1. Jacob Persily
Professor Sidney Seligman
HR and Health Administration
23 April 2015
Physician Recruitment and Retention Strategies and Techniques
Introduction
Healthcare has come to be one of the most cost-consuming portions of the Gross
Domestic Product of the United States. At over 17% and rising, Americans expect the best care
possible when they seek healthcare. Though the implications of the Affordable Care Act on
access to, and quality of, care still remain to be seen, one concept remains as a primary concern
of healthcare organizations. That concept is the physician.
Though certain healthcare professionals, namely physicians’ assistants and nurse
practitioners, will tell you that healthcare will, in the future, be moving away from physicians as
primary providers, the fact of the matter is that, today, physicians are still the primary component
of care. It is important for healthcare organizations to solicit and keep the highest quality of
providers in their organizations, to yield the highest levels of quality of care and patient
satisfaction, and the lowest levels of readmissions.
There are two major components to this crucial component of the world of human
resources in healthcare, recruitment and retention. Physician recruitment is the process of finding
and hiring physicians, and retention is the process of keeping the physicians employed within a
particular healthcare organization. Though recruitment and retention are a major part of the
human resources process in any organization, this paper will address the intricacies and

2. variations in hiring physicians, a large class of professionals, whom patients will trust with their
life on a daily basis.
Recruitment
Physician recruitment is an intricate process, which must be handled by human resources
professionals with the utmost care. Healthcare organizations rely on physicians to care for
patients and put complete confidence in their physicians that they will treat each patient with
respect and dignity at all times, regardless of ailment or injury. Physicians are often among the
top paid staff in a healthcare organization, so it is useful to look at the role of compensation in
the physician recruitment process.
Like most professional staff positions in healthcare, there are three primary compensation
concepts used in the recruitment of physicians, each of which has its own unique characteristics
and advantages. The first concept is the quartile strategy. In this compensation strategy, the staff
is paid under the market rate of pay. This methodology is effective for organizations looking to
cut costs, in areas where physicians are plentiful and fresh-out-of-school doctors are just happy
to have a job to begin paying off their mounds of medical school debt.
The second quartile strategy pays staff right at the market rate of pay for their position.
For physicians, this is often a nice six-figure salary. This is an effective compensation strategy
for community hospitals, allowing for quality staff recruitment and retention, while maintaining
a reasonable cost containment concept.
The final method of compensation, commonly seen in healthcare, is the third-quartile
strategy. In this strategy, compensation is often set at rates above the market price, to attract the
best and the brightest physicians to an organization. This practice is often carried out by

3. academic and teaching hospitals, who have the economics means to pay above the market rate.
This is also effective for hospitals with strong sub-specialty departments, like pediatric
neurosurgery, or geriatric endocrinology, to attract the strongest candidates to bolster these
highly specialized department in the facility.
Various healthcare organizations have their own methodologies of physician recruitment.
However, to determine best practices, it is often effective to look to the top healthcare
organizations in the country. One of these top organizations is the Cleveland Clinic, in
Cleveland, Ohio.
The Cleveland Clinic is one of the leading hospitals in the nation, ranked number one for
cardiac care for the past twenty years, and also ranked in fourteen other specialties by US News
and World Report (Zeltner, 2014). Their incredible staff of physicians provides this quality of
care.
The Clinic has published what is essentially a White Paper of physician recruitment
techniques, and it is worth looking at some of their majjor points as the major concepts of
physician recruitment in America. The first concept noted to conduct a nationwide search. It is
true that, in a given community, candidates for a particular subspecialty of physician might not
be found, but a national search will yield the desired candidate. It is also important to maintain
strong connection with residency and fellowship programs, which will be looking to place their
graduates into quality positions. The Clinic further elaborates on national recruitment with the
concept of advertising. Joe Vitale, the Clinic’s Director of Physician Recruiting indicates the
importance of utilizing trade magazines, professional journals, and online advertisement to
ensure that open positions reach the eyes of the maximum number of candidates, and maximum

4. number of job placement agencies, which will then send their top applicants in to apply for an
open position within your organization.
Vitale next indicates the importance of rapid contact with each and every applicant, to
notify them of the receipt of their application. Vitale indicates that this contact should occur
within five days of the receipt of materials, to ensure that the candidates know how much the
hiring organization cares for its prospective employees. Physicians want to work for an
organization that will take care of their personal needs at the level they desire.
Vitale also acknowledges a more strategic usefulness for this early contact. The
Cleveland Clinic uses this first phone call as a intitial screen of their applicants. Their strategy is
to use this brief communication to determine which candidates to advance to a further stage in
the application/interview process. A few minutes speaking to someone can be very telling about
one’s character and background, and can determine which applicants seem like they would be
the best fit for the culture of an organization.
The Clinic’s literature also speaks of the importance of working with each candidate in
scheduling site visits and in-person interviews, again to be accomodating of potential employees.
This is especially important if the organization will be flying applicants in for interviews from
around the country and around the world.
The Clinic also establishes the importance of making the applicant, and his/her family,
feel comfortable in the community in question. This is notably important in rural areas of the
country. It may an easy decision for a physician to move to West Virginia for a position in a
practice, which may have the strongest compensation and benefits package of any job offer. It is
an entirely different situation to get his wife, born and bred in Manhattan, to uproot the family
and make the move with her husband. The Clinic makes note of giving personalized tours of the

5. community, and providing information about housing, the local school districts, and other
opportunities in their region to develop a sense of pride in the community from perspective
applicants.
Though the Cleveland Clinic lays out several major components of traditional physician
recruitment, there are several other means of recruiting top physicians to a healthcare
organization. One of these methods is contracting with a physician group. For certain services,
like radiology and emergency medicine, it has become common practice for hospitals to contract
with a specialty physician practice to staff the given department. This is, at times, the most viable
financial method of recruitment for a healthcare organization, and also simplifies the hiring
process for these departments, as the contract group now deals with recruiting and retaining their
own staff.
There are other recruitment strategies, often used only in the vent that traditional
strategies have proven ineffective. The first is by contracting with a physician agency. An agency
is contracted to provide a certain number of physicians for a certain number of days. While this
is often one of the most expensive means of staffing a hospital, it can be the deciding factor
behind whether or not to close a wing of the facility because of a lack of physicians.
An interesting component of physician recruitment is international recruiting. Though the
cost of relocating staff from another country to work for your organization can be rather
expensive, there a many more physicians around the world then there are in the United States,
and many of them will work at lower rates of compensation than American physicians will,
thanks to the conversion rates of the American dollar to their home currency. There are many
regions of the world that provide physicians to major American hospitals. These include, but are
not limited to, the European Union, China and its neighbors, India, and many others.

6. Though some patients may argue that using foreign-born providers takes jobs away from
Americans, if there are no individuals seeking the positions, international doctors can provide the
same care as the American doctors and are actively seeking positions. There is one important
thing to recognize in recruiting internationally. It is important to accurately evaluate the English
language skills of non-native speakers, to ensure that they have full fluency in conversing with
patients. TOEFL, and other equivalent exam, scores may not be telling of one’s true English-
speaking capabilities, so it is important to use Skype and other voice protocols for this
evaluation.
Retention
It is one thing to hire a physician, to find the best and brightest talent to fill and open job
position. It is another thing entirely to keep that person working for an organization for an
extended period of time. This is the concept of retention. Retention is an important concept in
healthcare. Not only is recruiting replacement physicians an expensive and time consuming
process, but it can be detrimental to patients.
Patients in a healthcare system come to rely on their doctors. It is often the same doctor
who will see the patient again and again over an episode of illness, and this physician knows the
wants and needs of their patients. If the provider was to suddenly leave the organization, the
patient would be left without anyone who knows their particular needs, without a friend in the
system. A new provider would enter the picture without knowing any of the patient’s history,
beyond what is in their chart, and could potentially create further health problems, continued
readmissions, and ultimately even death for that patient. As healthcare human resources

7. professionals, having death tied to staffing practices is not a very good thing, so looking at
retention strategies is key.
One major retention strategy is, as often is the answer in any industry, monetary.
Compensation can make-or-break the deal of staying at an organization for an employee. For
example, if a competitor offers staff a starting salary higher than the annual raise mark at your
facility, many employees would be tempted to leave your facility for the other facility.
Human resource compensation professionals must always be cognizant of the market rate
of pay for each and every position, especially physicians. Physicians can be easily tempted by
compensation offers from competition to leave an organization. Being aware of the local
competition can keep physicians compensated to the point that it is needed to keep physicians
working for an organization.
Another major means of physician retention, in terms of monetary means, is incentive-
based pay. Healthcare organizations that pay their providers accordingly based on how much
care they actually deliver will lead to the retention of their strongest employees, and the loss of
those who are not the strongest, leaving those physicians in the market for jobs with other
organizations in the region, which, in turn, puts the competition in a place to hire unproductive
staff. Whether the incentives are for patient volume, procedure volume, lack of readmissions, or
any other means, they will function to keep the hard working providers, who are being
compensated at the highest rates.
The third monetary means of physician retention, though not really monetary, is through
benefits attached to a job position. One might think that benefits, most often thought of as health
insurance, would be of much importance to physicians, who can just provide themselves and
their family medical care. However, if a neurosurgeon’s wife is pregnant, he is going to want top

8. health insurance and benefits to provide her the best possible care. Most doctors cannot do
everything in medicine, and they, more so than other professions, find comfort in strong health
for their families.
There are many other techniques to aid in physician retention to a healthcare
organization. The below thoughts come primarily from a 2011 report by Merritt Hawkins, a
leading healthcare consulting firm, in a report to hospitals, which are struggling with physician
retention issues.
The Hawkins report indicates that the most crucial key to physician retention is
communication with physicians. It is essential for healthcare organizations to keep an open ear to
their physicians to handle issues which may arise, before they arise. The organization must be
open to making changes that are needed to keep physicians happy. After all, happiness is key to
life, especially to the stressful life of the physician.
The Hawkins report also takes a moment to speak of the importance of scheduling to
providers. Many physicians may have other obligations, whether professionally or personally,
and are more likely to want to work for an organization that provides flexibility of scheduling.
Doctors want to be able to have shift changes available to leave earlier in the day to make it
home for little Bobby’s baseball game or Suzie’s cheerleading practice. They also want to be
able to adhere to other professional obligations, whether major conferences of their specialty, or
service to civic and non-profit organizations. Healthcare systems, which provide for the ability to
maintain these connections to the community as a whole, while maintaining satisfying
employment, are most likely to be chosen for long-term employment by the largest number of
physicians.

9. The report from Merritt Hawkins also indicates that physicians are more likely to set their
stakes down for the long term at a healthcare facility, which tries its best to provide support
services to its providers. Services like providing physician’s assistants to lighten caseload,
hospitalists and nocturnists to cover basic care, and skilled nursing staff goes a long way in the
physician retention game. Some other, simpler concepts also go a long way toward physician
staying put. Simple things like convenient parking near the part of the hospital a physician works
in, discounts in the cafeteria, and easy external access to the facility and digital records might
seem like they would not really make an impact on physician retention. However, if a previous
facility did not provide these services to a physician and your facility now is, they will be more
likely to stay at the convenience of your facility.
There is another major point, acknowledge in the Merritt Hawkins report, and this is the
concept of on-call pay. Most hospitals have a provider from each major specialty on-call at all
times for the emergency department, if needed to assist in the care of patient who come through
the emergency department. At some facilities, emergency department on-call coverage is
contractual to each specialty. At others, however, this is not in specialty contracts, but rather paid
on a per-diem rate.
Offering on-call hours as a per-diem contract, in addition to base pay, if a viable
economic option for the facility, can be a fantastic retention tool. The report indicates the
average per-diem rates for being on-call can be quite fantastic. From internal medicine averaging
around $350 per 24-hour call period, to $1200 for general surgery, up to nearly $2000 for
neurosurgery, this can be a notable source of income for providers, considering they may make
this money without needing to be called. An opportunity to make over $1000 just for going about
their day, with the possibility of a phone call, is one which many physicians will not say no to.

10. Even if on-call days are contractual, the opportunity to pick up open call shifts at per-diem rates
can go a long way in keeping physicians satisfied and working for an organization for a long
period of time.
Conclusion
Human resources in the healthcare industry is a unique subset of a difficult industry.
Finding staff, and keeping them happy, is a full-time job, none more so than in the recruitment
and retention of physicians. There has been discussion that it is easier to leave physician
recruitment to national recruiting agencies, and only handle lower-priority recruitment in house.
However, this is an ineffective means of handling the crucial task.
In-house physician recruitment and retention ensures that those physicians, often the top
of the organization, are a good fit for the organization. Organizational culture and
recruitment/retention go hand-in-hand. If an employee is not a good fit for an organization’s
culture, it should be discovered during the recruitment process. If this process is outsourced, it
will show in poor retention rates among physicians.
This paper has merely scratched the surface on methodologies and concepts in the
recruitment and retention of physicians. This is, in all honesty, an art and a science, and must be
handled with the utmost care. The methods that work for one organization very well will not
work as well for an organization across the country, or even just across the city. It stands to be
seen that the work of human resource professionals in healthcare is essential, as without strong
human resources departments, healthcare organizations will not find the best providers to bring
in the most patients, and keep the organization financially viable.

11. References
http://www.cleveland.com/healthfit/index.ssf/2014/07/cleveland_clinic_tops_us_news_1.html
http://my.clevelandclinic.org/ccf/media/files/Alumni/A_Guide_To_Physician_Recruitment.pdf
http://c.ymcdn.com/sites/www.wacmhc.org/resource/resmgr/Trainings/2011_Keys_to_Physician
_Reten.pdf