Jason Crepeau

A strategy for physician recruitment is vital to a health system's success. Here are five action steps for improving physician recruitment and retention at your organization.

At a Glance

Strategies for physician recruitment should include the following:

  • Consider creating an in-house recruiting system to save money and to "own" the health system's first impression.
  • Gain a competitive advantage by nurturing relationships with prospects over the long-term.
  • Use innovative recruitment techniques, such as video interviewing and electronic reference checking, to better coordinate recruitment, follow-up, and mentoring.
  • Make a new hire's job satisfaction and home life a top priority during the first 90 days of employment, and then plan regular follow-ups to maintain a positive relationship.

He was a star orthopedic surgeon. She was a new CEO who needed to make a key hire in orthopedic surgery quickly to establish the health system as a leader in this competitive specialty.

Her team wined and dined the surgeon on a whirlwind visit, serving up an extravagant relocation and compensation package. The surgeon ate up the star treatment and wanted the big pay day even though he didn't know much about the health system or its leaders. Once on board, he felt no sense of loyalty to the organization when conflicts arose. His core values greatly differed from the health system's own strong values, and his inflated ego turned off his new coworkers. His family also was unhappy and missed city life. He felt ignored by the health system.

The relationship faltered after just six months and he resigned. The cost to the health system: Several hundred thousand dollars in recruiting expenses and lost revenue opportunity.

Now consider a scenario that's quite different-one that resulted in wins for both sides:

She was an up-and-coming orthopedic surgeon. Although she lived 300 miles away from the hospital, she grew up in the town where the hospital was based. The health system's physician recruiter had been in touch with her for years, sharing holiday wishes, changes in leadership, and even updates on the revival of the downtown restaurant scene. In her regular conversations with the recruiter, she forged a connection with the health system.

When a position opened up, the hiring process was organized and comfortable. The physician recruiter and hospital leaders listened to her needs and kept her informed of her status. When she was hired, she went in with eyes wide open. She understood that the health system's core values, though different from hers, were very important to the CEO, and she worked to embrace them.

She appreciated the organization's proactive approach to resolving issues that both she and her family had with the relocation. Although she experienced a few bumps and unexpected surprises, she trusted the health system enough to give leaders the benefit of the doubt. Less than 15 years later, she was promoted to chief medical officer.

In the competitive world of physician recruitment, the impression a health system makes on physicians, not just initially, but over time, is critical to a successful long-term relationship. That means a health system can gain a competitive advantage by pursuing a long-term strategy to nurture relationships with potential physician candidates-particularly for specialties most important to the health system-and to create long-term job satisfaction. A well-thought-out recruitment and retention strategy can significantly reduce the cost per hire and can help protect patient volume and revenue, making this an issue that should be on the radar of healthcare finance professionals.

Physician Recruitment Best Practices

Five best practices can improve the physician recruitment process and establish a positive relationship with physicians during the pre-hire, hiring, and onboarding process.

Pre-hire strategy: Lay the groundwork by nurturing relationships with a pool of potential candidates. Because of a tight labor pool, especially for specialties such as rheumatology and orthopedics, physician recruiters and hospital leaders are often forced to hire physicians if they have the right technical skills, even if their behavior and core values do not align with those of the health system.

To address this predicament, health systems should start by looking beyond the usual prospects to build and nurture a large candidate pool. By building its own internal database of potential candidates, a health system can gain a competitive advantage over organizations that limit their choice of candidates to those made available through staffing agencies and third-party recruiting databases. Having an internal resource allows a health system to focus on potential candidates likely to share the organization's core values and be a good fit for the community.

"While there's much to attract a physician to live and work in a small town in a physician-led clinic focused on community-centered care, it's not a career move for everyone," says Jan Chaney, senior director of physician recruitment and retention at Quincy Medical Group in Quincy, Ill. "The bottom line is that if the fit factor isn't there, retention won't follow. Building systems and processes that screen for fit by tracking skills, clinical preferences, personality, and location and family considerations is essential."

Physicians often "come home" to practice, choosing a health system near where they grew up, trained, or were licensed. Hospital leaders can target physicians likely to settle in the area and foster relationships with them well before a hiring campaign heats up.

The best candidates are likely to be:

  • Physicians who live, but do not work, in the community
  • Physicians who grew up near the community
  • Past candidates who were not selected, but who had good potential fit for other roles
  • Former residents and fellows of the health system
  • Physicians who passed through the health system during training

Creating long-term relationships with these candidates requires a strategy of scheduled communications. Health systems should tailor their communications to each candidate's preference, identifying the right frequency (monthly, quarterly, yearly), content (job-related, branding, community news) and medium (email, phone, direct mail, social media).

Rather than relying on email files and documents maintained on individual desktop computers, the health system should keep centralized, online electronic files for each candidate, including a detailed history of communications and commentary on his or her fit for the organization.

"Physician recruiting requires extraordinary organization and an ability to find and act on information quickly," says Mike Fitzner, director of physician recruitment at War Memorial Hospital in Sault Ste Marie, Mich. "Having an in-house system to automatically track and manage everything associated with candidate screening, pre-credentialing, and referencing has helped our hospital save hundreds of thousands of dollars in external recruitment fees."

Fitzner and his staff use their database to track all interactions with individual physicians-from emails and interview notes to contracts and offer letters.

Hiring strategy: Focus on the physician's emotional needs and wants. Once an opportunity has been created, the physician recruitment department and hospital leaders should screen candidates by taking into account the physician's emotional needs and wants. During the screening process, a consistent method should be applied to each candidate (see the sidebar below). The recruiter should identify issues with the candidate's work history and discuss them early and openly. The physician recruiter also should meet with the candidate's spouse to understand the family's needs and concerns. All conversations should be captured and made available to decision makers so they can personalize their conversations with the candidates.

"Deliberate selection of new physicians who fit the organization is critical to retention," says Debbie Gleason, physician development administrator at The Nebraska Medical Center in Omaha, Neb., and president-elect of the Association of Staff Physician Recruiters.

Another way to build strong relationships is by providing a well-organized outline of the job requirements, details on the health system structure and goals, an overview of its culture, mission, and core values, and a snapshot of the greater community. Make it easy for candidates to evaluate the organization and shape their views and impressions.

Focus on the little things that leave a lasting impression. Physician recruiters should use software that helps them stay organized and responsive. Questions should be answered immediately and feedback should be shared with all decision makers. Concerns should be identified and responses cataloged. Next steps should be outlined and followed through. The decision-making process should be clearly communicated.

Draft versions of contracts should be made available to the physician prior to the interview to allow both sides to quickly work through any concerns or issues. 

Recruiting strategy: Invest in physician recruitment as a core competency. With the dramatic increase in physicians employed by health systems, the shortage of physicians available to be recruited has worsened. As a result, many health systems recognize the need to develop physician recruitment as a core competency.

According to the 2011 Association of Staff Physician Recruiters' (ASPR) In-House Physician Recruitment Benchmarking Report, a typical healthcare organization conducts an average of 18 searches per year (including physicians and advanced practice providers). This number is comparable to the average number of searches performed annually by physician recruiters, which range from 13 to 23.

"An in-house physician recruitment professional offers unique and crucial insight into the organization's mission, culture, and goals for prospective physicians," Gleason says.

Health system leaders should provide the physician recruitment office with the resources they need to be successful, including staffing and technology, and then hold them accountable. The ASPR report found healthcare organizations hire about one in-house physician recruiter, on average, for every 50 employed physicians.

Recruitment expenses should be tracked so the health system can determine the cost to recruit an individual candidate and to fill an open position by individual facility and by physician type. These costs, along with projections for the number of expected hires, should then feed the next budgeting cycle.

"By tracking everything from referrals to expenses, we not only increase our efficiency, but also provide key data to leadership," says Joey Klein, senior physician recruiter for Cleveland Clinic in Cleveland, Ohio. "After examining advertising costs versus results, we found that 65 percent of our ad expenses were returning only 3 percent of our sourced candidates." That equaled a cost per sourced candidate that was more than four times the sum of all other ad sources combined.

"We can now aim at high-quality and low-cost avenues that we would never have been able to consider before," Klein says.

Onboarding strategy: Create an early warning system and self-evaluation for new hires. A physician's experience within the first 90 days of employment can greatly affect his or her long-term job satisfaction.

Creating a highly structured process of gathering feedback and responding to a physician's early needs can foster loyalty by building physicians' perceptions of the organization as being well-run with a supportive and caring culture. It also minimizes "buyer's remorse" and the second-guessing that comes with any significant life-changing decision.

To effectively manage the onboarding process, physician recruiters and physician liaisons should conduct online satisfaction surveys. The online survey, designed to complement verbal conversations, offers a nonthreatening way for physicians to communicate any concerns or issues.

The first survey should take place immediately after the physician joins the health system. It should gather information on why the physician took the job and what he or she regards as important. Roughly 30 days after the physician's start date, the health system should gather feedback on the onboarding process, orientation, and other basics.

After 90 days, another survey should focus on the new hires' comfort with the work environment and culture, as well as the extent to which they feel their expectations have been met.

For physicians who relocate, how they adapt to the community-and how their spouses and families adapt-can have a significant impact on their job satisfaction and relationship with the health system. Spouses should be surveyed-online, via telephone, or in person-after six to 12 months to gauge their satisfaction and identify any issues.

All issues should be tracked and resolved in a timely fashion. Resolutions should be reported to management. Programs also should be created to manage any trends of issues identified in the surveys.

Kelly Ford, director of medical staff affairs for HSHS Medical Group in Springfield, Ill., says the organization's physician survey initiative saves money. "Although the survey process and its related activities are the human touches of our physician retention program, the reality is that these activities fully impact our bottom line," says Ford. "Ensuring that our new providers and their families are happy and well-adjusted means we don't spend money on recruiting replacements. Also, our patient volumes and revenues aren't negatively affected by provider departures-we maintain the continuity and growth of our practices."

Creating a physician liaison program can serve as another way for personal feedback between physicians and the health system. A semiannual meeting should allow discussion of updates on the health system, new service lines being offered, and any concerns the physician may have. The liaison should document all conversations and outcomes and make these notes accessible to leaders.

Onboarding strategy: Create a mentoring program. Mentoring programs can be instrumental not only in improving the quality of patient care, but also in strengthening relationships and connections between physicians and the health system. The programs also allow new physicians to seek advice and can help communicate the health system's mission and culture, thereby also creating an opportunity for social connections with physicians and their spouses.

Mentors should be presented with information on the new physician's needs, wants, and concerns. The mentors should be matched by not only medical discipline, but also their ability to help build relationships. Maintaining a strong database can facilitate matching.

"A structured new-physician mentoring program provides the perfect opportunity to pass on the legacy of the organization or move the culture in a new direction," Nebraska Medical Center's Gleason says. "Ideally, mentoring of a new physician begins before the physician's start date, providing a jump start for the practice's success. One-on-one discussions provide opportunities for a mentor to influence attitudes and behaviors in a way that is mutually beneficial to the new physician and the organization. Ensuring new physicians understand the essence of the organization and know how to tap into the resources available to them can contribute to building an alliance with them, enhancing retention."

Gleason also notes that a new feedback can provide valuable insight into best practices from other institutions, and can help strengthen the ongoing relationship by providing information on the physician's career goals.

First Impressions Are Lasting

An abundance of research has focused on the need for job candidates to make a good first impression on employers, but there has been little attention given to the need for employers to make a strong impression on prospective employees. In the competitive world of physician recruitment, the first impressions a health system makes on physicians become critical in shaping and influencing the long-term relationship between the organization and the physician.

Setting the right tone as an organized, efficient, responsive employer during the recruiting process is the best way to create a first impression that will begin to foster loyalty and evoke a positive emotional connection with the health system.

Through an approach predicated on nurturing of a long-term relationship, and intently focused on fit and emotional needs throughout the hiring and onboarding processes, health systems can build physician recruitment as a core competency and establish lasting strong relationships and emotional attachments with their physicians.

Jason Crepeau is physician recruitment solutions leader at HealthcareSource, Woburn, Mass., and was previously CEO at Medearc Physician Recruitment Software (Jason.Crepeau@healthcaresource.com).


5 Steps for Screening Candidates  

1. Gain a thorough understanding of the physician's motivation for seeking a new opportunity (e.g., income, call schedule, location).

2. Understand any background issues he/she may have (e.g., prior suspended or restricted licenses, malpractice claims or settlements).

3. Speak with the physician's spouse to understand his/her needs and wants in a new location (e.g., whether the spouse also will need to find employment).

4. Check references prior to bringing the candidate on site.

5. Perform a background check prior to the first site visit.

Publication Date: Tuesday, May 01, 2012

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