Finding & Hiring Talent for Academic Health Centers & Medical Schools in an Age of Uncertainty: Better Practices
Richard A. Skinner, Ph.D., Senior Consultant
At a time when new medical schools are being established in significant numbers with new facilities in design or under construction, also being created is the human infrastructure needed to lead and staff these organizations. Both trends are taking place in the midst of implementation of the Affordable Care Act (ACA) – itself undergoing change - so the landscape of health and medical care is evolving in profound ways that are not yet complete or clear.
Recruiting, hiring, and retaining outstanding physicians and other health care professionals have long been challenging tasks. But today, the success of those efforts is never more important but never less certain as search committees and search firms seek to “hit a moving target” of sustainable organizations responsible for more but in less direct control of the factors known and thought to influence health outcomes.
In a time of great uncertainty, there is little that can be done to assure the outcomes of recruiting talented medical faculty, department chairs, and deans. Indeed, academic health centers and medical schools may undertake to recruit medical faculty using a set of assumptions about how care can be both effective and efficient and hire persons whose expertise and skills hew close to those called for by an overall strategic plan. But if those assumptions are faulty – for example, fee-for-service does not give way in toto and some specialties, in fact, continue to be paid for in traditional ways – recruitment, however well done, cannot make up for a flawed projection of how the clinical enterprise actually operates or will operate in the near future/
Still, the search process is something an academic health center or school of medicine can control to an extent. So, conducting searches in ways that produce new faculty-physicians, department chairs, and deans is a good investment of time and imagination.
What follows is a brief outline of what we think are better practices for executing searches in conditions that are less familiar to many of the people seeking to fill posts, especially administrative ones, that may no longer operate as they once did but do not yet provide a clear mandate of what is to be. “Best practices” will emerge in due course, but for now we think it prudent to work to improve search practices in the expectation that the changes in health and medical care will evolve and take on shape and substance sufficient to make it possible to design best practices.
What follows is a set of questions we think may be helpful to try and answer at the outset of a search for a department chair, division head, or dean. Some address the matter of how best to describe the position and the essential qualifications sought in candidates. A second group deal with the search process itself.
POSITION PROFILES & CRITICAL QUALIFICATION
- Relevance of experience and the role of imagination: Administrative experience remains a critical consideration, all the more so today because past behavior remains the best predictor of future behavior. At the same time, changes to the clinical enterprise or the “business of providing care” may be of such magnitude as to reduce the importance of experience and enhance the role of creativity and innovation in an administrator. Seldom will this be a zero-sum or all-or-nothing situation as both imagination and creativity are likely to be needed going forward, but it’s worth asking at the outset of a search. For this position at this time, should we give greater weight to experience and imagination in describing the role and assessing candidates
- The essential importance of diversity: For much of the past half century, diversity was viewed in moral and legal terms. Today, America is more diverse than at any other time in history. The importance of having health and medical providers whose faces resemble those of patients remains a moral and legal matter but it is all the more important because past discrimination and lack of care for certain demographic groups reveals itself in severe and profound health disparities. If those disparities are to be addressed and the nation’s overall health improved, there is a pragmatic and very practical reason for asking at the beginning of a search. How can we be certain that persons under-represented in administrative posts of schools of medicine and academic health centers are deliberately sought out for this position throughout the search process and certainly among the finalists?
- Capacity to lead cooperation and collaboration within AHCs and beyond: All signs point to the near-certainty that 30+ years of discussion and exhortation about inter-professional education and training of health care professionals will take on a new life in inter-professional care and treatment. This, in turn, puts a premium on administrators who can forge stable partnerships within schools of medicine, with other health care professions and professionals, and, increasingly, with agencies outside the health care realm in schools, public health departments, employers, and other entities that influence the health and well-being of populations being managed. How should we evaluate candidates’ experience with and capacity for establishing and maintaining collaboration with other units both within and outside of the immediate health care domain?
- Patient-centered care over provider-focused care: Much as higher education has come under pressure for focusing too much on the needs and aspirations of professors and staff and too little on the parameters and challenges students contend with, academic health centers and schools of medicine are being asked to think more of what patients desire and need when engaging with health and medical care. This prompts the question,What sorts of indicators should we look for in candidates’ CVs and letters of application that reflect more a concern for what the patient needs than SOPs and protocols of their care providers and their organizations?
- Understanding the financial/resource fundamentals of care, education and training, research, and service: Medical education, research, care, and service to the AHC or school of education have always relied on complex cross-subsidies to pay for non-revenue-generating activities which, in turn, created an equally-complex set of incentives to various units and persons within an AHC or medical college. Those subsidies and incentives are changing, in some cases, in very profound ways. What should we look for in a candidate’s record to suggest a solid understanding of the changing ways by which the costs for all of the essential aspects of AHCs and medical schools will be paid directly or else subsidized by other sources?
IMPROVING THE SEARCH PROCESS
- Keeping search firms accountable: A search firm should be more than a “hired gun” or the proverbial “headhunter” and, instead, be vested in the success of a search beyond the hiring of someone for the position. One way of demonstrating that investment is by providing clients with means for holding the firm Does the search firm press us on the qualifications for a position that go beyond duties and responsibilities to reflect the context and culture of our organization? Does a firm provide us with means for assessing their consultants’ efforts to understand us, the ways in which they communicate with us, how they go about identifying and vetting strong candidates, and how they seek out references to attest to the particular qualities of candidates?
- Expediting the search process: Due in part to the conflicting demands on members of search committees at AHCs and medical schools as well as the lengthy transitions often required by successful candidates in moving from their former to their new organizations, searches for division heads, department chairs, and deans can last as much as 16-18 months. Experience tells us that searches do not improve with age or duration. In order to expedite a search, there needs to be -
o a clear and shared vision of what the position’s first six months, first 18 months, and first three years will put on the successful candidate’s plate;
o what personal and professional attributes are particularly important at the particular point in time;
o what will constitute effective administration and leadership when gauged at regular intervals, allowing for time to effect change;
o the clear delineation of what are the search committee’s role and responsibility, what belongs to the search firm, and who will be the person making the decision to hire and assess a candidate
- Collectively, these considerations entail asking early on. How much alignment in views and expectations exists among the search committee and the superior to whom a new-hire will report? Is there a shared expectation of what type of person is needed to do what in how long or short a span of time with what results? Can the search firm articulate a satisfactory understanding of alignment and expectations for the position and the person needed to fulfill these?
- Focusing the efforts of search committees and search firms: The hefty lifting required of search committees ought to come at the very beginning in formulating a position profile and qualifications and in the assessment of candidates. Often, members of committees are eager to reach out to persons thought to be strong candidates and this should be encouraged, albeit, with the search firm’s consultants making contacts. Confidentiality of candidacy is always important for most candidates and essential for some. But the technologies of our times make it very difficult to safeguard word of a search being undertaken (indeed, such notice is often publicized widely), persons being contacted as potential candidates, and candidates being vetted or interviewed.
- Search firms are paid to identify candidates, recruit the “best” candidates for the position, help with interviews, and facilitate the assessment of candidates while acknowledging throughout the process that the search committee members are the experts with the subject matter knowledge that enables them to rate credentials and candidates. Search firms can also assist in negotiations, public communications, and on-boarding of new hires. Their time is best spent in asking tough questions of the search committee and the decision maker who actually makes the decision of whom to hire, contacting and recruiting good candidates, assisting with the sometimes tortured logistics of interviews, and bringing the search to a close in an expeditious manner.
All of this ought to prompt the question of a search firm: Can you tell us where your services actually and specifically add value to our efforts to hire the right person for this job? What roles do you see your work fulfilling in the search we are about to undertake?
- Preparing for growth via on-boarding: Recently, the number of AHCs and medical schools launching searches for administrators and faculty members, often with multiple hires in mind, has grown substantially, fed partly by retirements, partly because wholly-new organizations are being established, and also because the convergence of medicine and health care with science and technology holds forth prospect of ground-breaking innovations and inventions. That this is taking place at the same time as reimbursement is changing, care is under scrutiny in terms of the real value provided, formats in which care will be provided are increasing – in short, when extraordinary change is already underway – it is prudent to ask how an academic health center or medical school will assimilate so many new professionals in what it likely to be too little time even as the health care system itself is being challenged to adapt.
Strictly speaking, such concerns are outside the province of search firms. But in another sense, the ability of AHCs and colleges of medicine to absorb, orient, and acculturate will contribute directly to the success or failure of search firms. Hence, the last question included is one the search firm ought to ask of the client: How do you propose to introduce this new hire to the organization, provide a sense of from whence it came, be direct and candid about the threats that lie ahead, and just where s/he fits? Will we be back next year to refill the position for which you just hired?
Asking and answering the questions posed here will not guarantee perfect hires, but they are a start at improving efforts to identify and recruit much-needed talent to a sector of society in the midst of change.