1 - Compatibility

First and foremost is compatibility between you and the practice itself-the physicians, the staff, the systems. Does it feel like a comfortable environment for you? I strongly encourage all new physicians to visit a practice for at least a full day so you can give people a chance to show their true selves, rather than their "interview personalities".

2 - Check References

Call the medical director or chief of staff of the hospital where the physician has privileges and say that you're considering joining the practice. If the feedback is positive, you'll know it. If it is lukewarm or guarded, you'll be able to read between the lines. Does the practice have a rude nickname in the community, and for any apparent reason?

Carefully assess the business health of the practice. The best approach is to have an independent medical practice management consultant perform a Practice Survey and tell you if it is a good opportunity. There are many hidden problems that a consultant can find that an inexperienced person might miss.

3 - Income and Financial Issues

Are you going to be an employee for a time, or a true partner? How much risk is there? Is there an income guarantee? Guaranteed by whom? Most practices pay a base salary plus a percentage for productivity: for example, $90,000 base plus 30% of all gross receipts over $200,000. By offering these incentives the practice is asking you to demonstrate an ability to manage volume and build a practice. Are the incentives reasonable, or so unrealistic that no newcomer could expect to reach them? Check out the turnover history of other associates in the practice to see if there's a revolving door situation.

A very important consideration that many overlook is the transferability of any HMO or managed care contracts. What if a practice gets the majority of its patients from one or two health plans, but the plans are closed to accepting any new physicians? Don't just accept the word of the partners that you will be accepted into the managed care plan, get it in writing from the plan itself.

Are you expected to eventually buy into this practice? How much and when? Is one partner planning to retire and expects to be bought out by the other partners? If so what kind of payout would be expected?

Are you expected to buy into the office real estate? (A real estate agent's joke: Q:What's the difference between venereal disease and a medical office condo? A: You can get rid of a venereal disease).

4 - Security and Risk

What kind of plan is there for you if things don't work out? If you decide after a few months that the practice is not for you, can you walk away without major obligations?

5 - Governance and Management

Who is in charge of the practice? Is there a senior doctor, or a president? Are there elections to determine this individual? What are the decision making rights of the physicians who do not have seniority?

If there are disagreements in the way the practice is run, how are they handled? Is there a protocol for arbitration?

What is the frequency of staff meetings? If staff don't get together at least once a month, expect some communication problems and unresolved issues.

If you're considering joining a practice with nepotistic tendencies, and you have a problem with a staff-family member, how will it be resolved?

What are your management responsibilities? What responsibilities do you want?

Some physicians leave their employer's practice after time to start their own practice in the community, only to find that their contract had a "restrictive covenant" prohibiting them from practicing within a large radius. Check with your attorney about enforceability if you find such a clause in the contract.

Ask the staff what problems there might be. Are there only a few minor ones or do they take hours providing war stories? Remember, staff really run the practice and often know more than the doctors about what is going on.

6 - Systems

Is your personal space an office, a cubbyhole, or a spot referred to as "we'll work that out"? Some physicians function very well sharing a desk in a noisy environment-others need those four walls and a door to get through the day.

Do employees have clear job descriptions? Do the doctors handle the employees professionally, or are they at risk for a lawsuit?. Does any doctor refer to any staff as Luv, Honeybuns or Sweetheart, or vice versa?

Patient distribution refers to how patients are divided up in the practice, and who gets new patients who call for an appointment. Do you alternate? Will all the new patients be referred to the newest physician on staff? Does the new physician get all the troublesome patients the other doctors don't want to see?

If the practice splits up, who gets to keep the phone number? Who gets to keep the office? Always plan your exit strategy going in.

Who's going to show you the ropes? Or are you just expected to absorb things through osmosis?

How does the practice plan to promote itself? Is there a plan for marketing or attracting new patients?
________________________________________

If the practice has a document that spells everything out on paper, wonderful! It's more likely that they may have the bare bones of an employment or partnership contract, 95% legal-ese, and often out of date. You can work with your lawyer or a practice management consultant to list everything on the document that could impact you in the future. Get everything in writing or risk future problems!

If the partners in the practice balk at this kind of detail or say, "We'll work out all of that later," your response should be, "I'm really interested in the position, but to be comfortable going ahead, I need to know these answers."

And get it all in writing.
________________________________________

Search Physician Jobs at MomMD Physician Job Board now!

Author Keith Borglum is a consultant with Professional Management & Marketing of Santa Rosa, CA at http://www.PracticeMgmt.com. He is a Director of the National Association of Health Care Consultants, and editorial consultant to Medical Economics Magazine. He coauthored the Medical Practice Forms Book http://www.practicemgmt.com/forms_book_details.html; one of the forms served as the basis for this article.

PMM www.PracticeMgmt.com