Are They Qualified to Hire You?

Many residents and fellows considering private practice job opportunities spend too much time thinking about their credentials and qualifications to get the next job. What they should be concentrating on are the prospective employer’s qualifications to hire them. Here are a few easy ways to spot good (and not so good) places to work.

The Work

Every new physician must build a constituency. In addition to your colleagues and the staff in your practice, your constituency consists of the referring physician community and the patient population served. He or she will have to build a practice, no matter what the setting. Joining large groups may put physicians to work faster than joining a solo physician, but to build the practices they want, they will need a practice development plan. Analyzing the types of patients, referring physicians, and the environment in which they will be working implies some crucial questions: Is there enough work for me to do? What are the competitive factors? Are there any problems with the referral base?

All of these questions really boil down to a fundamental one: Why am I being recruited? If the answer is, "to help pay the overhead," there may be trouble ahead. Physicians don’t pay overhead — patients pay overhead.

The Doctors

The potential employer is also a potential long-term business associate. How well the physicians fit together is crucial to long term success in group practice.

Physicians should evaluate potential employers the same way they should evaluate potential employees. Look for people who are smart, educated, experienced, friendly, and mature. Look for big differences between your personality and his or hers. They don’t bode well for a long-run success. Great differences in age, personality, religious or political concerns, and personal life style could make it hard for you to co-exist as associates.

All this is not to say that practice colleagues should be clones of one another — complimentary differences can strengthen a practice. But if they are too great, these differences may make it difficult to find common ground on practice issues.

The Staff

Generally, the best employees work in the best practices. One of the most important indicators of a potential employer’s qualifications to hire you may be the caliber of personnel he or she has assembled. Employing a crew of sub-par employees may indicate lack of leadership, a naive approach to management, or a strangle-hold on the checkbook that inhibits success.

Look for a smart, trained, and experienced receptionist who is personable, friendly, assertive, and reasonable. Poorly managed offices frequently have the youngest, least experienced, and lowest paid employees in this crucial position.

Look for an administrator, office manager, or lead employee who can communicate clearly, solve problems, and answer questions with a minimum of hand-wringing. Employing a good office manager is the sign of a good doctor and an excellent indicator of a good place to work.

Beware of practices that employ family members or close personal friends of the physicians. While it sometimes works in solo practice, it almost never works in group practice. Job candidates may also wish to explore with the manager and potential employer what influence they would have on the selection and supervision of the staff. While new physicians shouldn’t expect to come in and take over, the personnel are so important to their success that the new physician should have some say in this essential issue.

Management

Other good early indicators of a good place to work are the practice management systems. How many rings go by before the telephones are answered? What do people say when they answer the telephone? Are the employees courteous, diplomatic, and tactful? You can learn all of these things by eavesdropping while in the practice. They are good early indicators of the sophistication of the office management and the attention to detail of the physicians.

What about the appointment schedule? How far are patients booked in advance? What is "on-time" performance of the practice? Is there room for emergency work-in patients? Does the practice have a reputation with referring physicians as "hard to get?" All of these are make or break issues for doctors building new practices.

The Plant and Equipment

While it may seem like a petty concern, the office in which the new physician will work and its proximity to the hospital are actually crucial. Many practices see the new doctor as the solution to the "we’re too busy" problem, with the new hire picking up the workload and relieving senior physicians from extended days and rigorous call. But are there enough exam rooms?

Most medical offices are too small. Determine early in the interview process if there is room for you to work. This means a minimum of three exam rooms available for each physician on the premises during scheduled office hours. Watch out for the practice that is going to "fit you in" during slack times in the schedule. Look at the appointment book to see if there are any slack times.

Another, often naive, approach is to create a satellite office to gather more square footage to accommodate the new doctor. Operating the satellite office is fraught with practical problems that only the most skilled managers can cope with. While the practice may look like a good opportunity, if there is no place to do your work, you will have a hard time building your constituency.

The Deal

Finally, if everything else looks good, what is the offer? Where is the risk and who gets the reward? The straight salary arrangement places the risk with the employer, who should demand some rewards for it. Count on earning more than you get. A compensation package based on your production places the risk of building a constituency on you. That may be a fair risk to take if the rewards are also fair.

Try to get the terms of the long-run arrangement spelled out at this point, too. It is reasonable to ask the potential employer, “Assuming things work out, what will be the terms of a long-run practice here?” Prolonged "employee" or "junior associate" status is generally distasteful and usually not necessary. Most physicians can determine if a professional relationship has potential within a year or so.

You should also determine at this point what the "dues to join the club" will be. This represents the amount that the employer or host medical group expects to realize in good-will contribution from you when you transition from employee to a more tenured status. Whether it is as an associate, partner, or shareholder in the practice, you may be asked to pay for the privilege of joining. While reasonable people can differ as to how much that payment should be, it is not reasonable to expect the new doctor to sign a blank check at the beginning of his or her career by failing to negotiate all of these terms in advance.

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