Sometimes it’s who you don’t hire that matters most. They might be great clinicians, but poisonous personalities can infect your entire department.
It’s that time of year again when residents are looking for jobs, and I’m trying to identify the best candidate to bring into my group. What hiring tips can you offer?
Lost in the CVs
Building a team is one of the most important components of a medical director’s job, and it starts with finding the right people. Many factors come into play in this process, but in many ways it starts with timing. For instance, new grads are unlikely to be available to start in the fall, so if you’re in a staffing nightmare, you’ll need to look for experienced docs. On the other hand, if you can wait until July, the energy and current practice style that new grads bring can be very good for the department. While the applicant pool is typically larger for new grads, keep in mind the experience level of your group and recent hiring history. If over the last two years you’ve hired a lot of docs fresh out of residency, it may be beneficial to look for a more experienced doc who can serve as a mentor.
What to Avoid
When I was in a fraternity in college, we looked for “good guys” to join us, and since becoming a medical director, my philosophy hasn’t changed much: make hiring the best people your highest priority. That might seem obvious, but what is more difficult is knowing the kind of candidate to fastidiously avoid. Stanford University professor, Dr. Robert Sutton, described the scenario perfectly in his book called “The No Asshole Rule.” So before I get started, a brief word about profanity. My mother always told me that people curse because they have a limited vocabulary, and I’ve written in the past about limiting profanity in the ED. However, sometimes no other synonyms (jerk? bully?) quite cut it.
Dr. Sutton points out that it can only take the hiring of one asshole (AH) to ruin a group. If we’re honest about our organization, we all realize it’s the jerks who take up most of our administrative time by causing patient complaints, damaging relationships within the hospital (whether it is with a nurse or a consultant), and interfering with the esprit de corps within the physician group. While there are numerous lessons to learn in Dr. Sutton’s book, there are two key components to understand initially. The first is his two part AH test. “Test one: After talking to the alleged asshole, does the “target” feel oppressed, humiliated, de-energized, or belittled by the person? In particular, does the target feel worse about him- or herself? Test two: Does the alleged asshole aim his or her venom at people who are less powerful rather than at those people who are more powerful?” Based on these questions, I’m sure you can think of numerous people that you’ve worked with in the hospital. Next, we need to recognize that a person can be either a “temporary” AH (an occasional or one time episode when we are placed in situations under the wrong conditions) or a “certified AH,” where they show a persistent pattern of behaviors of belittling, putting down, humiliating or disrespecting. We probably all achieve the temporary status, but we need to avoid hiring the certified ones.
Many people have categorized employees into high, medium, and low performers, or A, B or C team players. Obviously, we’re always looking for the high performer or someone from the A Team. These are the people that everyone loves—patients, nurses, administrators, consultants—and they get the work done with super productivity and high quality. Let’s be honest though – that’s not a huge proportion of available docs. There are plenty of medium performers. I’ve come to appreciate them more and more. They show up on time, keep their head above water, and don’t generate complaints from patients and consultants. But you probably can’t afford to have a whole staff of them or your ED will always be average. While C team players are below average in many ways, they still differ from the AH, who may be very productive with high quality, but whose personality will toxify your department.
The interview is the most important part of the recruitment process in my mind. Unless you know the applicant through another channel, it’s likely the best opportunity you’ll have to gauge their personality and fit within the group. Strangely enough, most of us have never had any formal training about how to conduct a job interview. I stay away from the standard questions that people prepare for—such as strengths and weaknesses. I might ask them about why they’re interested in my facility or group or even my city and why I should hire them. Mostly, however, I’m talking about the job, and trying to engage them in a conversation that, over two hours, allows me to evaluate their personality, enthusiasm in their work, energy level, and commitment to medicine. During the interview, I also lay out very clear expectations of the emergency physician’s role and performance in the ED. These include metrics (productivity, patient satisfaction, core measure achievement); relationships within the hospital; night, weekend, and holiday coverage; and expected behaviors. I try to explain the culture and how evaluations are handled so they can see for themselves if they would be a good fit or not. Of course, I’m also “selling” my ED and why they should work here versus another facility. Even if I won’t hire them, they need to leave with the impression that my ED is the best place to work. I generally am confident that most residents come out of training with the proper knowledge to be an attending, and that I have enough confidence in myself and my colleagues to serve as mentors to improve their productivity. So, what I’m ultimately looking for is the person with the right attitude, without signs of prima donna status, assholeness, or anything else that could be detrimental to the workplace.
For those that I’m very interested in hiring, I usually follow up with a phone call to get to know them better. I also ask the candidate to talk to one or two of my docs and then I’ll get their take on the candidate, too. After a two-hour interview and 30-60 minutes on the phone, I generally know if the person has the right or wrong personality for the job.
Have you ever spoken to a residency director who didn’t tell you their resident was the best, fastest, nicest, etc…? Even from a very good friend of mine who was a long time residency director, I rarely got anything helpful when he served as an official reference. After all, their job is to get their residents good jobs. One tip when you check references is to ask slightly different questions. How does this resident compare to their peers? Is productivity tracked and how do they perform? Any complaints or reports of negative interactions with patients or nurses?
What is particularly helpful is when you can call someone who works with the individual and is not on their reference list. These conversations can help you understand the applicant’s unofficial strengths and weaknesses. I use my network of contacts at teaching centers to get the skinny on residents, and I also speak with colleagues and friends in my metropolitan area to understand why experienced docs are looking elsewhere.
Just as our gut instinct teaches us to recognize drug seekers or the patient with a subtle presentation of a critical illness, we need to recognize people that can be a toxic addition to our group. We interact with almost every aspect of the hospital, and as a contracted service, we’re fairly easy to replace. It may not be possible to only hire “A” team players, and we can cover up under-performers, but it’s suicide to add an asshole to the mix in the ED. Spend time with your job candidates, clearly explain performance expectations, look for red flags in their personality, and get at least one other person from your group involved in the evaluation process.
Michael Silverman, MD, is a member of Emergency Medicine Associates and is chairman of emergency medicine at the Virginia Hospital Center.