Make a Great Catch

When hiring a colleague, it's not enough to respect clinical skills and have similar philosophies about caring for patients. You have to connect on that hard-to-define level called "fit."

By Christine Hinz | 411 | May/June 2004


It didn’t take Fredric Serota, MD, and Jo Ann Serota, a pediatric nurse practitioner, long to realize that they hadn’t hired the right person for their Ambler, Pennsylvania pediatrics group. On paper, the physician certainly looked impressive. With a PhD in microbiology, he’d obviously honed his scientific skills before going off to medical school. But the ink had barely dried on their one-year contract when the Serotas saw a spoiler in their midst. Instead of feeling his way and learning their system, he came in with his own agenda, ready to make change. “He alienated everyone,” says Jo Ann Serota. “He felt he knew more than the rest of us.”

Perhaps you’ve had the same chilling realization. Hiring competent professionals who will be the right “fit” for your practice is the most challenging management task you’ll ever face. You want colleagues adept in their clinical skills and attuned to your philosophy of medicine. But they should also mesh with your group. Obviously, there’s no foolproof system for selecting the professionals—doctors, physician’s assistants (PAs) or nurse practitioners (NPs)—on your staff. Gut instincts may give you a heads-up, but letting intuition alone drive your decision-making could hook you a misfit who knows how to ace an interview. As Fredric Serota observes of the doctor he hired: “He was more of a laboratory type. He really didn’t have the fiber to be a general pediatrician.”

Similarly, you don’t want to be blinded by someone’s solid gold credentials. An Ivy-league background may cast a glow over your candidate’s resume but the challenge is to get beyond a program’s glowing reputation to assess its graduate fairly. Too often, says Sharon Buchbinder, PhD, RN, an associate professor and the coordinator of the health-care management program at Towson University in Maryland, interviewers fail to separate the two enough to realize “I don’t want to work with that jerk every day. He’s believing his own press releases.”

Caveat emptor

So how do you prevent buyer’s remorse? Industrial psychologists will tell you that the hiring process should be used to spot the best performer for the job—not the best personality for the office. They even suggest a systematized approach—the “structured interview”—to reveal if a candidate exhibits core competencies and behaviors necessary to be a standout on the job. You might argue, however, that persona is so much a part of someone’s package—and so important to your esprit de corps—that you want to get a handle on those characteristics, too. Will he be moody? Will she be a complainer? Can either find humor when the going gets tough?

Of course, you can’t measure every iota of a personality any more than you can gauge every intangible aspect of a job, but there are ways to get value-added information without sharing your office or tapping your intuition. The trick is to identify what you consider part and parcel of a right fit, then build your interview around that.

The good news is that the same type of open-ended questions experts recommend asking to see if a candidate has the clinical or “hard” skills for the job can be adapted to “soft” attributes as well. By using behavioral—”Tell-me-about-a-time-when. . .”—or situational—”What-would-you-do-if…”—formats, you not only can determine if someone shares your practice values and goals, but will get along within the group.

“People will often say, “I’ll know it when I see it,” says Ann Marie Ryan, PhD, a professor of psychology at Michigan State University. “But without being specific, you really don’t know what you’re looking for in a candidate. That’s why a structured interview is important. You’re making it concrete.”

For instance, candidates who interview at Colorado Permanente Medical Group in Denver meet with a cultural fit team, a small cadre of physicians whose objective is to see if they fit the “physician-as-leader” patient care model of the 700-member practice. By asking questions like, “Tell me about the last time you went over the top for a patient,” these volunteers have learned, for example, how one young doctor arranged a necessary procedure for his uninsured patient, even convincing a specialist to do it. Another made house calls on an elderly patient throughout training.

“It can be very instructive to find out what someone thinks is over the top,” says Patricia Fahy, MD, the associate medical director of human resources at Colorado Permanente and the concept’s architect. “If it’s something I’d expect as routine, that’s important information. But if it’s something extraordinary—and this person seems committed to doing it on a regular basis—that’s wonderful information!”

Similarly, when Michael Fleming, MD, the president of the American Academy of Family Physicians, interviews candidates for his Shreveport, Louisiana, practice, he poses questions that get to the heart of the matter: “It’s 10 minutes to 5 when you get a call from a mother about her child’s 103-degree temperature. It will take her 20 minutes to get here but the office is about to close. What do you do?” For Fleming, whose practice includes 10 MDs and two PA colleagues, there’s only one acceptable answer. And it’s not, as some candidates have suggested, refer her to the nearest emergency room. “If I hear anything other than ‘I’ll wait so I can see this child,'” he says, “I probably don’t want to hire this person.”

Of course, your candidate isn’t going to mimic your words, unless he is clairvoyant. But, like Fleming, by thinking out an acceptable answer, you’ll know what you want to hear. “It’s a mistake to throw out a question without having a clear sense of what you consider favorable and unfavorable responses,” says Andrew Garman, PsyD, an associate professor in health systems management at Rush University Medical Center in Chicago. “My rule of thumb is if you don’t know, then drop it.”

Other hiring experts agree that it’s not just the answers that should concern you; it’s the questions you ask, too. Queries such as “What are your strengths and weaknesses?” and “What is your career goal?” are unlikely, they say, to tell you much about this person’s capacity to do the tasks at hand. They’re also such expected questions that most savvy interviewees are ready for them.

Yet, you may disagree. When Dale Buchbinder, MD, the chairman of surgery at Greater Baltimore Medical Center, is looking for physicians to staff his surgical practice or hospital service, he asks candidates to name their weaknesses. Buchbinder isn’t so interested in hearing that this person is a micromanager or delegates too much. What’s important to him is for the individual to recognize a particular Achilles heel and be able to overcome it. “Those are insights I like to hear about,” he says. “Somebody who can’t tell me that they have any weaknesses either isn’t willing to admit a mistake or has too much of an ego. Those I worry about.”

Similarly, when Fleming interviews candidates for his practice, one of the open-ended questions he asks virtually every time is “What are your expectations? Tell me where you want to be in 10 years.” He thinks vision is so important that he wants to know if this person can articulate a strategy for her own professional life. “I want somebody whose values and vision fit into our culture,” he says. “Working closely together is much like a marriage. If you don’t fit, it becomes very difficult.”

Indeed, finding a person whose temperament jives with those of your team could be your most daunting interviewing task. Hiring gurus caution about remaining objective throughout the process, but especially when you’re evaluating persona. As one expert notes: “We’re not saying hire people you hate. What we’re saying is don’t hire people just because you like them.”


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