Hiring for fit

By Gale Pryor | June 1, 2016

The High-Performing Physician Network

Data Snapshot

98% new patient retention rate

Key Takeaways

  1. Hiring for cultural fit is a shared trait of high-performing physician networks.
  2. Defining organizational values is as important as defining strategy.
  3. Approach every hire as an opportunity to protect and reinforce the culture.

Vik Mali, M.D., needed to hire a doctor — fast — for a temporary job in his pediatric office outside Detroit. One promising applicant was a resident at a hospital in California. Mali had no time to fly her in.


So he did the next best thing: Called the secretaries at her teaching hospital and asked them, confidentially, "What's she like?" When he was told she was the friendliest and most empathetic of the residents, Mali hired her, sight unseen.

“We had to protect the culture of our practice," Mali says. And when that culture hinges on strong relationships — Mali & Mali Pediatrics has a 98 percent retention rate for new patients — it's critical to bring in the right doctors, for the right reasons.

“I can teach a new pediatrician to nod," Mali says. "I can teach her to lean forward. I can teach body language in the exam room. But I can't teach anyone to care."


In an ongoing project, athenahealth researchers are examining key financial and operational metrics from across a national network of 99,000 providers, and have identified the top 10 percent of performers. Mali & Mali Pediatrics is one of them: A busy pediatric group that, like many high performers, puts a high priority on hiring for cultural fit.

Even in an era of data-driven management, culture — a concept that's hard to measure — can determine the success or failure of a medical office, a merger, or an integration. Culture is the gut response of every team member to a goal, to change, to a patient, to each other. It's the patterns of behavior that enable team members to pull in the same direction.

Culture varies among health systems. But a common denominator among high performers is the ability to define a set of in-house cultural values — and preserve those values as their organizations grow.

Pay attention to hunches

“We spend a lot of time evaluating physicians before they come to us," says Lynn Wolff, CEO of Georgia Hand Shoulder Elbow (GSHE), a large specialty clinic and ambulatory surgery center in Atlanta that is also a high performer on the athenahealth network.

“We want to make sure that they think like we do," Wolff says. "Fitting in with our culture is almost more important than skill. We expect physicians to be skilled; that's a given."

Sometimes hiring for cultural fit comes down to a hunch. Wolff recalls when GHSE was ready to make an offer to a new physician. "We were in a meeting talking about him and I looked around the room at our physicians and said, 'You know, I'm just not feeling it.'"

One by one, the team shared hesitations about the candidate. "Everybody had that 'I don't know' feeling," Wolff says.

The almost-hired physician "talked a lot about 'me, me, and what I'm going to do and how I'm going to do it,'" says Wolff. "That just didn't fit with us. Our practice is not about making one guy famous. It's about making the practice the very best it can be. We work hard and treat patients. That's who we are."

Look for alignment on vision

Sometimes, working in the same direction leads to uncharted territory. Carilion Clinic, a health system with 650 physicians based in Virginia, recruits leaders and administrators by sharing its vision of growth, then gauging the reaction.

Recently, the system was in the midst of a re-organization, aimed at increasing its capacity for ambulatory specialty care, says Donna Littlepage, Carilion's senior vice president for transformation and finance. So she spelled out the plan carefully to prospects, telling them, “If you're coming, here's what we're trying to create."

Being upfront about impending change "interested the right people," Littlepage says.


Lifestyle matters

Culture isn't limited to the walls or hours of a practice. After vetting surgeons from fellowship programs across the country, The San Antonio Orthopaedic Group, another high-performing physician group, often focuses on those with family ties to the region.

“Those are the ones who become the happiest doctors," says chief operating officer Chris Kean.

Cardiology Associates of North Mississippi attracts new physicians with family-friendly hours and generous time-off benefits — understanding that happy doctors are more productive.

“That's the lifestyle they like, that's why we're able to get them here," says CEO Eddie Barber.

Lifestyle may also mean a shared work ethic. GSHE looks for physicians "who want to work as hard as we do, including being on call 24/7," says Wolff. "You can tell over a series of interviews who wants to work like that and who doesn't."

Make hard choices

Some organizations keep careful track of who stays and who leaves within five years of being hired or acquired. True fit — or misfit — emerges after the dust settles and a new physician or group is no longer new.

That means letting go of staff that isn't working out — a situation that, years ago, led Vik Mali to hone in on his hiring philosophy. Several years ago, after hearing persistent patient complaints, he made a difficult decision to let go of some doctors.

Now, his vetting process always includes a character component. When prospective hires visit, he walks them around the building and carefully watches every encounter.

“Look, you're going to be really nice to the guy hiring you, but how do you treat the unit secretary?" Mali said. "How do you treat the janitors and the folks in the cafeteria?"

Read more about the drivers and habits of high-performing physician networks.

Gale Pryor is associate editor for athenaInsight.

Image credit: Courtney Hayes


Hiring for fit