Note: This is the second installment in a seven-part series on best practices in physician executive recruiting. To download the entire document, click here, or call Kurt Scott at 800-366-1884 to request a printed copy.

Part II:

Fine-tune and agree upon selection criteria
This is an important and often time consuming task, but an essential investment. Discuss the qualities and experience committee members believe the perfect candidate would possess. Discuss qualities and experience scenarios that are questionable or raise “yellow flags.” Come to consensus on criteria that are “required” and that are “nice to have.” Sticking by this list helps you evaluate candidates consistently, even if interviews are several months apart. More importantly, it ensures your compliance with EEO and Affirmative Action plans your organization may have.

Categorize your list and split it up among committee members, making each member consistently responsible for asking questions and assessing candidates in a particular area. This protects candidates from answering the same questions all day long and makes the interview process fresh and interesting for both sides. Of course every interviewer should feel free to ask general questions and to follow interesting threads of conversation.

It’s always a good idea to provide a quick refresher on legal interviewing. Contact your HR department for assistance. This is very important to the success of your process and the protection of your institution.

Check back next month for Part III, Creating a Resource Compendium, or go to http://www.vistastaff.com/facilities/services/search/locumtenens to download the complete document.

Note: This is the first installment in a seven-part series on best practices in physician executive recruiting. To download the entire document, click here , or call Kurt Scott at 800-366-1884 to request a printed copy.

Part I:

As our healthcare organizations become increasingly complex and competitive, the search for effective physician leadership has become a sink-or-swim issue. Physician executives today must have the ability to build new programs, fix ailing ones, secure referral and payer networks, manage professional staff, recruit new talent, understand and plan for budgetary and regulatory challenges, and much more. And the hard truth facing many organizations is that physician leaders of the past—often senior and very well respected members of the medical staff promoted into the job—may not have what it takes to lead in these interesting times.

On the one hand, I say kudos for understanding this change and focusing so precisely on this emerging need. On the other hand I say, “Get ready to rumble. You have entered the most competitive space in healthcare recruiting.” The following suggestions will help you gather the right team, build a solid plan, set expectations, avoid some common pitfalls, and find the best clinical executive for your organization, all within eight months.

Establish your Executive Search Committee

As a chief executive or chief medical officer, you know that recruiting new physician leaders is one of the most important steps in building or changing the culture and personality of your organization. It is very important to go into the process deliberately, with a clear idea of the change you need to make or the standard you need to uphold. The right search committee brings this vision squarely into the process.

Create a core Executive Search Committee that participates in ALL physician leadership searches, regardless of program or specialty. DO NOT create a different committee for each search; you will lose the consistency, vision, and the chance to build a team of “super interviewers” who understand your organization’s leadership needs. DO plan to add additional members to the core team based on the position you are filling.

The committee should be heavily weighted toward physicians, of course. Include community-based physicians who can positively influence their peers. Take the time to interview these physicians, and select those who can be positive and supportive of the position and your effort to fill it. In addition to an eagerness to “sell” the position, select members who are willing and able to critically assess candidates. Most importantly, core team members must be committed to taking the time and maintaining the flexibility to participate in first-round interviews.

Set clear expectations for the committee’s role

Surprise—the Executive Search Committee doesn’t get to “pick the winner.” It is vitally important that committee members understand that their role is to evaluate, screen, and recommend candidates to the leader responsible for hiring and managing the new executive. The committee should present two or three candidates the entire committee can support for and in the position. They may rank candidates, but given the competitive nature of recruiting in this space, they must be comfortable and supportive of all recommended candidates, no matter who gets the job. The final decision must be that of the hiring leader—always.

Check back next month for Part II, Fine Tuning Selection Criteria, or go to http://www.vistastaff.com/facilities/services/search/locumtenens to download the complete document.

One evening, I was cruising through downtown Boise on my favorite Harley, Boomer, and as always, I was flying a 3-by-5 foot U.S. flag on it. I went through an intersection and heard a lot of hootin' and hollerin' behind me. I turned around and there they were, at a sidewalk café, about 20 Army personnel in uniform. Some even stood at attention! I waved back, and kept going but I thought: that was awesome. I should get back there and tell them I appreciate their service to this country. So I went around a few blocks, and pulled my obnoxiously loud badass machine onto the sidewalk, right by their group. They went nuts. They said it was the greatest thing that I flew that flag, and they thanked me for it. I replied: No, I ought to thank YOU all for your service and I want to buy the whole group a round of drinks. No, they said, that was not necessary, just flying that flag was good enough. Of course, I insisted. They may pay for me with their lives, so my paying for their drink is a no-brainer. It cannot begin to compare. They invited me to sit with them. What an honor! Every single one of them had been in either Iraq or Afghanistan. We then parked the bike in the middle of the street and got the bartender to snap a few pictures of the whole group gathered around it. At the end, each and every one of them shook my hand, and the tall serious looking guy in the middle of the back row (he could be a Russian extreme fighter) looked me straight in the eye and said:" Sir, it is people like you who make me proud to serve this country. Thank you, SIR!"

Folks, it doesn't get any better than this. God Bless these superb people and God Bless America.

Straight from the heart,

Frank Daniels
Boise, Idaho

P.S. Happy 4th of July from VISTA!

Since 1983, I have worked as an emergency physician at small and large hospitals all over the Western U.S. and Alaska. I find that there are many similarities in my two professions. Every day I spend as an outdoor photographer is different and full of surprises. The same could certainly be said for a day spent as a locum tenens in an emergency department. And in the same way that providing good health care is a team approach, my success as a photographer depends on multiple factors--weather, planning, animal behavior, and luck. While the contribution I make to a community as a locum tenens is easy to measure, I still feel challenged to use my photography as a tool for improving the world. I can’t help feeling that artistically capturing pure beauty seems hedonistic and socially irresponsible at times. Yet it is important to document what we are trying to save as well as what we are destroying at a fast pace.

VISTA note: Howie Garber/Wanderlustimages.com is currently featured in a solo exhibit of his nature photography at Evolutionary Health Care Gallery, 461 East 200 South, Suite 100, in Salt Lake City, Utah. The exhibit is titled “The First 18 Years of Wanderlust.” Howie is introducing new prints to his fine arts collection. He has done landscape, wildlife, and environmental photography on seven continents. You can meet the physician/photographer at a Gallery Stroll June 20th from 6 to 9 p.m. He will be donating 20% of photo sales to Utah Physicians for a Healthy Environment and Utah Moms for Clean Air. The exhibit will run through July 15, 2008. You can view Howie’s photography on his website www.wanderlustimages.com.
Photos courtesy of Howie Garber, MD.

Once again we are in the very busy time for both locum tenens and permanent licenses. Many boards are overwhelmed with new resident licensure. Here is a list of boards that have advised us of how far they are behind.

1. Arizona – two to three months behind with applications and verifications
2. Alaska – one month behind in going through the mail. Once the application is complete and ready for executive review it is taking three weeks to be reviewed.
3. California – 90 + days just to process the application. The board is also not able to respond to emails or message left on the phone.
4. Texas – Not able to commit to dates. They report that it is currently taking 9-12 months from start to finish of a license.
5. Wisconsin – Reports that they are six months behind.

New Mexico renewals: If a doctor received his or her license prior to September 1, 2007 and is up for renewal, the doctor will need to submit fingerprint cards as part of the renewal process. There is an additional charge of $34.00 to process the fingerprints. This process will be in effect during the 2008, 2009 and 2010 renewals periods. All New Mexico licenses expire on July 1.

The last time we visited the wonderful world of hospital credentialing for locum tenens assignments, we focused on the ever important ‘documentation of procedures’ or procedure log. As I mentioned in my last blog, paperwork and more paperwork is the norm now when applying for hospital privileges—whether it’s for a permanent position or a locums job. Although not a recent or extraordinary request, I am seeing more and more hospitals require documentation of all physicians’ TB skin test or PPD taken within the past year.

As a physician you probably realize there are a lot of you out there with positive TB tests who have no symptoms. Hospitals realize this and are fine with those results as long as we can provide them with a copy of a chest x-ray as supporting documentation. In most cases copies of your TB test and the chest x-ray are all that are needed. However there are a handful of hospitals that may ask for additional documentation from the physician who performed the TB test, and in extreme cases they may require you to take a TB test during your locum tenens orientation process prior to seeing patients.

So….like the procedure log, it’s a good idea to keep a copy of a recent (within the past year) TB test and a chest x-ray if your result is positive in your locum tenens credentialing file. I’m certain that over the next few years it will be a requirement at every hospital and clinic regardless of location.

Note: This is Part 2 of Dr. Herring’s observations during a recent international assignment. Part 1 explained medical training and a doctor’s progression through the medical ranks.

About the practice of medicine

In general – No malpractice, sort of. If a complaint comes up, a government-appointed board decides whether to pay the patient/family some money for damages based on the merits of the case, and may take disciplinary action against the MD if indicated. This is ‘socialized’ medicine, so all residents and citizens get their care covered, but they have to pay for some things. For example, $20 to see your GP, or maybe $5-15 for some drugs (drugs are cheaper everywhere outside the US).

Emergency Department – Similar to working in American EDs about 20 years ago, as far as I can tell. On the minus side, you might have to wait up to four hours for a CXR because the radiographer is tied up in theatre. Also, you might have to convince a radiologist that a CT scan is really is necessary. On the plus side, you can make a clinical diagnosis without having to ‘rule-out’ everything under the sun with expensive tests to avoid litigation. Also, patients referred to the hospital for surgical or medical consultations are seen by those services in the ED and will only ask for your help if they need you.

Medical Training – Based on the UK system for obvious reasons.

1. Medical Student – Medical school is an undergrad program – you are accepted either from high school or after one year of undergraduate scientific studies. It takes six years to finish medical school.
2. House Officer – Equivalent to Intern, but at least two years. Also known as House Surgeon regardless of affiliation with any actual surgical practice. Their work is supervised by Registrars. A House Officer may work in any major field – meaning he/she may work in Surgery/Medicine/Peds or a combination, depending on the needs of the hospital. So an MD working as a House Officer in Surgery may actually have no intention of completing training in that field.
3. Registrar – Equivalent to Resident, except training lasts longer. Registrars have completed their House Officer years and have applied for their Registrar position. They practice fairly independently at times and are sometimes allowed to perform surgery without their Consultants present, etc. Training as a Registrar typically takes five years or longer, even in primary care fields like internal medicine. They also generally must re-apply for a new position every year, often moving to a new hospital every year. They typically do not finish training at the same hospital where they started. Also, not all Registrar positions are actual training programs, so working these jobs does not necessarily mean you advance up the totem pole the next year. This means you can be a Registrar for the rest of your career, which some MDs apparently don’t mind.
4. Medical Officer – A Medical Officer has completed some type of training program but has not reached the level of Consultant and must still be supervised in some aspect.
5. Consultant – Equivalent to Attending in that you are allowed to practice independently without ‘supervision,’ except it takes about 10 years of training after Medical School to attain this status. If you train in surgery, it is considered an honor when, at some point, you graduate from ‘Dr.’ to ‘Mr.’

"I have loved working in New Zealand! My two stints have been in very different settings. The first experience was in a small rural hospital. Well-seasoned GPs provided most of the obstetric care. They did operative vaginal deliveries and assisted at cesareans. Midwives were involved in a smaller portion of the cases. I really appreciated not having to do normal deliveries, but only being involved in complicated OB cases, or cesareans. There was a reasonable flow of GYN surgery. The GPs do routine Paps and provide contraception. They refer "interesting" cases to you, the specialist. This system had obvious advantages and disadvantages.

This time, I am in a setting with a higher volume of patients. It is a district hospital. The pathology is stimulating (two cases of malignant pleural effusions and a couple of ectopics this week. And a leiomyosarcoma last month). I also love teaching the new "house officers." Their training is very different from the ob/g residents at home. Most of them will become GPs, not OB/GYNs. This system is much more closely aligned with British practice than with American traditions. As a result, I have learned many new approaches to O&G. There is an enormous cross cultural to medicine, not only to life and times in NZ.
I have worked in both urban private/ academic and rural/non-academic settings in the States. There is a greater difference in practice patterns within the States than there is from the US to NZ. Some differences are frustrating, while others are joyous.

I went off to Anchorage to work for three weeks and to find out what spring was like in Alaska. I had been there twice before in August and September and had seen late summer and early fall and had watched the snowline gradually move down the Chugach Mountains. Yes, break-up is over and spring will be getting going, they assured me. Well…

The last 20-30 minutes of the late afternoon flight into Anchorage were past range on range of rugged snow-covered mountains. There was still lots of snow around on the ground, including those dirty late season heaps piled along the roads and at the edges of parking lots. The woman who let me into my apartment, when I made some comment about it looked like a lot of winter was still around, said, “At least the light is back…”

As the days went by things gradually got warmer. The first nights were nearly in the teens but some of the days were getting well into the 50’s. I am still amazed how quickly the days lengthen – more than 5 min. 30 seconds each day. You can notice from day to day. I am also amazed how warm 40-50 can feel. I never would think of walking around here when it is in the 40s with my jacket unzipped. And locals would be appearing in T-shirts and shorts exposing very white legs. Last Thursday I thought I saw the first sprigs of green along the road as I drove home after work.

Then Friday, April 25th dawned. There were a few flakes of snow beginning to come down as I drove to work. It was hovering just about at freezing. They were those big, fat, sloppy flakes we are all familiar with from western Washington. And they kept falling and they kept falling and they kept falling …They stuck to the bushes and the trees and the cars and everything. The parking lot looked like a lot of overstuffed marshmallows when I went out to drive home. I’m not used to driving in snow and ice. We don’t go off to the mountains in the winter here. It was 40+ years ago we moved to California. And, in fact, I had never driven in that much snow. I was scared – even for the 3 or so miles I had to drive to get home. It still was not freezing so there was not any ice down on the road surface. Lots of slush. All seemed to be driving slower and I did get home uneventfully.

Turns out that all this snow is not at all the Anchorage-rule. It kept snowing until there was 15-16 inches in the bowl where most of the city of Anchorage is located It was the most snow ever to fall in an April day and the third most snow to fall in Anchorage in a single day ever in the nearly 100 years they have been keeping track of such things. And it was late. The snow plows had been put in the yard for the summer. They got them out and went to work. Not surprisingly my week-end plans were cancelled. I got my exercise by leaping over ankle deep and more slushy curbside puddles. The days and nights kept warming, most of the snow is now melted and I think that I saw those blades of grass again as I drove home my last afternoon...

And, so it went for another short stay working in Alaska. Thought you might be interested. I certainly find it interesting. Alaska is a different place. They say the rest of us live Outside. We do.