Physician staffing of an emergency department (ED) is an ongoing and seemingly never-ending process. Although many may consider recruitment as a tool to fill available positions, recruitment has more significant implications. Particularly in emergency medicine, there is a constant ebb and flow of providers due to changing professional goals, personal goals, family needs, illnesses, the rigors of shift work, physician burnout, and other unforeseen circumstances. This unpredictability creates a dynamic not encountered in most other specialties: a comparative instability in physician staff. This relative instability creates opportunities for recruiting desirable candidates. Staffing needs will usually be ongoing, and thus recruitment should be an ongoing process.
Another purpose for a continuous recruiting model is to recruit for performance improvement. In a chronically understaffed department, opportunities to focus on improving provider performance and accountability may be lost due to staffing pressures. In other words, when the priority is to fill the schedule, other priorities, such as quality of care, may inadvertently become secondary. Further, when demand for physicians greatly outweighs supply in a given ED, the existing providers find job security in their ability to simply solve the staffing “crisis.” However, in a fully staffed or slightly overstaffed department, in which supply may actually exceed demand, it is not enough to simply fill shifts; every provider must perform to the institution's and medical director's expectations. Continuous recruiting provides an incentive for better performance of the existing providers, while seeking providers who are a better fit than those who cannot or will not improve.
Retention is a critical piece for recruitment. Stated simply, retention is putting forth effort to recruit the current physicians to stay. This is usually a far easier task than recruiting, orienting, and retaining a new physician. One factor of successful retention is a thorough and effective orientation process. Orientation is also critical to the long-term success of a director-practitioner relationship. The days of orientation consisting of “here are the charts, and there are the patients” have long since passed. Structure is needed to address the various elements of an effective orientation process.
Once a new provider is hired, they must be credentialed or the efforts of recruitment have been lost. During recruitment any potential issues with credentialing should be identified, discussed, investigated, and resolved. As discussed in this chapter, the credentialing and re-credentialing processes of hospitals are very complex with many associated pitfalls. The skilled leader is adept at navigating this process to avoid credentialing delays or denial of hospital privileges.
Recruitment is the beginning of the relationship between the director and the provider. Many ED leaders do not recognize that the relationship exists until a contract is signed or the provider begins clinical duties; this misconception may result in a weakened foundation in that new relationship and cause future issues. From the first contact (phone conversation, hand shake, etc), the practitioner and the director begin to form ...