Kyri Ioannou: On the phone with orthopedic physicians. I’m starting to see a drip effect, just not seeing the full blown everybody, but lots of physicians are looking or if they’re not happy they’ll move.
Speaker 2: Welcome to the Growing a Successful Orthopedic Practice Podcast. Join us every episode to hear from fellow medical practice administrators, staff, and physicians as we break down current issues affecting the industry and share real stories from guests on their way to growing a successful orthopedic practice. Let’s get started.
Keith Landry: Hello everyone and welcome to another episode of the Growing a Successful Orthopedic Practice podcast. I’m your host, Keith Landry, and this episode is sponsored by OrthoLive. Let’s get right into it. Today we’re talking about recruiting orthopedic physicians, and maybe you’re that orthopedic physician who’s been hunkering down in place during the pandemic and you’re thinking, “Might be time for me to make my move.” We’re going to talk about that today as well. Tips on recruiting and maybe from the other side of the equation for the physician himself or herself landing the dream job.
We found just the gentlemen to get this done for us today on the podcast, talking with Kyri Ioannou, who is a senior consultant in the orthopedics division with Enterprise Medical Recruiting. Thanks for being with us today.
Kyri Ioannou: You’re welcome, thanks for having me.
Keith Landry: All right Kyri, let me give folks a little background on where you’ve been, what you’ve done, and why you’re on the other side of the microphone today. Kyri started his career in sales with Barclays Bank in London and later received a master’s degree in sports therapy. That focus on sports therapy is especially useful for him when he’s talking with orthopedic physicians. He’s got 10 years experience in healthcare industry. Worked the last five years in physician recruitment and has successfully worked with corporate health systems, community networks, and even those small private practices, so a little something for everyone today. Thanks again for being here.
Kyri Ioannou: I’m glad to be here. Can’t wait.
Keith Landry: All right. Let’s get into it. How long have you been working in the medical recruiting field?
Kyri Ioannou: Like the bio said, the last five years, as most recruiters do, we just fall into it or happen by it. It was just putting the sales background and the healthcare background together is really what it is.
Keith Landry: Wow. Great field too, for the future. When it comes to orthopedic practices, recruiting orthopedic physicians, what are you seeing right now in early 2021? What are the trends you’re observing that you can share with our audience?
Kyri Ioannou: I guess the first thing is, we’re seeing orthopedics open up. I had a Becker’s article probably last month, maybe the month before, orthopedics were, I think, the top three hit specialties within The States, as you can imagine, with electives being shut down. Early 2021 trends, definitely seeing orthopedics open back up. If we dive into that a little bit more, seeing a lot more of the Midwest and Southeast start their recruiting processes earlier. The Northeast, I say dragging behind loosely but their restrictions were a lot tighter, they had a lot of outward migration, which I’m sure has hurt them. The same goes for certain states in the West.
The other thing I’d say that I’ve been seeing, places that maybe were more difficult to recruit to, and I’ll give you an example, are no longer having trouble recruiting. An example that I came across Boise, which is one of the most livable states in the US, a lot of Californians have gone to Boise, which their population has just exploded. I called after a practice there and the internal recruiter there told me that he had 30 applications on his desk, which I’m sure he’s spoiled for riches now.
Keith Landry: You know, it’s funny Kyri, many years ago I lived in Boise, Idaho for a couple of years.
Kyri Ioannou: Did you?
Keith Landry: And the most popular bumper sticker on the car of Idaho residents in Boise was: Don’t Californicate Idaho.
Kyri Ioannou: They’re definitely going through that now.
Keith Landry: They like it small and simple, they didn’t want those Cali folks moving in. But it’s interesting to know that’s been going on for 20 years now. All right, skipping ahead to the next thing I want to get some insights on for our audience. COVID-19 pandemic obviously affected hiring in every sector, every field in the American economy. What have you observed about how the pandemic affected hiring trends in the orthopedics field and where we are now on that? How has the pandemic affected that?
Kyri Ioannou: Yeah. The biggest thing is, every year you’re going to have your graduating classes, your residents and your fellows, so when they’re coming to the end of their terms, they’re mobile. What is not as prevalent is your experienced doctors, they are sitting down waiting to see where things go. They’d rather stick with what they know than go somewhere else, whether it’s culturally or professionally upgrading themselves, their families, and just going somewhere. A lot of them are staying where they are. Again, starting to see some upward trends in mobilization but not anywhere near the levels we would normally expect. With physicians not moving as much, obviously there aren’t as many jobs opening, that cycle just isn’t turning over. On the phone with orthopedic physicians, I’m starting to see a drip effect, just not seeing the full-blown everybody, but lots of physicians are looking or if they’re not happy they’ll move.
Keith Landry: Maybe by the second half of the year as more people are immunized with the vaccination and the economy starts to open back up a little more, maybe we’ll see some more movement on that front.
Kyri Ioannou: One would hope from a recruiting perspective, yeah.
Keith Landry: All right. Let’s switch gears just a little bit here. When you’re helping a medical group recruit a top orthopedic physician, what are the qualities they usually mentioned to you in those initial phone calls while you’re trying to help them identify their need?
Kyri Ioannou: That’s a unique question. It’s really practice-specific, different practices run differently. There’s the typical board certification, whether or not they want a specialist orthopod, whether it’s sports, spine, hand, foot and ankle, what have you. But beyond that it really goes down to the culture and the work ethic of the practice. Some practices may be a little bit more focused on quality of life, that’s the culture that they’ve ingrained into the practice. Others may be a little bit more work heavy, they … Forgive me for using the term, and I hope I don’t offend anybody, but they’re a turn and burn kind of practice, they’re really go-getters, maybe that’s the correct word. They want to maximize their volumes, they want to maximize their efficiency, they want to maximize their surgeries.
They may be pushing for higher numbers of surgical cases per annum whereas more quality of life focused practices are more focused on, “We want to spend time with our family. We think we make a good enough living as an orthopod so we’re okay to back off a little bit.” Beyond that, really just the cultural fit and when I say cultural fit, just personality. What type of person will fit into the practice? If you have a high volume practice will a surgeon who’s not looking to really maximize those volumes day in day out be a fit, and vice versa. How do you feel? Does it really make … What I always ask, “What kind of person are you looking for,” and work backwards from there.
Keith Landry: Awesome. From your perspective, from a recruiter’s perspective, is there something different about helping a medical group recruit an orthopedic surgeon compared to other specialties in medicine?
Kyri Ioannou: Definitely.
Keith Landry: Or is it pretty much the same?
Kyri Ioannou: No, definitely not the same. Very detail driven. Orthopods are very … They’re detail driven, they’re very volumes driven. Something that I come across quite often, and I had an example probably a couple of weeks ago. Whether it’s a private group, medium-sized medical group, or even the larger system, is making sure that you have the need. Sometimes you’ll have a practice saying, “We would like a total joint, we would like a foot and ankle,” but do you actually have the need to supply that surgeon or that physician? If we are looking at your more specialized surgeons, are they going to be able to solely focus on that?
I’ll give you the example, you’re not going to get a lot of hand or upper extremity or foot and ankles wanting to do knee scopes, so making sure that you have the need and you have the data to back it up. Unlike family medicine, and I use that just because it’s a very easy example or primary care, it doesn’t have to be family medicine. The devil’s in the details that they want to hear that you have the need. They can come in and build a practice, whether it’s around that specialty or just build the volumes to make a good living.
Following on from that, that actually helps with longevity because if you’re giving them numbers on the front end that don’t translate on the back end, then what we have is turnover in a lot of cases.
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Keith Landry: Wow, that becomes costly over time with retraining and doing research and all the elements that come with that.
Kyri Ioannou: That’s absolutely right. That’s probably the biggest thing is that a lot of … You tend to see it more in private practices. They know what it costs because they feel the loss of revenues quicker than a larger system, but absolutely right.
Keith Landry: All right. Let’s get to a general 30,000 foot view question here. What is the advice you give to medical practices and how they should best go about recruiting a physician? What’s the checklist or the main points to consider?
Kyri Ioannou: Sure. The first thing that I always ask, getting back to the last point, is why do you have the need? Again, is it that we would just like a total joint surgeon or we absolutely need a total joint surgeon? In recruitment as well, when you want and when you need you tend to act very differently when there’s a candidate in front of you. Again, going back to the lost revenues. Why do we have the need? Can you back up at the need with data? Again, sometimes we don’t have absolute data, and that’s fine, but you can sometimes tend to get a feel from just speaking with the practice for is this a want or is this an absolute need? Are we bringing someone in where we’re putting all the expectation on them to build, or we’re going to give them all the tools to be successful? Again, wants versus needs. The need is the biggest one, the data.
And then again, I go into what type of personality of person are we looking for? Because every surgeon is different but, I hesitate to say, potentially you can classify, again if you’re more quality of life focused versus your volume driven, and there’s gray areas. What type of person is going to fit into the practice? Going on from there, what is globally offered? A lot of times we get the answer straight away, employment versus a private practice. Employment you don’t actually have the ancillary revenues that are associated with imaging or an ASC, but if you do have ancillary revenues, ancillary incomes, whether it’s profit sharing, ASC incomes, what does that look like? Sometimes groups don’t want to be transparent about that, and for recruiting we don’t need to know down to the Nth degree.
But I’ve been in situations with private groups where they only actually own, between eight of them, and I’m using it as an example, but let’s say between eight of them they only own 25% of their surgery center, so getting someone else, and again it really dilutes the pool. But if you are on the other side and you own 50%, 75%, even 100% of an ASC, that’s something that’s actually very attractive to physicians, so you want to advertise to them. And again, what you’re doing in advertising, and I think this is lost on a lot of practices, is we’re really just trying to elicit a phone call. We want to speak … It doesn’t mean that every person we talk to is going to be a fit for whatever reason. Those are really probably the biggest things.
Transparency is another one, transparency of compensation when taking that larger view. Again, on both sides, private or employed, sometimes they’re hesitant to share compensation. In recruiting, typically in a lot of cases if you’re hesitant to share compensation, sometimes it gives the wrong impression that the compensation is poor. Again, highlight your top points. If you don’t want to get into the compensation, even percentages of MGMA help.
Keith Landry: That raises a question for me that I hadn’t thought of before the podcast. When you’re getting down to the nitty gritty and you almost have a deal that’s done, obviously the compensation is probably question number one, but I imagine there are some other elements that put the agreement over the top versus not. What are some of those? Compensation, maybe ownership in the group, things like that.
Kyri Ioannou: Yeah. Really we’re looking at a couple of points there. Yes, your base salary. If it’s on the employed side it tends to be a little bit more of a hospital or a system package. There aren’t a lot of differences and most times you can’t actually make a lot of changes to a boilerplate agreement. 90%, 95% of physicians have all signed the same thing, you won’t have 200 separate contracts, that would be a legal nightmare. But on the employed side, a lot of times making sure that the RVU threshold and the RVU dollar amount equate to the total compensation. Employed hospitals sometimes give a bonus, so you’ll actually find that the RVU threshold and the dollar amount don’t quite add up to the total compensation but you’re actually getting maybe it could be sometimes a $20,000 boost, or whatever it may be.
On the private practice side, really it’s so much more open. But you’re actually right, how many years are we looking to obtain partnership? What is the transparency of obtaining partnership? Is it that everybody in the group has to agree? If we have eight partners, does every single partner have to agree or is it a majority, and what are the details of that? Yes, percentages, compensation, benefits. This is going to sound maybe a little bit strange, but some private practices you have to pay for your own malpractice. That’s becoming less and less prevalent, but reading those details, knowing those details.
What is the likelihood or what is the ramp up? Typically it’s six to 12 months to ramp up, you’re bonusing in year two, but what is the two- to five-year plan? What does that realistically look like? That also gets back to is this a need or is it a want? Because if it’s a need we should be able to paint a picture of, in two years this is what we expect, in three years. If it’s a one it starts to look like, “Well, we hope. This is what we hope it looks like.” Yeah, just some of the finer details.
I always like to look at it like this, I always call it shared risk. When you’re getting into a contract, if all the risk is on the doctor they tend to feel a little bit antsy, whether there’s penalties for compensation, whatever it may be. But if there’s a shared risk, we’re going to put a moderate or sometimes even aggressive financial package together, but in doing this we expect this, and then there’s a shared risk as opposed to low compensation versus we expect you to go out there and do everything.
Keith Landry: Yeah. If you look at it from the perspective of the orthopedic physician, he or she is a highly skilled professional.
Kyri Ioannou: Very.
Keith Landry: Who wants to feel welcome where they’re going, so they don’t want all the burden to be on them.
Kyri Ioannou: Right.
Keith Landry: All right, so Kyri let’s switch gears just a little bit. Talk about diversity in the workforce. Obviously a major push in our country for diversity in many companies across many sectors. How are you seeing that reflected in your recruiting picture, and are you seeing a more diverse pool of candidates in 2021 as you work to recruit orthopedic physicians or do we still have a long way to go in terms of diversifying that pool of professionals?
Kyri Ioannou: Yeah. Culturally I think, from what I feel, and I apologize that I don’t necessarily have the data to back this up, but culturally I feel that the orthopedic market is fairly diverse. If we’re looking at gender demographics it’s probably a little bit less so, and there maybe needs to dig into why, going back to whether it’s from coming out of med school, what residencies are chosen. But the orthopedic world is very male dominant. I’ve heard a couple reasons that’s possible, and I don’t think it’s down to skillset.
I’ve heard that a lot of females don’t like the breaking of bones if they’re doing a total joint. Again, I don’t know if that’s the absolute truth. What I have heard from a surgeon is that the orthopedic world is a lot more physically demanding when doing surgeries and you actually have to have the strength. If we’re looking at differences there, then yes that may be a reason, but overall it is a male dominated specialty. Again, I don’t feel that’s through exclusionary factors, but I would say we would definitely have to look into that.
Looking on the other side of it though, if you are a female orthopedic surgeon, very much more marketable because they’re more rare in the field. Females generally like to see female doctors, so if you are a female orthopedic surgeon a lot of times the patient is researching surgeons within a practice, they’re naturally going to gravitate towards the female as long as they can meet their surgery needs.
Keith Landry: Interesting. Okay, let’s switch gears just a second. I want to give our audience … Most of our listeners on this podcast are either physicians or practice managers so I want to make sure we get the other side of this ice cream sandwich.
Kyri Ioannou: Sure.
Keith Landry: For orthopedic physicians who maybe have been sheltering in place so to speak during the pandemic, they see the sun is coming out and the economy is starting to pick up again and they’re starting to think about making their move. Do you help those physicians find the dream job as well or is the focus more on the employer?
Kyri Ioannou: That’s a great question. It depends on what side of the business you’re on. In recruiting we have two sides of the business, you have a retain side which is similar to how you would retain an attorney or an accountant. On the retain side you’re very much client focused, you’re trying to find the dream physician for the client. On the contingent side you’re working more of a physician focus, so we speak to physicians and then we go out and we market them and try to find them … I hate to use the word dream, sometimes it is dream, but we try to find them a suitable job or an ideal job based on … Contingent, let’s say, on their situation.
But yes, if we’re working on the contingent side it’s more acting almost as a quasi agent. I hate to use the word agent, but it is somewhat like an agent. We speak to a physician, we get their situation, what they’re looking for, experience, history, et cetera, and then we’re actually working on their behalf. A lot of times they call in about a specific job and we speak with them about that position, but then we go out and we network in the area and try to find other jobs that are suitable. Like I said, the retain side of the business is just the opposite. We’re very much client focused and we have one job, but multiple candidates and we’re trying to find that fit. The contingent side is just exactly the opposite.
Keith Landry: All right, awesome. What else would you like to add to that? I think we’ve given some great insights on recruiting orthopedic physicians. What else do you want to add?
Kyri Ioannou: Yeah. I guess the biggest thing that I see within recruiting, it hasn’t just been in orthopedics, but the ability to be flexible. I think we’re starting to see more flexibility with a lot more people working remote. And be realistic about what you’re looking for. If you’re looking for a million dollar job, let’s say, in Miami within the first two years, the location and the compensation just aren’t going to add up. Also with highly competitive areas you’re going to be going into a lot more surgeons so it’s harder to find that role. Just balancing compensation versus location and how quickly you’re looking to build with total revenues. That’s really what I see a lot of. People wanting downtown Atlanta, a million dollar job.
Keith Landry: [crosstalk]
Kyri Ioannou: Yeah, I’ll tell you what. But just having that flexibility to really consider what you’re looking for and do they match, because a lot of times what we want and what reality is are sometimes different things. But that flexibility, a lot of times you can find a balance in the middle and those are the jobs where you’re going to be happy longterm, volume wise you’re going to fill your books, and then if those two things are taken care of, I would say compensation is going to come.
Keith Landry: That’s awesome. Kyri Ioannou with Enterprise Medical Recruiting. Some awesome insights here today. I want to thank you so much for sharing your insights and experience and tips with our audience, and thanks again for being here.
Kyri Ioannou: Yeah, you’re more than welcome. I appreciate it.
Keith Landry: You bet. That’s a wrap on another episode of the Growing a Successful Orthopedic Practice podcast. I’m Keith Landry. We’ll do it again soon.
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