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Evaluating Physician Career Opportunities
Jeffrey J. Denning, a principal of Practice Performance Group, completed his Bachelor of Science degree in Management at San Diego State University in 1971 and spent his first five years in clinic administration and accounting and tax practice in California and Texas. He then entered the private practice of management consulting in 1976 working with independent professional practices in both the U.S. and Australia. Since entering the field Mr. Denning has worked in a consulting capacity throughout the nation with nearly 300 practices representing over 800 physicians, has conducted more than 500 workshops, seminars and speaking engagements in the United States and Australia, and written over thirty feature articles for leading industry publications. They include Medical Economics, OBG Management, Pediatric Management, Managed Care, California Physician and numerous specialty academy journals. Mr. Denning is editor of UnCommon Sense , a monthly practice management strategy and tactics information service of Practice Performance Publishing, Inc. ®
Practice Performance Group
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Management Consulting & Continuing Education for Physicians 8070 La Jolla Shores Drive #518 La Jolla CA 92037 858/459-7878 Toll Free 800/452-1768 Telefax 858/459-6144 www.PPGConsulting.com
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Start with self evaluation -- What makes you happy? Personal Satisfaction: 1.
Personal life style
2.
Patient relations
3.
High quality, innovative clinical care
4.
High visibility -- fame
5.
Research, academics, mentoring, teaching
6.
Membership in a medical team
7.
Full control over your professional life
8.
Political involvement
Financial Reward 1.
Your tolerance for risk
2.
If your goals are unclear
3.
Need for secure and consistent income
4.
Immediate need vs later, larger requirements
5.
Expectations for the career -- who is your role model?
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Opportunity Rating Worksheet Lifestyle Work volume Culture Public schools Climate Recreation Accessibility Stress Vacation time Housing options Neighborhood options Subtotal Financial Benefits Minimum salary guarantee Incentive package Health insurance Malpractice insurance Disability insurance Pension plan Sick time Buy-in options Other income sources Annual nugget storage potential Subtotal Cost of Living Housing Entertainment State income taxes Sales taxes Real estate taxes Public or private schools Subtotal Professional Climate Quality of colleagues Tertiary backup Patient mix Clinic staff Financial stability Adaptability to future changes Specificity of future alternative Market control Prevailing fees On Call Subtotal Total Score
Location ______________________________ Rating
___
Weight
_____ _____ _____ _____ _____ _____ _____ _____ _____ _____
X X X X X X X X X
4.5 2.0 3.0 2.5 2.5 3.0 4.0 4.0 3.0 X
_____ _____ _____ _____ _____ _____ _____ _____ _____ _____
X X X X X X X X X X
_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ X
Score
= = = = = = = = = 3.5
_____ _____ _____ _____ _____ _____ _____ _____ _____ = _____ _____
4.0 4.0 3.0 2.0 3.0 3.5 2.0 2.0 2.0 4.0
= = = = = = = = = =
_____ _____ _____ _____ _____ _____ _____ _____ _____ _____
X X X X X X
3.0 2.0 2.0 2.0 2.0 4.0
= = = = = =
_____ _____ _____ _____ _____ _____
X X X X X X X
3.5 2.0 4.0 2.0 4.0 4.0 3.0 X 3.5 =
= = = = = = = 4.0 = _____
_____ _____ _____ _____ _____ _____ _____ = _____ _____
X 4.0
_____
_____
_____ _____
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Entrepreneurial Challenge
1. Personality types: Introspective, shy, withdrawn Overt, assertive, compelling 2. Marketing instincts Finding your unique niche Patient and referral source service Willingness to promote 3. Management skills Analysis Planning Initiative Communication Leadership Delegation Attention to detail 4. Energy for change and risk 5. Long term commitments
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Realistic Expectations Demand for Your Specialty 1. Want to be a success? Go where you're needed. 2. How is the community served in your specialty now? 3. What specialties are doing your work? 4. Will you be able to "break in"? 5. How will you be different? Can you? 6. If you represent "more of the same" what's the waiting time like to get an appointment? Can you take the business away from someone else?
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Employee, Contractor, Owner or Associate Status?
1. Employee
2. Independent Contractor
3. Solo or Joint ownership
4. Association
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Finding the Best Position 1. Set your criteria: Practice size Practice style Location 2. Community considerations The competitive environment How many physicians? How many new physicians in the last few years? How many nearing retirement? How many hospitals? Are they competitive? Open staff policy? Restricted privileges? How many new physicians on staff in recent years? Are there competitive alternative delivery centers? Freestanding emergency care centers? Primary-care centers? Diagnostic testing centers? Industrial or workers' compensation clinics? Others? How many managed care systems in the community? HMO? IPA? PPO? EPO? A major force? What's the trend? Demographics What is the population of the drawing area? How has it changed in the last 5 years? What are their ages? Number of new families? New homes or subdivisions? New townhomes or apartments? Number of retirement or nursing homes? Older, established neighborhoods? Do these age distributions fit your desired service profile? What's the employment picture? Expanding or contracting? What kinds of jobs? Stable or transient? Good employer paid benefits? Location of Practice Visibility of location? Convenience to patients? Near competitive alternatives to you? Near major transportation arteries? Traffic congestion problems? Adequate parking? Room for expansion? Convenient to your home and hospital?
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3. Getting help from the hospital Income guarantees Referral services Subsidized rent, purchasing services and staff Loans Marketing services Practice purchase facilitation What contracts do they have? Strength of IPA / HMO activity? 4. The word-of-mouth network 5. Specialty academy Example:
AAFP Compass (Computer Assisted Site Selection Program) American Academy of Family Physicians PO Box 8723 Kansas City MO 64114
7. State or county medical society 8. Classified ads 9. Your own direct campaign? "Help" letters Direct solicitation of positions
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Presenting Yourself Well 1. The medium is the message Correspondence CV Telephone communications 2. Appearance Dress for success Grooming 3. Behavior Do what you say you will do Show up on time Smile and be friendly to everyone Listen and prove it by taking notes Do your homework: show knowledge of the community, hospital, local employers and medical issues Ask: show interest in the important issues of practice "I hope you won't think I am prying or being rude; if you prefer not to answer please just say so. But since my time here is limited and this is such an important step, I feel obligated to ask . . ." 4. Closing the interview If you're interested, ask for the order: "I'm impressed with what you've done here. I think this might be a good place to consider developing a practice. I would be very interested to go into the specifics of what that might mean. Are you?" "If you decide I'm right for this practice, what do you plan to offer?" "When can I expect to know your intentions?" If you're not interested: “Thank you for your time. You have given me a lot to think about and I will give your opportunity careful consideration." 5. After the interview Personal thank you note to principals and manager Follow-up if interested
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Are They Eligible to Hire You? 1. Why do they want or need you? "What need will I be filling?" "What problem am I solving?" "How long have you been looking for an associate?" 2. Is there room for you to work? "How many exam rooms?" "Is there a satellite office?" "Where will I be working?" "When would I have office hours?" 3. Is there work for you to do? "Could you describe the marketing plans for adding an associate to your practice?" "What will I be permitted (required?) to do to build a practice?" "Where do your patients come from?" 4. Evaluate the management Phone answering Appointment book control "On time" performance "Hard to get" reputation with referrings or patients Evidence of high overhead? Waste? "What is your mechanism for making policy decisions?" "Are there management responsibilities for the physicians?" "May I see your personnel policies?" "May I see your job descriptions?" "May I see your OSHA protocol?"
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5. Evaluate the physicians Smart ? Progressive? Personable and friendly? Sense of humor? Mature? Seek to minimize huge differences of age, personality, life goals, etc. Professional liability actions pending? Resolved? Credit rating? 6. Is there medical community unrest? "Are there any unusual problems here?" "What tough new competitors do you foresee on the horizon?" "Which hospital do you use? Why? Are there unusual Hospital problems?" "What about IPA (or other staff politics) problems?" 7. How good are the employees? Receptionist Nurses and techs Manager Any family members or other ‘sacred cows’? History of high employee turnover? Why? 8. History of physician turnover? "May I have the names of physicians who have worked here in the past ten years who don't work here now?" "Do you mind if I contact them?" "What do you think they will tell me?"
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What is the ‘Deal’? 1. Is there a contract? If so, use it as your starting point If not, will there be one? Who will draft it? 2. Compensation: Base salary or guarantee Incentive payment Non-cash benefits Health and accident insurance Disability insurance Life insurance Professional liability insurance (and "nose" overage, if needed) Vacation Sick leave Continuing education time Continuing education expenses Signing bonus? Relocation expenses? If they have no specifics, be prepared with your own list of what you consider reasonable And, for the long term:
"How do you pay partners?"
3. Work load: What are you expected to do for your pay? Call responsibility Nights Weekends What are the other members of the call group like? Productivity expectations Surgery assisting Charity work / Medicaid component Capitation patients
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Urgent care / extended hours clinic How will you know if you're meeting their expectations? Production targets Published charge and payment statistics 4. Equity arrangements: "Assuming things work out for both of us, what will the long term hold for me?" "When would I be offered an equity position?" "What will I be buying?" "How much will it cost?" "How would I pay for it?" Get these issues on the table early. If they have no specifics, consider your strategy: a.
Accept the "wait and see" approach, strengthening your position each day as you build your practice
b.
Offer your own ideas for buy-in / buy-out, income split, etc. Get the negotiating out of the way now.
5. What if it doesn't work out? "If I accept your offer, what will be the mechanism if either of us later changes his mind?" Resignation Expulsion Non-competition agreements Professional liability tail
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What it Takes to Build a Practice 1. All physicians need to build their practices Academic practice HMO or institutional employees Large group employees Smaller group associates Soloists 2. Formal announcement Reach your referral constituency Individuals Physicians Community leaders Employers Hospital employees Other medical community influentials pharmacists therapists administrators PAs and nurse practitioners dentists Simple and to-the-point One page letter Cover your training and skills Stress skills new to the community or the practice 3. Introductory social functions 4. Community outreach Join state and county medical societies Participate in specialty organization activities in community Meet key potential referral sources 5. Press release the event Successful recruitment of new physician Addition of new skill / training to community Improvement of hospital's service as a result of new physician's arrival Send release to your VIP list as well as the media Alumni association Home town paper Membership organizations Friends and colleagues 6. Consider professional help
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ARE THEY QUALIFIED TO HIRE YOU? by Jeffrey J. Denning 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 check book that inhibits success.
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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 physician/s. 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 work load 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
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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. Jeffrey J. Denning, a principal of Practice Performance Group, completed his Bachelor of Science degree in Management at San Diego State University in 1971 and spent his first five years in clinic administration and accounting and tax practice in California and Texas. He then entered the private practice of management consulting in 1976 working with independent professional practices in both the U.S. and Australia. Since entering the field Mr. Denning has worked in a consulting capacity throughout the nation with hundreds of practices, has conducted more than 1000 workshops, seminars and speaking engagements in the United States and Australia, and written over fifty feature articles for leading industry publications. (c) Copyright 1991-2009 Practice Performance Group, all rights reserved
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EVALUATING PROSPECTIVE EMPLOYERS: Is bigger better? by Jeffrey J. Denning In trying to determine where to send your C.V., your first attention should be to the size of the organization where you want to work. No other single factor has as much impact on the early private practice success of a physician coming out of a residency or fellowship. Solitude You may have what it takes to strike out as a solo practitioner. What it usually takes is a deviant personality, the inability to get along with others, the need to make all your own decisions for better or for worse, and the confidence (ego) to believe you can succeed all by yourself. Seriously, the popular wisdom -- that the day of the solo practice of medicine is over -- is simply not true. Some of the most efficient and happy physicians we've seen practice in this mode. If a physician is a superstar, solo practice may be the best way for him or her to work. Our observation is that solo practices are more efficient than group practices, operating at lower cost. They are also more sensitive to the physician's leadership (or lack of it). For the physician willing to take a lead in describing what he or she wants from practice, a solo practice will respond to the owner's management touch more rapidly than a group practice can. For complete freedom and independence, solo practice can't be beat. Soloists aren't bound by the constraints of consensus among colleagues in decision making and don't have to pay for the management layers a larger organization requires. Solo practice can be professionally lonely, though. Cross-consultation must be more formally (and inconveniently) arranged. The same is true for coverage. When solos are in town, they tend to cover all their own call. And when they leave town, their practices are covered by a competitor, leading many to stay home. This fact contributes to the higher incomes of many solo practitioners: they work harder than their colleagues in groups. The good news is that all physicians are smart enough to become a success in solo private practice. We generally recommend, though, that physicians seriously entertaining the notion of solo practice should do it after having worked in a group practice. Physicians can learn a lot about the workings of an office -- both the things you wish to replicate and the things you wish to guard against -- by working in someone else's practice. Residencies don't usually fill this educational need, though some fellowships may. A well run private practice setting is the best place to try out management ideas and learn from other people's management mistakes.
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Big Groups Big groups such as multi-specialty groups and HMOs have certain advantages. The cross-specialty collegiality and clinical stimulation may be attractive. A built in referral network may provide you with plenty of work to do. And the community visibility that a big group may experience could give it a marketing boost in attracting patients. On the other hand, the disadvantages of multi-specialty group practice are manifold. Because they are larger organizations, they are harder to manage than smaller, single specialty groups. They require a professional clinic administrator with the inevitable assistant administrator, and various levels of supervisors just to operate. All of this is costly and, in unenlightened hands, chaotic. We often find physicians working in this environment exhibiting an "employee mentality" regardless of their ownership status. The "nine-to-five" attitude is often hard to shake in an environment that restricts the individuality of the physicians and forces them into an essential bureaucracy. Splitting the income of the multi-specialty group is always embroiled in controversy, too. There are many ways of computing who gets what, but someone will always feel it is unfair. This leads to an inherent instability that takes energy to overcome. Sometimes, it cannot be solved, leading to some of the more spectacular examples of the shifting of wealth from physicians to lawyers. Small Groups The single specialty group of more manageable size -- say three to five physicians -- is a very popular way to practice cardiology. The single specialty group can support its own non-invasive lab, as well as other clinical programs that the solo practice or the small cardiology department in the multi-specialty group might not. Group practice institutionalizes the call coverage routine and the professional stimulation of colleagues in your same field make it in many ways a more desirable mode of practice than being solo. But don't mistake easier coverage arrangements for a way to get more time off. You pay for your thrills, and when you take time off you can expect it to come out of your income. Many physicians recruit junior associates as a way of "getting more time off without losing income." While this strategy may work in the short-run, it never works in the long-run. Single specialty group practice can also give physicians the security of a formalized buyout arrangement in the event of death, disability and normal retirement. Our experience is that physicians in single specialty groups earn more than physicians in multi-specialty groups, too. On the other hand, they often earn less than physicians in solo practice. The principal disadvantage of the single specialty group is the "magic number" problem which bound-up in the notion of manageable size. Two physicians practicing together is probably the worst number for joint practice, because in the absence of one, the other cannot do the work of two. A group composed of three physicians often works, since two can easily handle the work load of three for short bursts of coverage. (Beware the myth of the three musketeers, however, since we often see decision making in the three
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physician practice falling into the "two against one" category). Four or five physicians can often work well together. But by adding a sixth physician, many practices go "critical". Covering for five or more physicians on call can mean a grueling weekend. And, the practice's management may no longer be able to cope with this increased level of activity. The larger number of personnel required may put too much of a supervision burden on the traditional office manager. This size practice is too small, however, for the clinic administrator/supervisor style of management. And, the size of the office space needed may mean a costly expansion, move, or the addition of an otherwise marginally justifiable satellite office. Our tentative conclusion, stick with three to five physicians in single specialty group practice. If you are about to be the sixth or seventh physician, be prepared for big problems. All of these alternatives settings are valid choices for some physicians. We see contented, fulfilled and successful physicians in each of them. Matching the setting to your own personality and goals is the trick. What it takes is some thought and introspection -- and a little luck.
Jeffrey J. Denning, a principal of Practice Performance Group, completed his Bachelor of Science degree in Management at San Diego State University in 1971 and spent his first five years in clinic administration and accounting and tax practice in California and Texas. He then entered the private practice of management consulting in 1976 working with independent professional practices in both the U.S. and Australia. Since entering the field Mr. Denning has worked in a consulting capacity throughout the nation with hundreds of practices, has conducted more than 1000 workshops, seminars and speaking engagements in the United States and Australia, and written over fifty feature articles for leading industry publications. (c) Copyright 1991-2009 Practice Performance Group, all rights reserved
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GETTING A JOB: Logistics and etiquette of the job hunt by Jeffrey J. Denning At some point in residency or fellowship, every ophthalmologist needs to confront the issue of landing the first job. While it may not be your only job in medicine—indeed, the odds are against it—every position is important in a developing career. That's why physicians in training should approach this assignment with a mission: to get the best interviews. Where are the Jobs? Your first pass through the advertising should be to find those listed opportunities that meet your ‘type of practice’ criteria. This would include the size of practice (number of physicians), style of practice (academic, multispecialty group, etc.) and the geographic location of preference. A telephone call (or letter to a blind ad) should help you determine if the opportunity is worth your application. The bromide in recruiting is that the best jobs aren't advertised. We don't know if it's true, but it doesn't hurt to proceed as if it is. This means enlisting the word-of-mouth network to spot good target opportunities. One technique is to let everyone you've ever met in the field of medicine (or even remotely connected with it) know you are looking and ask for their help in spotting opportunities for you. It would certainly include hospital administrators in your target communities, leaders of organized medicine, outstanding figures in your specialty and related fields. Asking for help is a great way to make a friend and the logical targets are people who will be helpful to you later as well. A mass mailing to everyone in your specialty in your target areas, asking for their help in spotting opportunities for you may yield several leads. It is hard to say who will be able help or who might have an opening for you, but it does get your name in front of a lot of people——something that can only help in the long run. The letter should be short and direct, telling people of your upcoming availability and asking for help in identifying opportunities. Put in a paragraph describing your credentials and experience but don't bother with the C.V. at this point. Your mission is to get leads on possible openings. If you have identified specific practices that you would like to join, solicit them. It costs very little and if you are persistent, they may take you on even though they don't have plans to expand their practice. We are continually amazed at the number of practices that hire doctors because they apply. Most physicians do precious-little planning so they may be ripe for your doing it for them.
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First Impressions All of your contacts with the outside world should telegraph the message of professionalism and quality. Your letters requesting help in the job search, application letters, and C.V. all need to be professionally prepared and letter perfect. When you go for your interview, get a haircut, shine your shoes and dress like the majority of doctors in the area. If in doubt, hang around the hospital for a while to see how they dress. Appropriate physician attire differs tremendously by area, but, for men, a natural shoulder, natural fiber traditional look is probably the safest. For women, a conservative dress or suit are appropriate. Avoid dramatic or fussy looks. Show up on time and smile. Be friendly to everyone. Receptionists, medical assistants, techs, and managers may be just as important to your success as your potential colleagues. Listen carefully and take notes. You will forget what people tell you. Ask plenty of questions and display a knowledge of the medical community if you can. It is a good idea to do some homework about the hospitals, the demographics of the area and the major employers, too. In most towns, the Chamber of Commerce or Convention and Visitors Bureau will have a brief demographic description to provide you with the background to ask some reasonable questions. Knowledge of the dominant employers, insurance plans and HMOs, and so forth will help you get the most from your interview. Some of the questions you may want or need to ask may seem awkward at first. Give the other party permission not to answer: “I hope you won't think I am prying or being rude when I ask you these questions. And, if you would prefer not to answer some of them, I hope you will just say so. But since my time here is short and this is an important step for everyone involved, I feel obligated to ask." First Interview Questions The interview process can be stressful to both the employer and the candidate. Both are often inexperienced in the professional hiring process. Employers are often seductive in the process, trying to entice the candidate by putting on a good front. And job candidates may be doing the same thing. But your desire to impress them with your credentials and winning personality should be balanced by the need to uncover important facts about the target employer. Here are some good questions to ask of the doctors, clinic administrator or office manager of your prospective employer's practice: Why am I here? Why are you looking for another physician? What need will I be filling? Could you describe your marketing plans for adding me to your practice? Where do your patients come from? What will I be permitted (or required) to do to build a practice? Would you describe the philosophy of the practice for me? What are you trying to do here? What kind of cross-consultation mechanisms do you have? What is the general internal medicine component of the practice? May I review some charts?
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Is the medical community facing any unusual problems here? What about the hospital? Are there any tough new competitors on the horizon? How long have you been looking for a physician? What are the names of physicians who have worked here in the last three years who are not here now? Do you mind if I call them? What will they tell me? What is the mechanism for making management decisions? What management roles do each of the doctors take? May I see your personnel policies? How about the job descriptions? May I see a sample employment contract? Having a short list of questions shows you are serious and interested in the opportunity. And, an organized set of valid and thoughtful questions to cover in the interview reflects positively on you, too. Ask for the Order If things are going well and the answers you got seem straight and reasonable, then tell them you are interested in pursuing the opportunity further. You should also ask if they are interested enough to talk about the specifics. "I am impressed with what you have done here. I think this might be a good place to consider developing a practice and I would be very interested to go into the specifics of what that might mean. Are you?" We think it is a good idea to get to a discussion of the deal as early as possible, provided one party isn't wasting the time of the other. (If either you or your prospective employer feels the situation doesn't hold much promise, why waste a lot of effort on the negotiation process?) But, if things do look good, it is usually the least awkward to get some specifics out on the table early. If they have no specifics to offer, as is often the case, you should be prepared with yours. Give plenty of advance thought to what you are looking for in terms of salary, benefits and working conditions. Generally it is better to let them make an offer first, since it may be higher than what you would be willing to accept. After the interview, send a personal thank-you note to each principal, regardless of the outcome. Most physicians recruiting associates are inexperienced at it and lack interviewing skills. They may actually be naive about what how to proceed or only appear that way out of sheer caginess. Either way, if you are prepared and conduct yourself well your odds of success go up. Jeffrey J. Denning, a principal of Practice Performance Group, completed his Bachelor of Science degree in Management at San Diego State University in 1971 and spent his first five years in clinic administration and accounting and tax practice in California and Texas. He then entered the private practice of management consulting in 1976 working with independent professional practices in both the U.S. and Australia. Since entering the field Mr. Denning has worked in a consulting capacity throughout the nation with hundreds of practices, has conducted more than 1000 workshops, seminars and speaking engagements in the United States and Australia, and written over fifty feature articles for leading industry publications. (c) Copyright 1991-2009 Practice Performance Group, all rights reserved
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