One of the most important tasks that private practice leaders must get right is the act of effectively recruiting the right surgeons at the right time to the right locations. I cannot think of anything more mission-critical for the long-term health of a group than ensuring that succession planning is well executed.
Hiring the wrong individual can lead to a painful firing, separation as a shareholder, division of the group, or even demise of a whole organization. I’ve offered contracts to dozens of orthopaedic surgeons, and fortunately I can only think of a few who were bad choices. I believe our group put the practice in a position to succeed by following some key hiring strategies. But I acknowledge that no matter how hard you prepare and strategize, sometimes you can just get lucky … or unlucky.
Strategy #1: Focus on Long-term Fit
A practice leader’s job is to determine whether the company should hire someone to fill an immediate need or focus on long-term fit. It’s been reported that half of all orthopaedic surgeons change positions in their first 2 years [1]. While that 50% number seems high to me, early turnover may indicate that more practices are filling immediate needs without contemplating the long-term consequences of the hire. Effective recruitment can weed out those “good resume, bad fit” individuals. This is crucial because the financial toll associated with a new hire leaving can be devastating to your practice, with costs potentially exceeding USD 1 million after including the expense of recruiting, onboarding, filling another vacancy, and hiring [2].
Ensuring that a new physician will fit into your organization has more to do with the candidate’s personality and his or her ability to get along than their overall competency as an orthopaedic surgeon. Watch carefully for self-centered statements during the interview and ask about these traits from references. Look for tendencies that demonstrate excessive competitiveness, that “winning” is more important than the group succeeding.
Strategy #2: Use the Curriculum Vitae to Your Advantage
After the interview, in my experience, there is little benefit in calling a candidate’s references. I rarely hear anything from an initial contact call or reference check that enabled me to better discriminate between candidates for the best fit. Instead, I prefer a candidate’s curriculum vitae (CV). Reading through a candidate’s CV may seem like a surface-level investigation of one’s professional career, but the CV is actually a great tool to understand your candidate’s personality or character. Look for general organization and attention to detail. If they can’t get their CV correct, they probably lack attention to other important details as well. I search for their declared publications on PubMed, look for coauthors who I know, and then contact them asking for their candid assessment of our candidate. If I didn’t know someone on a candidate’s CV, I almost always knew someone who could call on my behalf. I believe that someone’s participation in a cited research paper is highly indicative of the partner he or she will become. If he or she is lazy and took credit for another person’s work in a research study, expect the same behavior in practice.
Strategy #3: Don’t Succumb to the Broken Interview Model
We need to assess candidates for more than their interview craft. The truth is, candidates today know how to ace an interview, which makes our jobs that much harder. Practicing orthopaedic surgeons may have experience conducting interviews, but few have training on how to get the most out of one. In my hiring experience, I’ve found that surgeons monopolize the conversation with little if any actual interviewing occurring. Write out specific questions that you want to have answered. Instead of droning on about your company or your role within the company, ask the candidate what he or she knows about the practice. Lastly, consciously focus on talking less and listening more. Silence is your friend. If they are excessively short with their answers, smile at them and wait, with the expectation that your silence will ultimately yield more elaboration.
Sometimes the opposite occurs and the candidate is too excited and refuses to let the conversation breathe. The interviewer can get seduced by the candidate’s excitement, compliments, and enthusiasm. Indeed, the candidate “wants to be associated with a great practice like yours” and they “are looking forward to being busy and contributing to the group’s effort.” One of my previous human resource directors told me that she could get any job offer that she wanted even if she had the minimal qualifications. When I asked her to explain that rather presumptuous statement, she said, “If I show more enthusiasm for the job than anyone else they have interviewed, they will assume I’m the perfect person for the job.”
To break this cycle, my practice interviews one-on-one and in groups. Interested candidates meet the local orthopaedic surgeons in our group at their practice site. They interview individually with the surgeons and then meet for dinner afterward. This social interaction is key to understanding the “real” personality of the candidate. The following day, the candidate meets with the “C-suite” leaders at the corporate office for individual interviews. These leaders are more adept at the interview process and listen carefully to what candidates say and don’t say. We seek out the motives behind the candidate’s interest in our specific practice as well as their hidden motivators (such as long-term practice opportunity or quick money).
Strategy #4: Ask Probing Questions
After the usual easy questions based on the candidate’s CV and overall interests, private practice groups would do well to start asking probing questions to determine character, integrity, and the candidate’s ethical framework. By no means should this be an intimidating or aggressive interaction. Instead, this part of the visit can—and should—assess the fit of a candidate, both for the practice’s benefit and that of the job-seeker.
Some questions I’ve found to be especially helpful include:
“What do you know about our practice?” We all have an internet presence. Successful candidates should know what is on your website and the profiles of some of the more influential physicians. They should know how big the group is, how many offices you have, etc. If they don’t know that information, I take this as a sign of lack of interest or lack of preparation; either is a bad sign.
“What are your best and worst professional character traits?” There is no right answer here, but people will give you information that you can expand upon. It is fascinating how people answer this. “I’m a perfectionist” is a weak, self-aggrandizing answer. A good answer that you appreciate means they are prepared and self-reflective.
“Tell me about a time that you failed and how you handled this.” Once again, are they revealing horrible character flaws or the opposite extreme of demonstrating conceit? A humble answer that was addressed with perseverance is invaluable.
“How would your friends describe you?” This is another introspective question that can demonstrate humility or arrogance.
Practice leaders should view interviewing with a specific goal in mind: to hire the best-fit candidate. By meeting with the candidate and asking probing questions with that goal in mind, your practice will be far more successful.
Footnotes
A note from the Editor in Chief: We are pleased to present the next installment of A Day at the Office. In this column, private practice orthopaedic surgeon Douglas W. Lundy MD, MBA, provides perspective on the pressures that orthopaedic surgeons face on a typical “day at the office,” as well as a broader viewpoint about trends in non-academic clinical-care settings.
The author certifies that neither he, nor any members of his immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.
The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.
References
- 1.Dopirak RM. Evaluating practice opportunities: part II. AAOS Bull. 2006;54:19-20. [Google Scholar]
- 2.Stajduhar T. The high costs of hiring the wrong physician. Available at: https://www.nejmcareercenter.org/minisites/rpt/the-high-costs-of-hiring-the-wrong-physician/. Accessed February 8, 2021.