By Lori Jackson Norris, FASPR, Senior Physician Recruiter, Dignity Health
During a recent ASPR webinar titled “Coaching for successful interviews,” Sheri Shaw, FASPR, polled her audience on several topics. The first question, “Has your organization ever made a bad hire?” got an unsurprising response with about 95 percent answering yes. The second question asked participants if their organizations utilize an interviewing tool for provider candidates. About 60 percent said they do. When Shaw asked specifically if behavioral interviewing was among the tools, approximately 60 percent responded no.
Shaw, who leads the advanced practice provider recruitment for Indiana University Health, is a certified behavioral interviewing trainer. Understandably, she encourages the use of this technique and urged webinar participants to take the time to “strongly coach” all staff members involved in the interviewing process.
“We have candidates’ lives in our hands. We need to respect this and be prepared to interview,” Shaw said. “Make sure every interviewer involved in the process has a purpose. Candidates are going to be more impressed by an organization that has an interview process in place…an organization that is prepared to ask the tough questions.”
In Hartford, Conn., Patti Lowicki manages the interview process for her organization, along with input from key leaders. She is the director of physician and advanced practice provider recruitment and integration for Hartford HealthCare, a five-hospital system with a large multi-specialty medical foundation. The system hires approximately 100 physicians per year, as well as approximately 25 advanced practice providers per year for the medical group.
Similar to Shaw, Lowicki is also a certified trainer in behavioral interviewing and has delivered training for many years. Although behavioral interviewing is at the core of her organization’s interviewing process, a combination of other techniques complement the process that include key background reviews and clinical and motivational questions.
“The behavioral interview questions are competency-based and tied to organizational values, the job description and competencies that we have identified as necessary in order to thrive in our environment,” Lowicki said. “With training, most interviewers understand the importance of this type of interviewing and the valuable data it produces. It works particularly well for primary care positions and we are using it more and more for specialists.”
“In addition to core competencies like safety, patient satisfaction, integrity and quality, questions are designed to determine if candidates will work well in a frequently changing environment, are prepared to work collaboratively as a part of a care team, and can think creatively and innovatively about care delivery,” Lowicki continued. “This alignment with our organizational values and the competencies that we believe drive satisfaction and success in our environment helps make the selection process more quantitative. Selection processes for best practices should be job critical and involve effective interviewing, data collection and evaluation, due diligence in background checking, and be legally defensible. Hiring decisions should be based upon data, rather than a ‘gut feeling’ about a candidate.”
Lowicki and her team ensure that candidates are interviewed by a broad spectrum of medical leaders, executive leadership, colleagues, practice management, referring physicians and other stakeholders. “In addition, primary care physicians must do a ‘working interview’ during which they see patients for three to four hours under the observation of one of our employed, experienced primary care physicians,” she said, adding that informal meals and tours of the facilities and region are often included.
“Behavioral interviewing requires training, which takes time and an experienced trainer. It also requires buy-in from all participants,” said Lowicki. “At times it is difficult to convince interviewers of its value toward accurate selection and retention. There is plenty of data and literature out there to demonstrate it yields much better results than traditional ‘tell and sell’ interviews or hiring based on a gut feeling,” Lowicki said. “It takes effort to ask the questions and accurately note and evaluate responses. It also takes some effort to gather a group to make a decision. We have an evaluation tool that all of our interviewers are required to complete and return within one day of the interview. The process is working well.”
Prior to the interview, Lowicki explained that physician recruiters screen every candidate by phone. If the candidate is out of state, the physician leader also performs phone screens. “We arrange a site visit once a candidate has passed these screens.” Lowicki added that they have not yet utilized Skype or Face Time, mostly because their information technology capabilities do not allow it. “It would require a breach of the firewall. We are working to eliminate this barrier but, frankly, I don’t believe that we will use it to any great extent,” Lowicki said.
Once the interview is completed, Lowicki collects interview feedback via an interview evaluation form. The physician leader and physician recruiter review all of the evaluations and the leader makes the hiring decision. “At times when politics dictate, or evaluation results vary widely, we assemble the group for a group discussion toward consensus.”
In Phoenix, Ariz., Katherine Harris, FASPR, recruits physicians and scientists for Mayo Clinic. She recruits approximately 40 physicians per year for employed positions. Harris described Mayo Clinic’s interview process as structured and comprehensive.
“Broad and diverse panels make up each search committee. Someone is designated to represent diversity, research, education, clinical practice, credentialing and staff services. We also have a personnel committee which ultimately approves all appointments,” Harris said. She added that she and the other Mayo Clinic physician recruiters also are an integral part of the interview process.
“Primarily, we utilize behavioral interviewing techniques,” Harris said. “We also include a scholarly presentation, facility tour, dinner with department/division members, and one-on-one meetings as appropriate to each position.”
Day to day recruitment activities are managed by Harris and the operations administrator from within the department or division conducting the search. “However, the personnel committee owns recruitment at the highest level. It’s a collaborative and joint effort which helps us make the best selection possible,” Harris said.
When looking at what has worked well in the interviewing process for her organization, Harris gave the credit to behavioral interviewing techniques, where questions are linked to the organization’s career and leadership development capabilities. “This alignment along with the use of best practices has helped us avoid making a poor hire on more than one occasion. Not everyone has embraced the process, but as they gain a level of comfort with it and see it in action, they become more supportive,” she said. “Showing them research on outcomes for behavioral interviewing practices has helped gain their confidence and buy-in.”
Along with in-person interviews, Harris said her organization also uses a mixture of GreenJobs Web-based video interviewing and other platforms. “When we know a few fact-based questions will help us weed a candidate in or out, we will opt for a phone screen. Other times, we want to know them on a deeper level but don’t have time to schedule travel or have too many candidates to fly out for an interview. In that case, we may opt for a Web-based video interview. However, all candidates receive at least one site visit interview. They must see the area before we’ll relocate them here to live,” Harris said.
At the conclusion of the interview process, Harris looks for feedback from those involved. “Ideally, we aim for consensus. If there isn’t consensus, the chair of the search committee makes the final call. However, he or she must explain what the area of concern was and why they chose one candidate over another.”
There can be a down side to the structure of a process this comprehensive, Harris cautioned. “With so many ‘cooks in the kitchen,’ recruitment can take an exceedingly long time. We have high standards and operate in a consensus-based decision making environment. We have to take care not to lose good candidates because we don’t or can’t move fast enough.”
Selina Irby is the physician recruiter for Bozeman Deaconess Hospital in Bozeman, Mont., where she recruits approximately seven to 11 physicians per year. Bozeman has a population of about 39,000, and this hospital is the only one in the area. While her physician placement needs are substantially fewer than that of Shaw, Lowicki or Harris, she also is responsible for the recruitment of all employed management and non-physician providers for the hospital and health group. Irby manages the process but always gets buy-in from the administrator who would eventually supervise the candidate, if recruited.
When recruiting physicians for her organization, Irby has a wide range of participants included in the interviewing process, depending on the specialty, including members from the C-suite; management; credentialing; human resources; and potential physician colleagues.
Irby and her organization prefer to primarily utilize traditional interviewing techniques but complement the process at times with behavioral interviewing. “I interview all potential candidates by telephone,” she said. Next, Irby explained that a physician from the group in which a candidate would potentially join also calls candidates. Once those hurdles are passed, the candidates are required to come for an on-site interview. Although Irby utilizes Skype for interviews with administrative candidates, she currently does not use this platform to prescreen or interview physicians. “We are moving in that direction. Skype has worked really great with management interviews because you get so much from non-verbal communication.”
What works especially well in her process, Irby explained, are physicians and managers who are really involved and are great at selling the hospital and the region. “What doesn’t work well is when you have physicians involved who tend to be negative,” she said, adding that it’s difficult at times to avoid this in a smaller medical staff and community.
Once interviewing is completed, Irby emails all interviewers involved asking for feedback. “I ask them to tell me what they liked or didn’t like and if they would offer the position to the candidate,” she said. “The president of the health group and I then meet and review the feedback with the hiring clinic. We also put this feedback in the employee file in HR if they are hired.”
In northern California, Colin Harris, FASPR, has been recruiting physicians for Dignity Health Medical Foundation in Sacramento for about seven years. Harris said he is averaging about 20 to 30 placements per year. He added that the organization’s benchmark is set a bit lower at about 15 to 18, but results vary based on fluctuating factors that are the nature of physician recruitment.
Similar to Irby, Harris has been successfully utilizing traditional interviewing techniques. “I’m not convinced that behavioral interviewing is the best technique for interviewing physicians,” he said. He added that although what they are doing right now with the interview processeems to be working well, he is always open to anything that might improve a process. “It’s fine with me if someone in our group wants to use behavioral interview questions. I just think that some physician candidates are unfamiliar and uncomfortable with the process and may be put off by it,” Harris said. He speculated that this may tend to be more common with seasoned physicians who have been practicing for a while. “Some members of our interviewing team do use behavioral interviewing questions, and I’ve had candidates give me negative feedback about it.”
Sticking to his “tried and true process,” Harris interviews potential candidates by telephone to determine if their interests are aligned with the organization. “I look for personality and overall fit,” he said. Once this is determined, he forwards CVs to the CMO, department chairs, and other leaders for approval prior to a site visit.
In Harris’ opinion, having an active, engaged team of physicians involved in the interview process is what makes his work successful.
“They respond with feedback quickly and that’s important in this process,” he said.
So, how do you and your organization prepare for asking the tough questions? Do you think the interview process should vary based on the size of an organization? Does the interview process depend on the location of the organization - a rural versus an urban area? How about if the opportunity is for an employed position versus a position in an independent practice? Should the interview process be different if it’s for an academic position? Do you use behavioral interviewing or other formalized techniques in your process? Is your interview process structured, informal or a hybrid of its own?
All of these are important questions to ponder…and like most aspects of physician recruitment, there is no one right answer. It’s an “apples to oranges” dilemma that makes the profession even more challenging as organizations try to determine what works best. As ASPR continues to compile valuable benchmarks and best practices in areas that impact physician recruitment, members will have a resource to turn to where they can compare and contrast different approaches. The bottom line? Sometimes it takes a bit of trial and error to find a process that will result in successful placement rates for your organization.