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AAOS Now

Published 8/1/2008
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Carolyn Rogers

How to hire a practice administrator

Frank discussions + due diligence make for a happy “marriage”

Business is booming at your four-person orthopaedic group practice, and your partners agree it’s time to bring on an experienced practice administrator. After interviewing several candidates, you select a well-spoken, seemingly intellectual and insightful candidate who holds a senior-level job at a major state-run hospital system. With numerous certifications and an advanced degree from a prestigious college, she boasts a sterling resumé full of accomplishments.

There’s just one hitch. You were so pleased to land this gem of an employee that you didn’t bother running that “time-consuming” check into her background. As a result, you are not aware—yet—that she never actually earned that advanced degree, nor do any of her certifications check out. In fact, most of her impressive achievements are pure fiction.

Not only does your new “star employee” lack the education, qualifications, and accomplishments she claimed, she’s already proved to be a very adept liar.

Do your “due diligence”
Sound a little far-fetched? Not to Ronald G. Eberhardt, president of Executive Development Center, Inc. (EDC), a San Diego-based practice management firm. The candidate described above is real—one of two outwardly impressive, yet deceptive candidates he’s encountered just in the past year.

“We’re finding more candidates who appear to be eminently qualified—people you would really like to hire—who are, in fact, neither,” he says.

What’s the lesson?

“Do your due diligence” when making a hiring decision, he says, particularly when that position has such a direct impact on the health of your practice.

“It is a bit of a marriage,” he says, “except you don’t have the benefit of a long courtship. So you have to work very diligently—in a relatively short amount of time—to put together a match that, ideally, will lead to a long-lasting, professional relationship.”

Due diligence isn’t the only hiring practice to keep in mind during your search. In his company’s 35 years, Mr. Eberhardt has developed a step-by-step process for successful recruitment.

The hiring process
Before you begin recruiting, define exactly what you want your practice administrator to do, and identify the necessary skill levels and expertise required.

Next, write a creative ad to capture the attention of the candidates you’re most interested in—and dissuade unqualified candidates from applying.

“It’s better to receive 50 good resumés than to be inundated with 250—most of which are totally off the mark,” he says. “A tightly written ad that’s very specific about the absolute requirements for the position will deter those other 200 people from applying. And you’ll start off with a better class of candidate.”

Making the grade
Conduct a paper review of each applicant’s credentials, experience, and background. Assign a grade of A, B, or C to each candidate; if the grade is below a B (or possibly a C), eliminate that person from consideration.

“This review usually drops the total number by one third,” Mr. Eberhardt says.

Then set up 60-minute telephone interviews with the remaining applicants.

“If you ask direct and probing questions during these conversations, you’ll get a sense of the person’s experiences and philosophies that goes well beyond what’s indicated on paper,” he says.

This step should reduce the pool by another third.

“By now, the group should be winnowed down to no more than 10 semifinalists,” he says. “All remaining candidates should be invited in for face-to-face interviews.”

“Are you trying to talk me out of this job?”
One tool that Mr. Eberhardt employs “religiously” during the initial interviews is the Wonderlic Personnel Test. This simple, 12-minute, 24-question exam evaluates a candidate’s mental acuity and ability to multitask.

“We use the test as a knock-out,” he says. “If you don’t make the acceptable grade, we stop the process right there.”

During the interview stage, at least one candidate will invariably ask Mr. Eberhardt: “Are you trying to talk me out of this job?”

“And my answer is ‘Absolutely!’” he exclaims. “I want them to know all the good, the bad, and the ugly. To do otherwise is to waste a lot of their time, energy, and effort, not to mention the time—and money—of the practice if this doesn’t work out.”

Candidates who survive this stage—typically three to five people—become finalists.

Meeting the docs
It’s “showtime”—time for the prospective physician-employers to meet the final contenders for the job.

All of the candidates undergo individual 90-minute interviews in a panel setting, with anywhere from one to four doctors participating. Each physician poses his or her own series of questions—typically asking a similar set of questions of each candidate.

“The administrators also come with their own questions, so there’s always a back and forth,” Mr. Eberhardt says.

At this point, the doctors begin to get a sense of who they’d like to work with and whose personality gels with their own.

“You look at people not only for their skills and qualifications, but also how they would fit into the practice,” Mr. Eberhardt says. “You need to ask ‘Is their personality compatible with ours?’ ‘Do they have a similar work ethic?’”

“Frank discussions” encouraged
To avoid any big surprises down the road, it’s essential to discuss matters such as how many hours per week the administrator will need to work to be successful, he says.

“Is it 40 hours? 38? 60? That has a great deal to do with the work ethic and attitude of the doctors in that practice,” he says.

Anything that will affect the relationship between the administrator and the physicians who own the practice is fair game. For instance, does the candidate have any health concerns?

“You can’t ask that question, of course, but if you make your expectations very clear to the candidates, they’ll be better equipped to make that judgment for themselves,” he says.

Other issues may include religious considerations, family obligations, or parent care issues. “These are discriminatory factors, so you couldn’t deny a person the job based upon them,” he acknowledges. “But if you’re having a frank and full discussion, candidates may bring up certain requirements or accommodations that can be worked out and agreed upon in advance. Or they may simply determine that they’re not suited for the job.”

Rigorous review
At the end of the interview process, the physicians share their opinions and then instruct EDC to offer the job to a specific candidate. After the position has been offered and accepted, one more critical step remains.

“The best indication of what a person will do for you is what they’ve done for others,” Mr. Eberhardt says. “Therefore, we do complete ‘due diligence’ on the candidate, who must account for his or her entire professional history since graduation from college.”

Any certification, degree, employment, or special accomplishment that is claimed is “absolutely verified.”

“But we also understand privacy,” he adds. “We only carry out this due diligence on the candidate who has been offered the job.”

It is also essential to present the candidate with a release stating that, “We have the right, with your written permission, to obtain a complete credit report, driver’s history, and criminal background checks for county, city, state, and federal,” he says.

“We’re not looking to play ‘gotcha’ with the candidate,’” he explains. “We inform them in advance that any misrepresentation would be an automatic exclusion from consideration.”

Cautionary tales
Whenever a prospective employee has served in the U.S military, proper “due diligence” requires that you be given his or her Department of Defense Form 214 (DD-214)—essentially a discharge paper.

Just this past year, Mr. Eberhardt offered a practice administrator position to a candidate who had a military background. “He was gainfully employed, had a long employment history, and had great insight about medical practice management, but he couldn’t provide his DD-214,” Mr Eberhardt recalls.

His firm filed a Freedom of Information Act request to obtain the document, but it would take several weeks to receive it.

“I explained to the candidate that we couldn’t move ahead with the process until we had the DD-214,” he says. At that point, the man admitted to having a ‘less than honorable’ discharge from the military.

“As far as we’re concerned, that’s an automatic exclusion,” Mr. Eberhardt says. “But it prompted me to say, ‘If there’s anything else in your background that we’re not aware of, this would be an awfully good time to come forward with that information.’” Seeing the writing on the wall, the candidate came clean to having an arrest record, for two misdemeanors, as an adult.

“Again, this deception is just not acceptable. We notified the client, who determined not to hire that individual,” he says.

“They count on it”
In this instance, as well as in the case of the “star employee” who’d claimed accomplishments, certifications, and an advanced degree that didn’t exist—the candidates were well aware that a rigorous review of their backgrounds would be conducted.

Nonetheless, “They were not dissuaded from continuing the process,” Mr. Eberhardt says.

When the woman’s falsehoods were uncovered, “I called her to say ‘We’re not able to confirm these degrees,’” he recalls. “She instantly replied, ‘Well that’s alright, I withdraw. I’ve taken another job anyway.’ This was within 24 hours of her expressing great enthusiasm for accepting the position.”

Although this is an extreme example, resumé fraud is anything but rare.

“The one thing that these [deceptive applicants] understand is that most employers rarely go to these lengths to verify all their information,” he says. “That’s simply a fact and they know it. They count on it.”

Avoid “resumé factories”
Mr. Eberhardt and EDC perform recruiting work solely for their existing clients. “We think it’s essential to be familiar with the operations, personalities, and circumstances of the practice before trying to fill the single most important job in the practice other than the doctors,” he says.

If your practice chooses not to use a consultant, a retained search firm is another option. “Search firms go through a recruitment process much like the one we use as consultants,” he says.

Physicians should be very careful about using run-of-the-mill placement companies, however. “Although there are exceptions, for the most part they are ‘resumé factories,’” he warns.

“These companies collect resumés and then send them on to the practice,” he explains. “If one of those persons is hired, the fee is generally a percentage of the employee’s total annual compensation for the first year. That’s a considerable investment, and it comes with absolutely no guarantees. There’s no refund if the person lasts just 30 days, 60 days, or 90 days.”

If you’d like to find a consultant to oversee your hiring process, your best due diligence is to get the “hearty recommendation” of other physicians whom you trust, Mr. Eberhardt says. In its more than 3 decades, EDC has never advertised. “All of our business comes to us by word of mouth,” he says.

Do-it-yourself
If your practice chooses to search for a practice administrator on its own, the managing partner should take the lead and follow the steps outlined above, Mr. Eberhardt advises.

“The managing partner should undertake a thorough and well-thought-out recruitment process,” he says. “The candidates should then be presented to the other partners for their review, input, and selection. And, of course, a complete verification of the selected candidate’s background, employment, education, and certifications should always be performed.”

For additional information, visit the AAOS online Practice Management Center at www.aaos.org/pracman

Access a sample CEO Position Description in the Practice Management Center (password protected)

Carolyn Rogers is a staff writer for AAOS Now. She can be reached at rogers@aaos.org