UO > Feature > Hiring a Colleague

It didn’t take Fredric Serota, MD, and Jo Ann Serota, a pediatric nurse practitioner, long to realize that they hadn’t hired the right person for their Ambler, Pennsylvania pediatrics group. On paper, the physician certainly looked impressive. With a PhD in microbiology, he’d obviously honed his scientific skills before going off to medical school. But the ink had barely dried on their one-year contract when the Serotas saw a spoiler in their midst. Instead of feeling his way and learning their system, he came in with his own agenda, ready to make change. “He alienated everyone,” says Jo Ann Serota. “He felt he knew more than the rest of us.”

Perhaps you’ve had the same chilling realization. Hiring competent professionals who will be the right “fit” for your practice is the most challenging management task you’ll ever face. You want colleagues adept in their clinical skills and attuned to your philosophy of medicine. But they should also mesh with your group. Obviously, there’s no foolproof system for selecting the professionals—doctors, physician’s assistants (PAs) or nurse practitioners (NPs)—on your staff. Gut instincts may give you a heads-up, but letting intuition alone drive your decision-making could hook you a misfit who knows how to ace an interview. As Fredric Serota observes of the doctor he hired: “He was more of a laboratory type. He really didn’t have the fiber to be a general pediatrician.”

Similarly, you don’t want to be blinded by someone’s solid gold credentials. An Ivy-league background may cast a glow over your candidate’s resume but the challenge is to get beyond a program’s glowing reputation to assess its graduate fairly. Too often, says Sharon Buchbinder, PhD, RN, an associate professor and the coordinator of the health-care management program at Towson University in Maryland, interviewers fail to separate the two enough to realize “I don’t want to work with that jerk every day. He’s believing his own press releases.”

So how do you prevent buyer’s remorse? Industrial psychologists will tell you that the hiring process should be used to spot the best performer for the job—not the best personality for the office. They even suggest a systematized approach—the “structured interview”—to reveal if a candidate exhibits core competencies and behaviors necessary to be a standout on the job. You might argue, however, that persona is so much a part of someone’s package—and so important to your esprit de corps—that you want to get a handle on those characteristics, too. Will he be moody? Will she be a complainer? Can either find humor when the going gets tough?

Of course, you can’t measure every iota of a personality any more than you can gauge every intangible aspect of a job, but there are ways to get value-added information without sharing your office or tapping your intuition. The trick is to identify what you consider part and parcel of a right fit, then build your interview around that.

The good news is that the same type of open-ended questions experts recommend asking to see if a candidate has the clinical or “hard” skills for the job can be adapted to “soft” attributes as well. By using behavioral—“Tell-me-about-a-time-when. . .”—or situational—“What-would-you-do-if...”—formats, you not only can determine if someone shares your practice values and goals, but will get along within the group.

“People will often say, “I’ll know it when I see it,” says Ann Marie Ryan, PhD, a professor of psychology at Michigan State University. “But without being specific, you really don’t know what you’re looking for in a candidate. That’s why a structured interview is important. You’re making it concrete.”

For instance, candidates who interview at Colorado Permanente Medical Group in Denver meet with a cultural fit team, a small cadre of physicians whose objective is to see if they fit the “physician-as-leader” patient care model of the 700-member practice. By asking questions like, “Tell me about the last time you went over the top for a patient,” these volunteers have learned, for example, how one young doctor arranged a necessary procedure for his uninsured patient, even convincing a specialist to do it. Another made house calls on an elderly patient throughout training.

“It can be very instructive to find out what someone thinks is over the top,” says Patricia Fahy, MD, the associate medical director of human resources at Colorado Permanente and the concept’s architect. “If it’s something I’d expect as routine, that’s important information. But if it’s something extraordinary—and this person seems committed to doing it on a regular basis—that’s wonderful information!”

Similarly, when Michael Fleming, MD, the president of the American Academy of Family Physicians, interviews candidates for his Shreveport, Louisiana, practice, he poses questions that get to the heart of the matter: “It’s 10 minutes to 5 when you get a call from a mother about her child’s 103-degree temperature. It will take her 20 minutes to get here but the office is about to close. What do you do?” For Fleming, whose practice includes 10 MDs and two PA colleagues, there’s only one acceptable answer. And it’s not, as some candidates have suggested, refer her to the nearest emergency room. “If I hear anything other than ‘I’ll wait so I can see this child,’” he says, “I probably don’t want to hire this person.”

Of course, your candidate isn’t going to mimic your words, unless he is clairvoyant. But, like Fleming, by thinking out an acceptable answer, you’ll know what you want to hear. “It’s a mistake to throw out a question without having a clear sense of what you consider favorable and unfavorable responses,” says Andrew Garman, PsyD, an associate professor in health systems management at Rush University Medical Center in Chicago. “My rule of thumb is if you don’t know, then drop it.”

Other hiring experts agree that it’s not just the answers that should concern you; it’s the questions you ask, too. Queries such as “What are your strengths and weaknesses?” and “What is your career goal?” are unlikely, they say, to tell you much about this person’s capacity to do the tasks at hand. They’re also such expected questions that most savvy interviewees are ready for them.

Yet, you may disagree. When Dale Buchbinder, MD, the chairman of surgery at Greater Baltimore Medical Center, is looking for physicians to staff his surgical practice or hospital service, he asks candidates to name their weaknesses. Buchbinder isn’t so interested in hearing that this person is a micromanager or delegates too much. What’s important to him is for the individual to recognize a particular Achilles heel and be able to overcome it. “Those are insights I like to hear about,” he says. “Somebody who can’t tell me that they have any weaknesses either isn’t willing to admit a mistake or has too much of an ego. Those I worry about.”

Similarly, when Fleming interviews candidates for his practice, one of the open-ended questions he asks virtually every time is “What are your expectations? Tell me where you want to be in 10 years.” He thinks vision is so important that he wants to know if this person can articulate a strategy for her own professional life. “I want somebody whose values and vision fit into our culture,” he says. “Working closely together is much like a marriage. If you don’t fit, it becomes very difficult.”

Indeed, finding a person whose temperament jives with those of your team could be your most daunting interviewing task. Hiring gurus caution about remaining objective throughout the process, but especially when you’re evaluating persona. As one expert notes: “We’re not saying hire people you hate. What we’re saying is don’t hire people just because you like them.”

But most physicians want colleagues who’ll add to the dynamics, rather than detract from the day. So how do you get that fit? Personality tests could reveal the person behind the CV, but there are drawbacks, not the least of which is that these tools are expensive to administer and often unacceptable to candidates.

You can do just as well by asking questions about how this individual handles the stresses and setbacks of a busy practice. How did he deal with his most difficult patient? How did she overcome her most challenging situation? What can he tell you about his most recent bad day? Even targeting something as pedestrian as a workplace pet peeve, says Ryan, can be a precursor to talking about conflicts on the team. How reasonable do these irritants seem to this person? More important, does she show an understanding of where others are coming from—or is she just placing blame?

Fahy frequently asks, “What’s the most recent difficult conversation or conflict you’ve had with a colleague?” Whatever the answer, she seizes the chance to probe deeper about what’s happened to that relationship. “I want to see how they sized it up after the fact, if they’ve learned anything from it, if they’d do it differently in the future.”

Your interview may have all the markings of a winner. But you still need to take a couple of steps to close the hiring loop.

First, be honest with your candidate about the job. Research consistently points to unmet promises as a primary incentive for turnover. So, don’t offer three of four weekends off if the schedule doesn’t allow it. Don’t suggest 65 percent of the revenue if the earnings can’t sustain it. And don’t promise a personal secretary if everyone already shares. “It’s a two-way street,” says Sharon Buchbinder. “You want the candidate to be honest with you. But you should be checking yourself, ‘Am I being honest about the situation?’”

Second-check references. Even though people tend to present names of avid supporters, there are many reasons to follow up beyond just a credential check. Not the least of these is your legal and ethical obligation to find out if this person is indeed qualified to treat your patients and will do it well. As Buchbinder says, “Above-all-do-no-harm includes hiring.” But you also want to be sure you’re not introducing a cancer to your group. When her husband, Dale, and his colleagues hired a house surgeon years ago, they thought he had the right stuff.

Board certified and an articulate candidate, he presented great references—at least on paper. But Dr. Buchbinder didn’t make the necessary calls to flesh out the man’s story. In the end, they fired him for substance abuse. “I’ve learned over time that first impressions are good,” he says, “but checking is even better. People can talk a great game. Then you find out later that some of it isn’t true.”

Not just untrue, but costly as well. Sharon Buchbinder puts the price tag of turnover at about $250,000 to replace a primary care physician. More specifically, she cites a study published in the November 1999 issue of the American Journal of Managed Care, that estimates recruitment and replacement costs for family physicians at $236,383; internists, $245,128; and pediatricians, $264,645. “The cost of turnover is not insignificant.”

As compelling as those statistics are, however, upheaval in your office may be an even greater cost. Granted, reference checks can be tricky to execute effectively—many people simply can’t or won’t talk—but by probing with the right person, you have a chance to answer the question, “How much of a challenge is this person going to be?”

The Serotas’ former pediatrician colleague provided nothing during the interview to set off any reference-checking alarms. He came across as quiet, knowledgeable, and caring, so they weren’t too concerned about getting only part of the story from former colleagues. After all, as Jo Ann Serota says, “he passed the interview test.” It was only later that he showed his true colors—cool and aloof—particularly to the group’s nurse practitioners. When they finally were able to replace him, the Serotas looked diligently for somebody different. And now they’ve added to their slate of questions when checking references, “How does this person get along with ancillary providers and staff?”