Dear Director,
I’m recruiting for my group and need to add a doc or two from the current resident seniors. What tips to you have?
As medical directors are going on summer vacation, senior residents are finishing CVs and starting the job hunt. It’s definitely recruiting season and all medical directors should be receptive to starting the process.
It’s funny when we reflect back to early in the pandemic when we weren’t sure there would be jobs available for graduating residents for years to come. Whether it’s due to higher volume or some current docs desire to work less, it appears the tides have turned and most medical directors I know are looking to add staff for next year. That means it’s going to be a competitive recruiting season for the medical directors.
When I was looking for a job 25 years ago, I had a department chair tell me the most important thing he can do is dedicate time to finding the right docs to fill his team. As a long time chair, I completely agree. We need to recruit docs who are not only great docs when it comes to the medicine, but they also need to be open to feedback so they continue to grow. And perhaps most importantly, new hires must fit in with the culture of the department that the department chair is working to build or sustain.
Staffing Needs
One of the first questions a medical director needs to answer is what are the real staffing needs I’m going to have over the next 12 months. My crystal ball is usually pretty fuzzy but having worked at and recruited for three EDs (volumes 40-80K), I’ve found that I usually need at least one new doc a year. And I don’t think I ever went a year without hiring someone.
There’s almost always a little turnover (moving, retirement, decreasing hours, etc.) and I also would always rather be a little overstaffed than a little understaffed. Now is the time to be talking to your docs to see if there are hints of retirement or leaving. It’s also the time to be talking to administration about any potential expansion plans. Maybe there’s a free-standing ER in the future or they want the emergency physicians to manage a telemedicine or callback program.
How many people you interview and how long you spend with them will depend on how many candidates you get. I’m in a metropolitan area with multiple residencies and I’m very fortunate to have plenty of high quality candidates interested in my site. However, my last site was more difficult to recruit for despite being in metropolitan area with local residencies.
At this site, I used to block half a day so I could spend a lot of time with top recruits and take them to lunch or happy hours afterwards. Currently, I block 60-90 minutes since it’s easier to recruit at my current site. When I talk to directors in less urban areas, those who get less candidates, or those in small groups where every hire is critical, it’s completely appropriate to spend more time wining and dining candidates and making sure they’re the right fit for your group.
And if you’re having trouble getting candidates, I encourage you to interact with the closest residency programs to you as well as your former program. This could mean attending grand rounds, giving a lecture to the residents (not always easy to get on the educational calendar), to hosting a dinner for the upper-level residents.
I’ve done it all over the years and sometimes you have to try a few things to figure out what works best for you and where the greatest return on your investment (both time and money) can be found. I’ve hosted some successful residency dinners through the years. I also remember hosting one with another chair where no residents showed up. Colossal failure. There was an upside though. We had a minimum amount to spend on food at the restaurant so the recruiting team, my colleague, and I walked out with a lot of to go seafood and steak.
Reviewing the CV
Although residents will spend hours perfecting their CV, most director’s will only spend a minute or two looking at it. However, this first glance is typically the first thing I’ll see when considering to interview an applicant or not. I’m certainly looking to see their education and residency history as well as if there are gaps in their training.
Since location is typically the top factor in deciding where to work, I’m also trying to figure out if they have ties to my area of the country. Finally, I look at how their professional activities and interests during residency will mesh with our extracurricular activities, as well as their hobbies and other interests.
Starting the Process
With so many job openings for new grads, we (as the medical directors) are definitely the “sellers” and this is a “buyers market.” For this reason, I think it’s important to establish communication with the recruit shortly after getting the CV. This might be an email but could just as easily be a text. Assuming you’re interested in going forward with an interview, it’s never too early to get that process started.
My preference is always to do in person meetings, however if travel is involved and a site visit may not happen for several weeks or longer, starting with a virtual meeting is appropriate. I’ve been doing virtual interviews for about seven years and I’ve learned a few things. Until recently, I pretty much completed my whole interview during the first virtual meeting. I felt this was great but then the candidate would come for a site visit, and I wouldn’t’ necessarily have much to talk about.
The tour of the ED takes 10 minutes and even with spending some time in my office chatting, I felt like the site visit was too short. I don’t know if I lost potential hires, but it left a bad taste with me. I’m now doing 30 minute Zooms to give the candidate a taste of my site while I still feel like I get the info I need. The site visit allows for more of the “getting to know each other” and discussion about the site.
I’ve made a few “bad decisions” when it comes to hiring docs and it’s almost exclusively due to my desperation for new hires. In this desperation, it’s typically because I offered a job based on a phone or Zoom interview without a second in person meeting where I think I would have picked up on potential issues the doc was going to have. While closing the deal means offering a job, I won’t offer jobs anymore based strictly on a virtual meeting.
Doing the Interview
The purpose of the interview is twofold—get to know the candidate to decide if you want them on your team AND selling your shop. I divide the interview into four parts. The first is getting to know the candidate. Ideally, this is just a conversation, but I do have a few prompts I use. My typical starter questions are where are they in their job hunt (and which of my competitors are they interviewing with if they’ll give me that), why my area of the country, and what are they looking for in a job.
I’ll file their answers away and bring up pieces of the conversation when I’m talking about my site. Typically, it’s easy to talk about how my site fits exactly what they’re looking for. However, on rare occasions, I’ve interviewed people and really felt they weren’t a good fit (typically it’s because they want a more academic job with residents), and then I’ll point them to one of my competitors.
I’m also trying to assess their enthusiasm for emergency medicine, their productivity, how easily they’ll adapt to a community hospital from an academic one, what they like best about residency and what is their program’s weakness (everyone has one and it’s usually ortho, ophtho, peds, or radiology). Towards that end, I’ll ask the candidate to tell me about an interesting case, describe their typical shift, and we’ll talk about their rotations and/or moonlighting experience.
The second part of the interview is the description of my site. Some of this involves “selling my ED.” This doesn’t mean hiding the truth or lying. I can give a pretty honest assessment of our pros and cons. I also am very clear on expectations and performance.
And the biggest difference I’ve seen when I’ve talked to directors who seem to have trouble recruiting is their inability to be positive about their site. As the medical director, we have to be able to find solutions to our problems. So even when someone asks me what our biggest issue is, I can usually answer it honestly while also explaining how we are fixing it. People want to join teams that are successful, and the interview is the time to show your successes.
The third part of the interview is the tour. I have a few points I make during the tour. I also try hard to introduce the candidate to any and all of the docs working. Establishing a face-to-face contact is great for connecting the candidate to a team member for further questions. The final part of the interview is going back to my office to answer questions and start to close the deal if it’s someone I want to hire.
Closing the Deal
I had a dream job as a resident, but I was really turned off by being offered a job there after a 15- minute interview. Because of my own experience, I’m a bit gun shy to offer a job too quickly. However, by the end of the interview, if not sooner, I’m usually pretty sure if I want to hire the candidate. With that said, the medical director has to be able to close the deal with good candidates.
I usually start with a question like “what do you think” or “can you see yourself working here?” From there, I’ll make a positive statement such as “you’d be a great fit here.” Then I talk about next steps.
If I’m only hiring one person and I know I have a great candidate coming in for an interview in the near future, I might want to stall for a week or two on making an offer.
Therefore, next steps I mention include checking references, getting through a few more interviews, and then telling them we should touch base in the near future (depending on the time of year and our conversation, this could mean in a couple weeks, at ACEP, or when the interview process is completed). Of course, I already said, I’d rather be a bit overstaffed, so my preference would be to find space to hire a second great candidate, even if I only need one, than to lose them to another site.
References
It is the job of every residency program director (PD) to help their residents get jobs. Because of this, I remind myself to take every reference from a PD with a grain of salt. I’ve even had good friends stretch the positives of their resident. If you hire from the same programs over time, you’ve probably learned who is a reliable reference and who isn’t.
Often, I’ll call people I know and trust at the facility, who aren’t on the official reference list to get feedback. Since every resident is “great,” I do try to get the reference to rank the doc among the classmates when it comes to medical knowledge, productivity, teamwork, and patient and nursing engagement. Getting them into a top, middle, or bottom third, can be very helpful. At the end of the day, references may reinforce my decision to offer someone a job, but more importantly, on rare occasion, provide enough insight or warning, that might get me to move on from a candidate.
I’ll also ask my own docs their thoughts on the candidate if they worked with them as a resident. If my doc has a friend who is an attending at the program, I’ll have them check in with their contact. At the end of the day, I want to know from them if the candidate is someone they want to work side by side with or not.
Contracts and Follow Up
In today’s world of rapid communication and positive reinforcement, I’ll usually send a text or email to a candidate I’m interested in shortly after the interview. For many candidates I’m interested in, I’ll offer to connect them to some of my younger docs so they can hear firsthand about the transition from residency to being attending.
And yes, you should work with your own team to make sure they can be positive ambassadors for your program and perhaps even talk to them about specific messaging. If you find a great candidate, don’t delay making an offer, so get a contract out to them with an official offer.
Conclusion
The medical director has a lot of responsibility and one of the most important parts of the job is recruitment. If you can’t recruit, you cannot consider yourself a successful medical director. Recruitment must follow a process with each step being intentional. Successful recruitment can have long term benefits to your program and is worth investing the time necessary to get the right team members.
