Compatibility is as important as competence

Selecting a new partner for a group practice is one of the most important tasks the group will undertake. Every recruitment should advance the practice toward achieving its goals, not just from a scope of practice standpoint, but also from the perspective of building a strong, cohesive, and sustainable practice. Yet groups often approach this undertaking in a haphazard and nonchalant manner.

Think about it: You will often spend as much time with your practice partners as you will with your spouse. Poor choices in either case can end in acrimony, divorce, and severe financial consequences.

The low number of potential candidates in certain specialties, as well as the increasing number of new surgeons choosing to be employed by hospitals, may have reduced the pool of applicants. But that doesn’t mean you need to accept any reasonable candidate.

In our opinion, compatibility is as important as competence. It is much easier and more pleasant to work with someone you like. A group should take its time in making a selection and have clear goals and expectations in mind when recruiting.

Put practice needs first
An important step in choosing the right prospective partner is to clearly identify the needs of the group and to decide whether a physician provider is the best solution. Explore alternative means of meeting the practice needs, such as adding a midlevel provider (a physician assistant or nurse practitioner). Although this may not reduce the group’s call burden, adding a midlevel provider may make the existing practice more efficient and profitable.

If another surgeon is warranted, outline the skills and characteristics of the person necessary to meet the needs you identify. If the group needs a joint reconstruction fellow to set up a new program with a hospital, or an orthopaedic traumatologist to establish a trauma service, your ideal candidate should have strong organizational, communication, and political skills in addition to the necessary clinical skills and training.

Neither you nor the candidates have time to waste on interviews where there is obviously a poor fit. Clearly state your expectations of candidates and accurately describe the practice in all recruitment ads. The goal is not to attract as many candidates as possible, but rather to attract the right candidates.

General guidance
References—Written references are of questionable value. A candidate will request references from only those people that will give a good report. A call or face-to-face meeting with a reference is more likely to provide a true report. This is especially valid if you know thereference.

With a little research, you may be able to identify the attending physicians and perhaps senior residents who worked with the candidate. In many cases, these people will have had the best opportunity to observe the candidate’s work habits, ability to handle stress, and decision-making abilities.

Training—Each member of the practice probably has personal opinions about the quality of residency and fellowship programs. This can lead to differences of opinion about a candidate’s training. Focus on the quality of the training—whether from a well-known or little-known program. Keep training on the checklist, but don’t make it a high priority for selection.

Appearance—Don’t be swayed by looks. If you are seeking a clean-cut, conservative, WASP-ish candidate, that is what you will get. But that could mean you are bypassing some exceptional, though off-beat, candidates. A large segment of your patient base will be attracted to ethnic, gender, and racial diversity. Candidates who have ponytails and body piercing may also have a valuable talent. A large segment of younger patients will have no problem with this physician.

Work ethic—How often have you heard “These young people don’t like to work?” Whether this is due to a generational disconnect or expectations that are too high, in interviewing candidates, put work ethic high on the priority list.

Compatibility—It’s easier and more pleasant to work with someone you like. This may be difficult to determine in a short interview time. A repeat visit for likely candidates is a good idea. “Gut feeling” is not a very scientific ingredient, but it may help exclude those with whom you are not going to be happy.

In many practices, the physicians may spend less than an hour each with new recruits—and frequently that time is in a group setting over lunch or dinner. Rather than ask personal or background questions, partners should consider asking questions that may reveal attitude and values, such as the following:

• What do you believe a surgeon’s role should be in the community?
• Why do you think you would fit better into a group practice setting than a solo practice or hospital employment situation?
• How would you handle a referring physician who has complained that you have not communicated well with him?
• What do you see as the advantages and pitfalls of participating in practice ownership?

Ideally, most or all of the physicians in a group should spend time getting to know the recruit on a one-on-one basis. Formal interview settings may not reveal much more about a candidate than a group lunch or dinner. Consider taking candidates away from the office. Take a tour of your town, focusing on residential areas. Ostensibly, the purpose is to better acquaint prospects with the area. In reality, the purpose is to put them at ease so that they are more likely to open up and be themselves.

Family—This may be the most critical consideration. Time spent with the “other half” in situations other than in a bar or restaurant is time well spent. This provides a view of the relationship and the enthusiasm for the move. It helps identify the spouse’s interests and potential for being happy in the community.

General—If you are seeking a fellowship-trained specialist, the selection process becomes simpler because the candidate list is smaller. You may want to look at older candidates who are looking for a change. However, it is essential that you know the real motivation for the change. “I wanted to get away from the big city traffic” may translate into incompatibility with former partners.

If you are considering a candidate who has already been in practice, you may have more sources of helpful information. Talk to the operating room coordinator, some of the primary care physicians within the candidate’s service area, and the director of the local medical society. Do not settle for general responses; ask about specific behaviors, such as response to stress and communication skills. If possible, find out about the candidate’s skill in accurate and timely dictation of notes. Finding a good surgeon is a prerequisite. Finding a good, long-term partner is the goal.

Poor choices can haunt an organization for years. New recruits may bring special expertise and generate income, but if they do not fit into the culture of the group, the overall growth of the organization may be stalled.

James K. Weaver, MD, is a former professor of orthopaedics at the University of Colorado School of Medicine and a consulting orthopaedist for Rocky Mountain Orthopaedic Associates. Dale A. Reigle is chief executive officer at Rocky Mountain Orthopaedic Associates.