The process of hiring a new physician has become riskier and more complicated in recent years. For today's physicians, safety in numbers and the perceived economic gains of a larger group setting often take precedence over the autonomy of a solo- or two-physician practice. They want professional security and attractive starting salaries, of course, but often they also want less responsibility. And they don't see their careers as the center of their lives; they want to spend more time with family and friends and have the freedom to explore personal pursuits.

Consider these examples:

• A group in California was struggling to recover from a hiring decision it made nine months earlier. The group had recruited a highly skilled physician from an East Coast residency program. The physician was at the top of his class and was excited to join this West Coast practice. Unfortunately, his wife, who was from New York, was less enamored with the move. The practice did everything to welcome the physician and his family, the patients and the medical community embraced him and he was easily meeting the group's performance expectations. However, his wife was unable to adjust to life in California and missed her family and life in the city. Within six months, it was clear that she could not make the adjustment, and the physician found a new position in a metropolitan area on the East Coast.

• A solo physician in his 50s hired a new physician. The solo physician planned to slow down, cut his schedule and eventually make the new physician a partner. However, during the selection process he didn't make his expectations clear. After the new physician was hired, it became clear that she hadn't planned on working that hard. She wanted a schedule like the solo physician's. They clashed, and within six months the new physician left and joined an HMO.

You can avoid similar outcomes by conducting a cautious and deliberate search for a new physician. Here's how:

The selection process

You will increase your odds of selecting the right physician for your practice by carefully evaluating each candidate during the selection process and choosing a candidate who is a good fit for the position and the practice. Generally, the selection process includes these six steps: review what you're looking for in a new physician, review the applicants' curricula vitae (CVs), conduct telephone interviews, conduct face-to-face interviews, conduct a post-interview analysis and handle negotiations and contract signing.

Review what you're looking for in a new physician. When you and your partners decided that hiring an additional physician would be financially viable, you probably talked about the skills you'd want that person to bring to the practice. For example, you may have decided that a physician with expertise in sports medicine or geriatrics might complement the skills of other physicians in your practice. Or perhaps you thought an Hispanic physician would help you reach a cultural group that's underrepresented in your practice. If you and your partners haven't had this discussion, now is the time; if you have, does what you decided still make sense?

Review the applicants' CVs. Take a critical look at each CV. Determine which candidates have the credentials you've deemed necessary for the position (e.g., board-eligibility or board-certification). But don't just look at where the candidate went to school and completed residency training; also look for any inaccuracies, misspelled words or typos in the CV. If the candidate has not taken care in preparing a document as important as his or her CV, you might wonder how cautious he or she is in other areas of written documentation.

Now rate the CVs and the applicants' qualifications, and select the 10 most promising candidates to further screen over the telephone.

Conduct telephone interviews. Telephone interviews enable you to gather additional information, form a cursory opinion of each candidate and decide whom you want to interview in person.

Start critiquing each person from the onset of the call. Is the candidate's telephone manner what you would want your patients and colleagues to hear when they call your practice? Ask questions, such as the ones listed below, that will help you learn a little bit more about each candidate:

• What kind of position is the candidate looking for, and what are his or her goals? Are the candidate's expectations realistic? Do his or her goals match the opportunity you have to offer? When you describe the position to the candidate, do you detect skepticism or enthusiasm? If the candidate is coming from another practice, why is he or she leaving?

• What appeals to the candidate about this position? Is it the location, size or reputation of the practice? Does he or she know someone in the practice?

• What are the candidate's requirements for the position? Does he or she have expectations about the minimum number of days off or the call schedule? If so, do the expectations match what you have in mind? How flexible is the candidate?

• Does the candidate have the specific clinical qualifications you're looking for? How would his or her clinical strengths complement the other physicians in the practice?

• When would the candidate be available to start?

Once you've gathered information from the telephone interviews, select the five most suitable candidates, and invite them to the office for face-to-face interviews. Consider ruling out any candidate who's playing hard to get; this could mean the physician would be difficult to please or may have an unrealistic opinion of his or her value. Your first impressions are important. After all, your colleagues, the community and the patients you serve will be forming opinions from the first impression on.

Conduct face-to-face interviews. Hold the interviews in a private setting that is comfortable, free from interruptions and conducive to open conversation. Be sure to allow adequate time for each candidate. Use the face-to-face interviews to develop a “personal profile” that will help you further evaluate each candidate. The personal profile should identify certain philosophical and psychological aspects of each candidate's personality. Here are some questions to ask yourself and the candidates during the face-to-face interviews that will help you form personal profiles:

• How does the candidate appear? Does the candidate present in a confident manner? Is he or she prompt, well prepared and dressed appropriately for an interview? Does he or she ask intelligent questions and have desirable “people skills”? Is the candidate a good communicator who will blend well with the existing physician philosophy toward staff and patients?

• What are the candidate's career and personal aspirations, and what is he or she looking for in a job opportunity? Find out as much as you can about the candidate's future plans. What appeals to the candidate? For example, is a high starting salary more appealing than joining physicians who are revered in the community and have the latest diagnostic and technological tools but who offer a lower starting salary?

• What influences the candidate's decisions? The three major types of factors that influence personal choices and decision making for job recruits are geographic, professional and economic. (See “Finding a match.”) Ask candidates to rate the factors in order of importance to them. Can your practice support the candidates' wants and needs? Discuss the rationale behind the ratings with each candidate to develop a better understanding of the candidate and what's important to him or her.

• How ambitious is the candidate? If the candidate wants to be on the cutting edge of new clinical developments, small-town opportunities may lead to boredom and frustration. He or she may prefer to join a group that's affiliated with an academic center or involved in research and is large enough to offer management opportunities.

• Is the candidate a leader or a follower? Is the candidate currently involved in organized medicine? Did he or she take on leadership roles during education and training? A leader is comfortable in most situations, knowing he or she will influence decisions and the direction of the practice. A follower, on the other hand, must pay close attention to the existing culture and leadership philosophy. He or she is buying into that culture and will not have as much of an impact on how it shifts over time.

• Is the candidate risk averse or a risk taker? A risk taker may be willing to buy into a young practice that's struggling with competition. On the other hand, someone who is risk averse may want the shelter and perceived security of working for a long-established practice or staff-model HMO for a guaranteed salary.

• Is the candidate civic-minded? Has the candidate contributed to the community in which he or she currently lives? What are the candidate's personal interests and hobbies?

Conduct a post-interview analysis. Once the interviews are complete, verify the credentials of the remaining candidates by calling the medical schools, residency programs and previous employers listed on the CVs. Then, discuss with your partners how each candidate's strengths and weaknesses would fit with your practice's specific needs and goals. When you're making your final decision, remember that chemistry is very important too!

Handle negotiations and contract signing. When you begin negotiating a contract, go into it knowing in which areas you will and will not be able to compromise. Give and take is essential, but be sure you're giving only in the areas that are acceptable for the practice in the long run. Take great care throughout the entire negotiation process, and seek legal counsel to develop a final agreement that is fair to both parties.

It's not always easy

Selecting the right physician candidate for your practice is not easy, and there's always an element of the unknown. However, you can increase your odds for success by carefully evaluating each candidate in relationship to the needs of the practice and the specific position you have to offer.