Ortho Chief Interviewing for Jobs, Looking for Tips

[DynamicHipScrew]

Hi all,

In my chief year and I’m getting serious about finding a place to land after fellowship. Thus far, I’ve interviewed with a satellite hospital that is within my residency hospital system. I’ve visited with them twice. I’ve also interviewed via teleconference with a private practice and I’m going for a site visit in the next couple of months. This location is much more ideal.

I’m looking for advice on what I should and should not ask at this visit. What is kosher and what isn’t. Seems there are so many variables that I have a hard time thinking of them all, which is in part why I started this process a bit sooner than probably others my same level of training. Also, because I know geographically where I want to land. Location is most important to me. Practice setup, types of cases, relationship with partners, call schedule are obviously important as well.

I’ve been in phone and email convos with members of another practice whose location is probably a little more desirable to me (not astronomically though), but those convos haven’t advanced beyond that. Planning on reaching out to have coffee with one or two of them the next time I’m in town. Maybe something more will develop from that over the next year. Thus far, the convos have ended with the typical “let’s keep in touch”.

Mainly looking for any sage advice from those older and wiser than me. Thanks.

[abds]

You should be able to ask anything quite frankly. You’ve gotten through the phone meet and greet stage, so I assume at this point you have a good idea of how the practice works, like call, support staff, patient scheduling, etc.

Call:
- How much group call do you take?
- When you’re on group call what are you expected to do? Wash out your joints partners’ infections over the weekend? Or just basically answer phone calls.
- Do you cover an ER on group call? Or just established patients’ questions?
- Is there an option for ER call coverage (paid hopefully)?
- Does everyone take equal call?

Scheduling:
- How does a previously unassigned new patient get assigned? Do the old guys cherry-pick or is it first available? (The latter helps new guys with open schedules get busy)
- How many clinic and OR days will you have?
- Where are your OR days (hospital, ASC, does the group own their own ASC)?

Support staff:
- Will you have a PA right away?Or will that be an expense out of your own pocket that you can delay months or years if you want?
- Will you have your own MA(s) or are they shared?

Assuming you have an idea of what your daily life will hopefully look like with the above questions answered, which are some of the first questions to get out of the way to see if a group is a good fit in the first place, then ask financial stuff:

- Salary? Benefits?
- Is it possible to bonus on top of your base salary?
- If so, how is that determined - this is a big one and there are very unfair and very fair options, I could write 2 more paragraphs on this alone, but I won’t expand unless you want me to.
- How long until you become a partner?
- What are the criteria for becoming a partner (for example might be paying for your own expenses (salary+overhead), and been year or more there, and a majority vote of partners)?
- What is the buy-in to be partner and what does that include (ie real estate, ancillary services, or just blue sky)?
- How many new surgeons have not made partner? Why?
- How are you paid once you’re a partner - this is another big one but once again I’ll leave it at this
- How is ancillary income (PT, MRI, DME, etc) handled as an employee and as a partner?
- Does the group own their MOB (is that a separate buy-in? How much and when can you buy in? What does that get you?
- Same questions for ASC.
- If they don’t own their ASC what are the opportunities for you to buy into other ASC?

That’s a start, off the top of my head. Also I use the term “partner” but the group is probably a Corp of some sort so the partners are likely technically shareholders and not partners.

[jfoxcpacfp]

Wow, that’s a great “OTTOMH” list! And learned a new acronym (MOB). Fwiw, I’ve seen far more partnership K1s for groups than S-corp K1s. I would presume they include clients who are in ortho groups, but haven’t really noticed. Is there something different about ortho in the area of business organization or has that just been your experience with various groups? (And I typically refer to all as partners, too, even when speaking with the random s/h owner😁.)

[abds]

Wow, that’s a great “OTTOMH” list! And learned a new acronym (MOB). Fwiw, I’ve seen far more partnership K1s for groups than S-corp K1s. I would presume they include clients who are in ortho groups, but haven’t really noticed. Is there something different about ortho in the area of business organization or has that just been your experience with various groups? (And I typically refer to all as partners, too, even when speaking with the random s/h owner😁.)

No nothing specific I don’t think, just my personal experience (my group and 5-6 other groups I know of through friends/co-residents).

[MPMD]

You should be able to ask anything quite frankly. You’ve gotten through the phone meet and greet stage, so I assume at this point you have a good idea of how the practice works, like call, support staff, patient scheduling, etc.

Call:
- How much group call do you take?
- When you’re on group call what are you expected to do? Wash out your joints partners’ infections over the weekend? Or just basically answer phone calls.
- Do you cover an ER on group call? Or just established patients’ questions?
- Is there an option for ER call coverage (paid hopefully)?
- Does everyone take equal call?

Scheduling:
- How does a previously unassigned new patient get assigned? Do the old guys cherry-pick or is it first available? (The latter helps new guys with open schedules get busy)
- How many clinic and OR days will you have?
- Where are your OR days (hospital, ASC, does the group own their own ASC)?

Support staff:
- Will you have a PA right away?Or will that be an expense out of your own pocket that you can delay months or years if you want?
- Will you have your own MA(s) or are they shared?

Assuming you have an idea of what your daily life will hopefully look like with the above questions answered, which are some of the first questions to get out of the way to see if a group is a good fit in the first place, then ask financial stuff:

- Salary? Benefits?
- Is it possible to bonus on top of your base salary?
- If so, how is that determined - this is a big one and there are very unfair and very fair options, I could write 2 more paragraphs on this alone, but I won’t expand unless you want me to.
- How long until you become a partner?
- What are the criteria for becoming a partner (for example might be paying for your own expenses (salary+overhead), and been year or more there, and a majority vote of partners)?
- What is the buy-in to be partner and what does that include (ie real estate, ancillary services, or just blue sky)?
- How many new surgeons have not made partner? Why?
- How are you paid once you’re a partner - this is another big one but once again I’ll leave it at this
- How is ancillary income (PT, MRI, DME, etc) handled as an employee and as a partner?
- Does the group own their MOB (is that a separate buy-in? How much and when can you buy in? What does that get you?
- Same questions for ASC.
- If they don’t own their ASC what are the opportunities for you to buy into other ASC?

That’s a start, off the top of my head. Also I use the term “partner” but the group is probably a Corp of some sort so the partners are likely technically shareholders and not partners.

this should almost be a sticky....

if i were a surgeon at some point i would want to get really granular on the things bolded above.

i definitely have surgeon friends who have found out that they were hired to take all of the crap. know one personally who's partner would take weekend call where he would basically just field phone calls, not go in, and have consults lined up on monday morning for the junior guy to see. as you might expect some of these cases would have benefitted from earlier consultation. when confronted older partner just shrugged and referenced his seniority. not sure that's sustainable, essentially the person was on call all the time b/c when he was "off" his partner was stacking up work for him and he never knew what hadn't been seen that should have been.

[GasFIRE]

While I wouldn't bring it up on initial contact, as you go through the job search process do find out if there is a non-compete clause. Since location is important you want to know what your future options are if things don't work out at a particular location. It's much easier to eliminate or modify a clause before signing a contract rather than after.

[Hatton]

I would ask who controls my schedule? Can I move patients around to practice more efficiently. Can I cancel an afternoon if I encounter a nightmare in the OR in the morning? Can I decide how many new patients I can see in a day? These types of things ie lack of control lead to burn out quickly.

[ENT Doc]

I would also seek to understand the arrangements between ancillaries/businesses including real estate. Ask how rents are set. Do you have access to the ancillaries? If you are on a revenue-expenses model you’re going to really care about A/R management, payer mix, and method of costing.

[Tim]

I would ask who controls my schedule? Can I move patients around to practice more efficiently. Can I cancel an afternoon if I encounter a nightmare in the OR in the morning? Can I decide how many new patients I can see in a day? These types of things ie lack of control lead to burn out quickly.

Just a note that control (hire/fire) over your MA, PA and OR schedule can really screw you up. Whether block time is available and the OR is availability can mess with your production. The tier level of the ER would also give you some insight into the call responsibilities overall.

[Sundance]

Agree with above:

1. control/flexibility of schedule
2. who controls hiring of support staff. Who do they answer to
3. call frequency/burden
4. road to partnership and pay structure

[Tim]

You are coming out of fellowship. How do you see your career developing and what are the referral systems? Is there a sufficient need for desired specific skills or will you be actually doing the general stuff and be content?
Or do you have a vision of your specialty practice and what are the referral patterns in place and what roadblocks will need to be overcome? Basically a competitive analysis. Make no mistake, Just because you are DynamicHipScrew, academic and even within your group they do HipScrews and won’t give up those referrals willingly. You won’t get referrals due to your expertise, Your trauma calls might be your bread and butter. You need to understand how you are going to build your practice and potential internal and external competition.

Support group: How often do you need a second set of trained hands in the OR? You are coming from an environment where that was a given. Anecdotally, you will be asked to scrub in and you will need to ask for another to scrub in. Same goes for informal opinions on plan A and plan B. Some groups are team oriented and some aren’t. Only you can judge the fit for you.

MPMD gave an example of the guy in call that cited “seniority”. Not a team player.
I would suggest you have some questions that give you insight. How far in advance call schedules come out? How often have they traded to accommodate a colleague? Do you scrub in to assist? Do you discuss treatment plans? Do you take a look at X-rays for a colleague? Do you have someone scrub in?
My hypothesis is that an unappreciated person that gets no flexibility and no support will leave in two years. Fed up and feeling abused. 50% turnover is the result. I could be wrong. A sink or swim environment for a new ortho is not advantageous. You want a group that professionally will do everything possible to build your practice as well. That is more attitude, not in a contract.

[8arclay]

When considering PP, have a plan in place for if/when a PE deal is negotiated.

[Medstud21]

What sub specialty? I went through this a couple of years ago. Interviewed and had 8 offers, mostly employed, couple private.

if you know where you want to be, it’s easier. Reach out to the groups and all employers to see if any need is there.

Most important is to see what kind of need they have and how many partners you’ll be competing with to get busy. Also, what kind of call you want and how much stuff you want to do on call.

Salary is important, for private groups, ask to see the books and really understand how partners are paid and what the partnership track is like.

employed positions, most important is to see how busy existing surgeons are. They will lure you with a big salary, but can you sustain it, or better yet, can you beat it? Also, conversion factor ($/wRVU) is more important than the starting salary. Higher, the better. I have a lot more to add about employed positions, can write many paragraphs but that’s enough food for thought.

[DynamicHipScrew]

Really appreciate everyone’s input. The info in this thread is invaluable.

I ended up visiting with multiple practices since I made this thread.

First practice was a full site visit and overnight stay. Really liked it. Call is 1:7 at 2 hospitals. One a community and the other a level II. PA’s take first call. Think I could be happy there, although there are some flags that jump out to me. I worry it is too general for me. I would also primarily team up with one other surgeon and spend the majority of my time at the community hospital. Call is arranged so that non emergent cases from overnight get added on for whoever the next day which can be nice, but I worry that means I’ll get dumped on being 1 of 2 guys at the small hospital in 1:7 call pool. Although I can participate in the ancillaries, I won’t get to operate in an ASC. Nice area with plenty of nice housing and good schools. Low COL, but would likely have to pay state income tax.

Also met with another practice I’m a little more excited about. Had lunch at their office. Small group, but under a larger umbrella group of 50+. Another general position, but feel it has more opportunity to shape practice into cases that I like most. All partners are considered generalists, but have their preferences. Some have fellowship training. Call is 1:5 at one community hospital without a trauma designation. Level 1 is just down the road (dont cover here). 2 days in clinic, 2 in OR including ASC time. PA’s stay in clinic with 1st assists in OR. Showed me their numbers (without me asking) and seems I could work as much or as little as I want. We’ve thought of living in the area for years. No state income tax. Smaller town but just outside large enough city. I suppose the only thing holding me back is if call is too frequent, even though it’s likely lighter. I’m planning to visit again.

Finally had a more informal lunch with guys from another practice nearby (under the same umbrella I mentioned above, though). This has always been my dream practice. Could be more of a sub-specialist position. Unfortunately at the moment they don’t have anywhere that looks like I could slide into. However, they continue to grow. Based on conversations, I feel I’ve built enough of a relationship over the years that these guys are willing to work to find a spot for me. At this point it’s just more of an unknown and less turn-key. I want to explore this more, although I don’t want to waste their time if they put in time to figure something out for me and I end up going somewhere else after I see what they can offer. Also wouldn’t want to miss out on one of the other opportunities if I wait for this one and it doesn’t work out.

Pretty confident I'm gonna end up at one of these places which is exciting.

[Tim]

Really appreciate everyone’s input. The info in this thread is invaluable.

Also wouldn’t want to miss out on one of the other opportunities if I wait for this one and it doesn’t work out.

Pretty confident I'm gonna end up at one of these places which is exciting.

Great to hear you are making progress.
Compensation (including benefits),Job (which is the advice you were requesting), and location (which is individual choice) are the three criteria that typically in evaluating an opportunity.

If you choose to actually expand and put on a spreadsheet all the questions and criteria that have gone into your job hunt, that might make a guest post for the blog.
Your path is not uncommon, "How to find and pick a job coming out of residency/fellowship". A lot of work to organize and work up, but you would be a "published author"!

Your story would be valuable to many. Simply a way to share your path and decision making process. Please consider it.