New Insights on the Recruitment Mating Dance

By  |  October 1, 2019 | 

It’s September – no, almost October. We’re right in the middle of that fraught season in which senior residents begin job searches in earnest, and hospital medicine groups gear up their recruitment efforts. So, it’s timely that the Journal of Hospital Medicine recently published a paper entitled Top Qualifications Hospitalist Leaders Seek in Candidates: Results from a National Survey.” This paper presents the results of work by members of SHM’s Physicians-in-Training Committee and represents the first rigorous inquiry into the skills, attributes and behaviors that hospitalists say they value most highly when recruiting new members to join their group.

I think the results are instructive for:

  • Physicians aspiring to join a hospital medicine practice
  • Those involved in recruiting
  • Those involved in teaching and mentoring residents as they prepare to enter the workforce


The investigators designed and distributed a survey to all SHM physician members; it included questions about both the desired qualifications and the desired attributes or behaviors of hospitalist candidates, as well as respondents’ approaches to candidate assessment. Respondents reported participating in various aspects of the recruitment process from phone screening to individual and group interviews to serving as the final decision-maker.

The results are interesting, though most aren’t too surprising. The top-ranked qualifications sought by respondents were:

  • Comfort level with patient acuity, patient volume and/or procedures
  • Experience in hospital medicine
  • Desire to be a career hospitalist
  • Interest in my specific hospitalist program
  • Perceived quality of residency training

The top-ranked attributes and behaviors were:

  • Provide a meaningful response to my unique (customized) question
  • Have positive social interactions with group and/or staff members
  • Demonstrate thoughtfulness and/or self-awareness
  • State a good reason for wanting to join my HMG
  • Ask informed questions about my HMG

A little more than half of respondents said they use different criteria or approaches to assess short term candidates (e.g., those planning to pursue fellowship training) and those who “articulate an interest in hospital medicine as a long-term career.” In fact, respondents were divided on whether they considered long-term or short-term candidates as the riskier hires. While some saw long-term hires as an investment in the group’s stability and performance over time but short-term hires as likely to be less engaged, others saw short-term hires as less risky since they would only be with the group for a short time; as such, any influence they had on the group (positive or negative) would be relatively short-lived.

Perhaps the most actionable information was a list of common interview mistakes made by candidates that respondents said serve as “red flags” that often disqualify someone from further consideration, including:

  • An excessive focus on work schedule or lifestyle
  • An excessive focus on compensation
  • Lack of interest, suggested by failure to research the HMG/job beforehand and failure to ask meaningful questions
  • Lack of long-term commitment, suggested by intentions to pursue fellowship training or perhaps a J1 or HB1 visa candidate willing to make only a 3-year commitment
  • Problems such as frequent job changes or unexplained gaps in employment history
  • Negative impressions, which might be related to appearance/dress, awkward social or communication skills, body language or negative social interactions
  • A flawed application, including spelling errors or typos in CV or cover letter, poor references, etc.
  • Unclear career goals

What This Means for Job Seekers

There’s a lot here for job seekers to consider, but a couple of the top things that stood out to me was the importance of investing some time up front to research the specific HMG and position you are applying to and preparing some meaningful questions that demonstrate a sincere interest in getting to know the hospital, the group culture, and the nature of the work you will be doing if you join this group. And, of course, candidly assessing your own job search approach to see if you are or have been guilty of any of those “red flag” behaviors. If you have a red flag, such as a gap in employment or some negative references, prepare a clear and concise response to explain them in a positive – but honest – light.

Think about how you want to position yourself – as someone who is committed to a career in hospital medicine? Or someone who plans to pursue a fellowship or other career path after a few years? How you position yourself will impact the approach others use to assess your candidacy. Understanding this up front and will help you prepare more effectively to present yourself in the best possible light. Positions for both long-term and short-term hospitalists are plentiful, and I believe that both you and the group you choose to join will be more satisfied if there is a clear understanding of your short-term and longer-term career goals.

Finally, keep in mind that the behaviors and answers that will get you hired for a particular job may not be the same as those that will ensure a good job fit. If you show those interviewing you what they want to see rather than who you really are, you risk doing yourself (and them) a disservice that you may regret in the long run. So, in spite of what research like this suggests about what hospitalist leaders are looking for when they recruit, I urge you above all to be authentic.

What This Means for Those Involved in Recruiting Hospitalists

I was struck by the highly subjective nature of most of the attributes survey respondents said they value most. I know it’s hard to put quantifiable metrics to many of these things, but the “I’ll know it when I see it” approach to interviewing and sizing up candidates is risky. For example, how accurate is a candidate’s perception of their “comfort level” with the workload or patient acuity in your practice – especially if they are just coming out of residency?

Similarly, are you overemphasizing the importance of candidates’ responses to your personal favorite interview questions or whether or not you “click” interpersonally? This New York Times article from 2017 offers good evidence that an unstructured interview process that relies mostly on informal conversation and subjective assessment probably doesn’t tell you what you think it does – in fact, in some cases, it may lead you to less accurate assessments than if you didn’t interview the candidate at all. I’m glad to see the authors suggest that HMGs consider ways to “internally standardize how to best approach subjective components of the interview.”

I also worry that hospitalist leaders may overemphasize the importance of candidates making a long-term commitment to their group and to a career in hospital medicine. From a practical perspective, a candidate who is willing to commit to a two- or three-year contract is often indistinguishable from one seeking a long-term position. My colleague John Nelson wrote briefly about this here.

Finally, the JHM study wasn’t really structured to capture this, but I can’t resist the reminder that in most markets, there is still a meaningful shortage of hospitalist manpower, and many candidates are able to choose from more than one job offer. So “selling” your HMG and job opportunity to candidates becomes just as important as assessing whether they would be a good fit for your program.

What this Means for Candidates’ Faculty Mentors

The authors point out that the research findings regarding what interviewers are looking for suggests that faculty mentors should consider providing more formalized job search coaching for senior trainees, including meaningful interview preparation, and I agree. And I’d take it a step further. Interviewers’ emphasis on comfort level with patient acuity and volume, as well as hospital medicine experience – even for candidates coming directly from residency – indicates a need for residency programs to ensure a training experience that more closely resembles the real-world environment and better prepares graduates for the transitions in both workload and clinical responsibility from learner to full-time clinical hospitalist.

Thanks to Dr. Allen-Dicker, et al. for giving us more fodder to prepare both job seekers and recruiters for the recruitment mating dance. Good luck, job seekers – most importantly, be yourselves.  Recruiters, seek more standardization going forward, and in the meantime, don’t forget you need to “sell” your program to candidates. And mentors, look for ways to better prepare residents for this process.

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About the Author: Leslie Flores

Leslie Flores
Leslie Flores is a founding partner at Nelson Flores Hospital Medicine Consultants, a consulting practice that has specialized in helping clients enhance the effectiveness and value of hospital medicine programs as well as those in other hospital-focused practice specialties since 2004. Ms. Flores began her career as a hospital executive, after receiving a BS degree in biological sciences at the University of California at Irvine and a Master’s in healthcare administration from the University of Minnesota. In addition to her leadership experience in hospital operations, business development, managed care and physician relations, she has provided consulting, training and leadership coaching services for hospitals, physician groups, and other healthcare organizations. Ms. Flores is an active speaker and writer on hospitalist practice management topics and serves on SHM’s Practice Analysis and Annual Meeting Committees. She serves as an informal advisor to SHM on practice management-related issues and helps to coordinate SHM’s bi-annual State of Hospital Medicine Survey.


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