Finding the Right Practice Caroline Kirkman Vice President Physician Recruitment HCA Physician Services – South Atlantic Division10/15/11
Planning Start Your Search NOW!
Write a Great Cover Letter • One page, only 2 to 4 paragraphs • Personalization • Be passionate – sell yourself! • Write directly, avoid generalities • Highlight unique experiences/expertise • Get a colleague or friend to review & critique your letter
Long Form CV Preparation Short Form Identification Postgraduate Education Experience Licenses & Certifications Professional Affiliations Everything on short form + Publications Presentations Remember to use reverse chronological order.
General CV Guidelines • Choose a format and be consistent throughout • List all education and experience in reverse chronological order • Ensure that all contact information is up to date • Use traditional fonts (Times New Roman, Arial, Tahoma, Georgia, Calibri) and appropriate spacing • Headings should be clear and stand out from the other text in your CV. • Text size should be 11-12 pt • Proof Read. Proof Read. Proof Read.
Take Control for Wise Decisions • Where do you want to live? • What kind of practice do you want? • Is the amount of loan repayment an issue? • What family ties are involved? • What about your spouse’s career? • Have you considered your hobbies and other interests?
Resources for Finding a Position • Medical Journals • Internet Job Sites • www.PracticeWithUs.com • Networking • Consult Alumni • Social Networking • Ex. Linked In • Hospital CEO’s • Physician Recruiters • Specialty Board • Locum Tenens • Program Coordinators • Career Fairs • CareerMD Job Fairs
Agency Recruiter Recruiters as a Resource In House Employed by Entity Concerned about retention Based on Community Need Commission-based sales agent Placement fee $20,000-$40,000 National perspective-not often familiar with the area
Basic ConsiderationsRegardless of which form of practice you choose, carefully consider the following: • Location • Colleagues • Hospital Affiliation(s) • Community Need • Call Requirements • Family
Multi Single Specialty vs. Multi SpecialtyComparing the Benefits Single Fewer competing interests Faster decision making Better call coverage Shared office staff Equitable cost sharing Built in referral base Ability to collectively benefit from referred patients’ care Ancillary development Ability for primary care and specialty physicians to consult together
Negatives Private PracticeLarge Group Positives Overhead costs and financial risk spread among more physicians Clinical synergies Referral opportunities Cash flow more predictable More leverage with payers Ancillary development easier Distribution of income can be difficult Clash of personality and style Reduced independence Reduced governance role Liability for group financial and clinical performance Senior vs. junior physicians
Negatives Private PracticeSmall Group Positives Greater role in governance than in larger group Shared risk and overhead Faster decision making Focused expertise of administrative staff Responsible for colleagues performance Shared financial losses Less predictable referrals Less capital and patient volume for ancillary investments
Negatives Private PracticeSolo Practice Positives Set your schedule Independence Clinical autonomy Immediate rewards for efficiency Rise and fall based on your own merits Need to be an excellent business person Sole financial responsibility and personal risk Must develop your own patient base Less predictable referrals Difficult for one administrator to be good at everything
Negatives Employment(Government, Corporate, Industry) Positives More secure and less risk in the short run No start up costs Guaranteed paycheck and benefits More structured work environment Practice Management support Ability to Focus on Patient Care Less control + little if any ownership Future Tied to Organization’s Success Limited control over staff + workload Multiple layers of management and bureaucracy
Joining a Partnership or GroupKey Considerations • Determine who owns the group and their corporate structure - PA, PC, LLC, PLLC, etc. • Determine how ownership is obtained • Determine the timeframe and terms of buy-in $ amount • Decreasing role of sweat equity • Determine who really “calls the shots”
What’s Next? • Narrow your potential practices down to < 5 • Phone Interviews • Prepare a detailed list of questions/concerns • Go on your site visits • Use a Practice Scorecard to critically evaluate your options
Success Over the Phone • Have no interruptions or distractions • Use a land line • Stay calm and listen carefully • Pause before answering any questions • Have your CV and schedule in front of you • Be confident
The Site Visit • Do your homework • Dress professionally • Arrive 15 minutes early • Bring extra copies of your CV • Have a firm handshake • Practice good eye contact • Have your list of questions/concerns with you • The lost art of the “Thank You”
Physician Due Diligence • How long has the group been in existence? • Does the group have enough patients to support a new physician? • How many new patients a year does the practice attract? How many does it lose? • Does the group have a marketing plan? • What will the group do to send patients my way? • How many managed care contracts does the group have? Do the payments cover costs?
Financial Due Diligence • Balance sheet, P & L, cash flow statement • Overhead-to-revenue ratio • Physician productivity • Debt / loans • Payor mix • Capital reserves • Managed care contracts • Accounts receivable • Audit history • Malpractice Claims
Compensation • Research (MGMA, Salary.com, etc.) • Consider the total compensation package, including all benefits / incentives • Signing bonus? • Will the practice help with loan repayment? • Consider the role / percentage of productivity • What happens after the first year?
Definition of a Contract An important and legally binding agreement between a physician and another party that defines the working relationship with mutually agreed upon duties, responsibilities and rights.
What a Contract Isn’t • A handshake • A letter of intent • A promise • An understanding • What someone said, thought, meant, or hoped for
Simple Steps for Contracting Read it. Understand it. Get at least two opinions.
Two Basic Contracts • Revenue Guarantee • Employment
Typical Revenue Guarantee One year of financial support with a two or three year promise to stay.
Revenue Guarantee Example: Hospital guarantees a physician net revenues of $20,000 per month for 12 months. Total contract worth $240,000 per year.
$90,000 \ 36 month forgiveness period = $2,500 to be “forgiven” every month the physician stays in the service area.
Revenue Guarantee Questions • Forgiveness versus Non-forgiveness • Payback versus Non-payback
Compensation • Research (MGMA, Salary.com, etc.) • Consider the total compensation package, including all benefits • Consider the role/percentage of productivity • Supply and demand, rural versus urban areas influence compensation • What happens after the first year?
Benefits to Consider • Malpractice (with tail coverage) • Health Insurance • Paid Vacation/Holidays/Sick Time • CME Allowance • Disability Insurance • Dues and Subscriptions • Licensure Fees • Pagers, Cell Phones, Mileage, PDA
Restrictive Covenant Prevents you from practicing in the same general area for a given period of time after you leave the practice. • Time • Scope of Practice • Distance
Restrictive Covenant Enforcement • The covenant must be written and supported by valid consideration. • No bad faith exists in the negotiation. • The employer has a legitimate interest to protect. • The covenant must be reasonable as to time, scope, distance.
Points to Remember • The contract is always drawn up by the practice or institution. Be aware that it is designed to protect them. • Always read the entire contract yourself. Ask for clarification if you don’t understand something. • Statements like “may,” “to the extent possible,”and “under certain circumstances” do not guarantee performance. • Do not pay for goodwill to join a group. • Obtain the services of a competent attorney and accountant. Look for someone specializing in healthcare.
Negotiation Tips • Do your homework. Develop your own yardstick. Start with the end in mind. • During the interview, listen to both what is spoken and what is unspoken. • Remember: strong, established practices are less flexible. • If it’s not written in the contract, it doesn’t exist. • The best predictor of future behavior is past performance. • Let the other side talk. No one has ever “listened” themselves out of a job. • Take turns. Don’t bid against yourself. • Pigs get fat, hogs get slaughtered.
Final Considerations Before Saying Yes • The salary and benefits package is competitive and commensurate with my experience level and the responsibilities of the position. • This opportunity will allow me to grow professionally and bring me closer to my ultimate career objectives. • The incentives offered are motivational yet attainable. • I am likely to find the challenges of the position stimulating.
Final ConsiderationsBefore Saying Yes(Continued..) • The hours required are acceptable and in line with my goals for work/life balance. • The practice culture is a match with my personality and values. • The work environment seems positive and professional. • My prospective colleagues appear to be people with whom I could enjoy working.
Recommended Websites Home Finder: www.homefair.com Rates: www.bankrate.com Demographics: www.factfinder.census.gov State Medical Boards: www.fsmb.com City Profiles: www.city-data.com Cost of Living Calculator: www.bestplaces.net/col Job Sites: www.practicewithus.com www.practicematch.com www.practicelink.com www.nejmjobs.com Contracts: www.ama-assn.org Salary Info: www.mgma.com www.salary.com Attorney Search: www.martindale.com Writing Help: www.writinghelp-central.com
The HCA “Earn While You Learn” Stipend Programwww.EarnWhileYouLearn-HCA.com