Issue 2 - February 2005

Hiring on more than a handshake
By Mark Sencer, MD

Setting up an integrated-medicine clinic isn’t as easy as inviting your neighborhood family practitioner to join your practice — even if you have completed the required legal paperwork (which is a must, with the help of a qualified healthcare attorney). Before you put an MD or DO on your clinic’s roster, you have some things to consider.

As you decide whether to bring in a specialist, consider that a specialist may cost twice as much as a primary-care doctor. (However, the higher cost may be offset by revenues from procedures a specialist can do.)

• Will you offer primary or urgent care? If your focus extends beyond physical medicine and you are planning to do primary or urgent care, you will need to have a physician with a family practice or other primary care specialty.

• Does your practice treat children? Many medical physicians do not feel comfortable treating children; always ask candidates about this.

• Will the doctor practice full or part time? What days and hours will the MD be available? For your medical doctor to be a real asset, s/he must be available when your practice needs the service. Decide what type of availability you need as a hiring requirement.

• Does the doctor have hospital privileges? Many insurance plans require board-certified specialists and primary-care doctors who have local hospital privileges.

YOUR SEARCH

Once you have defined the scope of services (which determine your requirements in a medical doctor), your next consideration is to find the right individual. The recruitment process of a medical doctor is a time-consuming process and it requires your participation. You should not delegate this to your office manager.

You conduct the search in much the same way as you would to hire a CA or an associate — by networking, advertising and using recruiters. Here are some specific ideas:

• Network. One of the best places to start your search is within your own professional circle.

Talk to all of the MDs you currently share referrals with. Talk with others in related fields that you come into contact with such as physical therapists, massage therapists, nurses and other paramedical personnel. One of them may have a friend or colleague who would like to work with you.

A word of caution: Be diplomatic in how you present your vision to those MDs in your referral network. Make it clear that you will not be creating competition for their services.

• Advertise. In addition to networking you will want to advertise in periodicals and on Web sites that MDs visit for employment opportunities.

Advertising is expensive. A knowledgeable practice-management consultant can provide valuable help. A good consultant can help you allocate your advertising budget to produce the best returns for your practice type and location. In addition, the consultant should be able to help you with the length and wording of your ads to keep costs down and maximize results.

• Hire a recruiter. If you don't have the time to do the recruitment yourself, consider hiring a search firm that can work with you to minimize the footwork. A good search firm will either have candidates in your area matching your hiring requirements or it will have the experience to advertise in the right venues to find them.

In addition, the company should have useful input regarding issues such as salaries for MDs in your area, cost and availability of malpractice insurance and typical benefits packages for medical doctors.

Unfortunately most search firms are not familiar with chiropractic and integrated practices.

Here are some questions to ask when you evaluate search companies:

1. Is the firm familiar with chiropractic and integrated practice?

2. Has it worked with other clients like you? Ask for and check references.

3. Will the recruiter help with negotiations? Most search firms will supply candidates, but do not generally offer other support.

4. What kind of credential and background check does the firm provide? Does it use the National Practitioner Data Bank, or does it have access to pro-prietary software to run a more extensive check? Be sure to get a copy of the report for your files.

5. Will the firm do a contingency search? When you hire a firm on contingency, you do not pay a fee unless you hire its candidate.

6. Does the firm pay its own expenses? Ask how expenses are handled. Ideally you should not pay for the firm’s expenses. Read the contract carefully. Contracts often contain hidden fees.

7. What is the policy if the doctor leaves the practice or doesn’t work out? Will the firm do another search to replace him/her?

YOUR SELECTION

Regardless of how candidates arrive on your practice’s doorsteps, you need to interview all of them personally.

• Keep interviews non-confrontational and non-committal. This is the time to get to know the candidate.

• Focus your discussion. The purpose of the interview is to ascertain if the candidate meets your requirements.

• Determine if the candidate makes a good ‘fit’ into your practice. Familiarize the candidate with your practice and your vision for the future.

• Do not negotiate an offer. During the interview you should review the job description, salary, bonuses and perks. But do not let the interview turn into a bargaining session.

THE OFFER

When you are satisfied that you (and the candidate) have made a good match, it’s time to make an offer.

• Create a competitive offer. Ask your practice-management consultant to help you create a realistic offer, which should be based on what other practices in the area are offering. You should offer incentives and bonuses based on the doctor's productivity. After all, you want the physician to stay on and take an interest in the practice.

• Ask your attorney to review the offer. Your healthcare attorney should make sure that the offer and bonus structure conform to legal standards.

• Negotiate. After you have found the best candidate and have made the offer, you may have to negotiate. (You should always have one or two back-up candidates in case your first choice backs out.)

Often the MD will accept your offer without negotiations, especially if it fair and competitive. More often, the candidate will ask for small concessions. Use your judgment and keep communications open.

If a demand seems out of line, discuss it with the doctor. Explain your point of view and why it is unacceptable for you. This will give you both a chance to see how you solve problems together. And remember: The negotiating table is no place for ego or emotions.

A candidate will generally have an attorney review the offer and contracts. It is important that you both communicate to your attorneys that time is of the essence and you would both like to move forward. Do not let the attorneys become deal-killers by trying to renegotiate things you've already agreed on with a handshake or by dragging their feet in performing their review.

Hiring a medical doctor isn’t as easy as hiring an accountant or a clerk. But what a good MD brings to your practice should more than compensate for the time you take to find him or her.