As a doctor, your choice of where to practice and who to affiliate with can be career-defining. Before you have completed your residency or fellowship, you will need to be deliberate and thoughtful in selecting a practice group to associate yourself with.
In weighing your options for this next stage of your medical career, there are key points to keep in mind.
1. Start with how well you expect to fit in with your peers and partners in the group.
How compatible are you, both professionally and personally? Consider your own professional goals. Do they align with the goals of the practice?
What about practice styles, schools of thought, training or competency issues – might the differences frustrate you professionally?
You also want to ensure that there is a current need for your services within the group. Referrals will be your lifeblood as you begin your practice; if you are filling a void, it may be more likely that the referrals will come your way rather than going to a veteran member of the practice. If you are to be the first member of a group to offer your specialty services, you must ascertain whether sufficient patient volume exists to support a practice.
Importantly, ask yourself: Can you trust the other physicians and support staff who you have met? Trust is central to a happy and successful partnership.
2. Factor in where you will live.
Remember that your choice of medical practice will affect your family (if you have one). Can you see yourself and your family thriving as part of this community?
Take a close look at the schools, churches, and social groups you might join. What kinds of activities are available in the area? Do you enjoy hiking and skiing, or are you a philharmonic aficionado? Will this location support your interests?
Consider housing: types, location, and prices. Would you prefer to live close to where you work, or are you okay with a commute? Do you want a single-family home, or would you prefer an apartment or condominium with fewer upkeep requirements?
Don’t let an unusually high salary fool you into moving to a community that will not support your lifestyle and your happiness.
3. Evaluate the environment and culture of the affiliated hospital.
Is there a need for your specialty or subspecialty? Much like a driven professional athlete, you want to come in as a first-string player rather than filling a spot on the bench.
Once you determine that there is, indeed, a need for your services, consider whether the infrastructure is there at the hospital to support your practice. Will your practice be adequately promoted? Have the leaders made a commitment to acquiring needed equipment, technology and other resources? Will you have resources to stay abreast of technological needs as treatment options expand? And, with lifestyle again in mind, ask about ER on-call and other coverage requirements of the hospital. Will they fit into your day-to-day life? Also, ask whether you could maintain that on-call coverage if you switch to another practice group in your region in the future.
4. Gauge the outlook for your professional growth and market-value based on historical precedent.
Assuming you are joining an established practice, consider how the group has fared over time. Just as an unusually high salary might suggest that the group has had difficulty finding and retaining physicians and staff, the turnover rate is an even more indicative metric.
Ask questions in the community. What is the group’s standing in the local hospitals and its reputation in the broader community?
Ask questions in-house. Have there been any splits or disagreements in the group? What were the circumstances that contributed to other physicians leaving the group?
Look at the legal history. Have there been lawsuits or disputes that affected the group? If you can, get a feel for the level of communication between doctors and staff. A positive, healthy working environment requires esprit de corp within the group.
5. Conduct extensive research on the group’s history and reputation.
When you join a medical practice, the reputations of the individual members of the group will affect how patients, hospital colleagues, and the community at large perceive you. Do some digging. Find any skeletons.
Have any members of the group been suspended from medical practice, had hospital privileges limited, or been sued for malpractice? Are any of them “rated” by the insurance carrier? If so, what is the history of malpractice claims, judgments, and settlements?
Have these actions affected the insurability of the group? Has the group changed carriers: why and when? Is their malpractice coverage with a mainstream carrier, or have they had to look further afield to “high risk” carriers for coverage?
You might consider having an attorney review the group’s insurance policy to ensure that you will be sufficiently covered if you ever need it.
6. Examine the financial health of the group, and probe compensation structure.
Arrange to speak with the group’s office manager and/or accountant and ask lots of questions.
How much practice debt exists and who is responsible for guarantying this? Are there tax liens? As with a marriage, you don’t want to be surprised that you are acquiring large debt responsibilities.
Ensure that bills are paid promptly and that staff members are adequately rewarded. Remember that support staff can make or break your experience and your practice.
Ask about the solvency of the group members, realizing that the group’s accountant might not have the answer to this inquiry. Turn to your own expert, too, to verify what you are told. Your accountant should review the group’s balance sheets and year-to-date income statements.
Also, ask the office manager or accountant about the group’s compensation schema. How is compensation determined for you and the other physicians in the group? Find out which parts of your generated income will go into the pool and which you will be able to keep.
More crucial compensation questions to ask: Must your “moonlighting” earnings be given to the group? What about drug studies and honoraria? Does the group pay productivity bonuses; if so, how are they determined? If you affiliate with a hospital are there economic opportunities available, such as the ability to secure a separate contract to be a medical director of a unit or oversee a clinical area?
From the group’s pooled funds, how are the revenues of “designated health services” and “ancillary services” divided or credited to the physicians? How is overhead allocated in determining compensation?
Look at the current range of compensation of physicians within the group to try to estimate your income potential in the future. Will that compensation be sustainable for you and your family? Just as you want your accountant to review the books before your join the group, get assurances that your financial professional will be able to verify compensation due by accessing the books and records on an ongoing basis.
Then comes the fun part: What are the fringe benefits? Financial compensation should be augmented with perks that improve your life and long-term security. You want to look at current benefits: automobile allowance, club dues, society dues and memberships, books and subscription reimbursements, CME allowance, even a cafeteria plan.
You’ll also need to review benefits that will support your lifestyle long-term: Is there a tax-qualified pension or retirement plan? What about deferred compensation plans? Will the group supply life, health, and disability coverage? Your largest financial burden to date is likely your student loans. Is there a provision for repayment or your student loans? Ask about the tax ramification of these benefits as well.
7. Beyond compensation and fringe benefits, review other key terms in the employment contract.
Understand the buy-in provisions for “partnership” and when this is typically offered. Do you feel comfortable with the duration of the agreement and the cancellation terms?
Is there adequate time off? Does the contract lay out pro-rata call and clinic coverage obligations? Do these assignments and the time-off fit into your vision of your professional and personal life? Consider the assignment of new patients to practitioners. Will you have a fair chance to see patients with the pathology matching your training and interests? Are patients assigned to physicians based on their insurance or pay classification? Does the scheme seem equitable?
Assuming that you are likely to make a change in the future, be sure you understand your rights if you leave the group. Become familiar with the financial arrangements in case of separation. Who pays the malpractice insurance tail premium? Is any compensation or interest in accounts receivable “earned” under a production formula payable after termination?
If you stay in the geographic area, some patients might choose to follow you. Will you have access to them and their medical records?
A non-competition agreement might be in play; understand it before you sign on the dotted line. You never want to entertain the possibility of a dispute, but you do need to be prepared. Alternative dispute resolution will likely control these talks.
8. Before making a final decision, turn to the people in your life who you trust.
What do your spouse, friends, colleagues, advisors and/or mentors think about the opportunity? What did your accountant report? Have you consulted an attorney? The contract is likely long and cumbersome. An attorney familiar with medical group contracts can provide assurance that you aren’t missing anything.
Ultimately, this decision is one of the most impactful choices of your life. Don’t make it alone.
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