It's A Great Big Recruiting World Out There

I have been working with a consulting group at my new Hospital and I have been introduced to the concept of a "content expert."  As we discussed the utlization of these people in the structural reorganization of our medical group practice I was suddenly struck by the fact that I am one of those content experts.  In my everyday dealing with all things physician recruiting I am constantly called upon to offer my expert opinion of matters ranging from successions planning to networ development.  I dare say that any of my fellow recruiters who have been on the job 5+ years are also content experts.  Globally we can add to the chat banter by offering expert advice on content areas such as immigration and budgets.  Locally, we are also content experts in our own markets offering expert advice to CEO's, COO's and the rest of senior leadership.  Of perticular interest to me is the fact that the content expert constantly evolves and grows in his/her role.  We attend conferences, write, lecture and pontificate about the world of medicine and the struggles of recruitment therein.  Content experts can also be harnessed to push projects forward, restructure organizations, and maintain best practices.  In healthcare today our roles are more vital than ever.  Our knowledge is of worth to our employers and we are continuously needed to provide substance and credibility to everything from medical staff development planning to network growth and market share capture.  I am grateful for my place in this wonderful industry and I take this moment to share that gratitude with all of you who are grateful also.

CEOs & Other Healthcare Executive See Easy Money In Hospital System

In this age of public scrutiny about financial wrongdoings and at a time when Occupy Wall Street sends a strong message to corporations about greed there is a segment of the financial sector that still manages to break the rules day after day, healthcare.  In a day and age when a piece of newsworthy material can make it from Beijing, China to Los Angeles, CA in a viral second the headlines are full of hospital executives, accountants, CFOs and physicians stealing.  We call it embezzlement because it sounds nice as it rolls of the tongue but it is stealing no matter which way you roll it. 

Consider the case of Paul Cardwell, the former CEO of Powell Valley Healthcare in Powell, WY who is accused of embezzling nearly$850,000 from the organization¹. Cardwell authorized the spending of $847,934 for recruiting physicians, monies which were found to have been funneled to a straw company owned by Cardwell’s friends and then transferred to Cardwell by way of electronic transfer.  Cardwell is currently believed to be living in Thailand even though he has no ties to that country.

Consider the case of Carol Maultsby the former VP of Corporate Risk Management for Novant Health in North Carolina².  Ms. Maultsby plead guilty to eight state counts of embezzlement, admitting to stealing $620,000 from Novant.  Maultsby had set up a dummy company and authorized 50 checks of amounts between $12,000 and $13,000 apiece over seven years to be deposited into a back account under the dummy company’s name.

Consider the case of Richard Crabtree, Senior VP, COO for Christus St. Vincent Regional Medical Center who billed and collected $3.2M for claimed services that were never provided or grossly overestimated³.  The Great American Insurance Co. filed the lawsuit last month against former hospital executive Crabtree, Loretta Mares, her two brothers and five of their companies, according to the Associated Press. The lawsuit, which calls the fraud "a pervasive scheme," alleges that Crabtree and the other defendants engaged in the plot to misappropriate money from the start of his employment in 2002 until his termination in 2008. Although St. Vincent officials didn't comment on Crabtree's departure in 2008, the executive's termination coincided with St. Vincent's merger with the Christus healthcare group.

Further consider the case of Susan J. Morrison a former accountant for Michigan’s Munson Healthcare who in September plead guilty to charges of wire fraud and money laundering that totaled $1.1 million⁴. She transferred the money from Munson's Regional Healthcare Foundation's bank account to her former business, Great Lakes Bear Factory, between October 2007 and April 2011. She also made up false receipt accounts to cover up the theft.

If you think physicians are immune then consider the case of University of Louisville medical school physicians inappropriately used $4.8 million in Medicaid state funds for their own personal bonuses, diverting money away from indigent care⁵. Even more, the physicians used another $5.2 million for electronic records that would earn additional bonuses, according to the article.  Known as the repeat of the "Passport scandal," the accusations against University of Louisville physicians are similar to claims that nonprofit Medicaid managed care organization, Passport, transferred $30 million in funds to University of Louisville, University Physicians Associates, and other board members, according to the article. The groups repaid most of the funds to settle allegations by the Attorney General, who established the Passport transfer was illegal.

Lastly, consider the case of Marlene Rice Hoyle, 45, who was charged with embezzling $1.2 million from Jones Family Practice, where she worked for nearly 20 years, most recently as office manager⁶.  Hoyle, who pleaded guilty to five felonies on June 6, has been sentenced to four to five years in prison, according to the superior court clerk's office, with at least five years supervised probation following her release. Judge James J. Morgan also ordered Hoyle to pay more than $1 million in restitution, $100,000 of which she has already paid voluntarily.

The lure of money is a powerful thing when people face foreclosure, medical bills, dependant parents and trying to live a more “comfortable” life.  The occurrence of such theft marks us all and reminds us that those of us who work in healthcare are keepers of truth and decency within our organizations.  The crimes committed her are shocking not only because they violate the public trust but also because they are brazen and because they are only about money. 

Sources:

1.  Ilene Olsen.  “Former Hospital CEO Accused of Embezzlement.”  Powell Tribune [Powell, Wyoming] September 29, 2011.

2.  Michael Hewlett.  “Former Novant Executive Pleads Guilty To Embezzling Nearly $620,000.”  Winston-Salem Journal [Winston Salem, NC] February 21, 2012.

3.  Phaedra Haywood.  “Insurance Firm’s Lawsuit Alleges $3.2 Million Embezzled at Hospital.  Santa Fe NewMexican [Santa Fe, NM] December 29, 2011/

4.  James Russell.  “Munson Embezzler Gets Prison.”  Traverse City Eagle [Traverse City, MI] December 8, 2011.

5.  Deborah Yetter.  “Medicaid funds allegedly misused: U of L doctors used $4.8 million in Medicaid money for bonuses.” Courier Journal [Louisville, KY] September 29, 2011.

6.  Rebecca Clark.  ‘Woman Pleads Guilty to Embezzling $1 Million From Doctor’s Office:  DA Says She Has Nothing To Show For It.”  Shelby Star [Cleveland County, NC] June 7, 2011.

Can Social Media Expand Hospitals and Groups Presence

Many Hospitals and Group Practices are beginning to look at Social Media as a lifeline to patients and customers.  Clearly the use of social media in the health sector has increased overt he last five years and as interest grows so does the risk/reward equation.  Patient identity, patient records and employee interface all make the social media forum a place where risk management and marketing co-exist.  As we look out across the internet we can see several applications that social media has for hospitals.  Most prolific is sharing organizational news and services.  This allows hospitals and groups to engage in social media without creating any new content.  Sharing general news is a feature that allows healthcare organizations to post links to stories from local or national media outlets.  Most hospital also host community event and social media is a great way to promote an upcoming blood drive.  Success stories promote health and happiness and social media is an excellent outlet for stories about triumphing over illness or the success of an employee.  Lastly, customer outreach and awareness shifts the hospital's focus to being aware of what patients and other consumers are saying about the facility and their experiences and then responding appropriately.  Keep in mind social media can be used for so much more depending on the audience.

If you are thinking about entering the social media arena here are a few things to consider:

1)  Develop a social media plan that outlines the organization's goals and intended audience in using social media.

2)  Assign an individual or group accountable and responsible for posting content, monitoring usage, ensuring overall execution of the social media plan, and monitoring policy violators.

3)  Define which staff other than the accountability group or individual may participate in the organization's official social media.

4)  Identify which social media tools will be used to support the various goals listed in the social media plan.

5)  Include social media in all HIPPA privacy training.  Consider having staff sign a form after completion of the training.

6)  Ensure that privacy policies specifically address the use of photos of patients, staff, volunteers, and visitors, and that use without authorization is prohibited.

7)  Monitor social media for mentions, positive and negative, of the organization.

Hospitals and other healthcare organizations have begun to use social media in ways that attempt to meet consumer demand.  In doing so, they must create and enforce social media plans that define how engaged the organization will be, who its audience will be, and who will be responsible for managing social media outlets, as well as establish policies and procedures for managing risks related to privacy, reputation management, and employment issues.

Social Media and Physician Recruiting

There is no doubt that the advent of social networking has been nothing short of prolific.  The world has grasped on to the network and friendships have been spawned all over the globe.  People meet on-line, in organized dating forums, people get married from those encounters, and people exchange ideas which spawn other connections.  There are no more agoraphobics thanks to the web because no one is afraid anymore.  Just look at the human statement that is YouTube and you will see for yourself everything that is the human condition.  So where do the networks go from here?  In my world they start to creep around the edges of how people find jobs and specifically how doctors find opportunities.  Nearly 90% of physicians reported that they used at least one social media site personally, according to a survey by the online physician learning collaborative QuantiaMD.  By those numbers, physicians are well ahead of the general adult population -- 65% of the general public use social media, according to a study published in August by the Pew Internet & American Life Project.  According to QuantiaMD, 87% of physicians make personal use of social media, but a lesser amount, 67%, use it professionally. And one thing that hasn't changed during those 18 months is the lack of patient-physician communication on social media.  One-third of the QuantiaMD survey respondents said they had received a friend request from a patient on Facebook. Three-quarters of the physicians declined those invitations. 


So how do physicians look for jobs?  Zeldis Research Associates was commissioned by the New England Journal of Medicine (NEJM) to do a survey in December 2010.  4,008 Surveys were sent out and 376 usable surveys were returned.  The results were as follow:

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• 89% rated professional/personal referrals as useful in finding a job  
• 15% rated social media as useful during a job search 
• 50% used classified/recruitment sources in print 
• 50% used classified/recruitment sources on-line 
• The most important factor online was job quality 
• 60% rated print and online versions as equal 
• 70% use a mobile device & 67% of them are interested in using a job app 
• Interest is highest for permanent positions at a hospital or group 
• 97% of respondents were 40 years old or younger 
• 50% were practicing physicians 
• 88% started looking just prior to or during their last year of training.

As you can see the social networking "medical edition" is not a mainstream construct yet.  Physicians don't friend you, they don't invite you to their LinkedIn inner circle and they don't follow you on Twitter.  Why?  Because they have professional standards to uphold.  A recruit is not going to let you into their inner most space and allow you to rummage through their proverbial under wear drawer.  The wall between us is high and wide but not insurmountable.  If we cannot get into their private world then we are just going to have to invite them to our public world of hospital sites and group Facebook pages.  The information superhighway has new billboard space and it runs of the freeways of the social network.

Next topic:  How can hospitals use social media?............................

Recruiter Credibility

The word credible is an adjective meaning; able to be believed, convincing.  It is a fundamental pillar of the recruiting business.  Without it I don’t think I could recruit a single physician to my area.  Its importance is summed up in a quote I once read from an unknown source: “Credibility is like virginity, once you lose it, you can never get it back.” 

As in-house recruiters credibility is applied in two different areas.  On one hand you must have credibility with your own staff and administration, and on the other you must have credibility with prospective candidate and would-be recruits.  So the first question is how do you build credibility, and the second, more important question is how do you keep it.  First things first.  For those of us who have been doing this for a while your credibility has been grown and cultivated through many years of experience.  Nevertheless, most of us would agree that there are about 10 (give or take) basic ingredients to becoming credible as a recruiter.  Note: These principles apply to all aspects of life but are applied to recruiting for obvious reasons.

1. Be yourself. To be credible, you don't have to appear perfect. You should concentrate on and play to your strengths.   You need to be honest, human and not present a plastic image.  Nothing kills a visit like phony.

2. Walk the walk. You have to be a person who has the organization uppermost in his or her mind and is competent in the way you represent the organization.  If you don’t care or believe in your organization find a new job!

3. Listen carefully. Make sure you understand exactly what is expected of you and when it is due.  Write down the information you are being given, to avoid confusion.

4. Be knowledgeable.  Know your organization, your community. its history, points of interest, weather, real estate market, school system.  Know your specialties, education requirements, types of procedures, practice setups, contract types.  Know your candidates, their country of origin, greetings, customs, culture, their schooling, their hobbies, their family…

5. Network/Share Ideas. ASPR helps!  Having an extensive network of contacts, both in your field and in unrelated fields, is important no matter what profession you're in.  Write articles, attend conferences…

6. Be a problem solver. If you cultivate the attitude that you can conquer any problem, you will cultivate the image of a doer, of a credible and reliable individual.  Come in on a Saturday, make an extra phone call, help with credentialing, solve a contract issue, help your CEO look smarter.

7. Keep an open mind. You need to keep an open mind toward all people, new opportunities, skills and ways of doing things. The more things you are able to do well and the more people you are on friendly terms with, the more credible you will be across the organization.

8. Cultivate self-awareness and set goals. Having professional goals conveys to people a feeling that you are someone who is going somewhere, someone not to be ignored, someone with credibility. However, you must first determine what is important to you.

9. Develop a professional identity. You will be perceived as being credible if you dress in a manner that is standard in your profession and that commands respect.  Armani is not a prerequisite but a pressed shirt or blouse should not be overlooked when outside your office.

10.  Think outside the box.  Sometimes the intangible aspects of recruiting are ideas that are unique and show creativity on behalf of the organization or toward a candidate.  Don’t be afraid to try something different.

11.  Develop meaningful relationships.  The best recruiters are the most passionate.  They stay connected and invested forever.

I am sure everyone could add a few more or switch out some for others but hopefully this helps you get started or helps you reconnect if you strayed off the path.

How do you lose credibility?  I give you this.

Everyday, we are bombarded with phone calls, sleazy tactics, and downright lies from firms and agencies seeking to sell us the golden ticket to the chocolate factory.  I have watched recently on the ASPR chat server as countless numbers of my colleagues have been victimized by some of the biggest firms in the recruiting business with such tactics as the bait and switch, the (recruiter) posting myself as a physician, and my personal favorite the bypass the in-house and go directly to a VP or CEO.  If you happen to run across any of these good folks making a mockery of our profession please share this article with them.  We owe it to ourselves to change their way of doing business and remind them that credibility is what sells.

Until next time...

Two Sides Of The Same Coin

As an outside recruiter I never understood that lack of urgency my clients presented as we teetered on the brink of losing a candidate after many months of work.  I never understood what went on behind the scenes and quite frankly I never bothered to try and understand.  All I knew was that the clients in ability to "pull the trigger" stood between me making a commission.  After all that was the goal, right?  My job was to deliver the interested candidate and close the deal, thereby, making my number, getting the cash, and moving on to the next account.  But it rarely happened that way. 

As an outside recruiter I was held to production numbers.  Make the number = Keep your job.  Simply put that is the equation all outside recruiters face every cycle.  Sometimes that cycle is 30 days, sometimes 60, sometimes 90.  Any way you slice it the outside recruiter is held to a number and that number is a measure of his or her effectiveness, talent, and skill set.  I can guarantee you that anytime an outside recruiter is getting pushy about getting a candidate signed (usually toward the end of the month) it's because they are being pushed to make their number.  Outside firms derive their revenue stream from multiple sources, e.g. mail, hourly billing, and the almighty placement fee.  It is the latter that helps an outside firm cover expenses, pay staff, and expand (sometimes the business and sometimes the partners bank accounts).  Either way you slice it the bottom line is revenue.  The firms see themselves as experts.  The motto is:  Follow their direction and plan and they will lead you to the promised land.  In-house recruiters are usually hurdles to be jumped over or blockades that need to be navigated around.  Often is the case that the firm does not understand that the in-house recruiter is an ally that will help them understand the unique obstacle course that is every hospital, group or individual client.   The firm erroneously assumes the in-house recruiter is a figure head position filled by someone who knows nothing about actually recruiting because they were transferred or promoted from HR or they were retiring as a nurse and must know something about bringing physicians to their institution.  While it is sometimes the case that in-house recruiters are plucked from other departments; it more often the case that in-house recruiters have valuable knowledge about their institutions and the politics therein making it easier for outside recruiters to do their job.  ASPR demonstrates every year that in-house recruiters are driven professionals looking for advancement in both their skill set and their professional standing.  Outside firms finally appear to be catching on.

On the flip side of this discussion the in-house recruiter is driven by results.  Fill empty positions = Keep your job.  Simply put that is the equation all in-house recruiters face every day.  While the outside recruiter is tasked with finding an interested physician the in-house recruiter is faced with a myriad of tasks that will result in the interested physician becoming a compatible physician.  The in-house recruiter sees the use of a contingent or retained firm as a sometimes necessary component of completing the task at hand.  But it is only one piece of the large puzzle that is in-house recruiting.  Let's run through what happens once a candidate is presented (my process will vary from others but you will get the idea).  First the candidate's CV is reviewed and discrepancies and holes are examined and questioned (often I re-format the CV to make it easier for my physicians to read and analyze).  The physician profile is then examined. The outside recruiter will present a 4-8 page document detailing background/history, family, current position/training, personality, interest in the community/position, and reason for looking at a new position.  This collaboration is vital to the process of qualifying a candidate but it where the outside recruiter leaves off and let's the in-house recruiter take over (most of the time).  This is an uncomfortable place for the outside recruiter as they have "given up control" of their candidate and left the next steps up to the in-house recruiter.  What the outside recruiter does not know is that there are protocols and procedures that the in-house recruiter is bound by within their institution/system that cannot be overlooked or circumvented. 

Once the in-house recruiter has what he or she believes to be a qualified candidate he/she makes contact with the candidate and re-screens them.  This is not a matter of distrusting the outside recruiter but rather a function of due diligence.  In addition, licensing, board certification and a Google search have all been completed on the candidate to determine if there are any red flags.  Once the qualified candidate passes that litmus test one of two things can happen.  Either the in-house makes a decision to bring the candidate out for a site visit, or the in-house recruiter presents the candidate to a committee which determines if the candidate will be invited for a site visit.  At this point the outside recruiter has called 2 or 3 times to find out if their candidate is in fact being invited out for a site visit.  Let's for arguments sake say we have a live one and the candidate is being invited out.  I think all of you know how to say "this candidate did not fit our parameters" in your own way.  Now the gargantuan task of building a site visit begins.  While the outside recruiter is pushing for the earliest interview date possible (again remember they are on a cycle) what they don't know is that the best interview, the one with the highest rate of success, takes time to plan.  You have to have the right people in the right places to make candidates really feel welcomed and wanted.  We all know if we had 50 candidates per search that the dog and pony show would not matter.  However, the reality is that we don't get that many candidates and "you never get a second chance to make a first impression."  It really does takes time to pull off a well orchestrated site visit.  In addition, what they also don't realize is that this position is not the only one with candidates and your a planning 2 more site visits in the coming weeks.  Nevertheless, hitting fast forward, you plan the best possible site visit you can having taken into account vacations, surgery schedules, clinic schedules, anniversaries, birthdays, and any other elements that could have scuttled your plans.  The site visit goes off with or without a hitch and the candidate goes home.  Now the outside recruiter wants to know if you are going to make an offer to his or her candidate.  What he or she does not understand is that you need to get feedback from all the participants to see if their is a consensus/majority of support or non-support for the candidate.  In many cases this a formal process requiring participants to email or fax their opinions to the in-house recruiter so a tabulation can be made to determine an outcome.  Consider that there is a majority of support and now we have to make an offer.  In many cases the outside recruiter wants a formal offer letter signed so that they can say their job is done.  Here comes the invoice and the subsequent desire for payment.  However, the truth of the matter is that an offer letter signals that terms are acceptable but nothing is real until the contract is signed.  So know we go to our respective legal advisors and draft a contract.  Negotiations are underway and the process takes a few weeks if not longer.  The outside recruiter at this point is wondering why the invoice is not paid and the in-house recruiter is wondering why the contract is taking so long to be put together.  Eventually the contract is signed and the invoice paid.  However, the candidate gets cold feet and does not show up for his/her first day...Until next time.

California - Wasting an opportunity

Here in California we hold ourselves out to be the last bastion of autonomous practice.  As one of only 7 states left in the union that do not allow hospitals to employee physicians directly we cling to a law written in 1930 that protects our physicians from interfering non-physician entities like CEO's, CFO's, COO, etc.  We do so in the face of the looming shortage of physicians (many say it already here) and at the detriment of all the Californians who don't live in suburban and metropolitan areas where access is not a problem.  Rural areas and the medically under served are left to find their own solutions, wallowing in Medicaid reimbursement or better yet indigent care that pays zero..


The state of California website states the following:

Business and Professions Code section 2400, within the Medical Practice Act, provides in pertinent part:
"Corporations and other artificial entities shall have no professional rights, privileges, or powers."

The policy expressed in Business and Professions Code section 2400 against the corporate practice of medicine is intended to prevent unlicensed persons from interfering with or influencing the physician's professional judgment. The decisions described below are examples of some of the types of behaviors and subtle controls that the corporate practice doctrine is intended to prevent. From the Medical Board's perspective, the following health care decisions should be made by a physician licensed in the State of California and would constitute the unlicensed practice of medicine if performed by an unlicensed person:

• Determining what diagnostic tests are appropriate for a particular condition.
• Determining the need for referrals to, or consultation with, another physician/specialist.
• Responsibility for the ultimate overall care of the patient, including treatment options available to the patient.
• Determining how many patients a physician must see in a given period of time or how many hours a physician must work.

In addition, the following "business" or "management" decisions and activities, resulting in control over the physician's practice of medicine, should be made by a licensed California physician and not by an unlicensed person or entity:

• Ownership is an indicator of control of a patient's medical records, including determining the contents thereof, and should be retained by a California-licensed physician.
• Selection, hiring/firing (as it relates to clinical competency or proficiency) of physicians, allied health staff and medical assistants.
• Setting the parameters under which the physician will enter into contractual relationships with third-party payers.
• Decisions regarding coding and billing procedures for patient care services.
• Approving of the selection of medical equipment and medical supplies for the medical practice.

The types of decisions and activities described above cannot be delegated to an unlicensed person, including (for example) management service organizations. While a physician may consult with unlicensed persons in making the "business" or "management" decisions described above, the physician must retain the ultimate responsibility for, or approval of, those decisions.
The following types of medical practice ownership and operating structures also are prohibited:

• Non-physicians operating in a business for which physician ownership and operation are required: any business advertising, offering, and/or providing patient evaluation, diagnosis, care and/or treatment. These are services which can only be offered or provided by physicians.
• Physician(s) operating a medical practice as a limited liability company, a limited liability partnership, or a general corporation.
• Management Service Organizations arranging for, advertising, or providing medical services rather than only providing administrative staff and services for a physician's medical practice (non-physician exercising controls over a physician's medical practice, even where physicians own and operate the business).
• A physician acting as "medical director" when the physician does not own the practice. For example, a business offering spa treatments that include medical procedures such as Botox injections, laser hair removal, and medical microdermabrasion, that contracts with or hires a physician as its "medical director."

"The Medical Practice Act" is not a static document and begs for updating and re-thinking.  It ties one hand behind the back of recruiters like me who simply want to serve their communities and serve their patients.  One interesting note:  Exemptions for direct hire exist in California for county facilities, the prison system, teaching institutions, and federal facilities like the VA.   Since we have these exemptions how about adding one more layer; rural/district hosptials!

Until next time...