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As the economy recovers, we know thousands
of medical professionals will relocate. As a result, healthcare organizations are involved in
a recruitment war. Thousands of hospitals and
group practices are involved in some kind of staff recruitment effort. Once an organization initiates discussions with
a physician candidate, it spends an average of seven to nine
months to bring that physician on board. Most organizations must then add three to four months to compensate
for a variety of delays or relocation problems.
Many organizations are surprised to discover the escalating
costs of recruitment. Although the costs of direct recruitment average $27,300 per physician, the full cost of recruiting a physician can easily top $100,000 once the organization
factors in such variables as income guarantees or salaries,
moving expenses, malpractice insurance, office space, new
equipment, and other practice start-up expenses. For this
reason, many private practices have attempted to split the
costs of recruitment with the local hospital.1
Organizations also are taking an increasingly scientific,
bottom-line approach to recruiting. For example, to evaluate the efficiency of a recruitment program, many organizations now track conversion ratiosâ€”that is, the number
of medical professionals who move from being prospects,
to applicants, to candidates, to finalists, and, finally, to
partners or associates. In most cases, organizations must
be prepared to interview five finalist candidates before they
sign the selected candidate.
Many organizations also are surprised to learn that
medical professionals are not always lured only by high
salaries and income guarantees. Often, they wish to
evaluate practice opportunities in the context of the total
community, environment, and lifestyle. Professional interests, such as hospital and peer support, cross-coverage,
and office space, account for 40% of the decision. Personal
interests, such as recreation, lifestyle, schools, housing,
culture, and shopping, account for the remaining 60% of
PAYING IN-HOUSE RECRUITERS
To remain competitive in the recruitment war, more
healthcare organizations have developed in-house recruiting functions and have hired full-time recruiters. These
professionals recruit an average of six physicians annually,
multiple physician assistants and nurse practitioners, and
an array of other professionals. Recruiters in especially
tough markets, such as rural or inner city locations, might
only recruit three physicians annually, whereas those in
multihospital systems might sign as many as 12 to 15 physicians annually.
But recruiters pay a price for their success. Between 30%
and 40% of physician recruitingâ€”including telephone calls
to physiciansâ€™ homesâ€”is done during evening and weekend hours, and many physician recruiters routinely work
60 to 70 hours per week. For their efforts, these recruiters
are paid an average salary of about $52,000 annually.
Some of the more fortunate recruiters qualify for bonus
or incentive plans. In one such plan, an in-house recruiter
is paid $5000 for developing the original lead that recruited
a medical professional; $3000 for relying on advertising,
mass e-mail, or a referral to recruit a medical professional;
$1000 for using a recruitment agency; and $500 for recruiting through other means. Another plan involves no bonus
for the first three medical professionals recruited; $1000 per
The Three Rs: Recruitment, Retention,
Nicola Hawkinson DNP, RNFA, RN*
For recruitment and retention ultimately to lead to revenue, everyone needs
to know what to do and how well theyâ€™re doing. This seems simple, but good
communication often is lacking in medical practices and hospitals. Practice
managers use recruiters to scout and hire qualified employees and keep them
KEY WORDS: Recruitment; retention; revenue; incentive; compensation; profitability.
*CEO and Founder, SpineSearch,
LLC, 55 Cherry Lane, Suite 101, Carle
Place, NY 11514; phone: 513 333-5050;
e-mail: [email protected];
Copyright Â© 2017 by
Greenbranch Publishing LLC.
112 Medical Practice Management | September/October 2017
www.greenbranch.com | 800-933-3711
medical professional for numbers 4, 5, and 6; $2000 per person for medical professionals 7, 8, and 9; and $3000 per professional for numbers 10, 11, and 12. Through this schedule,
an in-house recruiter who had recruited 12 medical professionals could collect a cumulative bonus of $18,000.
SMALL PHYSICIAN POOL
Despite these incentives, recruiters face challenging odds.
Of the 900,000 physicians in the United States, only a small
percentage is willing to relocate at any given time. The
â€œshelf lifeâ€ of a physician, or the time a physician is on the
market, is typically no more than 90 days. For example,
while there may be more than 100,000 family practitioners
in the nation, an organizationâ€™s total recruitment pool may
be fewer than 3000 family practice physicians.
And many of these physicians make practice decisions
far in advance. For example, 80% of the residents who
graduate in June had probably already made commitments to organizations by January. Unfortunately, many
healthcare organizations insist on waiting until the last
possible moment to recruit physicians. In addition, many
organizations limit their recruitment possibilities by clinging to such â€œcriteria of exclusionâ€ as board certification,
education, gender, age, and insistence on an MD rather
than a DO degree.
An organization hasnâ€™t successfully
recruited a physician until he
or she has been on board for
a minimum of three years.
Unfortunately, a recruiterâ€™s work is never done. Physician recruitment does not end when a physician signs
a contract, and an organization hasnâ€™t successfully recruited a physician until he or she has been on board for a
minimum of three years. The sad reality is that over 30% of
newly recruited physicians leave an organization or practice opportunity within three years.
Because newly recruited physicians are so mobile, a growing number of healthcare organizations rely on sign-on
bonuses of as much as $20,000 or more, with a third paid at
the signing of the contract, a third paid when the physician
arrives on site, and a third paid at the end of the first year.
In almost every case, these sign-on bonuses must be large
enough to affect a physicianâ€™s lifestyle. Neurosurgeons
who earn $750,000 annually will rarely be impressed with
a sign-on bonus of only $20,000. For this reason, organizations might want to think of a sign-on bonus of at least 5%
to 10% of the physicianâ€™s anticipated net pre-tax income.
Other organizations have attracted physicians in the last
year of their residency by offering them stipends of $1000
per month. If the physician fails to arrive on site, he or she
has to return all of the stipend or sign-on bonus. And if the
physician leaves within the first year of employment, half
of the stipend or bonus must be returned.
Other organizations lure younger, cash-poor physicians
by negotiating favorable loan rates with banks, or by offering to serve as cosigner on a mortgage that provides the
physician with 100% financing. Still other organizations
provide newly recruited physicians with a miscellaneous
fund to cover such household basics as utility deposits.
The national average cost for relocating a white-collar
employee, including physicians, is $9000. But healthcare
organizations should plan on relocation costs of $10,000 to
$14,000 per physician if the physician is already in practice
and moving a large household.
As reimbursement declines, one way to enhance practice
revenue and profitability is by adding ancillary services.
Ancillaries assist in maximizing practice profitability, while
providing patients with the convenience and continuity of
in-house care. Integrated clinical services also can increase
productivity, revenue and patient retention.
Employee retention is challenging in the current
healthcare environment. Millions of dollars are invested in
developing services geared toward creating a memorable
and satisfactory patient experience, facilities upgrading,
and creating a concierge medical environmentâ€”but a
major facet of creating a satisfactory patient experience is
committing to hiring, developing, and maintaining a staff
of high-quality physicians and surgeons.
The high cost of turnover should take into account not
only the advertisement and fees for recruitment, but also
the amount of time it takes to train an employee and the
cost of business lost from the time an employee leaves to
the amount of time it takes to hire a new staff member.
TRAINING AND GROWTH
Well-trained employees feel confident and knowledgeable
in their roles, and, therefore, happier in their jobs. Make
sure your practice has a comprehensive employee manual
and everyone has a copy of it. Give each employee a thorough job description on the first day that covers major
tasks and expectations. Offer to pay for cost-effective online
training programs to encourage your employees to grow
Highly driven employees need to feel their personal
goals and development are being recognized and acknowledged by the practice or hospital. Employees who want to
get into management tracks should be given the opportunity by increasing responsibility. Allow your employees to
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Hawkinson | The Three Rs 113
take on more difficult tasks and help them succeed in their
goals by providing them structured work plans and routine
meetings to monitor their progress. As a manager, your responsibility for developing an engaged work force starts by
recognizing each individualâ€™s personal learning style and
rate of understanding.
Compensation is one of the most important factors in retaining staff. Disgruntled employees often are upset about
not being compensated properly. Offer more than an annual cost-of-living adjustment to your more productive
employees. It is always worthwhile to focus your time and
money on the employees who deliver the highest value.
You should also make sure that your paid time off and vacation time policy is competitive.
Evaluate your benefits package and see if you can offer
extra time off, flexible hours, free parking, or gym memberships. Create an employee-of-the-month program to
recognize outstanding work. Set individual or group goals,
and reward the achievement of those goals with gift cards,
gas cards, movie tickets, or lunch.
Nurses and midlevel employees are vital players in the deliverance of healthcare. Training providers to develop and
retain positive relationships with the healthcare team is an
essential component of creating a positive workplace. Encourage providers to show appreciation to staff members
for their hard work and commitment. Giving a thank you
card for a job well done with a difficult patient or recognizing someone in front of his or her peers goes a long way in
nurturing trust and self-worth. This contributes directly
to employees feeling connected to their company and an
increased sense of accomplishment.
Physicians should always make a point of finding time
to speak to their employees. When you see them, address
them by name. (Institute name tags, if you have to.) Itâ€™s
fairly easy to visit with your medical assistant or nurse, but
go out of your way to say â€œhiâ€ to your front-office employees
and your business staff. Meet with new employees briefly
and find out a little about them. In addition, make sure your
office manager is readily available to talk to staff members,
particularly when they have an issue or new ideas.
To do well in their jobs, employees need an accurate
job description and an annual review that lets them know
how they are performing and what they can do to improve.
When good or bad things happen to staff outside the office,
be certain to let staff know promptly. Donâ€™t drift past them
in the office and let them find out some other way. By keeping staff informed, you communicate that you think they
are a valuable part of the team and important to patients. In
return, most employees will go the extra mile for you over
and over again. Y
1. Hawkinson N. Invest in Your Workforce: Simple Solutions for Recruitment, Retention and Revenue Generation [PowerPoint Slides]. 2016;
Physicianâ€”Time to Invest in Yourself: Work-Life Balance,
the Needs of the Patient, and Medical-Legal Risk Management
Timothy E. Paterick, MD, JD, MBA and Elizabeth Ngo, MD
â€¢ The wisdom and tools to confront the challenges of a medical career and the struggle to
maintain the primacy of the doctor-patient relationship
â€¢ Practical techniques to sustain your body, mind and spirit
â€¢ No-nonsense risk management strategies and the increasing risk of allegations of
â€¢ Strategies to meet the daily demands of your challenging medical career
Print $38.50 | eBook $31.00
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