Word to the Wise
8 July 2008
The great Bill Cosby once said “A word to the wise ain’t necessary, it’s the stupid ones who need the advice.”
I have a client who I’ve had a fairly long relationship with. We’ve worked together for long enough that he probably knew how I would react when he sent me an email last weekend updating me on a search that we’re getting started on. The email was from one of their physician groups and went something like this:
“I know we’ve scheduled to meet with Jim Stone next week to kick off this search effort, but we managed to find a candidate through our society whom we really like. They will be coming out of residency in the summer of 09 and he and his wife are both from this state and looking to return upon completing their training. He is going to come visit us in September and if things go as well as our initial phone call, we will extend him an offer at that time. As such, there is no need to meet with Jim or look elsewhere as I think this one is taken care of.”
Questions spinning through my head (in no particular order) were as follows:
- Do they want to come to your small town or one of the many big cities in your state?
- How many other places are they interviewing?
- How committed are they to the specific offerings of your practice?
- Have you spoken with the physician’s spouse about the position/community? How does she feel about things?
- Where does your position rank amongst the others they are evaluating?
- Have they similarly put all interviewing on hold pending this site visit in 3 months?
- Have you conducted references on this candidate? Background checks?
- When will they be prepared to make a decision?
I’ve had a lot of difficulty communicating with this group already so I think I’ve probably dodged a bullet here. The last thing I need is a client who counts their chickens before they hatch and doesn’t communicate. We’re going to change our search to a different specialty with a different group in town so we’ll still be working there. In the spirit of helping them out, however, I asked my client if they had already shared with the group the pitfalls of putting all their eggs in one basket and that their deal, as described in the message, had a long, long way to go before a prudent recruiter would even consider letting their foot off the gas. I was assured that they had been informed of that and that they are confident that this one would work out.
I don’t get the impression it will.
I hope I’m wrong. I hope I don’t get a frantic call in 90 days about being behind on this search and needing to make something happen fast. I hope this candidate saves the day.
I also hope I get sprinkled with pixie dust in my sleep tonight and that I wake up tomorrow with the ability to fly.
Jim
NAPR
3 July 2008
Bob mentioned in a post several weeks ago that I was recently elected to the Board of Directors of the NAPR. It’s a three year term that involves quarterly board meetings (at our expense) monthly conference calls and lots of additional work to my normal, everyday job.
So, it’s a lot of work and expense, but I’ve enjoyed the two meetings I have attended so far and I’m excited about helping to further the association.
I’ve been shocked to learn how many firms in physician search who are not members.
If you are a physician recruiter, you should join the NAPR for several reasons.
- You get access to excellent sourcing tools that aren’t available elsewhere.
- The continuing education offered by the association is invaluable. From professional sales trainers to the former Surgeon General of the United States, the access to training is unmatched.
- You can associate and network with like-minded recruiters who are committed to doing this business ethically.
If you are a hospital or physician group, I have two messages for you.
- Only work with NAPR member firms. Our ranks consist of more than 300 organizations consisting of more than 2,000 physician recruiters. The fee to join the NAPR is $450. Any firm who is not a member has probably choseen not to be for reasons other than money. Most likely it is the Code of Ethics that all members agree to operate under. It basically prohibits members from lying, cheating and stealing so if they won’t sign that… beware.
- Join the NAPR. It’s a great organization. See #1 and #2 under why search firms should join.
I’m certain that I’ll have much more to come on the NAPR front. Until then, Happy Independence Day!
Jim
My Wife Contributes to the Physician Shortage
2 July 2008
After 17 years of taking care of other people’s kids, my wife has hung up her white coat. She had been struggling with the idea for more than 2 years when she made up her mind in January and informed her office manager and three partners. They were in shock. She was the founding physician of the group and the four of them have been together without interruption for 13 years.
They had an incredibly nice goodbye dinner last Tuesday night at a nice restaurant that was reminiscent of high school graduation. Lots of tears, a great slide show, thoughtful toasts, unnecessarily nice gifts, the whole 9 yards. Wednesday was her last day. Her replacement, the most recent Chief Resident at Children’s in Dallas, starts on Monday.
I’ve been shocked by the reaction to her retirement. Since she announced it in March, she has received hundreds of gifts from her patients ranging from flowers to homemade cookies to hand-written cards from young patients. I started to wonder when she kept bringing home roses with cards signed by different men…. Scott, Mark, Billy… but she assured me that none were over the age of 10. Many, many tears have been shed over her departure by patients’ moms and dads. Based on the fact that her practice has essentially been closed for the last 10 years and that people call all the time to try to get in, I shouldn’t be surprised I guess but it has been amazing to see the appreciation for what my wife has done for these families.
I’ve never had a close, personal relationship with a physician that would result in my being upset if they moved to another state or retired. Truth is, I hope I never do.
My wife was committed to her patients and her trade for 17 years. Now she’s going to be a stay at home mom. I’m proud of her for what she’s accomplished and for her courage to do what she wanted to do in spite of how tough it was for her.
As for the overall state of medicine, it’s been suggested that 50% of graduating medical students being female is going to be a huge problem based on females’ propensity to retire earlier. I guess she’s confirming that fear.
Jim
Customer Service, Part II
1 July 2008
I recently had my twice a year visit to the dentist. I have been going to the same dental office since I moved to Austin 8+ years ago. The original dentist sold her practice to a dentist that relocated from New Jersey. Slowly but surely he got rid of all the old staff and hired new staff. I liked the old staff (the dental hygienists were better) and wasn’t crazy about the new staff but I stayed with him through the transition for no other reason than I am a creature of habit and wasn’t willing to invest time or effort to find a new one.
Based on my most recent visit I had finally said “enough” and was mentally ready to find a new dentist. I’ll spare you the details but his front office person was way too rigid for my taste and I was kept waiting much longer than necessary. My dentist briefly apologized for any inconvenience and went about his business. There are too many dentists and too many closer to my home for me to choose from to deal with a front office Nazi.
About two weeks later I received a hand written card (not an email, not a phone call, but an old fashioned hand written card) acknowledging the issue and apologizing again for the inconvenience. This alone was enough for me to stop my plans to change dentists. But in addition to the hand written card he also included a gift card to Barnes and Noble. I have no idea if the gif card is $1 or $50, the amount is irrelevant. To use a very old adage, it is the thought that counts.
He has figured out that the cost of keeping an existing patient is less than the cost of acquiring a new patient. I suspect there are many physician offices that could take a cue from my dentist.
Bob
Secrecy, Lies and Half-Truths
26 June 2008
“The first rule of Fight Club is - you do not talk about Fight Club. The second rule of Fight Club is - you DO NOT talk about Fight Club.”
For many years, it seems, there is a similar pact between hospitals and groups who employ physicians and the search firms who help them hire new ones. For the most part, I think clients have thought about it like it was making sausage. You don’t want to see the process or what goes into it, you just want to enjoy the finished product.
As much as clients didn’t want to know what went into the making of their revenue-producing physician, firms had less interest in full disclosure. There seemed to be some upside in making the process more complicated than it really is, more cloak and dagger.
For example, I had dinner with someone last week who runs physician search for a huge hospital system in the US. He told me that he had a sales person in his office that afternoon who was telling him that the difference between his firm and others is that they have access to special lists. When pressed for details, he said that they start with the AMA masterfile (from whence virtually all lists are derived) and then they cross-reference that list against census bureau lists. At that point, he claimed, they do something with local phone books or something ridiculous. He said they have the ability to target candidates down to where their grandparents are from!
Seriously? First, none of the sources listed or parts of the process support that claim. I’m not claiming to have all the information on lists, but that just sounds like hooey. Second, why would one go to all that trouble when the AMA masterfile guarantees 99% deliverability? They have tracked ties for many candidates such as where the spouse is from, etc… so what’s the point in the big lie?
I had someone ask me last week which areas (specialties) we tend to have greater success in. I told them we’re better in the ones that are easier to fill. She laughed and then paused for a moment; I feared my answer had upset her. Then she caught me off guard by asking why I don’t lie? She said that most firms, when asked the same question, come up with all kinds of crazy answers, most of which don’t make sense. I went on to tell her that I don’t know why someone would lie, that the answer seems pretty obvious to me. When there are fewer suitors chasing more candidates, the odds are in your favor and that’s no different in physician search.
So, enough background. The point of this post is to let every loyal reader of the dochunter know the truth about physician recruiting. You are about to get a close up of the sausage being made, bits and parts being ground up and shoved into entrails.
- Step 1 - Try to set your search up to be as attractive is it can be. This doesn’t mean just offering more money, but also considering call/coverage arrangements, production incentives, signing bonuses, etc. Also be mindful of wants vs needs when it comes to candidate parameters. Don’t be too quick to wipe out huge swaths of candidates based on broad generalizations.
- Step 2 - Get in touch with the candidates you seek. Reach them via every medium available to you. Phone, email, online postings, journal ads, training programs and direct mail. Keep in mind whether or not you are reaching only active job-seekers or passive ones as well. See our post about that subject.
- Step 3 - When you get in touch with the candidate, learn what might motivate them to look at a new opportunity, what is important to them, how they practice, etc. If you’ve got a relatively close match, present the opportunity to them and talk with their spouse to get their take as well.
- Step 4 - Plan and deliver an excellent interview experience.
- Step 5 - Negotiate and secure an agreement with the physician.
- Step 6 - Remain in contact with the physician through their relocation and start of practice and constantly strive to create a positive environment in which they can thrive.
That’s it. This process is not complicated at all, but it is difficult. When I talk with clients I often tell them that. The only value we bring to the process is that we’re very good at doing the same thing that anyone else with half a brain could do if they tried. It’s like painting I guess. Any toddler can pick up a brush and rub it around on the canvas, but that doesn’t mean it is a work of art to anyone buy mommy. We like to think of ourselves as a group of artists creating as pretty of a picture as we can each day in the communities we represent.
Jim
Customer Service at its Best
24 June 2008
There are a handful of companies that have developed a reputation for superior customer service. Nordstrom’s, Lexus, The Four Seasons are just a few that come to mind. Based on my experience this weekend there is another company that belongs in that elite list of companies. The Ritz Carlton. They blew me away. To be fair I have stayed in very few really really nice hotels and have never stayed in a Ritz Carlton so my basis of comparison is fairly limited. However, I have a difficult time imagining how a hotel can exceed the customer service the Ritz Carlton in Dallas delivered.
I was in Dallas this weekend for a very special occasion, to get engaged. WOW, we were blown away with the service, helpfulness and friendliness from EVERY Ritz Carlton employee we encountered. It was as if a memo went out to every person working Saturday night and Sunday morning that the couple with the beautiful brunette girl and the average looking guy were getting engaged and their mission was to make it as special and memorable as possible. The reality is we were not treated any differently than any other couple staying there. They are trained to make everyone feel uniquely special. In our case they hit a home run!
Thanks to Julie, Didi, David, Coco and everyone else went above and beyond the call of duty to make a special event an unbelievable experience.
I take a lot of pride in our focus on customer service at Medicus Partners but this weekend has helped me realize we have a long way to go. My new mission in life is to install a fraction of the customer service the Ritz Carlton delivers in everything we do at Medicus Partners.
In case you are wondering my amazing and special girlfriend…..I mean fiancé said yes!!!!
Bob
Finding Nirvana…..
20 June 2008
There is no Nirvana.
This is the title of a presentation I have done for various residency programs over the years. The presentation outlines the pros and cons of the primary settings in which physicians go to work post training; solo practice with financial assistance from a hospital, single specialty group, multi specialty group, or hospital system employee. I realize I am leaving off several other options but the majority of physicians fall into one of these four buckets.
All four of these settings have distinct benefits and distinct drawbacks. For example, a solo practice offers tremendous autonomy and flexibility and allows you to be accountable to one person….YOU. On the flip side you have no economies of scale with your overhead and you are ultimately responsible for all business and personnel decisions. A large multi specialty group on the other hand offers the complete opposite benefits and drawbacks. You typically have very little autonomy and flexibility and are accountable to all of your partners but you have tremendous economy of scale, greater ability to leverage your contracts with payors, and no business responsibilities.
The June 6 issue of Medical Economics cover story is titled “Challenges of large groups” by Wayne Guglielmo. From my many years recruiting physicians I would offer that large groups probably get a “bad rap” more often than any other practice setting. Wayne’s article does a nice job of highlighting the financial challenges and benefits of large groups. Shelly Reese writes a “sister” column titled “Human dynamics” that addresses the interpersonal challenges of large groups and suggestions on minimizing the inevitable clashes that come when you put a lot of very smart, opinionated, and strong willed physicians in a business together.
As a recruiter our role is not to make judgment on which practice setting is good or bad because they are all good and bad in their own way. When we talk with physicians our goal is to identify which setting “fits” the individual physician best and then appropriately outline the specific benefits of the opportunity we represent. When we do this effectively it makes for happy clients, happy physicians and happy recruiters!
Bob
Admission of Shortcoming
19 June 2008
Let’s be honest for a moment, shall we? We’re very good at what we do. We feel that we, as a company, put our clients in the best position to be successful. We’ve got a group of very talented individuals who have come together to provide a valuable service for the clients we represent. We’re very proud of our group’s talent, ability, intelligence and results. 
At the same time I must confess that I had trouble getting a drink out of the water cooler in the kitchen today. I put my cup under the spigot. I pushed the button and just a trickle of water came out.
Certain that someone had rudely drained the thing and not replaced it I immediately looked up and found a full bottle staring back at me. Hmmm. Could there be a blockage somewhere? Did our machine peter out?
With great strength and force, I heaved the bottle off the top being sure not to spill on myself. Strangely, no water splashed or anything when I lefted it off the dispenser.
That’s when I saw it. Some genius was kind and courteous in that they took the emty bottle off when it was empty and replaced it with a full one. Their mistake was in not taking the plastic lid off the bottle before doing so.
Jim
Midwestern Floods
16 June 2008
Weather-wise, we’re in a unique position because we work all over the US and are consequently sensitive to the various difficulties certain regions are having. It hurts us both emotionally and financially when we see extreme weather.
This flood in Iowa is no different. We’re thinking about you and hoping for the best.
I’ve got a little bit of personal experience with flooding. My house flooded when I was a senior in high school. We didn’t have flood insurance and the waters rose slowly so my Dad was able to buy a policy and then we put sandbags around the house and baled water until the policy kicked in a week after we purchased it. Ironically, that took place at midnight the night before the state track meet so my Dad and I were up baling water until midnight and then went to bed. I remember asking him at 9 or 9:30 why we didn’t just quit since it wasn’t like the insurance company was watching us. He answered that we wouldn’t do that because it would be lying. Pretty simple, I guess.
We ended up with a foot of water in our house for a couple of weeks, living in a hotel room for a couple of months. Not much fun, but we survived.
To those of you out of your homes, our thoughts and prayers are with you. Hang in there.
Jim
Do you Recruit the Physician or the Physician’s Family?
4 June 2008
One of the most valuable lessons I learned early in my physician recruiting career was the spouse was typically 51% or more of the decision for a physician and his/her family to relocate. If this is true (and believe me it is) then why do most organizations that recruit physicians spend 95% of the time on the physician and 5% of the time on the spouse? Two reasons, they refuse to accept that the spouse has that much “pull” in the decision process or the recruiter they are working with doesn’t stress the importance of building an interview itinerary that caters to the real decision maker.
In the June issue of Inc. magazine there is a great article (http://www.inc.com/magazine/20080601/how-to-hire-a-star-employee.html) about an arts and crafts company based in Provo, UT that truly “gets it”.
I realize that being committed to recruiting the family is much more difficult and time consuming than just recruiting the physician. Especially for organizations that interview and hire numerous physicians a year. If you are fortunate enough to recruit for an organization that is in a very desireable area you might be able to get away with not focusing on the spouse and family. For everyone else, you don’t have that luxury.
Many organizations choose not to focus on the spouse because they think if they have a great medical community, a good hospital, good equipment, etc. then that should be enough. WRONG. I have just described about 80% of hospitals in the U.S. Those variables should be a given. A practicing physician is not an executive and he/she is not advancing their career by moving. With all due respect they are very similar to any other tradesman (plumber, electrician, etc) in that they provide a service and can provide that service wherever they want. Invariably, decisions to relocate are based as much on the “feeling” (aka emotion) a physician and spouse gets as it is on the tangible facts and figures.
What can you do to cater to the real decision maker? Following are a few simple things that can make a BIG difference.
- Have someone from the hopital or group call the spouse before the interview to say they are looking forward to meeting them and ask if there is anything specifically they would like to see or do during their visit
- Ideally have someone meet them at the airport upon their arrival
- Have a welcome basket of local “stuff” waiting for them in their hotel room including something to take home to the kids if possible
- Have a seperate itinerary for the spouse
- Arrange for the spouse to meet with people in the community that share similar interests or hobbies
- Arrange for the spouse to meet with other physician’s spouses
- Arrange for the spouse to meet with someone from a local school (counselor, teacher, principal)
- Arrange for a community tour with a local realtor (make sure the realtor understands he/she is selling the area not trying to sell a house on this visit)
- Dinner with 2 to 3 other physician couples (ideally something casual at someone’s home)
- Have the people that met with the spouse send a hand written note (not email) after the interview
You get the idea. If the last interview you had with physician and spouse did not include most of these ideas I encourage you to rethink your interview itinerary. I am confident you will be pleased with the results.
Bob “cater to the spouse” Collins
