Looking for a hospitalist? Be prepared, proactive

Kirk Mathews, CEO and co-founder of Inpatient Management Inc. of St. Louis, explains his cardinal rules of recruiting.


Kirk Mathews, CEO and co-founder of Inpatient Management Inc. of St. Louis, began his talk on recruiting hospitalists with a lighthearted warning.

“If you're here for the address to the Doctor Warehouse, you are going to be disappointed,” Mr. Mathews teased. “That warehouse doesn't exist.”

Instead, Mr. Mathews offered audience members at the Society of Hospital Medicine's 2009 meeting a thorough explanation of his three cardinal rules of recruiting: Be prepared, be proactive and be prompt.

Know your practice, know your candidate

The first step in recruiting a new physician is to understand what you have to offer the prospective hire. This means taking an honest look at your practice culture and asking: Is it formal or laid back? Are decisions made democratically, or are they handed down from on high? Do employees socialize after hours, or have a work-only relationship?

“Once you know the answers to these, you can recruit to match your culture, recruit to change your culture, or simply hire the first doc that will take your job and hope they stay,” Mr. Mathews said.

Recruiters should also have a good handle on the scope of the practice, and be able to identify the tasks the new hospitalist will be expected to perform. These may include daily rounds, night shifts, time on-call, attending codes, consults for surgery and/or mental health, and coverage for other services such as rehab, he said.

On a related note, recruiters should be able to articulate the volume of work expected of their new hire. This may mean detailing the number of patients he or she is expected to round on, or the number of billable and non-billable hours needed—including consults.

“I think that looking at patient encounters is a better measure (than census) of what the real work will be,” Mr. Mathews said.

Understanding your target candidate is just as important as understanding what you have to offer, he added. Residents tend to be younger (ages 27 to 32 years), tech savvy, and concerned about lifestyle issues; a block schedule with no call and no nights is ideal for them. Their financial concerns are more immediate; they want signing bonuses, loan repayment and money for relocation.

Recruiters should also have a good handle on the scope of the practice and be able to identify the tasks the new hospitalist will be expected to perform
Recruiters should also have a good handle on the scope of the practice, and be able to identify the tasks the new hospitalist will be expected to perform.

Practicing physicians, on the other hand, are usually younger than 55 years old and prefer a block schedule, but tend to be more flexible. They are more likely to accept night call, and are more concerned with long-term financial issues like retirement plans. Their motivation for switching to hospitalism is often a desire to see more interesting cases than the typical low back pain and sore throats of primary care, as well as a wish to escape administrative hassles.

“I've talked to so many candidates from primary care who tell me they are sick and tired of having to replace yet another receptionist,” Mr. Mathews said.

Getting your ducks in a row

The next step to being prepared is to make sure every member of your recruitment team takes ownership of a certain element of the recruitment process. Identify the person or persons who will handle initially screening candidates, interviewing candidates, negotiating and closing agreements, and retaining candidates.

Then, define the process you will use to land your candidates. For starters, create a job description and stick to it.

“Establish your criteria for the job, and compare your candidates to those criteria—not to each other,” Mr. Mathews said. “You want to avoid a beauty pageant.”

Before you begin sourcing candidates, get pre-approval for a financial range you can use when making offers, including the salary range and benefits. This way, you can act quickly with an offer when you find a good candidate. It's also helpful to have a preapproved employment agreement to show the candidate during an interview, Mr. Mathews said.

Finding the right candidate

Locating the right candidate for a position can be as simple as asking around within your own hospital. There may be someone on the existing medical staff whom you never suspected would be interested, or someone who may know of an outside candidate.

“Be deliberate in seeking referrals from existing medical staff,” Mr. Mathews advised.

Nearby hospitalist programs and medical staff can be a good source of candidates, because they may already have a good reason to be living in the area. This can be tricky, however.

“It may not be politically correct to look for candidates at your competitor hospital. Understand the politics of your area, and use your judgment,” Mr. Mathews said.

Internet job postings can be a good source, though it's necessary to “mine those CVs” to find the wheat within the chaff, Mr. Mathews said. Likewise, be selective about which journals you advertise in, and write your advertisement to match that publication.

Also consider the area for which you are recruiting when it comes to certain strategies. Direct mail may work in a city like Chicago, where there are lots of potential candidates, but it's not as likely to be effective in Hays, Kan., Mr. Mathews said. Likewise, career fairs tend to be more effective when you are hiring for a hospitalist within the region of the fair.

“Don't go to a Seattle career fair to find a Kentucky hospitalist,” Mr. Mathews said.

Social media is another potential avenue for sourcing, given that about a third of adult Internet users have a profile on a social network site, and half of users 25 to 34 years old have one, Mr. Mathews said. While most people still use these sites primarily for personal use, they are starting to be more popular for professional use. If nothing else, they can serve as a referencing tool to find out more about a candidate.

Assessing candidates

Once you've found a potential candidate, it's time to more deeply assess him or her. Take a look at his or her training and work history first. Is it continuous and in one location, or were there frequent changes?

“Moving around a lot or disrupting training doesn't automatically eliminate someone, but you should ask why it happened,” Mr. Mathews said.

Professional references are increasingly less valuable, as our society becomes more litigious and the threat associated with saying anything negative increases, he said. To get the most out of references, ask for specific types—like a nurse, program director, or attending doctor the candidate worked with—and ask those references tough questions.

“For example, ask whether the reference has seen your candidate in a stressful situation, like dealing with a family after a bad outcome. How did he or she respond?” Mr. Mathews said.

It's also important to determine, when assessing a candidate, whether or not the practice is likely to accept him or her. Does the candidate's training and clinical skills, and prior work experience, fit in well with the rest of the team? Does he or she appear to have communication skills and a work ethic that blend well with the group?

Likewise, is the candidate likely to be happy with the practice? What is his or her motivation for changing jobs—is it related to geography, income or professional growth, and can this position satisfy those desires? How does his or her spouse feel about the change?

The big day: The interview

If you've done your assessments well, you should be fairly confident that the candidate you invite to the interview is someone you want to hire. As such, the purpose of the interview is not to grill the candidate, but to convince him or her that their personal and professional needs can be met at your location, Mr. Mathews said. A good assessment also means that only one interview should really be necessary.

“Don't build two interviews into the process. Your target, which is contingent on a stringent pre-interview assessment, is a one-interview process,” Mr. Mathews said.

The interview itself should include an icebreaker event, so your team and the candidate have a chance to interact in a casual environment, and some sort of introduction to the community. The more personalized you can make the latter, the better.

“If he or she has kids, driving by the school is good. But introducing him or her to the principal is better,” Mr. Mathews said.

If the candidate is married, involve the spouse as much as possible. If he or she has kids, try to discourage them from coming to the interview, since they will present a distraction. Provide babysitting, if need be.

When it comes to divulging any negative aspects associated with the job, assign one person on your team to discuss them. If, for example, the city has bad schools, make sure someone mentions it—as well as the fact that the other people in the practice deal with it by, say, sending their kids to private school—and leave it at that.

“The last thing you want is to have several people bringing up a negative point over and over again throughout the day,” Mr. Mathews said. “Make sure everyone on your team is on board with this.”

Give the candidate plenty of time with his or her future colleagues; in fact, try to make sure the standard hospital tour is led by the actual practice leader. At the end of the interview, have a wrap-up discussion where you can probe the candidate's impression of the practice and environment.

“This discussion gives you a chance to correct any false impressions, and to get some buy-in. You can also ask at this time for a decision-making timeline,” Mr. Mathews said.

Closing the deal

Once you've decided to make an offer to a candidate, move quickly—and encourage the candidate to move quickly with his or her decision as well.

“We've all had that candidate who accepts but nickels and dimes you at the end, with vacation time or a little more salary, and you end up hating his guts,” Mr. Mathews said. “Encourage your candidate to put all his or her concerns and questions on the table before you start any negotiations, so you aren't negotiating one issue at a time.”

Just as you can't allow a candidate to string you along for weeks while he or she waits to hear about other offers, you shouldn't pull a similar routine on a good candidate.

“If you've got a good candidate who meets all your requirements, but you have an interview lined up next week with a superstar, go with the good candidate,” Mr. Mathews said. “At this point you need to act fast, because too much time kills all deals.”