For the last 10 years, I've spent a good portion of my time recruiting family physicians. When I was in solo practice, I found myself looking for a partner. He left after two years when his wife, also a physician, changed fellowship programs, and I was recruiting again. A short time later, having decided to sell my practice and go into teaching, I recruited someone to purchase my practice. Now in academic family medicine, I've found that a major part of my job is recruiting faculty and residents. Fortunately, I've been successful, and I'd like to share some of the lessons I've learned along the way.
Personal contacts by physicians with positive attitudes are strong recruiting tools.
Deal with potentially negative issues about your practice head-on.
Present clear offers, and take the spouse's needs into account.
Maximize your strengths, especially the value of intangibles.
1. Use recruitment firms sparingly, if at all
A recruitment firm can't do anything for you that you can't do yourself, which makes the fee ($15,000 to $22,000 plus expenses in our area) hard to justify — if not impossible to afford. If a recruiter approached me about a doctor who was interested in looking at my practice, I would consider working with him or her on a contingency, but I would just as soon control my own destiny.
2. Choose a positive lead recruiter
Emotions, both positive and negative, are contagious. A physician who is genuinely excited about your practice will make the best recruiter. At a breakfast that the hospital arranged for recruits and hiring physicians, two doctors who were looking for someone to take over their practice when they retired got into a discussion about how “terrible it was to practice in New York state” due to the “awful regulatory climate.” This was the first thing I had to address with our out-of-state applicant when we had some private time.
3. Use your networking skills
Nothing beats personal contact when recruiting a physician. The question is how do you find your prospects? Start by talking with your friends. This approach worked well for my own family doctor. I was seeing him for a physical when he asked if I knew anyone looking for a job. I told him about an excellent resident who would be finishing our program in a year and a half and later gave the resident my family doctor's number. The resident called him, they met and then arranged to use some of his third-year elective time so that they could get to know one another. When he graduated, he joined the practice.
Teaching is also a great way to find recruits. One doctor who teaches in our residency program half a day every other week and also has residents visiting his office recently hired one of our residents. You should also talk to residency program directors in your area.
Finally, use the American Academy of Family Physicians' Placement Service. The computerized matching program is free for physicians looking for jobs and available at a nominal annual fee for physicians looking for recruits. I have successfully used this service twice.
4. Don't allow location to be a negative factor
Recruiting physicians to work in Buffalo isn't easy. But I've learned that for every negative (extreme weather conditions, in our case), I can identify a positive. For example, it was important to the physician who bought my practice to know there was a synagogue near my office. Similarly, because of its large Polish community, Buffalo has also been attractive to Polish physicians looking to build a practice. Other location-related issues that seem important to recruits include proximity to extended family, schools, crime rates and social and cultural issues. The point: location means different things to different people.
5. Solve the night call problem up front
Lifestyle has become an extremely important issue to many new residency graduates. Even before you begin recruiting, you should make arrangements that will help to ensure that the person you hire will have sufficient personal and family time. I've found that most physicians will not take a job where the call is more frequent than every fourth night. When I decided to sell my practice and began recruiting, I arranged for cross-coverage with other family physicians who were also new in practice so that the physician buying my practice would be on call only every fourth night and every fourth weekend. The arrangement has worked well for all concerned and even helped a local community health center to successfully recruit two physicians.
In addition to minimizing call requirements, you should consider whether your practice can accommodate a part-time schedule or job-sharing arrangement. These types of situations have become increasingly desirable among recent residency graduates.
6. Make a clear offer
My best recruiting tool is a simple one-page offer sheet that I present to the recruit as early in the process as is practical. It establishes these terms: salary; incentives; work hours; night call; malpractice, health, life and disability insurance; vacation; CME; holidays; partnership; and restrictive covenant. The offer sheet also makes it clear which terms are non-negotiable.
This is many young recruits' first time ever in the job market, and the offer sheet establishes a framework for our discussion and helps them understand the process. Many have expressed appreciation for having the terms put in writing and have said that it established my trustworthiness up front. (I've been astonished to learn that some recruiting physicians allow the process to drag on for months before making a concrete offer.) All seemed to appreciate having something in writing that they could take away, study, share with their spouse and go over with an accountant.
7. Recruit the spouse
Listening carefully to the needs of both the recruit and the spouse and trying to meet them really works. When I recruited my first partner, I realized that his spouse was leery about him joining a solo practice because she wanted to be able to move after she finished her fellowship. She wanted him to join a large organization instead so that leaving would be easier. Aware of this, I offered him a contract where he would have to make no investment in the practice. All I asked was that he give me a year's notice if he intended to leave. He subsequently joined my practice.
8. Maximize your strengths; minimize your weaknesses
When I was looking to sell my solo practice, I knew my strengths were that I had a well-equipped, efficient office that was financially sound. I knew my weaknesses were that I needed to improve my night call system and that I needed to match the salary that the local hospital was offering: a generous first-year guarantee with no initial financial investment required. So I arranged a better night call schedule, as I explained earlier. Next, I structured a purchase that didn't require the physician to bring any money to the table.
Under the terms of the sale, the physician would finance the hard assets through the bank and finance the good will and other soft assets through me, at 10 percent interest over five years. So that he would have cash flow to get him through the first few months, I also “loaned” him my accounts receivable under the provision that it count as revenue and be returned to me if he exceeded the first-year guarantee. Knowing I had the accounts receivable as a cushion and taking into account what I had earned over the last several years, I raised the first-year guarantee 20 percent above what the hospital was offering its recruits. I sold my practice and at the end of the year recouped all of my accounts receivable when my buyer exceeded the guarantee.
9. Don't underestimate the value of intangibles
The way the recruit intuitively feels about your practice can have a very powerful effect on his or her decision, so don't allow yourself to feel defeated if the compensation package you can afford to offer is below average. Two of my former residents took similar positions working in rural areas, one earning a salary of $100,000, and the other $60,000. When I asked the physician who was getting the lower salary why he was working for so little, he said that he really liked the group of doctors and the work environment they had created. Make sure you communicate your patient care and management philosophies, and help the recruit to understand the rewards of practicing with you and caring for your patients.
I have found that these nine keys are very helpful in successfully recruiting doctors. I hope you do also.