Now that the ink is drying on our new physician’s contract, we should be all set, right?

Maybe. Maybe not. Look at the results of your employee engagement surveys and the effort that you expend generating more engaged (aka aligned) employees. Why should physicians be any different?

But he agreed to be employed in our organization. Doesn’t that imply that he wants to be one of us?

Did you ask the physician why he wanted to be employed? He may be escaping the uncertainties of private practice or even personal financial ruin. Or he may be looking to return to your area or escape a bad situation. Employment may be a means to a personal end.

To set the stage for success, the recruitment and acquisition process is the time to examine motives — both yours and your candidate’s.

Scrutinize what you hope to accomplish and why. Be wary of “must fill/buy now” pressures. All too often, “fit” is sacrificed for expedience. Defensive practice acquisitions to stave off a competitor may bite you in the end.

What do you mean by that?

Acquiring practices to protect market share might be a crucial organizational strategy; however, acquiring any or every available practice may not be prudent. Similarly, quickly filling a vacant position might be crucial to maintaining heads in beds, but accepting any recruit could be a mistake. Expedience should be tempered by “fit.”

What does “fit” mean? The recruitment/acquisition “fits” our budget, “fits” our manpower plan and “fits” our strategic need. What’s left not to “fit”?

The first step in determining the potential candidate’s “fit” is measuring him/her against the group’s cultural norms. To do that, you need to understand your group’s culture. What does it mean to be a part of the group? What will be expected of the candidate if she becomes part of the employed group?

Once the group culture is established, every physician and hospital leadership interviewer must communicate shared expectations and behavioral norms to the candidate. Clearly convey the rights and responsibilities of both the organization and the physician.

These steps increase the likelihood of a successfully aligned relationship. Of course, the devil is always in the details and the process doesn’t stop here. Once employed, the onboarding process is crucial.

Onboarding process? You mean having her attend new employee orientation and showing her around?

Ideally, onboarding should begin before the physician’s first day on the job.

Review the employment process with the physician prior to the start date. If attending new employee orientation is expected, explain that upfront. Be prepared for some resistance. Most physicians see themselves as partners in the care delivery process, as opposed to employees. Emphasizing how orientation provides a glimpse of the organization’s culture and imparts tools that will help her be successful is of paramount importance.

Work through practice logistics (e.g., space, staffing, etc.) and credentialing processes (both for the Medical Staff and for third party payers) well in advance. Have everything in place so she has a sense of belonging and can hit the ground running. These steps also ensure patient care revenues are realized from the first day.

So we do that. Can we put him to work then? 

Maybe. After training on the EMR, reviewing practice operations, and providing similar tools that affect productivity. But that’s just a beginning.

Consider assigning a volunteer physician mentor to help smooth the transition and further instill group cultural elements.

Touch base or personally check in with the physician often to see how things are going from his perspective – and have others in the practice do the same. Involve him in the regular practice meetings (you have those, right?). Address issues as soon as they arise – don’t let them smolder. Make him feel welcome and wanted.

This is when your new physician learns about the group’s and network’s “real” culture. And why it’s really important to have a well-established group culture aligned with your goals and strategies.

“Culture eats strategy for lunch” is not just a cliché; it’s a reality. Establishing and sustaining a group culture, measuring potential recruits against cultural expectations, conveying the culture to new members, and assimilating them into that culture are the real predictors of successful alignment.

Terrence R. McWilliams, MD, FAAFP

Chief Clinical Officer and Managing Director, Employed Provider Networks