visit; during second visits, the recruiter encourages the candidates to bring their spouses. The recruiter spends a lot of time and energy making sure that the site visit is perfectly tailored to each candidate’s preferences. One important event during the visit is a formal dinner, typically at an upscale restaurant; however, an occasional cookout has been hosted at a physician’s house during the summer, if the recruiter feels the candidate would prefer that type of event. Individuals invited to this dinner depend on the specialty area of the candidate; for instance, an orthopedic surgeon candidate would probably attend a dinner with the following individuals:

Director of the local medical school (if the candidate is interested in teaching) Orthopedic surgeons from the group Senior vice president of the orthopedic service line

In addition to the formal dinner, candidates go on a real estate tour with a local agent. The real estate agent knows not to be pushy and lets the recruiter know if she overheard any pertinent information that the recruiter may find useful, such as strong feelings about the community or health system. The recruiter noted that the most important part of planning for a site visit is adapting the itinerary to personal interests of the candidates and their families. Listed below are several examples of special arrangements the recruiter has made for candidates.

Arranging for a visit to churches, synagogues, and mosques Scheduling school tours for candidates with children in school Arranging meetings with special education for candidates with special needs children Visiting the zoo or science museum for candidates with children interested in these sites Renting a VCR and 10 movies from Blockbuster for candidates with children who really

enjoy television Borrowing a sled and renting a camera for a candidate whose children had never seen snow


Importantly, before the candidate arrives, the recruiter tries to tactfully and informally provide the hiring physicians with guidelines about appropriate behavior during the site visit. Because physicians are not professional recruiters, they may not have a sense of what is appropriate. Thus, the recruiter tries to provide physicians with small tips, such as the fact that it is inappropriate to ask how old candidates are or whether they are married. Physicians should also be reminded to be culturally sensitive—for instance, physicians should not ask Hispanic candidates if their first language is Spanish or English. Health system offers income guarantees, medical school debt repayment

The hiring practice conducts contract negotiations with physicians they are interested in hiring. To encourage physicians to join the medical community, the health system offers income guarantees based on fair market value, as determined by the Medical Group Management Association (MGMA) annual compensation survey. The health system is also one of the few institutions that also helps pay off medical school debt. Recruiter offers professional, non-profession post-recruitment support

After a physician is successfully recruited to the area, the recruiter helps the physician settle into the community by sending a packet of information from the visitor’s bureau, including information from different banks and information about realtors. The recruiter can also recommend bank and mortgage companies. On a more practical level, the recruiter gladly recommends hair dressers, dry cleaners, and grocery stores, and she can help physician’s spouses become involved with the health system auxiliary and religious groups, for instance. Professionally, the health system provides recruited physicians with hospital orientation and an introduction to medical staff. Additionally, the health system assists newly recruited physicians build their practice with an advertisement in the local newspaper welcoming the physicians to the community and informing the public that the physician is accepting new patients. The recruiter may also coordinate other arrangements for the physician including a speaking event, public service announcement on the radio, teaching opportunities with residents, grand rounds, educational lunches, and screenings at schools to increase the physician’s exposure to the community and referring physicians.


VI. PROFILE: Recruiters rely on pre-interview screening, invite only most viable candidates Fourteen year-old-program has recruited approximately 250 physicians

When the in-house physician recruitment program began in 1990, there were 165 physicians on the medical staff. Since then, the medical staff has grown to 345 physicians; three-quarters of the new physicians have been actively recruited by the hospital. The recruitment program enjoys a strong interview-to-placement ratio. Of every 20 physicians whom recruiters speak to on the phone, approximately six physicians receive an information packet. Of those who have requested information, approximately three will come to the hospital for an interview, and one of the three interviewed candidates will eventually be placed in the community. Bonus structure provides recruiters with incentives

The hospital’s physician recruitment team is composed of two physician recruiters, comprising 1.8 FTEs. The physician recruiters report to the director of marketing, who in turn reports to the vice president of network development; this vice president has a shared role with both the flagship hospital and corporate office of the health system. On average, 25 physicians are recruited to the community each year; of those 25, the hospital’s physician recruiters play a major role in three-quarters of successful placements in the community. Although the proportions shift constantly according to vacancies in the community, approximately 40 percent of recruited physicians are PCPs and 60 percent are specialists. Specialists have been recruited more often as of length because the strength of managed care in the area has been waning, which has lessened the demand for PCPs as gatekeepers. Both physician recruiters receive a base salary plus a flat bonus for achieving a successful physician placement. In addition to recruiting physicians to the area, the physician recruiters work to retain newly recruited physicians, help meet temporary physician staffing needs, and use national physician-to-population ratios to create a medical staff development plan that determines how many physicians are needed in the community. Recruitment costs average $13,000 per search

The recruiting office’s annual budget is $333,000; a large part of the annual budget comprises labor costs. The hospital splits the total cost of each search with the hiring physician practice; the hospital’s contribution, including advertising costs, site visit expenses, relocation expenses, and department overhead costs, totals $13,000 per placement. The total cost per recruitment efforts remains significantly lower than the cost of outsourcing to a search firm, which, according to the director, costs up to $15,000 to $30,000 per search for the finder’s fee, in addition to the aforementioned advertising, site visit, relocation, and department overhead costs. Furthermore, the director has discovered that the internal recruiting program is more reliable and that hospital-recruited physicians are more likely to stay in the community for an extended period because in-house recruiters tend to find better matched candidates.

Institution type: Not-for-profit, 400-bed hospital located in the Midwest

Source: Director, Marketing Physicians recruited 15 specialists; annually: 10 PCPs Staff: Two recruiters (1.8 FTEs)


Hospital’s recruitment program provides half of recruitment costs

The physician recruitment program abides by a “Recruitment Assistant Policy,” which states that the hospital’s recruiters assist all the area’s clinics recruiting efforts as long as there is a demonstrated need for the physician. As stipulated by the policy, the hospital’s recruiting office pays for half of the following costs, while the hiring physicians pay for the other half:

Advertising to identify physicians

Site visit costs, including airfare, lodging, and meals

Relocation expenses

While the hospital does pay for half of the aforementioned costs, the hospital contributes no money to the cost of an external search firm due to the expense of the external searches and because the hospital’s recruitment program already offers the services provided by external firms. The hospital has 345 physicians on its medical staff, approximately half of whom are employed by clinics affiliated with the hospital; the other half of the medical staff is composed by independent private practice physicians. The hospital’s physician recruitment office facilitates the recruitment process for both affiliated and private practice clinics. Furthermore, the program occasionally assists rural clinics that need recruitment assistance, even if the clinic’s physicians are not members of the medical staff. Recruiter uses various resources to identify candidates with ties to the area

Affiliated clinics and private practice physicians approach the hospital’s physician recruitment office when they can demonstrate a community need for new physicians. When that need is demonstrated, a recruiter is dedicated to the physician search and begins to identify potential candidates using the strategies listed below.

Contacting residency programs at the highest rated programs: The recruiters may e-mail residency directors with a description of the available position, requesting the director to pass the information on to residents. Alternatively, recruiters may ask medical staff members to contact directors of their former residency program to learn of high quality candidates who will soon be exiting the program; this strategy often works well because the residency director knows and (presumably) respects the physician and will thus be likely to recommend quality candidates.

Listing position openings on the Internet: The hospital’s homepage lists practice openings and provides contact information for the recruitment office. Recruiters also purchase listings through an Internet-based physician matching service. In addition, recruiters have listed openings on electronic bulletin boards of physician association homepages.

Purchasing database: The physician recruitment office has purchases access to a large database, composed primarily of residents and fellows. The database lists the physicians’ preferences, including location. Lists created from this database allow recruiters to make targeted direct mailings lists and calling lists.

Attending continuous medical education (CME) events: Most specialties have an annual conference at which recruiters can buy exhibit space to advertise their position openings.

Advertising in journals: Recruiters make sure only to choose those journals from which they have received quality responses in the past.


While physicians’ are welcome from all party of the country and world, many successful placements tend to be physicians with ties to the Midwest, having either grown up or studied in the Midwest or a spouse from the area. Those with a connection to the Midwest are more likely to accept the weather, appreciate the culture of the Midwest, and thus be more likely to remain in the community. Screening ranks as one of the most important stages of recruitment process

When a potential candidate responds to notifications of openings to practice in the community, the physician recruiter conducts an introductory and preliminary screening conversation. During this conversation, the position opening, hospital, and community are described to the physician, so that the physician can decide if the opportunity is desirable. After this conversation, if the recruiter believes the physician is a viable candidate, the recruiter sends the candidate an information packet and asks for references and permission for release of information so the recruiter can conduct a background check. The director stressed pre-site visit screening as one of the most important stages of the recruitment process. Recruiters stand to save thousands of dollars by identifying suitable candidates before incurring expenses through site visits. The director estimated that the recruiters and hiring physician spend between two and four hours on the phone, prior to the site visit. According to the director, screening discussions allow physicians to remove themselves from the search if they recognize the opportunity is inappropriate, and recruiters can determine whether a candidate merits a site visit. Prior to the site visit and interview, the physician recruiter should also ensure that the hiring physicians check the candidate’s references. Hiring physicians should check references because physicians can better understand the clinical qualifications of the candidates. Although checking references probably takes only half an hour and costs very little, the director has discovered that physicians sometimes resist checking references. Recruiters have to be diligent in reminding physicians that checking references prior to the site visit saves all parties time, energy, and money. Site visits customized to each physician’s interests

If a candidate remains a prospect after screening, the recruiter and/or hiring physicians invite the candidate for a site visit and interview. As previously mentioned, the hospital splits the airfare, lodging, and food costs of site visits with the hiring clinic or practice. Regarding the accompaniment of spouses and children, the recruiter is given discretion to decide if it would be appropriate to invite the entire family. Naturally, recruiters try to avoid inviting large families because of the cost; however, exceptions are made if the recruiters sense that invitation of the family is important to the candidate. Each site visit is carefully orchestrated. Recruiters support the physicians as they plan a highly detailed itinerary for the candidates. From years of experience planning itineraries, the recruiters have developed standardized itineraries; however, these itineraries are usually tailored to the visiting physician and spouse. Standard site visits include the following tours:

Clinic tour Community tour highlighting sites of interest to the candidate, such a local community theater Hospital tour to relevant parts of the hospital School tours if the candidate has school-aged children

Typically, site visits become more involved if the physician being recruited is from a high demand and hard to recruit specialty area.


Income guarantees no longer offered to recruited physicians

After the site visit, the hiring physicians decide whether to make an offer to the candidate. If so, the clinic seeks to negotiate a contract. Until eight years ago, the hospital selectively offered income guarantees to physicians. However, because of several experiences from which the hospital suffered financially, income guarantees are no longer offered. The director has found that as the practices became stronger, there is less need for the hospital to provide income guarantees. Hospital helps build newly recruited physicians’ referral bases

When a recruited physician finally arrives in the community, the recruiters typically announce the physician’s arrival in the local newspaper. The announcement will note the physicians’ training and that the physician is accepting new patients. The hospital also adds new physicians’ biographies and photographs to the hospital’s online directory to expose the new physician to referring physicians. A hard copy of the physician directory is mailed or delivered to 2,000 physicians/referring clinic staff in the region, which also encourages referrals.


The Advisory Board has worked to ensure the accuracy of the information it provides to its members. This project relies on data obtained from many sources, however, and the Advisory Board cannot guarantee the accuracy of the information or its analysis in all cases. Further, the Advisory Board is not engaged in rendering clinical, legal, accounting, or other professional services. Its projects should not be construed as professional advice on any particular set of facts or circumstances. Especially with respect to matters that involve clinical practice and direct patient treatment, members are advised to consult with their medical staffs and senior management, or other appropriate professionals, prior to implementing any changes based on this project. Neither the Advisory Board Company nor its programs are responsible for any claims or losses that may arise from any errors or omissions in their projects, whether caused by the Advisory Board Company or its sources. 1-BX4BV

© 2003 by the Advisory Board Company, 600 New Hampshire Avenue, N.W., Washington, DC 20037. Any reproduction or retransmission, in whole or in part, is a violation of federal law and is strictly prohibited without the consent of the Advisory Board Company. This prohibition extends to sharing this publication with clients and/or affiliate companies. All rights reserved.

Professional Services Note

During the course of research, Original Inquiry staff searched the following resources to identify aspects of “gold standards” physician recruitment programs:

Advisory Board’s internal and online (www.advisory.com) research libraries Factiva, a Dow Jones and Reuters company Internet, via search engines and multiple websites, including the following:

Merritt, Hawkins & Associates at www.merritthawkins.com National Association of Physician Recruiters at www.napr.org

Based on leads generated from the sources above, staff members contacted physician recruiters with successful recruitment programs at hospitals across the country.

Research Methodology

Documents

Creating a “Gold Standard” Physician Recruitment Strategy · CREATING A “GOLD STANDARD” PHYSICIAN RECRUITMENT STRATEGY PAGE 2 I. INTRODUCTION Physician recruitment is a multi-faceted