When it comes to his job, Michael Griffin doesn't usually break a sweat.

But in August of 2004, when the director of medical staff recruitment at Sierra Health Services in Las Vegas, Nevada was challenged by senior management to sign twenty primary care physicians and extenders by the end of the year, Griffin, along with his physician recruiter colleague, Marci Jackson, knew they were facing a potential crisis.

"In the boardroom, I said 'Absolutely, we'll get this done!' and then I walked out of the boardroom and said to myself 'How are we going to do this?'" Griffin now confesses.

 

During the first month, a pattern emerged forcing the team to recognize their limitations.

With the calendar allowing only four months for signing the new hires, Griffin and Jackson drew on their combined twenty six years of recruiting experience and calmly developed a plan. They created a list of options that included: contracting with search firms; signing on for a sourcing agreement with Profiles Graduating Physicians Database; purchasing physician lists from Medical Marketing Service, Inc., and posting all positions on PracticeLink. They also contacted the Las Vegas Chamber of Commerce for research to target the ten states where the majority of new residents of Las Vegas were moving from.

Both Griffin and Jackson's proficiency as recruiters was the most potent tool in their arsenal. A physician recruiter and manager for ten years at Duluth Clinic in Duluth, Minnesota, and four years experience at Mayo Clinic in Rochester, MN, Griffin knew the drill. Jackson brought experience from two years at the Monroe Clinic in Monroe, Wisconsin and nine years at Duluth Clinic, as well. During her time at Duluth, she and Griffin worked as a team and were very effective. But they weren't in Minnesota anymore, and they needed to adapt their approach.

As a diversified company operating a managed health care organization and a multi-specialty group, Sierra Health Services, Inc. enjoys rapid growth. Their health plan membership collected 15,000 new members as of last January, 2004.

At the end of 2003, when Sierra announced a June 2004 target date for the implementation of a new Electronic Medical Records (EMR) system, soon afterward, turnover in primary care was becoming a trend. Physicians and extenders began leaving for a variety of reasons, and many because they weren't interested in participating in the computer-driven, paperless system.  With a smaller staff and steadily increasing membership in the health plan, demands on the remaining physicians included increased patient loads on a daily basis. For some, that triggered a further decline in morale causing additional staff to leave the medical group.

With this turn of events, senior management gave Griffin and Jackson the four-month window to re-populate the primary care clinics. Two assistants provided the support to log curricula vitae, send out applications, coordinate the reference process and schedule interviews, allowing Michael and Marci to focus on the “big picture.”

Both Jackson and Griffin had recruited fifteen to twenty physicians and extenders per year in Minnesota, so the number of new hires was not intimidating. The challenge now was meeting those numbers in four months while keeping other recruitment assignments in the specialties alive. In their favor was the draw of Las Vegas and its inviting surroundings. Known as the entertainment capital of the world, Vegas boasts 300 days of sunshine per year, housing more affordable than most markets, and no state income tax. With positives like that, it ranks as one of the top ten metropolitan areas in the country.

During the first month, a pattern emerged  forcing the team to recognize their limitations. They created a list and christened it "Barriers to Recruitment."  On that list were all of the things that Michael and Marci knew were beyond their control. Their list soon grew to four pages.

"We needed more control in the offer process," Griffin says. "We reviewed the number of days credentialing requires, and we talked about how Sierra really didn't spend much time with the candidates in terms of 'warm and fuzzies'."

Griffin remembers, “People were hesitant to send in their CVs when we informed them they would have to undergo aptitude and personality testing before interviews could be scheduled.”

Sierra’s hiring process includes application screening, testing, and references prior to scheduling any interviews. First, Michael and Marci screen the candidates using about 25 questions. Next, the division chief contacts the candidate and covers about 10 clinical questions. Then, the candidate is e-mailed websites and passwords allowing them to take two tests, each requiring roughly 60 minutes of uninterrupted time. The candidates also are required to provide a minimum of two professional references prior to interview and a total of five prior to a written offer.

“If the results did not fit within our established benchmarks, then we did not invite them to interview,” Griffin states.

Sierra uses their incumbents’ results as a benchmark to compare scores. “If someone scores a 70, then in terms of what we are looking for, that person is a 70% match,” Griffin explains.

Requiring testing prior to interview was scaring potential candidates away. “To facilitate meeting our short timeline," Griffin says, "administration agreed to test candidates post interview.”

According to Griffin and Jackson, the testing is invaluable. “If we hire someone and they somehow come through the interview and have buffaloed us, we can go back to the test results to look for reasons the provider did not match the position,” Griffin explains.


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Michael Griffin and Marci Jackson

To fill those positions, Michael and Marci sent out mailings to California, Washington, Florida, Arizona and Nevada, including four distinct mailings to a list of Nevada Trained/Board Certified/Licensed Physicians. The results were impressive.

“Because we had such a narrow timeline, we pulled out all the stops to set up interviews,” Griffin says.

The team created an approach that presented Las Vegas as the fastest growing city in the country, and Health Plan of Nevada (HPN) as the largest health plan in the state.  Candidates learned that HPN increased members by at least 15,000 in primary care and with a panel size of 2,700 patients per physician, there was a need to recruit at least 10-15 physicians and 5-10 extenders.

As it turned out, potential candidates were very responsive to that approach with results of 19 interviews in September, 6 in October, 10 in November and 5 in December.

“We downplayed turnover when speaking to candidates,” Marci says. “We put more of a family spin on it and stressed the strong economy, especially in the medical market. We told them how the neighborhoods are growing with planned communities, and that we offer a good, stable career position.”

One detail made the greatest difference -- No Call, No Weekends. Griffin and Jackson found that when people responded to the ads and letters, they would invariably ask if the “no call, no weekends” claim was really true.

Marci says, “I’d respond ‘Yes! Urgent Care takes care of outpatient needs outside of office hours, and our hospitalists take care of inpatient needs. This is basically a 40 hour/week job!' ”

Jackson found that there were many people interested in the product she and Griffin were selling. But when the responses began coming in, they noticed a difference between the candidates they sourced and those offered by the search firm. The veteran recruiters have strong feelings about using firms. The fees and frustration in not speaking to the candidate unless the firm provides positive feedback are most notable. They found, too, that  candidates from firms were not as motivated to complete paperwork and meet deadlines. So, when Michael and Marci placed the candidates side by side, the candidates from firms tended to receive lower priority based on experience and interest. They did not rule them out completely, though. Three of the firm’s picks were interviewed.

Today, Griffin and Jackson estimate they have sent over 50,000 pieces of mail, along with utilizing the websites PracticeLink and MedHunter.

The results are 17 new physicians and 5 new PAs/NPs hired with an additional 3 pending contracts. “We hired very few new graduates,” says Griffin. “Seven years experience is the median for our candidates.”

According to Griffin, the individuals they hired had, in general, already gone through the “trying on for size” phase of their careers and knew a good thing when they saw it.

“We found our target candidate was someone who had six or more years of experience. Managed care is more predictable than other practices, with more time to go to shows, eat out, maybe travel to California on weekends,” Griffin notes.

Griffin estimates that during the two-month period, both he and Marci worked sixty hours a week.

“The process we have for interviewing cannot be done during the weekend, due to what we call a panel interview,” Griffin states. “In the interview, the candidates actually meet with five or six people at once. These are usually two physicians, an administrator, and two support people, such as a nurse, and an HR person. The human resources representative ensures that no one asks an illegal question,” he says.

Griffin admits this process is fairly intimidating “when they each ask questions and make notes.”

After the interview, the panel meets to give a recommendation. “Each panel member does their own evaluation,” Griffin explains, “but the group comes together to recommend ‘hire’, ‘do not hire’, or ‘need more information’.”

The advantage is that the process produces immediate results. “If we have all of our references, we can sometimes turn around, shake their hand, and offer them the position on the spot,” says Griffin.

Griffin’s department is both within budget for the year and within plan for the amount of money spent per hire. The figures include sourcing, candidate travel, Michael and Marci’s salaries, but not the costs for relocation.

With the goal of twenty physicians to hire, Griffin and Jackson are just three contracts shy of the magic number. The metrics data that Sierra Corporate will ultimately request is still being compiled. Having just recently incorporated the KontactIntelligence physician recruitment application to their department, Michael says, “We’ll input that data and look forward to being able to track days to fill and interviews to hire for a specific position.”

For now, they can only estimate the site visit to close ratio was 2 to 1.

Some in the industry say that if you’re doing the best possible job you can, the goal is 3 to 1. And, with a search firm average between 5 and 7 to 1, Griffin and Jackson’s ratio of 2 to 1 is exceptional.

At Southwest Medical Associates/Sierra Health Services in Las Vegas, Michael and Marci may be on a roll, or just doing the best job they possibly can. Either way, they’re enjoying the rewards of a Vegas-style streak of hiring!

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