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Put more than money on the table when recruiting hospitalists

Showing potential new hires a career path can be the key to retaining top talent

From the February ACP Hospitalist, copyright © 2007 by the American College of Physicians.

By Lisa Holton

Despite statistics showing that hospitalists are the nation's fastest-growing medical specialty-the Society of Hospital Medicine estimates that the current pool of 15,000 U.S.-based hospitalists will double by 2010-recruiting and retention remain major challenges. That may be due to growing pains, say some in the field, as the relatively young specialty finds a place within the hospital organization.

"Hospital medicine is still seen to some extent as a short-term career choice, particularly for new doctors," explained Aaron L. Gottesman, FACP, director of hospitalist services at Staten Island University Hospital in New York. "For the specialty to become a career destination, hospitalists need to build their knowledge of business and management skills so they can create a higher place for themselves."

As it stands, hospitalists have a laundry list of complaints that range from getting dumped on by emergency department doctors and specialists who'd rather focus on their private practices, to rotating night duty that threatens family lifestyles, to having little or no say on important medical policy issues. Perhaps worst of all, most hospitals offer a limited path to advancement.

"It doesn't take much for the job of a hospitalist to become one of the least attractive in the hospital organization," said Kathleen Mimnagh, MD, a family practitioner and head of the department of medicine at Charleston Area Medical Center in Charleston, W.Va. "When it comes to recruitment, working conditions, empowerment and career path can become almost as important as the money and incentives."

Best practices

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John R. Nelson, FACP, recommends looking at life from the hospitalist's point of view.

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So, how do hospitals effectively recruit for these positions? John R. Nelson, FACP, director of the hospitalist practice at Overlake Hospital Medical Center in Bellevue, Wash., and cofounder of the Society of Hospital Medicine, said it's critical to stay flexible and "to look at life from the hospitalist's point of view."

Realize that potential new hires may be weighing the pros and cons of a hospitalist job versus working in an office practice, and be ready to offer comparisons on compensation issues or administrative workload, as well as the schedule, pay and advancement opportunities they might expect in hospital medicine, said Dr. Nelson, who is also a principal and hospitalist practice management consultant with Nelson/Flores Associates.

"Looking at national surveys won't help," he added. "Effective recruiters need to keep their ear to the ground in their own communities and look outward."

Dr. Nelson and others offer the following tips for effective hospitalist recruiting.

For now, hospital medicine is largely a young doctor's game. Hospital medicine is a young specialty and, until a stronger career path into leadership roles within hospitals becomes clear, Dr. Nelson advised recruiters not to be unrealistic in their recruitment goals.

"When it comes to recruitment, working conditions, empowerment and career path can become almost as important as the money and incentives." — Kathleen Mimnagh, MD

"Hospitalist practice is more like dating than marriage," he said. "I've recruited doctors who say they can commit for only two years. Yes, you'd love to have them longer, but what's wrong with that? If you can create a great working environment for a doctor whose spouse is finishing up a surgical residency after which they're planning to relocate, that's good word of mouth for bringing in other candidates." He also pointed out that new doctors are much fresher in their hospital experience, which can be a plus. And, he added, plenty of two-year commitments turn into much longer ones.

Get close to residents now. "It's simply common sense to start watching physicians in training at your hospital as well as others as a growing talent pool for hiring and referral," Dr. Nelson said. Informal face-to-face meetings-dinners, lunches, coffee or a drink after work-can yield huge dividends in what should be a nonstop recruitment process. You can even do a once- or twice-a-year dinner for groups of residents inside and outside your service area when warranted. Resident-and sometimes intern-word-of-mouth referrals can be far more valuable than advertising or marketing efforts that cost much more. "Residents, interns and medical students talking to one another may be your best source of long-term advertising," Dr. Nelson said.

Test-drive your recruits. It might make sense to offer an elective "away" rotation for residents to spend a month working with your hospitalists. It's labor-intensive to set up, but it's a great way to assess talent and get an outsider's view of your program.

Create a great hospitalist support system. Great hospitalists usually go well with great nursing and physician assistant teams. Make sure yours is the best in your area. "Learning how to best utilize physician extenders is very important," Dr. Gottesman said.

Nurses and physician assistants need to be included in staff meetings so they can share feedback that can make the hospitalist workload more efficient, Dr. Mimnagh added. "You have to let voices be heard," she said, and it makes sense for nurses and physician assistants to be paired with specific doctors on a consistent basis.

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Insist on a hospitalist-friendly culture. Doctors should be talking to doctors. A worst-case scenario is when a specialist communicates with a hospitalist through a nurse or physician assistant-specialists need to treat hospitalists as peers, not as glorified residents.

According to Winthrop F. Whitcomb, ACP Member, director of performance improvement at Mercy Medical Center in Springfield, Mass., and, with Dr. Nelson, co-founder of the Society of Hospital Medicine, "there's a thin line between feeling like a bona fide specialist and feeling like an intern in some programs. If a cardiologist wants me to take care of a chest pain patient, they should call me versus telling the nurse to tell me."

Reach out to office-based doctors. Dr. Nelson pointed out that the first years of business development in an office practice can be brutal. Hospital medicine-with the right working conditions-can be another career path, but it might also be a good idea to reach out to office doctors as potential moonlighters. If hospital patients don't have a primary physician, office doctors might view a part-time job as a hospitalist as a way to reach out further in the community.

Always ask doctors about their dream job. There may be doctors willing to work nights in exchange for a shorter workweek or increased pay. As you recruit, always ask candidates what they believe the perfect hospitalist job would be in terms of pay, work environment and advancement track. Their casual suggestions might be the genesis of a pay and workplace package that could make your hospitalist program a major draw.

Create training programs and support for career advancement. Dr. Gottesman, at Staten Island University Hospital, supports training programs for medical managers and encourages them to read business publications, such as the Harvard Business Review and the Wall Street Journal.

"Hospitalists need to educate themselves in management and become experts in the business side of medicine," he said. "There's nothing wrong with full-time focus on patients, but this is a specialty with ceilings, and opportunities don't always surface. You have to be ready for them."

According to Dr. Whitcomb, at Mercy Medical Center, "we have to offer ways for hospitalists to assume leadership roles in quality improvement, to give them ways to grow within their institutions."

Develop better pay-for-performance systems. Hospitalists need to own quality care initiatives at their institution and receive pay incentives for doing so, Dr. Whitcomb said. "Payers have already pushed us in this direction, and talented hospitalists will be attracted to these opportunities."

Spend advertising dollars wisely. Successful advertising, like successful recruiting, is rooted in knowing your community and your audience of recruits. "Doctors today are more interested in lifestyle issues," Dr. Nelson noted. "Why not create an ad that emphasizes how much time they'll have with their kids, or to train for a triathlon, if they go with your program? That may be your best selling point." Send an annual mailing in the late fall to internal medicine programs around the country.

Give your hospitalists a higher profile. If you have hospitalists who are effective public speakers, put them in front of local community groups or medical groups to talk about your growing hospital medicine program. Make this extracurricular activity part of the management track at your hospital.

Invest in technology. Dr. Mimnagh noted that digital records access for patients and other key technology is a lure for hospitalists who are already spread thin in most organizations. "I can biometrically sign in, and it can tell me who my patients are, where they are and I can click to all the information about them."

Help office practices help you. Simply swiping local office physicians for your hospitalist program isn't going to make physician groups love you. Instead, if you've hired someone away from an office to work in your hospitalist program, extend your recruiting resources to those offices to help them fill the new vacancies. It's a way to keep peace, and widen your network.

Lisa Holton is a freelance writer in Evanston, Ill.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated