Preparing to Recruit Neonatologists

Robert White, MD, FAAP
Robert Cicco, MD, FAAP
John Hartline, MD, FAAP

Process of Evaluation at One's Own Practice Site

Before embarking on recruiting, it helps to look inward---an evaluation process essential for the practice to set its expectations for the practice itself and for new associates. An examination (hopefully a re-examination) of the mission, vision, and goals of the practice are very useful steps in beginning to set priorities and to set the stage for the more detailed analysis associated with the areas explored.

Before outlining the process in detail, all practices may want to consider the following big questions:

What major challenges does the practice need to confront in the near future?
What is/are the major missions of the practice?
What do you want the practice be like in 3 to 5 years?
What are the earliest anticipated steps in the change process and what preparations are being made to deal with them?
Why are we hiring an associate?
What specific roles do we expect new associates to fill?
Are we aware of and ready to assimilate the generational differences that influence candidates' career goals, work-life balance, mode of learning, means of communication, and style?
What flexibility in work assignments and time-lines for advancement will be discussed with applicants?

Academic practices may want to formalize thinking about the following:

Is the position to be a traditional, tenure-track position or is it a clinical track position?
What scholarly areas are of greatest interest for the practice?
Who will mentor and guide the new associate while in a junior faculty role?
What specific expectations in scholarly productivity do we expect from a new candidate?
What funding, laboratory, or staff support can we offer to support academic achievement?
What academic or scholarly activities are expected from clinical track associates?

Private practices should prepare to discuss:

Will shareholder (partnership or stockholder) status become available and what will be the "buy-in" process?
What range of non-clinical activities and interests will the practice support?
Who will be the sponsor (mentor) for a new associate?

If the practice does an in-depth analysis in preparation for recruiting an additional or replacement member, discussing the answers to these questions that would come from each of the existing practice members can help solidify motives and understanding before anyone has to answer questions from recruits! Once the practice can present a unified front to potential associates, securing a new associate with goals and interests compatible with the practice is more likely.

Pre-recruiting preparation: a detailed outline for practice associates.

Early in the recruiting process, a few meetings among practice associates can be very useful. Expect prospective associates to inquire as to the reason(s) behind the practice's need for a new associate early in the process. Although it may to be to replace a departing or retiring associate, it is unlikely the new associate will just drop into the departing doctor's duties. If the added associate follows an expansion of the workload, not all of the new work is likely to go to the new associate—more likely the work distribution of the entire practice will be modified. The practice has needs and expectations, but so does the applicant. Fellows seeking a first position are encouraged to develop a career plan, and then to seek a position that fits well as a first step toward their longer-term ideal. Applicants will also wish to know the process the practice will use to select its new associates, the expected timeline, and the means for communication. The topics below outline some of the discussions that can help a practice understand its needs and present itself well to applicants.

Summary

Recruiting is difficult, time consuming, and often frustrating. The process is expensive, requiring up to the equivalent of one-year's compensation (spent in time and money) to successfully recruit a new associate. There are ample jobs from which applicants can choose. Among the 150 -200 newly-trained fellows and the few neonatologists seeking relocation each year, likely there are some whose interests concur with yours.

Retaining newly-hired associates is becoming more challenging for several reasons. An important consideration involves the generational differences in job-expectations, communication styles, work-life balance, role of compensation, and learning methods. Physicians from the "millennial" and "generation X" cohorts are as intelligent and as interested in high-quality medicine as are those senior practice members of the "baby-boomer" or "traditional" generations. Understanding the generational differences in the approach to one's profession can be useful, especially if most of the practice associates are in mid- or late- career. The business world has found generational issues to be the most challenging force for human resources departments to address. Practices who explore these differences and discuss means for the practice to adapt are more likely both to successfully recruit and to retain associates.

Detailed preparation allows for a more comfortable interviewing process for both sides. If a potential fit is present, for the practice to be prepared and open to discuss all aspects and details of being a colleague in the practice can be welcoming to applicants and seal the deal. Good luck.

Preparing to Recruit

Questions for discussion about recruiting

I.) What does the practice need from a new associate?

A) Why is the group recruiting?

1) Replace departing associate
2) Add to meet increasing work demands
3) Add to reduce overall individual work load

•B) What skills/specialty interests of current practice are needed?

1) Immediate needs
2) Mid- and long-range needs.

C) What additional skills would help the group grow and improve?

II.) Will some members of the group be interested in reducing or changing their responsibilities in the next few years?

A) Senior associates
B) Family issues: pregnancy, adoption, etc
C) Part-time or Job-sharing options
D) What alternatives will we support?
E)What alternatives will we NOT support?

III.) What is the ultimate status expected of newly hired physician?

A) Employee forever
B) Academic advancement

1) Traditional
2) Clinical
3) Realms of scholarship
4) Tenure

C) Shareholder status and ultimate parity in private practice or practice plan
D) Timing of advancement

1) Achievement of full partner status
2) Tenure expectations

IV.) How will the practice seek recruits?

A) Advertise

1) May reach candidates inaccessible by other means
2) Cost depends on number and duration of ads
3) Postings at meetings, eg AAP, PAS, Hot Topics, etc.

B) Recruiter

1) More expensive than advertising, but can reach potential candidates who may not be actively seeking a job, and can screen applicants according to your criteria, saving you time
2) Some hospitals employ physicians or may assist practices admitting patients to the hospital through hospital-based recruiting services. [Remember, use of such assistance precludes having a restrictive covenant in an employment contract (Federal law).]
3) Nationwide database sometimes.

C) Personal contacts

1) Least expensive
2) Source of reliable candidates
3) Restricted to those you know
4) Influenced by competition (your friends may be recruiting too)

D) Web-based resources

1) Job listing and matching sites (eg, AAP's PedJobs site)
2) Potential to have to screen large number of applications or inquiries.

V.) How will you screen applicants?

A) What are the "deal-breakers" and "deal makers" from the practice perspective?

1) Assuming you get more applicants than you want to interview, what "red flag" information will be important to narrow your field?
2) What are the most important desirables? [Interest in a specific area, such as teaching; experience in a new or needed skill; etc.
3) What characteristics should raise concern, resulting in either rejection or at least in more information-seeking? [Multiple moves in a short time, lukewarm letters of recommendation, absence of experience in a key skill you are seeking (e.g., research, teaching, ECMO), excessive interest in financial aspects, poor communication skills, immigration status].

B) What group process will be used to sort prospective candidates from the list of applicants?

1) Who assumes first line responsibility?
2) How will persons for visits, interviews be selected?

C) How will initial contacts be done (pre-interview)?

VI.) How will you process potential applicants?

A) Phone or email contact

1) Information to be obtained
2) Primary contact: identification and responsibilities
3) Criteria to invite for face-to-face interview and site visit

B) Who is on the interviewing team?

1) Primary contact and coordination
2) Schedule for meeting group members.

C) What is the content of the interview visit?

1) Interviews with the neonatal group representative(s) to discuss responsibilities, expectations, shared goals and develop question list
2) Process for all practice members to meet candidate.

D) Interviews with key hospital individuals/groups

1) Nursing leadership
2) Hospital administration
3) Department and/or Division leadership

E) Academic contacts

1) Department leadership
2) Dean
3) Potential mentor or sponsor

F) Introduction to the community
G) Financial discussions
H) Unscheduled time

VII.) What will be the practice's process for selection?

A) Number of candidates

1) Will there be a series of candidates interviewed before a selection is made?
2) If a "great fit" comes along, will the process be stopped?
3) Responsibility to assemble responses from interviewers & report to group

•B) Notification of applicants: Schedule of communications

1) When can applicant expect a decision?
2) Commitment on part of applicant to notify you if he/she takes a competing opportunity
3) Who will be the liaison with the applicant?

(a) Practice manager
(b) Physician contact

VIII.) How will the practice decide whom to interview and ultimately whom to hire?

A) Backchecking

1) Pre-interview review and invitation for interviewing & visit.
2) Addressing areas of uncertainty that become apparent during the interview process.

(a) Review responses given to practice associates in one-on-one settings
(b) Re-contacting those individuals who are familiar with the candidate [Their first comments when you were screening candidates may have been general and laudatory, but when you explore new information with them after the interview, they may be more open and helpful in discussing areas of concern that come from the interview, especially if done in a personal or phone contact

B) Group discussion and process for decision making

1) Timing: after each applicant, or after all have visited, or both
2) List required information to be evaluated and reviewed

(a) Credentials and CV, including ABP eligibility
(b) Letters of recommendation
(c) Reports from interviewers
(d) Interaction during visit: rounds, individual interviews
(e) Specific interests or requests
(f) Availability

3) Operating agreement: what process of selection applies? consensus; voting process; conflict resolution (eg, does anyone have a veto?)
4) Assignments for notification of both accepted and not-accepted candidates.

C) Liaison makes contact with applicant

1) Candidate selected for job offer

(a) Indicate offer; be ready for answer, and if
(a) Yes: Proceed to letter of understanding
(b) Maybe:

(i) Re-visit?
(ii) Time interval requested?
(iii) Other information practice can provide?

2) Promising, but no consensus re offering position

(a) Process for final selection or rejection determined
(b) Plan for interaction with candidate prior to ultimate decision

3) Non-accepted candidates notified of decision promptly

IX.) Acceptance process

A) Letter of understanding is sent to accepted candidate. This should provide, in lay language, the duties, term, benefits, and compensation as well as answers to any specific issues requested by candidate. Candidate can send signed copy of letter, email receipt and agreement with letter—or work out any misunderstandings. This often can be done among physicians, without attorney, prior to addressing the contract per se.
B) Contract preparation: ◦

1) For a new contract, once letter is reviewed and resolutions to questions have been work out with mutual acceptance,, lawyer prepares contract, and sends to applicant
2) When ther is an existing contract (used by other practice employees), send to applicant.
3) Applicant should be encouraged to have independent legal review of the contract

(a) How are questions or concerns to be addressed?
(b) Attorney should be aware of whether he/she is expected to directly negotiate terms with employer

4) Timing for return of contract

X.) Confirming the unwritten understandings

A) Often, key expectations (responsibilities, financial, etc.) on both sides are discussed but do not end up in contract language. Some contracts have a "null and void" statement regarding previous agreements or statements, written or verbal, making a full and detailed understanding to be included in the contract. Sometimes promises inaccurately inferred by one party from a conversation while the other party is unaware such an impression had been given. It is important that both sides confirm in writing all additional expectations in order to avoid misunderstanding and hard feelings later. This is best done before a contract is signed (see above). But, if issues arise after a contract is signed, resolve them in writing—inquire of attorney if addendum to contract is needed.
B) Remember, the discovery of unexpected consequences or "surprises" is one common factor in separation early after hire.

XI.) Licensure and privileges

•A) Licensure process should be begun as soon as possible, it takes a long time

1) State level – there is no national licensure process
2) Reciprocity: some states recognize other states' licensure and/or testing requirements
3) May require letter from potential employer

•B) Privileges;

1) Contact hospitals,

(a) Preapplication (if used) is begun, and
(b) Documentation is gathered to allow credentials committee action soon after licensure is secured.

2) Procedural credentialing may be required

(a) Secure letters re training and procedure competencies as needed
(b) Keep log of procedures.

3) Board certification and Maintenance of Certification

(a) Initial certification requirements
(b) Maintenance: required or voluntary.

•C) Billing numbers: how will new associates be added to insurance and health plan contracts?

XII.) Getting started with a new associate

A) "Sponsor" appointed from within group
B) Relocation support:

1) Moving expenses
2) Re-visit after "signing" for relocation planning

C) Spousal and family support

1) Employment potential
2) Schools
3) Realtors

Summary

Last Updated

04/15/2022

Source

American Academy of Pediatrics