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.
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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.