Listening

I suppose it sounds cliche or even drab to repeat the phrase: “It is important to listen”.

But listen.

In medical recruiting, listening is vital.

Our client may say,

“I am concerned about money (or reimbursement)” or “We are not in a hurry right now”.

Well, this is a time not to breeze over these statements but to listen.  And listening doesn’t just mean saying to ourselves, “yeh okay” and then move on.  Listening involves asking the next best question.

In this case, our response would be: “Tell me more about your financial concerns.” or “When would you like to interview the first candidate?” This conveys that we are actively listening.  We are responding in a way which proves that we are in tune with our clients.  We are on their side.  We are not their enemy.

Recently, in another situation, I learned  the importance of listening.  A potential candidate and I were talking about a prospective job.  She had some hesitancy about interviewing for the position and when asked about her reservations she said her mother was sick therefore she could not handle a major change right now.  Not wanting to discuss her mother’s sickness, I moved on to talk about the job’s schedule to see if that would ease the perceived burden of this new job prospect.

On retrospect,  the candidate did not say that her mother was sick; she said her mother had a major medical concern.

Big difference.

Sickness is often temporary whereas major medical concern means debilitation or close to death and obviously requires a lot of time and attention and taxes the caregiver’s emotional, physical, mental and spiritual reserves.

Lesson learned.

Day of Prayer prayer

God our Father in Heaven

We praise You for Your glory, love and mercy.

We thank you for calling us to serve our neighbor helping them through injury and illness.

Lord we rely upon You for health and healing and we acknowledge You – Lord Jesus as the Great Physician.

Guide and lead us in our work. Give us knowledge and wisdom for the benefit of others.

And may all that we do be for Your glory.

In the name of the Father, the Son and the Holy Spirit. Amen

St Luke's Church

Little League Baseball: Lessons in Health and Recruitment

I have been accused of stretching conversational associations too far.  In fact, friends have said, “Where did you come up with that…we were talking about (such and such) and you totally out of left field said (such and such)…I don’t get it.”  Then after explaining myself, they see some connections with the  line of thought but usually say, “That is quite a jump in logic”.

Oh well.

So out of left field, I bring to you the topic: Little League Baseball: Lessons in Health and Recruitment.

My boys play Little League baseball and I love baseball too.  I have the privilege of coaching one of my sons in swing league aka coaches pitch the ball.  The boy’s ages range from 5-7 y.o.  and the rules state that if they do not hit the ball by the fourth pitch, they must use a tee.  Well, we never use the tee. The parents have made that clear – “He was in tee ball last year, we want him to hit live pitching.”  And there are no strike outs or walks.

OK

So it’s swing-miss, swing-miss, swing-miss, swing-miss —(batter spins around and helmet flies off) — swing-miss, swing, swing, swing, swing, swing, —-(Of course before each swing is the pitch of the ball and before each pitch of the ball is an admonition to the fielders to “stay alert and get ready!”)—swing, swing, swing; miss, miss, miss, miss, missmissmissmisssssssss, mmm…hit!

Home Run!

Now, once the ball is hit, the batter can only run one base at a time.  Only singles in swing league – that is the rule.  Well, on occasion, a zealous lead-off man gets a double.  Ya’ know if the kid wants to go for two while all the fielders dash off to scrum around the ball, we give it to him.

This goes on for about 50 minutes.  Parents, grandparents and siblings  sit in lawn chairs or stand hugging the fence line cheering and encouraging their lad.  And the boys have so much fun swinging that bat, hitting that ball, running like mad, throwing that ball and every great once in awhile a fly ball is hit and even in a greater once in awhile the fly ball is caught.  Joy for all.

Well, you might say, “If this blog is about health and recruiting, what does all this baseball talk have to do with the topic.

Nothing.

Unless you consider this.

Being in good health has everything to do with having joy in our lives.  And joy has everything to do with seeing others do well and succeed.  For the five year old success is hitting the ball (even after 20 whiffs) or running the bases.

In recruiting, success and joy meet at a place where it is realized that people can be honest and sincere, where professionals can describe and demonstrate competence, a time when all of us can sense humor and allow mistakes.

Children typically do not hit themselves on the head with the bat because they whiff, they stand in the box (usually with a smile especially if the coach smiles at them) and take another swing.

That is what we do.  We keep swinging and enjoy the process.  At Northview Health Solutions, success is about living out  joy and joy is about being in the game.

What color is an M?

“What color is an M?” was a interview question posed by a rehab director.  He wanted to take the candidate off their prepared set answer platform and see how they would respond off the cuff.

Nonsensical? yes

Effective? I prefer more standard questions which I have listed below.

What color is an M?

A candidate should be prepared for the expected and unexpected.  When the odd question comes up, clarify and then roll with it.  It may be one of those: ‘what’s the first thing that comes to mind when I say the word…elephant’ type of questions.

Anyway, here is a list of questions to prepare for when interviewing for a healthcare position.

Skills and aptitudes questions:

• What skill set /attribute do you bring to our organization that distinguishes you from the others?
• What areas do you feel you will need the most mentoring over the next 3- months
• What areas do you feel you will need the least mentoring?
• Talk in depth about your therapeutic clinical strengths
• Describe your community involvement and public speaking experiences.

Strengths and weaknesses questions:

• What are your strengths and weaknesses.
• If I were to ask you last supervisor what they thought was your greatest strength, what would they say? What would they say is the area you most need to work on?”
• If I gathered all your references in one room and asked them to talk and think about them for a little
  bit – then I would ask – “what are 5-6 words that describe ________.” and I try to get them to stick with words or short phrases And then – “I really like __________ his/her skills are great – I wish s/he would work on ____________”
• Talk in depth about your therapeutic clinical strengths
• You mentioned that your greatest weakness was attention to detail. What would you say if I told you that there is a spelling mistake on your CV?

Professional values questions:

• What is your proudest accomplishment
• What are some things you would like to avoid in a job
• Tell me about a customer service experience that you think best shows your willingness to provide exceptional care.
• Tell me about a work situation, that, if you had to do over again, you would do differently.”
• Describe your community involvement and public speaking experiences.

Overcoming challenges or obstacles questions:

• Tell me about a major change you experienced in the workplace. What strategies did you use to cope with the changes and what was the final outcome?
• Tell me about a time where you had to overcome a major obstacle. What have you learned from that and how have you used it

Dealing with stress questions:

• Work in healthcare is often stressful. Tell me about a time you worked in a particularly stressful situation and how you handled yourself.
• How will I know when you are stressed? How would you handle yourself and how would you let me know?
• Hospitalization is often a stressful time in a patient’s life. Tell me how your interpersonal skills can ease this time.

Conflict resolutions questions:

• Interpersonal conflict can often be a fact of life in working teams. Discuss a time you were in conflict with a co-worker. How did you handle the conflict.
• Almost everyone has been unfairly criticized on the job, either by the boss or a co-worker. Please describe for me such an instance and how you handled it.
• Tell me about a time that you found yourself pulled in several directions at the same time. How did you resolve that situation?
• What frustrates you most about your current position and what do you do about it.

Teamwork questions:

• Working well with others is essential to a smooth operating team. Give me an example of a team you worked on and tell me specific strengths you brought to that team.
• Sometimes people are needed to pitch in on tasks that may not seem a typical part of their daily duties. Give me an example of a time you found yourself doing this.
• Rehabilitation has moved toward a greater awareness of adjusting to the needs of our consumers. This means potentially working into the evening, working early mornings or working weekends. Please discuss your willingness to flex your schedule to meet these varied needs.
• How do you work in groups? What role did you play.

Character questions:

• Tell me what you don’t like about yourself
• You work with a therapist that constantly offers negative remarks about the job and management. However, this behavior does not occur with patients and you know for a fact that patients choose to use
  your services because of him. Would you consider this person to be a good employee? Why or why not?
• What are some personal qualities you could bring to this position
• Tell me about a work situation, that, if you had to do over again, you would do differently.
• Describe your community involvement and public speaking experiences.

Employer knowledge questions:

• Tell me what value you think you can bring to this organization/department/position.
• Why are you seeking employment at our organization? (What interests you about this position? Or Why are you here?)
• What do you know about our organization, our values?

What color is an M?

My response:  “Black…unless I am writing with a blue pen which have been banned in most hospitals and clinics.  Or other colors if my kids are writing their letters with crayons. “

Reference: PT Manager Forum at Yahoo – string titled Interview Questions

Stoppage of starting a new recruiting business?

Recently, a colleague asked, “What prevents a new recruiting business from starting?”

I replied by letter:

A new start up staffing / recruiting business is challenging however you slice it and analyze it.
A cost analysis, overall business plan, proper training and consulting, networking, initial debt free capital, a broad database and good ole fashioned blood, sweat and tears is a recipe for success.

Issues certainly involve costs so a cost versus benefit analysis of insurance, database, computer systems and software, consulting and training, hiring personnel,etc. is vital.

Recruiter's Tool

There are many things a new recruiting business can do without. But musts include developing network and establishing solid relationships with clients or potential clients.

One of our underlying principles has been to operate debt free. So far this is working and has required in a step wise and methodical approach. With this frame of mind, consideration of the risks of expenditures must be exercised.

Early realization of benefits is important to keep the mojo going – and this can be in the form of positive networking, learning opportunities, building relationships and eventually monetary gain.

Another case of dizziness / near fainting

History: A 29 y.o. female c/o one week history of dizziness.  She reports 2 month history of irregular periods.  Other symptoms include racing heart on and off for 3 weeks.  Symptom of dizziness worsen when standing up.  This week vaginal bleeding has been heavy and irregular.

Patient denies chest pain, shortness of breath, vertigo (e.g. spinning room), palpitations, abdominal pain.

PMH: metrorrhagia, thyroid goiter (hypothyroidism)

Physical exam:

• BP: 140/90
• HR: 68
• Temp: 98.6 F
• Orthostatic BP readings: no change supine to sit to stand (no complaints of dizziness or racing heart)
• Cardiovascular exam: RRR, no murmurs, rubs or gallops.  No carotid bruits
• Respiratory exam: clear to auscultation bilaterally
• Neurological exam: CN II-XII intact, Rhomberg negative; rapid head movement – no dizziness
• EKG: NSR at 68 beats per minute

Differential  diagnosis:

• orthostatic hypotension due to hypovolemia/ irregular menses
  

  Fainting

• vertigo
• presyncope due to vasovagal hypotension

Working diagnosis:

orthostatic hypotension due to irregular menses

Plan:

1. Check CBC for anemia, TSH for thyroid dysfunction.
2. Start oral contraceptive pills
3. Increase fluids
4. Monitor for worsening symptoms

Follow up:

1 month

A case of vertigo

History: A 48 y.o women complains of dizziness/vertigo for two days.  Symptoms worsen with activity including head movements and bending forward.  She also complains of sweatiness and feeling faint.  There is some ringing in the ears.  She has a history of CVA and loss of hearing.  Increased sinus drainage over the past two weeks.

She denies chest pain, shortness of breath, slurred speech, facial numbness, arm or leg weakness, difficulty swallowing.  No change in symptoms with moving supine to sit to stand.

Meds: calcium channel blocker (CCB), beta blocker (BB), angiotensin converting enzyme inhibitor (ACE inhibitor), clonidine

Physical exam.

• BP 180/100
• Heart rate: 60
• Cardiovascular and respiratory system exam: unremarkable.
• Neurological exam: unremarkable
• ENT exam: unremarkable
• Rapid head movements: no vertigo
• Dix Hallpike: neg
• EKG: NSR at 60 bpm

Differential diagnosis:

• acute vestibular neuronitis (peripheral)
• benign paroxysmal positional vertigo (BPPV) (peripheral)
• Meneire’s disease (peripheral)
• postural hypotension
• presyncope / vasovagal response
• vascular compromise
• subclavian steal
• middle ear infection (peripheral)
• acoustic neuroma (peripheral)

Working diagnosis:

1. peripherally caused vertigo
2. uncontrolled hypertension

Goals/plan for this patient:

1. control blood pressure : increase CCB
2. treat symptoms of vertigo: meclizine
3. decrease salt intake
4. stop smoking
   

   Effects of smoking

Follow up in 1 week.  Sooner if needed.

Cost Analysis of Hiring Full Service Medical Recruiter

There are main two indications to use a full service professional recruiting process.

1. An immediate need for critical talent (i.e. Physical Therapist, Pharmacists, Mid Level Practitioner)
2. Your company wants to position itself at the top of the pack in your industry

To justify the cost of full service recruiting, the cost of a critical position vacancy has to outweigh the cost of running a full scale recruiting effort but should also recognize that the successful recruitment of qualified top talent adds the benefit of meeting #2 indication above. The marketing benefit of having top talent and top recognition is one of the keys to business sustenance and growth.

To determine the cost of the position vacancy add the following costs:

1. Cummlative cost contracting professionals (physical therapists, pharmacists, mid level practitioners) above the regular pay scale. Time (weeks,months, years) equals money.
2. The cost of buying out any contracts
3. Ongoing recruitment efforts

• • advertising
    

    Physical Therapy

  • job boards
  • registration as vendor at conferences
  1. Cost of building and sustaining an internal recruiting effort or department

• • time for networking (phone calls, emails, building social networking, building online network groups)
  • time to find and qualify candidates
  • time for interviewing candidates
  • time to set up interviews and follow up
  • time to thoroughly check references
  • time to help deal with needs of candidate’s family.
  • time to arrange relocation
  • cost of tools to recruit (computer, software)
  • cost of memberships for effective recruiting (e.g. physical therapy association if available)
  • cost savings for employee retention (a thoroughly qualified candidate will tend to stay longer- projected 5 years)
  • resources to hire, train and pay an internal human resource person or recruiter
    • employee costs (workman’s compensation, taxes, benefits, salary)
    • training material
    • consulting fees

To build an effective internal recruiting process you will need to address all the points above.

Recruiting fact: The average length of time to find (for an interview…not for placement) one highly skilled and qualified medical professional (e.g. PT or Pharmacist) is 100 hours

Advertsement:

Northview Health Solutions full service recruitment process partners with its client for the purpose of:

1. engaging in and actively working as your temporary internal recruiting partner.
2. make ongoing recruitment effort until the candidate is placed
3. satisfying a critical need
4. positioning your company above competitors by the hiring of qualified highly skilled Physical Therapists.

Swollen Lymph Nodes

When swollen lymph nodes in the neck, above the clavicles (collarbone) or in the axilla (armpit) occur there are a few immediate questions we need to answer.

• Is there infection occurring in the body?
• Could lymphoma (a cancer that begins in the immune system lymphocytes) be present or developing?
• Is there cancer spreading from other sites?

A number of factors will help determine the importance of each of these questions.

For example, if a teenager has signs and symptoms of tonsillitis and there lymph nodes are swollen in the neck, we disregard the question of cancer.  We know infection is causing the lymph node swelling.

On the other hand, if a 30 year women has swollen lymph nodes above both clavicles and complaining of weight loss and night sweats, we must rule out lymphoma (e.g. Hodgkin or non Hodgkin).

Lastly, if a patient with a history of cancer …say prostate or cervical cancer…develop swollen glands in both axilla,  then we should wonder if the cancer has reoccurred and is it metastasizing (traveling to other parts of the body).

The lymph system is comprised of lymph vessels, lymph tissue including lymph nodes and lymph fluid.  These components are located throughout the body and are intimate with cardiovascular, pulmonary, digestive, genito-urinary, musculoskeletal and neurological systems.  The lymph system also includes the spleen, thymus and bone marrow where blood cells are produced.

The basic job of the lymph system is threefold:

1. circulate interstitial fluid (fluid located around and between tissues in the body)
2. transports chyle (fatty fluid from the gut)  into the circulatory system
3. transportation and implementation system for immune function i.e. for fighting infection and disease.

Lymph nodes become enlarged with the increased influx of lymphocytes (white blood cells).  The immune response to foreign material also increases the production rate of T and B cells (part of the immune system) withing the lymph node.

Since lymph nodes are spread out in the body, some are palpable and some are not.  During infection of the throat for example, lymph node swelling may be felt in the area below the jaw or along the side of the neck.

In other cases, if cancer is suspected… say due to unexplained weight loss or lump in the breast, lymph nodes in that region of the body will be evaluated with palpation or sometimes with a CT scan of  the chest and abdominal cavity.

In sum, if you notice swollen glands, question why they are there.  Often it is nothing more than a short term infection.  But the best route is to notify your physician who will take a history and physical exam and give an appropriate diagnosis and treatment plan.

Physical Therapy salary with or without bonus.

“Which is better: a higher salary without bonus or a lower salary with bonus incentives?”

Which is better: a higher salary without bonus or a lower salary with bonus incentives?

A Physical Therapy student recently asked this question as they were planning their first job. Thought I would throw my two cents in.

For the first 1-2 years, it is important to find a work environment where other PT’s will support your career values and goals. If you want to be a manual therapist then by all means surround yourself with like minded therapists. If you do not know which area to go into, then seek out a hospital with both inpatient and outpatient programs or practice in a department that rotates the therapists through acute rehab, outpatient ortho/sport and inpatient care.

There are hospital systems out there willing to work with most student’s needs and career aspirations. With coaching many hiring managers should sell their company to the top PT students and likewise PT students should sell too… but that’s another topic.

The money often is a secondary issue. If I were to pick between which is better (question above), the higher salary without bonus is better.

In my next post, I will explain why.

Michigan Physical Therapy Schools

Andrews University

Central Michigan University

Grand Valley State University

Oakland University

University of Michigan – Flint

Wayne State University