How many doctors will Australia need in 30 years from now?
Imagine launching a sailing boat in Sydney, setting the compass for Vancouver and then sitting back with a Gin & Tonic expecting to arrive at your chosen destination on time!
Predicting a future outcome without adjustment along the way is a risky undertaking for anyone that puts a high value on being right. Medical workforce planning is notoriously hard to get right because of lengthy lead times and the multiple variables that are involved.
Yet based on demographic predictions, the past decade has seen Australia boldly increase its medical graduate numbers by over 80% in an attempt to address a projected workforce shortfall. In the late 1990’s an “opinion” that the Australian medical workforce was over-supplied was suddenly inverted – an about-face that is hard to reconcile with the principles of rigorous scientific projection.
The subsequent over-compensation in medical school numbers has seen the first wave of new graduates spilling out of universities in 2011. Like the post war baby-boomers they have already proven to be a somewhat indigestible cohort to those involved in the actual employment and training of doctors and will no doubt continue to cause headaches as they progress up the career ladder.
Australia could learn a lot from the British experience, which has not really settled since the Calman Report triggered sweeping changes to the way doctor’s careers were structured. This led to all sorts of unintended consequences – mainly bottlenecks in certain specialties, deficits in others. Its successor, Managing Medical Careers has yet to fulfill the promise of resolving some of the earlier oversights, highlighting the risks of tinkering with complex systems.
Given our interest in medical worforce issues we also gaze into our crystal ball from time to time to try to anticipate supply and demand issues in the future. I used to think in terms of a 15-year time horizon for medical workforce planning (graduation to specialization) until I met a medical school planner who worked on a 30-year planning cycle. How had I missed it? Of course – 5 years to decide there is a problem, 5 years to create medical school places and 5 years to complete the undergraduate training – then the graduate years.
So who can accurately predict what the medical landscape in Australia will look like in 30 years time (2042 at time of writing)? It’s a tall order. Population numbers are probably the most reliable statistic, yet I have seen projections everywhere from 25-45 million. Things start to get increasingly wobbly after that. Throw in complexity of medical technology; political situations; international workforce pressures; demographics of the medical workforce etc. and things start to go seriously awry.
Like our sailor setting out for Vancouver we won’t be far out from port before we need to re-assess and trim the sails accordingly. We will all, no doubt, get to the future but it is unlikely to look anything like we expected.
The implications of accurate predictions for patients, medical graduates, governments and taxpayers are huge. Time alone will tell if the dramatic increase in medical school numbers is: a gross over reaction leading to a glut of doctors; too little too late; or right on the money. I personally suspect that the chances of the current and proposed graduate numbers being just right are somewhere shy of a snowball’s chances in hell.
Dr John Bethell
Director, Wavelength International
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Promoting your Employment Brand – the Wavelength way
Forgive me an indulgence but this week’s topic is a somewhat shameless promotion of our new interactive “Work for Us” website which we launched this week. I will, however, also dwell on the broader theme of employment brand and what it could mean for health employers.
It is well known that doctors are a scarce resource worldwide. Good recruiters, believe it or not, are also in short supply. I emphasize the word good and anyone who read my last blog would understand where I am coming from on this one.
In any candidate-short market you have to do something to stand out from the crowd – there is plenty of competition for the talent that you want and if you cannot differentiate yourself you are doomed to suffer chronic staffing problems, whatever industry you are in.
What does Employment Brand mean in a practical sense?
Generally speaking, when people walk into our office to meet us they want to work for us. The hard part can be getting them to take notice in the first place.
We have traditionally relied on good recruitment firms (yes we use recruitment firms) and winning awards such as placement on the BRW “Great Place to Work” top 50 list to put our message out in the marketplace. This works well but can only go so far to describe what it is truly like to work here.
So why build a website solely for the purpose of attracting staff? We realized that there is something unique about the Wavelength environment that is hard to describe in a few words and very hard to convey through some text on a job board.
We put our heads together and came up with an interactive website that we hope showcases some of the professionalism and satisfaction of working at Wavelength. We had a lot of fun making it and we are very pleased with the outcome. We hope you like it to.
What can health employers do about Employment Branding?
Sadly, the concept of employment branding seems to get little airplay in the health industry, particularly in the public sector. Yet we have demonstrated for our health clients, again and again, that good marketing of a job, a facility and a location can make the difference between no candidates and a healthy shortlist.
It requires some strategic thinking and a bit of courage on the part of health management to give it a go but imagine if your organization had a promotional video or website to direct prospective employees to when you were recruiting. What a difference it would make to the process of attracting staff. Just read the next job description you send out and ask yourself how excited you would be reading it.
Every hospital and clinic has its own unique selling points and unless you present them in an accessible and appealing way then the message is lost before you begin – you can’t talk a candidate round if they never apply in the first place.
In the meantime one final plug for our own “Work for Us” website – we’re pretty proud of it but we’d love to hear your feedback.
Dr John Bethell
Director, Wavelength International
“Like” our Facebook page before 1st April 2012 and we will donate $1 to Médecins Sans Frontières. Read some gripping accounts from MSF doctors in the field.
Do medical recruiters deserve a bad reputation?
I used to be a doctor, and whilst there were many reasons why I chose to no longer be one, there was one significant element of secondary gain that I still miss. Once you told a fellow traveller on the bus, someone in the pub or even a distant auntie that you were a doctor, a favourable response was virtually guaranteed. It was nice to be appreciated (irrespective of merit)!
Then I became a medical recruiter. I was delighted – I had reinvented myself. I had an office downtown, a smart new suit and a career that I personally found stimulating and rewarding. Yet when I told people that I was a recruiter… well the response was anywhere from neutral to downright hostile.
It was hard to adjust. It seemed to make sense that the person that finds you your dream job (or perfect candidate) should be held in high regard. So where did a profession, that could be highly respected rather than reviled, go so wrong?
The profession itself seems to be its own worst enemy in many ways. I have seen many medical recruiters at work in the marketplace – I know how they are generally hired, trained and incentivized and the whole system is a perfect storm for unhappy customers.
Let’s pick apart some of the main issues:
- Low barrier to entry – Unlike other professions (including medicine) there are no qualifications required to work in recruitment. There are no registration barriers to join the profession, and few to start a recruitment firm. That leaves the field wide open in terms of quality. When you lower the bar the whole profession runs the risk of being benchmarked against the standards set by the bottom dwellers. There is also no quick frame of reference that a customer can use to identify who is worth working with versus those that are best avoided.
- Selling products, not solutions – Recruitment is largely about sales but there is a distinction between pushing your product versus a tailored solution based on your client’s needs. Recruiters are usually measured by their sales calls and financial results rather than process or customer satisfaction. They are incentivised to deliver for themselves and their employer rather than their customer.
- Transactional rather than strategic – Recruiters can fall into the trap of lurching from one job to the next rather than thinking about the client’s broader strategic HR needs. There is little impetus on either side to view the relationship as long-term. Clients see recruiters as a short-term means to an ends and vice versa. It is hard for a recruiter to demonstrate the expertise and value that they can bring to the relationship in this context. Where value is not demonstrated fees look expensive and resentment creeps in when bills are to be paid.
- Loss of trust for one tarnishes all – Recruiters are often hired for their pugnacious and competitive nature with scant regard to customer focus or integrity. Trust is one of the few bankable qualities that recruiters can carry into the marketplace and when they breach this by acting unethically, trust that can take months or years to build up is lost in an instant – often irretrievably. Sadly, their behaviour tends to cast doubt in the client’s mind over the trustworthiness of all in the industry.
Faced with all the above, medical recruitment does have some reputational challenges that will take a huge effort to overcome. When Claire and I started Wavelength we were acutely aware of the standard model for the industry and we resolved to build a company that conformed to some higher standards and ideals.
We set about building a workforce who demonstrated integrity, trustworthiness, respect and a genuine passion for helping others. In doing so we have built a team of people focused on providing a quality service rather than ‘winning deals’. Our company benefits because the majority of the work we do is repeat business rather than new business that has to be hard won – 90% of the clients that worked with us in 2001 still worked with us in 2011.
So how do you, as a customer, sort out the wheat from the chaff?
Ask around your colleagues to find out who has a good reputation and who does not. When you are talking to a recruiter spend a bit more time trying to establish whether they are on your side or theirs. Why not turn the tables – interview them first and ask for references.
Use your instincts and if you detect even a smidgen of blarney – excuse yourself from the conversation and don’t look back.
Dr John Bethell, Director
Wavelength International
Check out our innovative new “Work for Us” website www.wavies.com.au
Why Médecins Sans Frontières has a world class ‘Employment Brand’
I admire Médecins Sans Frontières enormously. I admire them for their humanitarian mission, for their no-nonsense attitude towards getting things done but most of all I admire them for their courage.
What fascinates me most, as a professional recruiter, is how they manage to attract people with their employment proposition. I am acutely aware of what you might call the “fill-ability” of a vacant role. This usually boils down to a couple of key factors:
- How attractive is this role given the salary, job satisfaction, work conditions, location, perks, etc?
- How tight are the selection criteria. i.e. how wide is the likely pool of candidates based on the mandatory skills and experience required, and how high is the quality bar set by the employer?
Considering these factors Médecins Sans Frontières appears to defy gravity, breaking many of the rules of workforce supply and demand. Their staff are called upon to work in challenging conditions and their extremely rigorous recruitment process rejects far more applicants than they accept. And yet, at any one time Médecins Sans Frontières has over 24,000 field staff helping people caught in crises throughout the world.
At Wavelength we have been raising and donating money to Médecins Sans Frontières for a few years now. Recently we offered to help them find Australian doctors willing to join their ranks. We advertise a lot of medical jobs but I can barely remember a campaign that stimulated more interest and excitement amongst our doctors.
So, how do they do it – what is the “magic sauce” that allows Médecins Sans Frontières to attract people so successfully?
I attended a Stephen Covey seminar a few years ago where Stephen asked the audience, “How many of you think that you have a high level of employee engagement in your organisation?” It was a room full of enlightened, ‘highly effective’ people – the majority raised their hand. He then re-phrased the question as a hypothetical, “If you told your staff on Friday that, from next week they would be working unpaid, how many of you would have a full office on Monday?” Not so many volunteers now (no pun intended).
I genuinely believe that the CEO of Médecins Sans Frontières is one person that could confidently keep their hand up in that room. Even Google does not have that kind of employment brand despite the gourmet lunches and rivers of M&Ms.
How you can help…
At Wavelength we are continually looking for opportunities to help our affiliate partners to do what they do, whether it be in the form of ‘in-kind’ assistance, such as the provision of doctors to Médecins Sans Frontières, or through financial contribution.
In order to help Médecins Sans Frontières we have decided to make a donation but at the same time raise awareness of the good works that they do by posting stories of their work on the Wavelength International Facebook Page. This is where you come in.
If you click the link to the Wavelength International Facebook Page you will be able to read and watch the experiences of doctors working for Médecins Sans Frontières in Nigeria, Democratic Republic of Congo, South Sudan and Haiti over the next few weeks.
To make it count more, every time someone clicks the ‘Like’ button between 28 Feb and 30 March, Wavelength International will donate $1 to Médecins Sans Frontières, so please come and ‘Like’ us.
CLICK HERE to visit our Facebook Page.
Dr John Bethell
Director, Wavelength International
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If you want to hone your clinical skills why not hire a coach?
I recently read an article in the New Yorker Magazine, ‘Personal Best’ by Atul Gawande asking why doctors don’t typically use the services of a professional coach.
I use a coach myself and strongly advocate coaching to improve the performance and well being of my own staff so I guess you could say that I am a convert. Having said that I am but a recent one. It would not have occurred to me to use such a service as a doctor – indeed the thought, let alone the subject, never arose during the clinical phase of my career. In retrospect this probably says something about the medical profession and their opinion or even awareness of such ‘new management’ ideas.
Firstly – a quick definition. Coaching (if done correctly) is a very specific skill that differs from other forms of teaching. Rather than traditional didactic and rote learning methods familiar to anyone that has survived medical school, coaching is about observation, judgement and guidance. The key is objectivity – the ability of the coach to see performance from the outside and to help the coachee arrive at their own insights and revelations. Subject expertise is not essential but it helps – it is hard to see how Pavarotti’s voice coach could help Federer with his backhand beyond a certain point.
So, why would doctors, ambitious and perfectionist as they so often are, not see the value in such an approach to performance improvement? I put forward a few explanations which I hope on reading come across as easily surmountable.
- Self-reliant Culture – doctors are taught to be self-reliant from the very earliest stages of their academic careers. A herculean work ethic, long hours and constant moving from job to job do little to encourage the idea that a doctor needs or deserves support during their career.
- Ego – doctors often see failure as unacceptable and shameful – coaching taps into the heart of this fear and exposure can seem like a genuine threat to the ego.
- Insight – doctors often lead sheltered lives. From high school to the top of their profession they are cocooned in the world of healthcare and can go the whole way largely unchallenged by those around them. It takes a major shift in paradigm for a senior clinician to suddenly invite feedback and criticism, however constructive it might be.
- Management Style – doctors, sadly, still seem to miss out on much of what contemporary HR best practice has to offer. Structured feedback for doctors seems to be the exception rather than the rule, except when it comes to scrutiny of their clinical outcome metrics – good to know what you should have achieved but some help in getting there would be useful. Furthermore, there is often a perception that feedback is for under-performers rather than for those at the top of their game.
- Professional Risk – doctors are increasingly guarded about exposure to medico-legal risk and could be concerned that their coach’s notes might look somewhat similar to a prosecution lawyers in cases where things go wrong. Who knows who, or what, can be subpoenaed in those circumstances?
- Invincibility – doctors usually see themselves as helping others but not necessarily in need of outside help themselves. It seems that when a doctor gets ‘help’ it is often thrust upon them by an employer or medical registration body. The idea, of course, that doctors never need support is belied by the alarming incidence of depression, alcoholism and suicide in the profession.
- Time – doctors are notoriously time-poor and coaching may be seen as another demand on this precious commodity. Of course it all comes down to priority – perhaps nine holes instead of eighteen?
Whatever the reason it is clear that the use of a coach for the purpose of improving clinical skills is still not common practice. Perhaps it is just a matter of time before it becomes a widely accepted idea with the medical profession. I was certainly encouraged by Gawande’s personal and very detailed account of how a coach helped him improve his operative skills and I strongly recommend that you read it – if only because, in typical New Yorker fashion, the cartoons are funny.
Dr John Bethell
Director, Wavelength International
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Doctors: find a good medical recruitment consultant and stick with them
I liked this post by blogger Dr Goodhook, providing advice to doctors on “How to work with a physician recruiter”.
I liked it because a doctor, not a recruiter, wrote it. He clearly has the measure of the way recruiters work (good and bad) and has suggested some handy tips on how doctors can get the best out of the relationship.
I particularly appreciate the fact that he acknowledges that such relationships are of value. Very few doctors do their own tax return or represent themselves in court (even rarer are doctors that remove their own appendix). You outsource these tasks for two reasons: it’s not a good use of your time and you recognise that it is an area of specialist expertise that you do not possess. Career management is not necessarily seen this way and yet there are big repercussions if you get it wrong. Why not partner with an expert in this domain?
If I could add my own advice to doctors looking for a recruiter to work with it would be this: find a really good one – then enter into a lasting, trusting and monogamous relationship with them.
There are a couple of reasons for taking this approach.
1. Sort out the wheat from the chaff – recruiters (much like doctors for that matter) sit on a bell curve of capability:
- 10% are at the top of their game, highly talented, hard-working, committed to their customers and have integrity to burn.
- 80% are OK – they’ll get the job done but they won’t set the world on fire.
- 10% are, shall we say, best to be avoided.
2. Commit to the relationship – it cuts both ways (as all good relationships do). A good recruiter will look after you throughout your career, providing advice at every stage – not just when you are actively looking for a job.
To make the right choice you need to understand firstly what a recruiter does. Recruitment is essentially a service role. Recruiters have to, at various times, be salesman, adviser, administrator, expert consultant, and counselor. Sound familiar?
This could equally describe a doctor … or a lawyer or an accountant. The difference, of course, is that there is a low professional entry barrier (no tertiary qualification required here) so whilst there are some highly ethical and capable recruiters there are many that are not.
In recruitment, as in all service professions, reputation is everything and it is hard-won over time. Ask around the market and connect with a few that have been recommended to you by colleagues until you find a good fit.
So why monogamy?
All relationships are defined by the degree of commitment from the parties involved, and that goes for professional relationships too. Lawyers, accountants and even doctors prefer to enter into a long-lasting relationship with their clients. Their clients, for the most part, are happy to reciprocate.
Imagine for a moment asking five accountants to work on your tax return – the one that gets the best refund gets paid! They just wouldn’t wear it, yet when you ask five recruiters to find you a job they are all happy to take your details. Of course, they are each likely to give you no more than one fifth of their attention. The sum of the parts, in this case, is definitely less than the whole.
So, in summary, a good recruiter should be your career guide and confidante through every stage of your professional life. If you find a good one stick to them. I promise, you’ll be happier in the long run.
Dr John Bethell
Director, Wavelength International
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There are few professionals more prone to mobility than doctors. Once released from the relatively constrained environment of medical school doctors tend to embark on a peripatetic journey, moving from one location to another for many years before settling down. Doctors are used to being on the road, but even the most hardened traveller will find that moving overseas is a big deal.
Our business specializes in helping doctors to relocate overseas and we speak to literally thousands of physicians who approach us with intent to do so. The first question we always ask them is, “Why do you want to do this?”
Some patterns emerge based on push factors. UK doctors will say something like, “I’m sick of the NHS – the paperwork and politics, and frankly, I can’t stand the weather.”
Doctors from the US are more likely to say, “I want to get away from of a culture of litigation, HMOs and practicing defensive medicine.”
South Africans are often concerned about personal safety and Europeans are frequently looking for better pay for fewer hours. Canadians generally love their work but want a break from nine months of winter.
There are pull factors as well. Australia and New Zealand are known for outdoor lifestyle, pleasant climate and their quality health systems.
Singapore practices Western-style medicine in Asia. Many doctors of Asian origin express a desire to live closer to their families but also to work in a system that is more familiar to them if they have spent some time in the West.
So, if you are a doctor looking to work overseas why is it important, or even relevant, for us to know the answer to this opening question?
For us, your first response to this question is the most critical thing that we will take away from our initial interview with you. The recruitment and immigration process that doctors have to go through to commence work overseas can be long and painful at times and one of our jobs as ‘career consultants’ is to remind you of your initial motivation when the going gets tough.
The rubber usually hits the road at the offer stage when a decision has to be made – yes or no. It’s all been fun and games up to that point but then suddenly you have to contemplate leaving your job, selling your house, outsourcing the pets and saying goodbye to mum and dad.
Cold feet is a typical response and a good recruiter will remind you “ Remember, you wanted to do this because… <insert reason here>.”
Leaving your comfort zone, and indeed your loved ones, is never easy. A good analogy I heard recently was that of a trapeze artist learning their new skill.
You feel safe holding on to the first bar and you know that when you grab the second you will be fine, but what of the period in between? Letting go is the hardest and scariest thing to do and that mid-air bit is the period of greatest anxiety.
Such transitions are always easier if someone is coaching and supporting you through the hard part, and your recruiter should be there to help you remember why you wanted to do this in the first place. So go ahead and let go. Sometimes the grass really is greener…
Dr John Bethell
Director, Wavelength International
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