As much as 80% of employee turnover can be attributed to bad hiring decisions, the Harvard Business Review reported.1 And turnover costs are high—one report estimated them to be 100–300% of the base salary of a replaced employee (with 150% commonly cited).2 Given this, the importance of hiring the right employees can’t be underestimated.
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So where should a rheumatologist begin when looking to fill an open position?
Nathan Wei, MD, FACP, FACR, practice owner and rheumatologist, Arthritis Treatment Center, Frederick, Md., suggests asking existing staff for referrals before advertising a job opening. “Good people tend to know other good people,” says Dr. Wei, who finds the majority of his employees this way.
This strategy has also worked well for Barbara Taylor, CPPM, CRHC, office manager, Arthritis & Pain Associates of Prince George’s County, Greenbelt, Md., who says that 80% of the time she finds great employees through word of mouth or networking.
Helen Wheeler, principal and consultant, Alexander Mann Solutions, a provider of talent acquisition and management services in Cleveland, Ohio, says the most cost-effective approach to hiring is through relationships. “Leverage your personal network,” she adds. “Consider people you’ve worked with before and who fit the mold of someone you would want to work with again.”
But where do you turn when referrals, word of mouth or networking come up short? A smart approach to advertising jobs, screening résumés, conducting interviews and evaluating potential candidates can help employers make better choices when it comes to new hires.
Employers should be straightforward when writing an advertisement, Dr. Wei advises. “Write what is expected, along with requirements, such as education,” he says.
Ms. Taylor recommends listing desired attributes in a candidate, such as a solid work ethic, flexibility, punctuality, a willingness to learn and commitment to patient service. In addition, her practice prefers candidates who have two years’ experience in a private practice physician’s office, a working knowledge of medical terminology and a passion for working on a team.
Eric Dickerson, managing director and senior practice leader, academic medicine physician and leadership recruiting for Kaye/Bassman International Corp., Plano, Texas, a firm that specializes in retaining academic medical physicians, says it’s also important to highlight two or three reasons in your ad that would draw a potential job seeker to your practice. “What makes your opportunity unique and different from other practices?” he asks.
Dr. Wei places ads in the local daily newspaper, which has both print and online versions, as well as on social media and Craigslist.
Ms. Taylor says she has found that local newspaper ads work better than ads in regional publications, because they target local candidates. “Traffic in the Washington, D.C., metro area is a nightmare,” she says. “I’ve found that when the commute is too long, an applicant will accept the position, but they keep looking for something closer to home.”
Dr. Wei throws a twist into the application process. “We require candidates to hand deliver their résumé and cover letter,” he says. “If someone can’t follow a simple direction like that, then that tells us that they aren’t right for the position.”
After you’ve netted a pool of applicants from your ads, it’s time to sort through résumés. But sifting out top candidates from a stack of one-page bios isn’t always easy.
When screening résumés, Ms. Taylor prefers candidates with two years of continuous employment for each position. “Stability indicates that someone is more likely to stay with the practice for a while,” she says. Applicants who have more than one job at the same time are also appealing, because it demonstrates ambition and willingness to work, she adds.
Even though Ms. Taylor favors candidates with experience in the medical field, she will hire someone without such experience if the applicant shows interest and ability. “I would hire the applicant on a temporary basis,” she says. “If it works out, I would offer them a full-time position.” She has also hired both high school and college students, if they are motivated to learn and work hard.
Résumés can also offer clues to a candidate’s future job performance. Dr. Wei says candidates whose résumés have large gaps between positions or show jobs held for only three to five months are red flags. “Past behavior predicts future behavior,” he says.
Ms. Taylor is wary of boilerplate cover letters. “Some applicants are looking for more than one type of job,” she says. “I had one applicant say that she was looking for a medical assistant position, yet her cover letter stated that she was applying for a security guard position. This inconsistency told me she was applying to many different positions and was not committed to, or passionate about, her career.”
Mr. Dickerson says he would avoid someone who has been demoted or regressed in their career, or someone who submits poorly written application materials with multiple grammatical and spelling mistakes.
Before granting an interview, Lawrence Lee, partner, Fisher & Phillips LLP, Denver, an employment attorney with clients in the healthcare industry, advises requiring every applicant to complete an application for the record. Carefully review the application and look for any statement that may indicate potential fraudulent history, he says, such as stating that the reason for leaving a job was because their “employer accused me of fabricating my time sheets.”
To identify candidates with the right skill sets, look for someone who makes a genuine attempt to understand your business and connect with you during the interview, Ms. Wheeler advises.
When discussing someone’s work history, look for an established record of success working on projects that weren’t clearly defined. “If someone says she did something, ask follow-up questions to make sure she really did have a hands-on role and find out how she handled the situation,” she says. “You’ll find out a lot by just asking them to tell you stories.”
Dr. Wei likes to ask interviewees to provide examples of situations they have previously faced, the actions they took and the end result. For example, employers could say, “I see you were an executive secretary for Mr. Jones and that you were in charge of planning his business trip itineraries. Can you walk me through the process you used?”
Ms. Taylor asks candidates to comment on how they would deal with difficult scenarios, such as handling an agitated patient or telling a patient that the doctor is delayed. She may ask job seekers applying for administrative support positions, “How would you call Mary Jones from the waiting room? What is your standard greeting when answering the phone?” She’d also present more complex scenarios, such as, “If five lines are ringing and your phone partner went to the restroom, how would you deal with the rush and provide quality service?” She would also ask them to alphabetize a list of patient last names and perform basic math skills. She may ask candidates applying for a medical assistant position to draw up two cubic centimeters of lidocaine and demonstrate aseptic technique.
Ms. Taylor says some key questions should look at basic, everyday requirements. For example, she asks candidates to identify their mode of transportation. “We have two offices, and I may need them to go to another office mid-day,” she says.
Interview Topics to Avoid
Bringing up certain topics can have legal ramifications, so be sure to avoid them during the interview process. These include asking for information concerning the applicant’s age, ethnic background, medical condition, domestic responsibilities, religion, sexual orientation, military status and arrest record.
For example, an employer should not ask an applicant, “How many days were you out sick last year?” Instead, a neutral question such as, “How many workdays did you miss last year?” would legitimately elicit information concerning dependability without inquiring about a possible medical reason, says Eric J. Holshouser, attorney/shareholder, Buchanan Ingersoll & Rooney PC, Jacksonville, Fla., an employment attorney with significant experience in the healthcare space.
Asking a female applicant, “Do you have small children at home?” could be perceived as discriminatory. On the other hand, the question, “Do you have any obligations outside of work that may interfere with your job?” is a legitimate job-related inquiry, assuming the question is not limited to female candidates, Mr. Holshouser says.
Instead of asking about a candidate’s ancestry or racial background, Mr. Lee suggests asking, if job-related, whether the applicant speaks any languages other than English. Instead of asking which church, synagogue or mosque the applicant attends, ask if they can work weekends if necessary.
Be Wary of Red Flags
Take note of a candidate’s remarks or actions during the interview process, such as those that pertain to how they treat staff and peers, or if there is a lack of cultural or personality fit, Mr. Dickerson says. If the candidate’s answers make it apparent that their concern is all about themselves and not about the patients and quality care, Mr. Dickerson considers it a significant red flag.
Weak or evasive responses from an applicant about why they changed employment in the past may indicate a lack of commitment or loyalty. Similarly, learning that an applicant left a prior job without having a new job lined up is a red flag. “That may indicate the applicant was dismissed, asked to resign or quit in an impulsive manner, none of which is favorable,” Mr. Holshouser says.
An applicant’s use of inappropriate language during interviews or non-verbal cues suggesting anger-control issues or issues of deceit or credibility should also raise an eyebrow, Mr. Lee says.
Dr. Wei finds inconsistencies in stories or stories that don’t make sense a cause for concern, and Ms. Taylor considers unkempt appearance and bad personal hygiene relative contraindications for offering employment.
Consider Aptitude Tests
Employers can use a number of different assessment tools to determine a potential candidate’s fit for a role. Mr. Dickerson’s firm uses a communication-style assessment tool, ProScan from PDPWorks, when screening candidates.
“Ideally, you will be able to begin to identify potential strengths, weaknesses and communication styles,” he says. “[Although] these tests shouldn’t be used to rule someone in or out, they do help people understand each other, and that better understanding can provide for greater collaboration and a more positive work environment.”
“One of the biggest causes of issues within a department or practice is poor communication,” Mr. Dickerson continues. “If you understand the communication style of the people you work with and they understand your communication style coming into the position, often you can avoid those initial road blocks and bumps.”
Conduct Background Checks
In some cases, employers may want to have criminal background checks performed on candidates being considered for a position. Mr. Lee says such background checks should be conducted only after a conditional offer of employment is made. He advises employers to ensure they comply with the Fair Credit Reporting Act by receiving written authorization from applicants in advance.
Keep in mind that some states and local jurisdictions have “ban the box” laws, Mr. Holshouser adds, which prohibit or restrict the use of criminal history information.
The U.S. Equal Employment Opportunity Commission (EEOC) has published its position that an arrest does not equal criminal conduct and such information should not be requested. The EEOC also takes the position that conviction records can be used only if the employer can prove job relatedness.
“Use arrest records for rare occasions, such as determining activity of behavior concerning fraud, theft or violence,” Mr. Lee says. Unless someone was convicted or entered a guilty plea, don’t use an arrest as a reason not to hire someone, he adds.
However, an employer could consider the conduct underlying the arrest if it makes the individual unfit for the position, Mr. Lee continues. For example, a hiring rheumatologist of a pediatric practice will have a legitimate concern if a nurse applicant has been arrested for child pornography.
Call all prior employers listed on a candidate’s job application, except the applicant’s current employer, if requested by the applicant, Mr. Holshouser suggests. He recommends sticking to questions that are legitimately job related. “Unfortunately, most employers will provide [only] neutral references (usually dates of employment, position held and ending salary) to minimize any risk of being sued for defamation,” he says. “However, some employers who provide neutral references will, if asked, advise whether the applicant is eligible for rehire. If the prior employer says, ‘no,’ or won’t answer a question, that is a red flag.”
Determining whether the information an applicant provides during the interview is consistent with what is on the employment application is critical. “If an employer finds that the applicant covered up a gap in employment or misrepresented his or her job position or pay, that is a red flag showing the applicant’s dishonesty,” Mr. Holshouser says.
Mr. Dickerson says professional references are most important when hiring rheumatologists. Get a 360º perspective on someone by speaking to a reference they provide who was in a supervisory role to them, such as a medical director or chair of a department; in a subordinate role to them, such as a staff or faculty member who reported to the candidate; and one of their peers.
Ms. Taylor always calls two to three professional references and asks both office managers and healthcare providers about a candidate’s work ethic and working relationship with staff. “If the office manager raves about them, they are usually a good pick,” she says. “If they give me one-word answers or can only verify salary and time worked, they may be holding something back. I have to read between the lines.”
Visit Social Media Websites
Checking an applicant’s social media information is a good idea, Mr. Holshouser says, but not without risk.
“If the applicant is rejected, he or she could allege that the employer’s decision was influenced by information concerning the applicant’s protected status reflected in social media, but not otherwise known to the employer, whereas if the applicant’s social media page was never checked, the applicant could not plausibly make that argument,” Mr. Holshouser says. “However, information from social media often provides legitimate job-related information about a candidate, allowing the employer to make a more informed decision.” For example, the applicant’s social media page might identify a prior employer the applicant failed to disclose on their employment application, or it might reveal sexually or racially inappropriate communications or conduct with co-workers or in the workplace.
‘We require candidates to hand deliver their résumé & cover letter. If someone can’t follow a simple direction like that, then that tells us that they aren’t right for the position.’ —Dr. Wei
Mr. Lee advises checking social media, but notes that states are increasingly banning employers from requiring access to employees’ and applicants’ social networking websites. In fact, third parties that perform social media searches may be subject to the Fair Credit Reporting Act.
The Bottom Line
Ms. Taylor says she has hired all types of employees during her 30 years as a hiring manager. “I have hired people who cheat on their time cards, steal toilet paper, steal food in the fridge, embezzle small amounts of money and those who are argumentative nay-sayers,” she says. “This can occur despite great interviews and references. Yet most of our employees are great ones, who work well independently, yet are still team players, and take pride in their work and in this office. If you have a hunch when you are interviewing that something is not right, go with your hunch.”
If any aspect of the hiring process seems concerning, seek the advice of counsel to minimize potential liability on a future failure-to-hire claim, Mr. Lee concludes.
Karen Appold is a medical writer in Pennsylvania.
- Yager F. The cost of bad hiring decisions runs high. Dice Reports. 2012 Jan 5.
- Ruyle KE. Measuring and mitigating the cost of employee turnover. SHRM [the Society for Human Resource Management] webcasts. 2012 Jul 7.