20 July 2010

Here we go again

Back in the day when we were a small group, we were what you would say is "very stable."  People came and tended to stay for a long time, and we had very few job openings due to people leaving.  The jobs that we created were usually due to volume growth and the occasional retirement.

So recruiting was a simple affair, conducted once a year. We figured out how many new docs we would need and recruited them out of residency.  They started in July and we could forget about it until the following year.

But once we hit a certain size threshold, it suddenly became apparent that attrition was going to become a more prominent factor in our staffing.  When there are fifteen docs in a group, stability is the norm. When you are up to thirty, things seem to happen with more frequency. People get sick. They decide to move back East or back to California to be with family. They decide that Emergency Medicine is just not the right career for them.  They have kids and decide to go half-time. Life happens, and as a result we start hiring to replace as much as to expand. (The one good thing is that we almost never have docs leave to go work for a local competitor.)

Still, we kept on our once-a-year recruiting schedule, just now with larger numbers of hires. As you get a little short-staffed during the year, you suck it up until the new crop of docs shows up over the summer.  And in July, watch out! A bunch of wide-eyed new attendings hit the floor all at once.

But we continued to grow. Now we are up to 45 docs, and we have had to switch to a more continuous hiring cycle.  We just can't afford to wait until July and get all our new staff at one time. So it's like a treadmill, reviewing CVs and interviewing and reference checks, we keep going and going and going.

I actually don't mind -- it's a lot of work but it's fun and it's important. I have now personally hired over half the docs in our group and it's very satisfying to see what a great group of physicians and people they have turned out to be.

We are just finishing orienting the summer hires and are collecting CVs for fall/winter hires. If you are an ER residency-trained doc interested in working in a large community-based democratic practice in the Pacific Northwest, feel free to email me and I will tell you more about the practice and the opportunities here.

And now I'm off to check some references.  Here we go again...


  1. Hi! I've really enjoyed reading and learning from your blog. Is it common for practices to grow to this size? I thought the solo physician practice was still the norm, although it was becoming less common more recently.
    Good luck with the recruiting!

  2. ER practices have pretty much always been group practices, due to the need to fill a schedule and the need to negotiate with a hospital, there has to be a group.

    Some groups employ their docs as independent contractors, but even those are still group practices.

    45 docs is pretty big for an ER group, but we staff the busiest hospital ER in our state and another smaller one, so it makes sense.

    Sadly the solo practice of medicine is just about gone. Even small group practices of 2-6 docs are fairly uncommon now. There are some left, but the consolidation of medical practices has been sweeping the nation for two decades or more. It's less fun, but the economics make such arrangements much more sustainable.

  3. Hi Doc,

    Have your blog on my short list. Really enjoy it. Couple of ?'s...

    Do you use a 'fast track' type clinic as an adjunct to your ER(s)?

    Do you use mid-levels in your system?

    If not, I'm curious as to why not.

  4. Yes, we do use PAs in a fast track -- it's absolutely essential. PAs are cheaper and offer good quality so long as you keep them in a scope of practice that is within their comfort zone.

  5. I am a regular reader of your blog as well and have a question for you...Does your group ever use a Search Firm? FYI: This is not for solicitation purposes. I am a recruiter (currently Construction Management) and have been pondering a switch so I am trying to do as much research as I can to determine which field if any I want to specialize in. Thank you and keep up the great posts!!


Note: Only a member of this blog may post a comment.