Preparing Physicians For The Interview process

1. Preparing Physicians For The Interview process

2. BIO Don O’Bryan, CMSR, FMSD has served for the past nine years as Corporate Director of Physician Recruitment for the Mountain States Health Alliance (MSHA), a 13-hospital regional health system with facilities in NE Tennessee and SW Virginia. He is responsible for the ongoing medical staff development for the system and full-cycle provider recruitment for a variety of practice situations that include private, employed, academic, rural, and metro. For the past two years, the MSHA Physician Recruitment Team has had a strong emphasis on screening and preparing physician candidates for the on-site interview. This session will focus on practical ways to not only understand a candidate’s expectations, but also communicate your hospital’s expectations with the goal of a good overall “fit”. Don has been a member of the Association of Staff Physician Recruiters (ASPR) for nine years and has served on their education committee. He is also a Board Member of Carolina’s Association of Physician Services (CAPS). He regularly speaks on topics related to physician recruitment. He has been married to Laura for 28 years. During their long romance, they have raised four boys (Dan, Chris, Josh, and Kevin). Don and Laura have two grandchildren and another on the way. 2

3. Agenda • Overview of our MSHA Physician Recruitment Department. • Recent Influences That Have Affected Our Recruitment Strategy. • Basic and Advanced Screening - Setting Candidate Expectations. • Reinforcement of Expectations Throughout the Recruitment Process. 3

4. History and Development • Johnson City Medical Center (our flagship) has had a formal in-house physician recruitment program for nearly 20 years. • All physician recruiters are trained and certified (Certified Medical Staff Recruiter) by the American Academy of Medical Management. Three have obtained the Fellowship in Medical Staff Development by this organization. • All physician recruiters are members of the Association of Staff Physician Recruiters (ASPR), and CAPS. • Average physician recruitment experience: over 10 years 4

5. Reporting Relationships • Directly report to the system VP of Business Development • Indirectly report to • Sr. VP for Tennessee • Sr. VP for Virginia • All Hospital CEOs • VP Cardiology • VP Oncology • VP Women’s • VP Children’s • VP for Ortho/Neuro/Trauma • President of our Physician Group 5

6. Donald O’Bryan, CMSR, FMSD Corporate Director Physician Recruitment Reg. Dir. of Medical Staff Development (Smyth, Russell, Wise Counties - VA) MSHA Physician Recruiter (Full Time) Washington County - VA Physician Recruitment Assistant (Full Time) Physician visits, weekly staff meetings, office operations, etc. Manager of Medical Staff Development Washington County - TN MSHA Physician Recruiter (Full Time) Sullivan/Washington County - TN Physician Recruitment Assistant (Part Time) Compliance, special events, career fairs, med staff list, etc. MSHA Physician Recruiter (Full Time) Carter/ Greene County - TN Current Organizational Chart 6

7. Physician Recruitment Challenges Five Areas of Concern and Focus: • Aging physician population. • Future supply of physicians. • The general effect of healthcare reform. • The economy and consumer confidence. • Retention of our current medical staff. 7

8. Physician Recruitment Toolbox 1) Practice Match - www.PracticeMatch.com Type: Sourcing web site. Description: Post opportunities, information on available candidates, useful for resident and fellows. Has capability to send bulk email and generate mailing lists. Database for sourcing responses. Cost: Currently under a corporate contract. 2) Practice Link –www.PracticeLink.com Type: Sourcing web site. Description: Up to 70 job postings, able to search for C.V.’s of available physicians who have self-posted their information for the purpose of finding a job. Post jobs. Practice Link attends all specialty meetings across the country, interviews candidates and makes info available. Able to send bulk emails and design a call list. Cost: Currently under a corporate contract. 3) Health E Careers - www.healthecareers.com Type: Job advertising site. Description: Manages the job advertising for dozens of specialty web sites and cross advertises on JAMA. MSHA purchases bulk advertising that can be used as needed. Current contract is for one year and up to 10 jobs per month. When running an ad, the recruiter has access to posted C.V.’s of available candidates of that specialty. Cost: Currently under a corporate contract. 4)Kontact Intelligence – www.kontactintelligence.com Type: Web-based Contact Management Data Base Description: Data storage tool and contact management system for collecting info on candidates sourced by MSHA recruiters and for tracking progress. We upload documents such as CVs and references to this site. Recruiters can access this via internet connection from anywhere. Cost: Currently under a corporate contract. 8

9. Toolbox (p.2) 5) MSHA.com Type: Sourcing and area information Description: Provides opening information, area info, video info, pictures. Cost: none 6). Social Media Type: Relationship building, maintaining contact with interested candidates Description: Establish a social media site, such as Facebook, and encourage med students, residents, candidates, spouses, etc. to “like” us in order to establish and maintain a long-term communication link for recruitment and retention purposes. Cost: none 7). Training Program Recruitment Type: Sourcing and Relationship Development Description: Contacting training programs with job opening information, maintaining on-going relationship with program directors and coordinators, arranging presentations to trainees on job-search related topics, etc. Cost: None, unless we do a lunch presentation or travel outside the area. $200 – $500 + travel 8).Speciaty Web and Journal Ads (as needed) Type: Sourcing and Branding Description: Varies with each specialty. At the request and/or approval of the Hospital CEO or Service Line VP, additional advertising may be secured at suggested sites or journals that are know to be a source of candidate traffic. Cost: $500 - $1,500 per month. 9

10. Toolbox (p.3) 9). Cold calling Type: Sourcing Description: Develop a targeted calling list of candidates to present information about your opening. Cost: Individual phone calls 10). Exhibiting (Specialty meetings and Career Fairs as needed) Type: Sourcing and Branding Description: At the request and/or approval of the Hospital CEO or Service Line VP, it may be determined that MSHA should to have a presence at a specialty meeting via renting booth space or attending the meeting’s career center to generate additional leads. Average cost: $2,000 - $6,000. 11). Direct Mail (as needed) Type: Sourcing and Branding Description: At the request and/or approval of the Hospital CEO or Service Line VP, a direct mail piece may be developed and sent to prospective candidates. Mailing lists can be obtained through Practice Match and using targeted criteria. Average cost: $1 per piece. 12). Contingency Recruitment Firms (as needed) Description: MSHA has signed contractual agreements with several firms that require payment only if we sign the candidate. Average cost: $23,000. 13). Retained Recruitment Firms (as needed) Description: At the request of the Hospital CEO or Service Line VP, MSHA will engage a retained firm to conduct a search. Average cost: $35,000. 10

11. Setting Goals 11

12. 5 Basic Goals For Each Approved Opening • Well thought-out recruitment plan that creates the necessary candidate flow to be successful. • Thoroughly screened candidates who understand our opportunity. • Well orchestrated visits that make a good first impression with good information exchange. • Streamlined contracting process. • Smooth on-boarding process. • An effective retention plan. 12

13. Recruiting in the Healthcare Reform Era Everything is being measured against the Triple Aim™ goals: • improve the health of the population; • enhance the patient experience of care (including quality, access and reliability); and • reduce, or at least control, the per capita cost of care. 13

14. CASE STUDY – Reform Influences on our System Culture - Continued commitment to patient-centered care - Tennessee Quality Award and the pursuit of Baldridge - Medicare quality initiatives - ACO’s rapid development - The shift from pay-for-performance to pay-for-value - Infusion of Medical Executives throughout the system - Decisions are becoming more becoming data-driven. - More employment of physicians - Less tolerance toward anything that loses money - LEAN – a management system derived from Toyota - Healthcare contraction 14

15. Physician Recruiter Responsibilities (Overview) • Insure the opening has been approved and/or support is obtained to begin recruiting. • Work with the group to define the job description, skill-set, and recruitment timeframe for candidates and verify with MSHA leadership. • Develop a message or script to share with candidates. • Develop and implement a recruitment strategy to produce a candidate flow. • Screen candidates and spouse/family for fit with emphasis on PBQ. • Preliminary background check (license, certification, google, references, NPDB, Medicare sanctions, etc.) • Present appropriate candidates who have cleared screening. • Arrange for phone interviews with group. • Set up on-site interviews. • Maintain energy from the first contact and all the way through the contracting process. • Nurture the newly-recruited doctor through the on-boarding process. • Make quarterly contacts with the doctor for three years (retention). 15

16. Two Parts of Effective Candidate Preparation • Basic Screening - Compatibility with the Area/Group/Job/Family needs and understanding their expectations. • PBQ Screening – Helping the Candidate Understand Your Expectations. 16

17. Ex·pec·ta·tion a standard of conduct or performance expected by or of somebody. 17

18. We spend our time managing these three things: Hospital Expectations Group Expectations Candidate Expectations 18

19. Information Exchange with candidates in the Recruitment Process 19

20. Basic Candidate Screening • Candidate qualifications (training, BC/BE, ability to obtain a license, medical staff privileges, get on the insurances, etc) • Candidate’s practice preferences • Compensation needs • Skills (what they do, what they don’t do) • Availability date • English or language needs • Personality • Ties to the area • Spouse/Family needs • Malpractice history • Verify state licenses and certification • National Practitioner Data Bank • Professional questions • References 20

21. Relaying Practice Information • Why the group is recruiting • Provider make-up of the practice • Basics of the compensation and benefits • Skills that are important to the group • Call arrangement • Payer mix • Benchmarks • Practice culture • Area competition • On-boarding assistance • Start-up assistance for a new provider 21

22. Relaying Area Information • Web sites • Tourism info • City demographics • Housing • School options • Recreation opportunities • Economic base • Key restaurants and shopping • Nearest airport • Housing options 22

23. Relaying Hospital information • Why the hospital would benefit • Specialty-specific info • Number of beds • ER volumes • Inpatient census • Hospital call issues • Available specialty support • Financial info to emphasize stability • Hospital culture (recent changes affected by Reform) 23

24. Setting Candidate Expectations: PBQ Screening ф • Productivity - work ethic, willingness to do the things needed to build a practice quickly, see the necessary patients to cover salary and expenses, etc. • Behavior – Professional, good bedside manner, treatment of family members, treatment of nurses and staff, cooperative with hospital administration, citizenship (serve on volunteer committees, call coverage, teaching residents and student who are on rotations, etc.) • Quality - Improved outcomes, establish and/or follow protocols, evidence-based medicine, best practice, malpractice history, claims data, etc. 24

25. Communicating your hospital’s expectations in these areas starts with the physician recruiter but must be reinforced at every stage of the interview. 25

26. Productivity Screening • Do some data gathering ahead of time. If there are other physicians in the practice, gain an understanding of their work ethic and establish production benchmarks - Research how many patients/surgeries a new doc needs to cover the proposed salary and overhead. • After screening the candidate for basic qualifications, geography, spouse issues, etc., point out to the physician that practices are very sensitive about financial loses at this time. • State to the candidate that productivity is very important to the group/hospital. • Ask the physician how they compare to the MGMA median for wRVUs or other benchmarks. • Ask the physician what is typical workday for them. If it doesn’t match your need, the interview may be over before you spend any money on a visit. • Ask for data to confirm their work ethic, especially if they are demanding a high salary. • Ask behavior interview questions – (Tell me about a time when you were informed that the practice was not making budget. What did you do? 26

27. PHYSICIAN BEHAVIOR:ACPE Survey 840 Physicians and Physician Executives were surveyed: • 41% of respondents witnessed profanity • 40% witnessed inappropriate jokes • 24% witnessed discrimination against colleagues or patients • 21% witnessed the spread of malicious rumors • 14% witnessed physicians throwing objects • 14% witnessed substance abuse • 13% witnessed physicians retaliating against perceived slights • 3% witnessed physical violence. * American College of Physician Executives – May 2011 27

28. Behavior Screening • Check licenses, Google, LinkedIn, Facebook, on every candidate. • In the initial conversation, state that your hospital/group is very interested in recruiting a well-behaved doctor. • Give some positive examples of behaviors that are important. • Ask behavior interview questions. 28

29. Quality Screening • State that quality is the highest goal for your hospital and, as the recruiter, you are seeking physicians that are also quality-oriented. • Mention your hospital or group’s quality initiatives. • Emphasize patient-centered care, the use of Press Ganey, the evaluation of the physician experience, and how physician behavior impacts our success. • Seek data or information that will reinforce that the candidate is quality oriented. 29

30. Quality Screening (cont.) • Interview questions: - Do you serve on any quality-related committees? - Have you had any quality issues in the past? - Can you provide documentation on your outcomes? - Are there any procedures typical for your specialty that make you uncomfortable? - For surgeons: Would you be open to one of our surgeons coming to your location to view an operation? 30

31. Have others reinforce PBQ in the interview process. 31

32. Responsibilities in the Recruitment Process 32

33. Recruiter Interview Components • Collect C.V. and inquire about incomplete information. • Initial phone screen using 20+ questions to insure a basic fit, including why they are leaving their current job, family issues, timeframe, probe for problems, etc. Behavioral interview questions included. • Share basic hospital, service-line, system, and area information including schools, area demographics, cost of living, taxes, shopping, outdoor activities, etc. • Introduce Patient-Centered Care emphasis. • Introduce PBQ expectations. • Send out Professional Questionnaire. • Share information collected from interview with group and MSHA. • Coordinate phone interviews. • Coordinate 1st visit dates. • Help secure offer information. • Help with Letter of Intent (LOI). • Coordinate 2nd visit. • Help insure contract process stays on track with good communication. 33

34. Hospital CEO Interview Suggestions • Where we’ve been - History of the hospital • Where we are - The role of the hospital in MSHA, recent awards, etc. • Where we’re headed - Strategic vision and goals for the future • Baldridge business model. • Inpatient/outpatient statistics. • Construction projects, new equipment being added. • How the candidate’s specialty fits in to the big picture. • Ask any questions about the candidate’s information. • PBQ - Emphasize our expectations regarding productivity, behavior, and quality. • Provide any appropriate info about the group and competitor’s in the area. • Ask how you can help the candidate with their decision. 34

35. Service Line VP Interview Suggestions • MSHA Service Line Corporate Strategy • Hospital Service Line Strategy • Where the candidate will fit in the picture. • Statistics, demographics, market share, competitors (as appropriate). • PBQ - Emphasize our expectations regarding productivity, behavior, and quality. • Ask questions about clinical skills, what they are comfortable doing, what they are not comfortable doing and why. • Behavioral interview questions. 35

36. CMO Interview Suggestions • Discuss our Patient-Centered Care philosophy. • Discuss our participation in the various quality initiatives, MSHA’s commitment to quality and outcomes, and the expectations we have for incoming medical staff. • Emphasize the hospital’s expectations regarding physician behavior. • Ask about any malpractice issues that we should know about and drill in to areas of concern that you may have. • Discuss medical staff structure at your hospital / entity. • Ask any questions about candidate information (training program, skills, if there is anything they are uncomfortable doing within their specialty, etc.) • Ask behavioral interview questions to gauge how they have reacted to situations in the past. • Discuss or answer questions regarding credentialing or privileging and probe for any possible issues that may cause delay. 36

37. Practice Interview Suggestions • Discuss the structure of the physician group. • Go over the strategic importance of their specialty to the group and community. • Share clinic history, set-up, and details. • PBQ - Discuss the importance of recruiting a productive, well-behaved, quality-oriented physician. • Provide basic contract information and benefits information. • Go over contracting process. • Probe for offer information. • Discuss any issues that may impact our ability to sign, credential and relocate the candidate. • Probe for start-up details (special equipment, space, staffing needs, etc.) • Discuss how the group measures progress. • Behavioral interview questions. 37

38. Congratulations! • You now have an established process that has better prepared a candidate (and your hospital) for the interview.

39. QUESTIONS? Contact Info: Don O’Bryan obryandr@msha.com 423-467-4852