The well-known JAMA study by Dorsey et al. and other research has shown that the "controllable lifestyle" factor often drives which specialties graduating medical students select. After their training is completed, new physicians often tend to seek opportunities with as many "controlled lifestyle" features as they can negotiate. Many candidates seek generous vacation policies. They respond positively to employers offering some flexibility on issues such as work hours, call schedules and job sharing. In fact, a growing number of physicians are interested in alternatives to working full-time, such as job-sharing or other part-time arrangements. On top of significant flexibility, candidates often expect compensation levels approaching those of experienced physicians and shorter time-to-partnership periods than were typical in the past. As a result of the latter demand, time-to-partnership trends are now firmly entrenched at two years or less across the spectrum of specialties.

It should not be a surprise when experienced physicians throw up their hands in response to these attitudes and say, "I don’t want to hear about work-life balance. No one did anything for us. Why do we have to be so flexible now that we’re hiring?"

Such responses, while easy to understand, only compound a practice’s hiring challenges. The more realistic employers are as they interface with the labor market, the better their chances of successfully filling positions. It is important to educate physicians on search committees who persist in belief that entry-level candidates for whom work-life balance is not an issue should be readily available, and easy to recruit and hire, about the realities of the labor force.

On the positive side, hiring organizations often find that if they address a broader range of preferences typical among younger physicians, they can create employment situations that work for everyone involved. To establish a culture and hiring process conducive to successful recruitment of young physicians, consider the following.

Understand the culture that has influenced younger workers in every field, including medicine. Today’s Gen X workers came of age seeing their parents and other adults laid off. As a result, they are skeptical of organizational loyalty. They tend to be focused on developing skills that they can use to successfully move from one employment situation to another, rather than being willing to pay dues to an organization, work to help address its problems or invest time prior to receiving high-level compensation and partnership.

These physicians grew up in a culture with a strong focus on leisure time and personal interests, which they may have and expect to pursue. In addition to their own personal interests, young married physicians often face spousal expectations of levels of family involvement that, at least for men, did not exist a generation ago. Those who have professional spouses know that they may have to relocate because of their spouses’ careers, further discouraging the concept of strong loyalty to an organization. In addition, most young physicians have high educational debt loads, making them averse to financial risk.

Be aware of the influence of geography on career decisions, and of the impact of the growing physician shortage on hiring. Younger physicians tend to believe that they can easily find the jobs they want in the geographic locations they prefer. Often, they are right. An employer located in a less-than-hot geographic location may have to make more compromises to hire a physician who brings the desired skills and the right cultural fit for the organization. As shortages in many specialties increase, this situation is likely to intensify.

In November 2003, the American Medical News reported that the Council on Graduate Medical Education had adopted a report by Ed Salsberg, executive director of the Center for Workforce Studies at the State University of New York in Albany. Salsberg projects a shortage of 85,000 physicians by 2020. Richard Cooper et al published an assessment of the physician labor including population growth, physicians’ work effort, economic expansion, and services provided by non-physician clinicians. This model reports an expected shortage of 200,000 physicians by 2020. Whichever of the two models is more accurate, it is clear that the health care industry is entering a lengthy period of challenges in physician recruitment.

A broad range of Gen X characteristics should be considered when developing physician recruitment strategies. These characteristics include the following.

Gen X workers place a high value on relationships and mentoring.

Reflecting this value, many Gen X physicians appreciate organizations that provide strong orientation and mentoring programs. Responding to this value, however, also can produce positive results for an organization in terms of productivity and longer-term loyalty from young physicians than might be expected otherwise. A strong and well-implemented mentoring program:

· Helps communicate the organization’s mission and vision to a new hire.

· Helps the new hire learn decision-making skills.

· Helps him or her cut through organizational red tape.

· Facilitates development of roots within the organization.

· Provides the reassurance of a "buddy" within the organization.

If presented effectively late in the recruitment stage, with introductions to physicians who serve as mentors, etc., a mentoring program can also contribute to success in recruitment as well as retention.

A relationship-oriented approach to recruitment helps reinforce in a candidate’s mind the fact that an organization has a strong relationship culture. Basics of such an approach include:

· Prompt follow-up when candidates call.

· A thorough and positive process for those who come to interview and their spouses, who should also participate.

· Effective handling of the pre-employment phase after an offer is accepted.

If you are using a search consulting firm, it is essential to make the firm your partner in a strong, relationship-oriented approach to physician recruitment. Giving the firm in-depth, honest information about your organization and about your ideal candidate will help its recruiters cultivate in-depth relationships with candidates that will reinforce their positive impressions of your organization.

Gen X physicians like organizations that will help them build marketable, portable skill sets that will help enhance their future career success. An effectively managed mentoring program also helps address this aspect of the Gen X worldview. Mentoring programs that help physicians build portable skills in areas such as decision-making, coding, maximizing collections, etc. Also, the more quickly and thoroughly they understand all of the organization’s internal practice management procedures, the easier it becomes for them to achieve high productivity. They also can more easily identify ways of conducting their practices that would allow them to be more efficient and effective, and develop proposals for solutions to problems they have identified. Overall, they can more quickly become strong contributors to the organization.

Each new physician hire should have regular opportunities to communicate not only with his or her mentor, but also with the organization’s executives who will be evaluating his or her performance. Make clear to the new hire what to expect in terms of evaluation standards, expectations for productivity, and preferred cultural behaviors. New physicians should receive ongoing feedback so that they have opportunities to refine what they are doing and make any needed behavior changes. Presenting this process as a training opportunity for the physician to strengthen skills that will help build professional success throughout his or her career will make it a motivational tool, driving performance improvement. It will help physicians feel that they are developing needed skills, and that the organization is helping them to do so.

Organizations offering financial assistance with high-level clinical training also find candidates responding positively. For example, there is an emerging trend of paying a residency graduate $40,000 or $50,000 a year for one to two years to continue training in a sub-specialty fellowship prior to joining the practice that is subsidizing the training. Very progressive single-specialty groups are implementing such programs in order to obtain highly specialized expertise. In return, they provide their physician hires with highly prized skills.

Hospitals and health networks that need to recruit new solo practitioners are finding that many candidates respond positively to professional management of the physicians’ practices. Managers help new physicians learn the business side of practice, helping make the financial risk of solo practice easier to accept for an inexperienced physician and arming the physician with strong practice development skills.

By addressing the relationship orientation and desire for skill-sets common among younger physicians, organizations can cultivate loyalty and productivity to help offset the inconvenience of accommodating candidates’ lifestyle issues. The right strategic approach to working with younger physicians can help build win-win situations that, on a long-term basis, will strengthen the organization.