Recruiting Primary Care for the Future

How to recruit primary care physicians in an era that demands team-based, collaborative individuals
Earlier this year, the American Hospital Association convened a roundtable to examine the evolving roles of primary care physicians. As part of that work, the organization recognized that new care models — such as the patient-centered medical home — will become more the norm if organizations are to succeed in accountable care, bundled payments and other risk arrangements.   

These evolving primary care models present a host of new challenges, and specific strategies will depend on a slew of variables. However, it's clear that future primary care physicians not only need the skills and experience to care; they also need to have the ability to lead. That means organizations must quickly re-focus their recruiting efforts.

Prospecting shifts
It's hard enough finding physicians who can deliver quality care, establish a good rapport with patients and families and work well with colleagues. Add to that the task of finding qualified physicians who can also lead care teams and manage complex relationships, and the challenge becomes daunting. The supply of physicians is so tight and the needs are so great, many organizations just struggle to find physicians willing to practice in their communities.  

While the odds may feel like winning a lottery, recruiting just any primary care physician won't work for those in accountable care or other risk arrangements. These organizations need physicians that actually possess the secret sauce — that intangible, focused-driven charisma that will make for a care team leader.   

What to do? One suggestion is to be interacting with those primary care residency programs that train using a patient-centered medical home approach. According to a recent report by the Association of American Medical Colleges, nearly 20 primary care training centers have reoriented their curriculum to these care team-based models. By targeting those residents, organizations can start to grow physicians with this built-in practice orientation.  In turn, these new primary care graduates will push the model forward.  

While residents can help to advance the care delivery transition, it will take a few years in practice to be able to lead others so organizations must also recruit experienced physicians — adapting the recruitment process to ensure they're effectively identifying, from the very beginning, physicians whose philosophies and executive abilities align with their vision for a new care model. Targeting physicians already in team-based type practices — such as those found in the military, community health centers, academic or larger group practices, or those that are now successful in value-based payer arrangements — creates a more aligned prospect pool from which to select.  

Beyond that, recruitment has to factor in "who" a physician is, in addition to "what" skills he or she has. Emotional intelligence will be equally as important as a candidate’s diagnostic and treatment skills. To do that, we need to first be asking: What, exactly, are we looking for? And how do we interview for it?  

Recruiting with vision
Many responsible for hiring and promoting physicians don't really know how to evaluate a physician's capacity to lead. In his article, "The Physician as Leader," Philip Tuso, MD, identified several characteristics that speak to a candidate's leadership potential. The first trait, and probably most important, is a physician's ability to share in a vision.

Recruiting for vision, as opposed to recruiting for need, requires a different kind of dialogue. To begin, the organization must clearly communicate their vision for who they are becoming as a care team. This encourages candidates to self-identify their fit within that vision. Being clear about the vision also helps the interviewer quickly assess his/her fit. For example, here is a synopsis received from a primary care medical director following his phone interview with a physician prospect.  

"The candidate's view of reality diverges from our view downrange  He wasn't so much interested in our patient care approach as in our scheduling expectations, bonus structure, etc…. He asked questions but the wrong ones."

Assessing leadership talent
Physician practice leaders' primary role, beyond ensuring quality patient care, will be to create positive and productive relationships — including the ability to make strong connections and inspire others toward a common goal. To do this, they need to embrace the larger vision but also have a good sense of themselves and their strengths and weaknesses. When recruiting new primary care physicians, it will be important to expand questions to assess (in the words of Daniel Goleman) their "emotional intelligence" — for they will set the tone that ultimately defines the practice. Some questions that can help gauge emotional intelligence include:

•    How would you describe the way you would lead your practice team? What kind of attributes will the team need to be successful?  
•    Share some examples of times you have led groups in the past — professionally or personally?  What worked for you? What didn’t?  
•    What does being a "team player" mean to you? How does that get demonstrated in a physician practice?

Evaluating for leadership ability is as much about listening as it is asking. It's very common to hear primary care physicians say things like "I just want to focus on my patients."  But going forward, we're going to need them to focus on more than just one thing. Instead, they will need to actively lead an entire care team that is effectively meeting their collective patients' health needs. Other critical questions to ask prospective hires include:

•    How have you delegated or referred care plan components to others in the past?
•    How do you manage other care providers that might disagree with your approach?  
•    Besides the physician, who else do you see in the ideal primary care team compliment? What will be the responsibilities of each team member type? How will you ensure they are providing the best care possible for your patients?  

With the healthcare industry in such flux, our future physicians will need to be flexible as the system continues to evolve. Gleaning from physician candidates their reactions to continued change is critical.  

•    What do you think it will take to be successful in the future?  
•    How prepared are you today for that change?  
•    What help do you need to get there?  

Leading toward tomorrow  
Looking ahead, the most sought-after primary care physicians will be both good clinicians and good leaders. What, exactly, the care model looks like and how those teams will be constructed is yet to be determined. But one thing is certain: Primary care physicians will be at the nucleus of that new model, whatever form it takes. Recruitment today must keep an eye on tomorrow. Those who are driving primary care recruitment must initiate the right conversations, ask the right questions and get to the heart of a candidate's emotional and executive intelligence. Those who can best identify and recruit care leaders today will be the organizations that will succeed long into the future.

Allison McCarthy is a principal with Barlow/McCarthy. Her consulting practice focuses on medical staff development, physician recruitment, on-boarding and retention and practice development. She can be reached at amccarthy@barlowmccarthy.com.

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