1. Only hire the most qualified specialists. The Virginia Spine Institute only hires specialists who are board certified and fellowship trained, aiming to create a practice of only elite experts in each field. However, finding fellowship-trained specialists in some areas, such as physician assistants (PA), can be challenging, says Thomas Schuler, MD, founder of Virginia Spine Institute. Dr. Schuler overcame this challenge by creating a PA residency and fellowship program in spinal surgery at the Virginia Spine Institute. The program trains PAs in spinal healthcare so they are able to diagnose and evaluate spinal problems as well as understand the appropriate pain management indications and techniques. "Our success is also dependent on the fact that our specialists are all at the top of their game," says Dr. Schuler. "We are very strict at who we have working here. Everyone has to have the same culture: excellence in operative and non-operative care. Most surgeons don’t truly practice non-operative care. Our surgeons’ emphasis on excellence in both non-operative care and operative care is what sets us apart."
Dr. Schuler also advises practice physicians and CEOs to take as much time as they need to find the right surgeons for their practice. He recently added a new partner to the Virginia Spine Institute after interviewing 25 surgeons over a three-year period. The process was so extensive because Dr. Schuler wanted to make sure the new surgeon’s core values were consistent with the organizational culture. "You can't just add bodies," says Dr. Schuler. "You have to add physicians that embrace your culture."
2. Look at market information during physician recruitment. According to Amanda Kane, manager, business development, for Blue Chip Surgical Center Partners, ASC leaders should look at local market information on volume in various specialties, payor relationships and surgeons' outlook toward the local hospitals. "Maybe there is another ENT practice in town that's looking for an outpatient environment for their patients," she says. "Adding spine cases may make sense. Hernia specialist, colonsocopists and physiatrists may all be viable partners and excellent sources of new cases."
Nap Gary, COO of Regent Surgical Health, says that ASC administrators looking to recruit physicians need to know whether those physicians are employed by a local hospital or have invested in another surgery center. The physicians may be bound by contractual restricts on making similar investments within the geographic area, and you need to make sure that new investors can meet safe harbor requirements.
3. Include all physician partners in the process. When working in an organization there is no "me." An individuals' personality, work ethic, behaviors and attitudes will affect all the employees and clients he/she has contact with, says Nicola V. Hawkinson, MA, NP, of SpineSearch. It is important the candidate is a fit not just with skill set, but with the office environment as a whole. Before the interview, share with the staff that there will be an interview and invite some to engage in conversation with the candidate. Provide the applicant a tour of the office given to them by a trusted employee. This frees up physician time and allows the physician to get feedback from the person providing the tour (second opinions are invaluable). Candidates are usually less guarded when they move away from the interviewer. Don't hesitate to do a second interview and include or have it conducted by another trusted staff member. You can also invite the candidate to attend a meeting and share in staff discussion.
4. Let the surgeon "try before they buy." Assuming the team identifies a few promising specialties that would benefit the business, the next step is more personal. Groups and/or individual surgeons need to be assessed in terms of their fitness for joining the team, says Amanda Kane, Manager, Business Development, Blue Chip Surgical Center Partners. When it comes to finding prospective owners, it's very much "whom you know" that matters; in our experience, the best prospects are already out there within the professional and social networks of existing surgeon-owners. So, to find candidates, the existing owners must commit to networking. We recommend assigning this responsibility formally to a few surgeons on the board.
Once a few candidates have been identified, there are number of questions to ask and areas to explore — from current caseload and preferred operating times to clinical reputation and personality types. In terms of the center's financials, the most important task is to validate the estimates of new cases that a new partner can bring. Overly optimistic case projections have been major problems for many underutilized outpatient surgical centers. The practice will also need to share some of its financial information with the candidate investors.
In terms of the overall business, ensuring prospective investors are hard workers and team players is just as important. We believe the best way to ensure new surgeons are a good fit is to let them "try before they buy." In other words, encourage new surgeons to bring a few cases to the center so they can experience firsthand the staff, facilities and patient experience. Streamlining the credentialing process, hosting a facility tour for the candidate, and coordinating with his or her scheduler are generally all it takes to get the ball rolling.