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Hiring clinical staff

Medical Economics JournalMarch 25, 2019 edition
Volume 96
Issue 6

How to attract and retain physicians and other providers


In a small Kansas town, an independent medical practice is taking an innovative step to attract talent. 

The practice owner and his team of six clinicians believe they need at least one more physician but expect the position will be part time, at least to start.

The owner developed a training program with a local hospital that allows new physicians he hires to get hours at the hospital, thereby creating the equivalent of a full-time position attractive enough to draw high-quality applicants, says Jillian Schneider, MHA, manager of practice support at the American College of Physicians, who has worked with the practice.

Many practices have difficulty recruiting and retaining clinical staff, but small and independent practices often face the biggest challenges as they try to compete for talent against larger entities that are better able to promote all they can offer.

Small, independent and rural practices don’t have as many recruitment and retention resources. They typically don’t have the financial capacity to offer compensation packages as generous as larger or system-owned practices, or offer the high-profile work environments that exist in major research healthcare centers. They might not even have a full-time schedule to offer to start, as the Kansas example illustrates.

Management experts stress that a well-crafted plan can help these practices be more successful in hiring the right people for their teams, ensuring the longevity of their practices, and, ultimately, serving their patients in the most efficient and effective manner. “At a small practice, there’s only so much money that can be spent on compensation, so they have to consider the types of the benefits they can offer, like flexibility and work-life balance. Those are big perks that money can’t buy,” Schneider says.

Target the talent

Smaller, rural and independent practices can be particularly hard-pressed to attract qualified candidates, says Travis Singleton, executive vice president of the physician recruiting firm Merritt Hawkins. 

These practices sometimes struggle to attract physicians and other clinicians because prospective employees are often unfamiliar with smaller practices, how they operate, and why they can be good places to work. Singleton says younger physicians typically train at hospitals or in larger practices affiliated with healthcare systems, so they’re only familiar with practicing in such settings. 

To attract physicians, Singleton says, independent practices should search for candidates who come from rural areas and are therefore likely familiar with life in those areas, the sense of community they often have and perhaps even how healthcare practices in those areas operate. Practices should use professional networks, medical schools or physician associations to identify clinicians who fit that profile. 

But that is just the first step. Independent practices also should work with medical schools or regional medical associates to attract potential candidates. “Physicians in small and rural practices should be reaching out to schools, saying, ‘We want students to come to us. We want them to learn about small-practice medicine, rural medicine, so let’s form programs so they can be exposed to this kind of environment,’” she says.

Russell Kohl, MD, had a solo family practice in rural Oklahoma from 2006 to 2012. He relied on networking to help attract candidates when he had positions to fill. But he also worked with his local vocational high school and area colleges, offering to be a preceptor for nursing students. 

“Some physicians say they don’t want to be a training center. Some might think it slows down the practice. But if you think about it as an on-the-job interview for both-you get to see these people, they get to see the culture of your practice-then you realize you both really get a feel for whether it’s the right fit,” he says. 

Indeed, Kohl, who now practices in Stilwell, Kan., and is a board member of the American Academy of Family Physicians, had hired a nurse practitioner and two licensed practical nurses from the training programs he had established with area schools when he was still with his previous practice in Oklahoma.

Offer competitive compensation

An attractive compensation package includes a competitive salary and standard benefits, such as health and dental insurance as well as paid time off for vacations, sick days, and bereavement. Schneider acknowledges that small and independent practices don’t often have the money to fund a new position as soon as they recognize the need for more staff, so she advises practices to plan strategically so they can start budgeting for new positions a year or two in advance of recruiting and hiring. 

To ascertain the compensation that other practices in their region offer, practice owners can access compensation surveys, such as those done by the Medical Group Management Association (MGMA), and talk to colleagues, says Nick Fabrizio, Ph.D., FACMPE, FACHE, a MGMA principal consultant.

“One of the best strategies is to talk with others. People will share what they’re paying, or share a range. That gives the hiring physicians the best benchmark,” Fabrizio says.

He notes that physicians don’t have to offer the exact same compensation package that others in their region do, particularly because small practices generally can’t afford to match the benefits packages offered by the largest healthcare systems. Still, Fabrizio says, the practice must be close to what others in their area offer their employees. That could mean a higher salary but a less generous benefits package, or vice versa.

Have options on employment, ownership arrangements

While salary is important, small practices can also attract and retain staff by structuring compensation to reward hard work or finding other ways to boost the total compensation package.

“Even more important than competitive pay is providing employees a sense of how they can earn more,” says Laurie Morgan, MBA, a practice management consultant and partner at the practice management consulting firm Capko & Morgan. 

She suggests creating bonuses for clinicians who meet productivity goals. “Creating that type of job structure, and then communicating it clearly, can be a powerful way to compete against larger organizations with more cookie-cutter employment policies for doctors,” she says.

Kohl established an employee profit-sharing program, which became an effective tool for retaining staff and boosting practice efficiency. “It made my employees very creative in getting work done. They were very focused on being effective and efficient, so we could do all the procedures we needed to do,” he says.

Similarly, Singleton advises practice owners to be open to various types of employment arrangements. He points out that many physicians don’t want to be practice owners, so there should be a career path for them, as well as an option for those who want to become partners.

Practices should also determine ways for their physicians, non-physician providers, and support staffers to grow professionally, Morgan says.

“Not all employees are interested in doing the same job forever; many people are aiming to progress. Enabling employees to pursue more education conveys that your practice is investing in your staff,” she says, adding that investing in continuing education can also save the practice money in the long run.

“The cost of the training plus a raise and promotion for the employee could be less than the salary you’d wind up paying an external hire. And you likely foster more loyalty in that employee you invested in,” she says.

Kohl says he used professional development opportunities as a recruitment tool. He encouraged members of his clinical team to pursue further education, and he worked with individuals who continued their studies to create schedules that gave them time to take classes yet still have the practice adequately covered. As a result, he retained top talent and his practice gained more skilled employees.

Offer unique benefits, perks

During his years running his small practice, Kohl says he learned that his staff members often didn’t use the benefits he expected them to need, but did want some degree of individualized benefits. 

For example, he found that most of his staff members did not need health insurance because they were already covered by their spouses. Some, however, were more interested in flexible hours or more vacation time. Kohl says he sought to learn what his staff members valued most and tailored what he offered to each one as a way to help retain them.

“One of the benefits of having a small practice is you have the flexibility to meet [employees’] needs. That’s a big selling point, particularly for younger physicians who are raising kids or still going to school,” he adds.

Practice owners should determine what benefits or perks they can offer, such as flexible schedules, and then highlight that to prospective candidates.

For example, practice owners could offer new physicians the ability to hire their own care teams, determine how broad to make the scope of their practice coverage, and even set their office hours, Singleton says. 

“That control goes a long, long way in recruiting and retaining physicians,” he says, citing a group of physicians that decided to join an independent practice where they’d make less money but could have more say in the way they provided care for their patients.

Management consultants say practice owners should also emphasize the unique qualities or professional opportunities that their practice offers as a way to attract clinicians seeking professional experiences different than those offered in larger ­settings.

For example, Schneider says, rural practices can sell the fact that physicians working in them generally practice a broader range of medicine and that they’re often a bigger part of these communities than their suburban and urban counterparts. 

Formal policies needed

Although management consultants say small and independent practices should use individualized employment packages as a way to recruit and retain top talent, they advise practice owners to have policies and procedures in place to establish available benefits so that even if employment packages are individualized they won’t seem capricious.  

“To a certain extent, you have to determine what you can do for each one and still maintain a practice, and you have to be fair,” Fabrizio says.

Fabrizio adds that practice owners who want to recruit and retain skilled professionals need to focus on being good employers- not just good healthcare providers. He adds: “Be the best employer you can be. Respect your staff, be responsive to your staff.”

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