**I = Interviewer
**R = Robert Hickey
Welcome to the D&Y Innovators exchange. A podcast series focusing on medical staff development leaders whose dedication, work ethic, and unique industry approaches have enhanced and inspired their medical staffs to provide the highest levels of clinical service and quality patient outcomes to the communities they serve
With us today is Mr. Robert Hickey, a tenured position recruitment leader with a Kaiser Permanente Mid-Atlantic division to discuss successful recruiting strategies.
I: So, Bob, again, congratulations on 10 fantastic years with Kaiser. All the success you’ve had here is truly exemplary. For someone who is just coming into a physician recruitment or a medical staff development role, as you look back on the last decade, what’s made you and your organization so successful – are there any nuggets of advice or wisdom that you would want to impart on someone who is just stepping into this field as a career move?
R: Probably the biggest thing in any new position is establish very good listening skills.
I: I’m sorry what did you say?
R: Yeah there you go.
So anyways, establish very good listening skills and find out what the market is for the specialty that you’re hiring. And find out what is the most motivation for people in that.
R: So, it sounds very simple, but it’s not. And it’s also a moving target. So, it’s one of those things that I constantly keep my finger on the pulse of and I try to stay ahead of the trends. You know, one of the things in reaching out to residency programs when I first got here everybody kept on saying “contact the residency directors” – They don’t want to hear from you.
R: I’ll tell you who does, is the coordicnate.rs They are the mother hens.
I: That’s a very good point
R: They take care of their doctors and they get to know them very intimately and their family situation and things like that. So we started having these residency dinners right off where we’d contact the program directors, no response, contact the program coordinators and get an amazing response. I’d establish a very good relationship with those coordinators and I’d talk to them from time to time and I’d try and go out to the residency programs’ local programs. But as we shared offline, I provide a list of programs for the candidates they ask in an interview, the reason being is we’re looking for that good match.
High turnover is very expensive for everybody. It’s a lose, lose proposition.
You’re much better off getting somebody to have them stay for their career than have someone be a revolving door.
I: especially if they leave less than 12 months. You’re immensely financially upside down in having that person – even if they practice for 9 months – you’re not in a position for that to be a financial break-even for you guys
R: Absolutely – and here’s the part that’s mind-blowing is the average resident only lasts 2 years on their first job. Reason being they don’t have the right questions to ask and the people interviewing them don’t know the right questions to ask them.
I’ve not found it’s not as much now as it was in 2008 when I first got here, many of the practices misrepresented themselves knowingly. And that’s really disturbing.
That hasn’t happened as much since then because I think that the candidates have gotten a little bit smarter, and did their homework a little bit better to find out why there is a revolving door.
One of the questions I tell every candidate they ask – ask if it’s a new position or if you’re replacing somebody- if you are replacing somebody ask them why – who else has left is the last 2 years if you don’t mind me asking?
Look at their body language, that’s a question you ask face to face, most people don’t do well with the body language.
I: Yeah. And then they also potentially the transition we’ve seen from practice to employment I think also is sort of mitigated a practices ability to misrepresent themselves because now it’s more of a hospital, a health system that’s putting that information out into the marketplace as opposed to a three physician practice
R: There’s some of that but even with the hospitalist groups – early on when I was interviewing with the hospitalist groups – they would ask what’s the sense of the amount of patients I’m gonna see, and they said well we like you to see 15…
Well in reality they were seeing 18-25. So they answered the question, they would like you to see 15, but they never have.
So, asking what is the sense is a snapshot in time, what is it today – what’s the worst it’s ever been, what’s the best it’s ever been?
You almost have to be an attorney to drill down to ask the right questions
I: Well once you get those numbers, those numbers are not subjective
I: We would like you to see 15 patients is incredibly subjective. The actual census, historical and projected is not subjective.
The same thing with the turnover. Why did they leave? Well, the census was too high. Well, why would it be if you’re seeing 15? Well, we’re seeing 25. Ok, that’s a problem
Again, that becomes a big issue.
Again, one of the other changes early on is several of the smaller practices were not under an EMR system – the cost of an EMR system was just through the roof.
I: It’s not viable for them or their practice.
R: No, it’s not.
So what they found was that — you know how to turn on a computer? You’re our IT guy. Which was bad news.
So, the smaller practices could not continue to survive so many of them got bought u by the hospitals.
I: Right, you’re the physician’s spouse, you’re now in charge of coding and AR. And why are we collecting 35% on an annual basis?
R: Right, it was ugly.
And when you take a look at that and that and the whole market changing and again people could afford to be generous when they were making a ton of money, but now we’re much more in accountability management with medicare, the reimbursements and things like that. Everybody’s trying to do more with less resources.
And our success here has been the efficiencies of an integrated model. And now you’re hearing more and more about integration and things like that.
When they came up with the cost bundling, again the question I had was “haven’t we always kinda done that?” and it’s like “well, yeah”
Okay, so some of the things that Kaiser’s been doing for years all of a sudden it’s become the norm in the marketplace.
I: Buzz phrases, like ACO, and IBM and things like you guys have already been on the forefront of, it just didn’t have a very flashy marquee acronym attached to it.
R: Exactly. And quite honestly people didn’t talk about it.
One of the things that you’re successful on your side of the street and I’m successful on my side of the street – we’re fine. There’s no reason to discuss it. It’s when things start to get tight for everybody it’s like hey we gotta get more collaborative here
When you take a look at it, the little mom and pop practice that we grew up with — with either slow proprietor or somebody that had a partner that’s pretty well gone.
I: You talked about, Bob, motivation, in terms of someone stepping into medical staff development as a career. What motivates you and what have you found to be most enjoyable about the last decade of your work for Kaiser.
R: It’s interesting cause it’s kinda changed over time and it really is pretty exciting. One of the things in my background is business. The average physician coming out has 0 business background. So sharing my knowledge is large for retirements and things like that, sharing that type of information with them.
Everybody I’ve ever interviewed, very very smart people, capable, the brain can only hold so much. So they come in on a residency and fellowship and they’re just trying to hang onto everything medically they can. So, it’s been fun and the ability to help people make the right decisions.
And I was trying to be very helpful to them in the beginning but then I also found it was helpful for me because — bottom line is — if I help them make the right decision, then they’re gonna stick longer.
So, over the years….
I: Well that’s scalable, you can transfer that to the next physician you interview, so the next physician in his/her family to relocate to this area.
R: Yes. The other thing too is helping them by setting them up with good real estate agents and very good mortgage people. My background with mortgage finance – one of the guys I refer them to is the to 10 guys in the US.
So, it’s easy there. When they want to call back and say ok this is what I’m doing for the guy, I tell them they don’t need to do that. You know, the bottom line is I send them to you. I’m confident you’re gonna handle it.
So that’s worked out really well, but actually giving the candidates the questions to ask in an interview and tell them use this through every interview you go on. Compare apples to apples. Be confident in the answers you have. I tell everybody there is no legal questions on your part, only on mine, ask absolutely everything you want to know about. We try and define the job and explain the job extremely well to people.
Because we want that good match. And having that good match has made a big difference in our turnover remaining low.
And I constantly talk to our current physicians especially our newer ones. Was it what I represented to you? Is there anything that surprised you either positive or negative when you got here?
And I’ll ask them that with the candidate sitting there. So I lob up for the candidate to ask everybody how long have they been with the organization, what do they like best, there’s no perfect job if you can change one thing what would it be. And if it’s a young physician what surprised you either positively or negatively when you got here.
And I’m almost to the point where I know what the answer is gonna be almost every time. Which is great. What really is cool when they say well they said they’re collegial, they seem to be collegial but man they really are. I think that’s a good test.
The second thing is they said that the in basket could be a bit of a bite and they said that it’s a very robust system and a lot to be done. Our physicians work very hard, but they work very smart.
So, when we’re talking about the cost savings, a large part of that cost savings is working smart. And the medical group is constantly looking to work smarter. We started an innovations committee and that committee is set up with a little light bulb in the corner of your computer so you click on that if you have a suggestion for the organization. It might be something you want to be involved in, or something you think is a good idea.
I’ve made some recommendations with that one. One of the things in the last few years that’s become a big deal is therapy dogs. So I recommend that we consider doing a therapy dog program, and now they are implementing that.
I: Well especially here in the capital I mean it’s… you’re gonna see a lot of it from a military standpoint I think there’s just a lot of good traction that can be gotten from that.
R: There is.
I: From the patient population you have here.
R: Absolutely. One of the things is again meeting the patients where they need to be met. You know what’s important to them. We have social workers, we have our own social workers, pharm D’s.. so we take a very holistic approach to handling the patient.
I don’t know anywhere in the community where you go to the Dermatology and they take your vital signs. We do. Or where they will talk to a woman about getting a screening for their mammo, or a person over 50 where they are getting their fit test.
We take a very holistic approach.
When I got here there was about 456 physicians, now we’re at about 1,600. A large part of those physicians came here with the expectation of staying for a career, and they have.
Which is pretty fun.
I: Incredible feedback. Bob, can’t thank you enough for your time today. One last question. Again, keep referencing your recent anniversary of 10 years… 5 years from now – where would you like to see your career in healthcare?
R: I would like to continue to expand and grow as far as helping the med group expand and grow. Helping the physicians and I actually have figured out by the time I retire, I will have hired half the physicians in the med group.
I: That is super exciting, you should be very excited.
R: Yeah, and honestly I didn’t consider med, you know, becoming a physician as a career.
This is gonna sound a little bit bogus, but it’s not – this is the closest I’m gonna come to saving people’s lives. But what a huge impact when you figure at the point the med group has 4000 physicians and I hired 2000 of them. How cool is that?
I: I mean, Bob, that’s an incredible achievement.
I think to go back to the question of wisdom and feedback that you would give to someone who is just coming into a role like yours, I think that having the understanding of the end result deliverable is a quality patient outcome, is matching up of quality clinician, with that patient and he or she could potentially be at the darkest point in their life; and you’ve connected someone who is very in-depth clinically and also with their bedside manner with someone who again is potentially at the darkest moment that they’ll see. So…
R: That’s true. And you know, honestly our physicians – I really enjoyed meeting with them even afterward a year or two later things like that, the radiology group was 32 when I got here, we’re at 75 now. I hired 60 of them. And they included me in their holiday parties and things like that.
I: Well, sure!
R: and I thanked them, and they said, “Hey, you helped build this!” And it’s very humbling to me. Because quite honestly I just feel like I’m just doing my little piece of the pie. But they are delivering hugely. And we’re the number 1 healthcare delivery system in the nation, that didn’t happen overnight. The bottom line is that enthusiasm has gone amazingly. And if you look at healthcare delivery throughout the US has skyrocketed. So when you take a look at that, when we were 235 out of over 400, now we’re the #1 in over 500. That’s pretty cool.
R: So… neat stuff.
You’ve been listening to the D&Y Innovators Exchange featuring physician recruitment leader Robert Hickey with the Kaiser Permanente Mid-Atlantic division.
Join us next time when we’ll be meeting with the team from Asante Health.
Part 5 of D&Y's exclusive interview series with today's medical staff development leaders