Private Practice Interview: First meeting etiquette

[Sid16]

Hi All, I enjoy reading WCI blog and forum and find it very helpful ! I'm 3 years out of fellowship and currently hospital employed. I'd be interviewing for a private practice position for the first time and would appreciate any assistance.

I've stayed back as faculty at my program and we want to move back to our previous location where we already own a home. I'm interested in this job as it is close to our home and would love to explore PP opportunity. I've spoken to him over phone once and we will be meeting in a week or two. He has been a solo practitioner for more than 10 years and added a PA 2-3 years ago. He wants to cut down clinical duties to be able to focus on his other business.I've no information except base pay the first year that was stated on job description. I have written down lots of questions regarding pay, benefits, partnership track, practice set up, non compete etc.

I don't want to put him off with too many questions but at the same time he is the only one that can provide me the information. What are the most important questions to ask during the first meeting ? Is there anything I should avoid ? Should I e-mail him some of the basic questions before I meet him.

I currently make about 50 K more than what he is offering but I don't have much potential for growth. I've spoken to some people and heard he has a successful practice and has been doing well financially.

Any advice would be appreciated.

Thank you !

 

[The White Coat Investor]

I certainly would not feel bad asking him any question that you or this entire community can think of to ask him. Ask them in advance. Ask them in person. Ask the ones you forgot later. Once the contracts are signed, you lose a lot of negotiating power so get as much information up front as possible from him and every other source you can find.

[Sid16]

Thank you ! I'm planning to send him an e mail with some of the basic questions. Should I mention my current benefits/vacation/CME( which I'm sure are much better than what he is going to offer) just as FYI or just wait for his answers.

[ENT Doc]

Sid16 wrote:

Thank you ! I’m planning to send him an e mail with some of the basic questions. Should I mention my current benefits/vacation/CME( which I’m sure are much better than what he is going to offer) just as FYI or just wait for his answers.

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Honestly, I would seek other viable options in the area you want to go.  And perhaps even be ready to stay.  See if you can improve upon your current contract - faculty searches aren't necessarily cheap and you are a known commodity that was asked to stay on.  That says a lot - you are a known, positive asset.  If there's something that you could see sweetening the current situation then I'd ask for that.  Then, separately, you've explored multiple options in the area you really want to be, so that if the chairman says no to a bump in pay/benefits you can more easily walk away.  You also improve your leverage with the guy you're thinking about joining now - especially if he knows you are looking in the area (which I would probably state...curious to hear others' opinions on this).  It allows you to understand the market in that area so you can more reasonably suggest what is more typical and what you'd be comfortable with.  I'd just do lots of information gathering first, but don't ask too many question that will be later discovered when you ask to see the financials unless it's really important - like what's your A/R turnover or something.  No financials offered?  Walk away.  Find out if you're obligated to give your current job X months notice and what vesting issues there might be with a retirement plan.  Might even be worth delaying a matter of months for that benefit.  I don't think I'd mention what you are currently getting.  You'll know if it's a good deal or not and what suits your own utility.  When it comes to negotiate something higher, however, you want to do this from a position of strength - a willingness to walk away to a better option.

[jhwkr542]

At first meetings, I always think it's important to first ask about work and practice dynamics (who splits up the work, how do you do it, etc), which will naturally lead into a pay/compensation package discussion.

[VagabondMD]

My position to your asking loads of questions in advance depends a lot on some factors that you did not specify in the OP, mostly that get to the question of whether or not this job likely to be in high demand and what are your alternatives (other than staying put).

If the job is in high demand and you are likely competing with dozens of others, I would be careful to not turn him off with an endless torrent of questions. That is not to say that you should not get all of the necessary basic information, but do it in a methodical fashion, with a purpose, not for sport.

As someone who has been in the position to recruit and hire for PP, I have had the both opportunity to attempt to fill jobs for which we were desperate and to fill jobs for which we had a seemingly endless number of excellent applicants. For the former, I would have gladly answered any and all questions, up to and including playing virtual Trivial Pursuit. For the latter circumstance, I might have been more favorably disposed to the less inquisitive type, all things being equal.

[Sid16]

Thank you for the advice. My 401 K is vested and I have to give 3 months notice. I can probably negotiate a better pay where I am but we are eager to move to our previous location. It is 3 hours away, a metro with better schools and more job options for my spouse who is not a physician.

[Sid16]

Thank you Vagabond. That is a very good question. He has been trying to recruit for quite some time. I know one other person who did not take up the offer and chose a hospital employed position. There was another physician who almost signed the contract but instead chose a part time job in an academic setting. He is quite desperate as he wants someone to join him ASAP so he could devote 50% of his time to another profitable venture. At the same time, I feel this may be a good fit for me. I don't have the motivation to start solo practice, am tired of hospital employed positions( have previous work experience as a hospital employee prior to fellowship) and find the idea of building a practice, becoming a partner exciting.

 

[Dreamgiver]

I would also ask him to see the books and, if you do not know what you are looking at, pay someone to examine them.

Also, I would not mention what you are getting right now. Why put your cards on the table like that?! Salary, vacation, CME, come later.

[q-school]

Re-tain-er.

Do you want to be an owner? Does he want to relinquish control? In a two person partnership, especially with a founder who has been sole owner for decades?, it will take some doing to create a balanced relationship.
Are you ready to do all the work he doesn’t want to do? He wants 50% out but he wants you to do the bad 50%?

Or he could be the fairest guy in the world.
Hard to know. What’s his exit plan? Does the pa expect ownership?


Good luck.

[Zaphod]

Why did these others not take the position is my first through ninety nine questions? If hes as desperate as you say nothing is necessarily off the table. In re: to benefits, just realize you can have whatever benefits you want, its all salary in the end. If he agrees to give you cme, that will come off the salary all things considered.

[White.Beard.Doc]

In my mind it is most important to discuss the clinical aspects of the job and the practice philosophy first to see if that is a fit.  There is no point in discussing compensation and paid time off if you are not a match in terms of practice style and philosophy.  When we are interviewing candidates for our group, it is a huge turn off when the first question asked is about pay.  It is way more important that the practice style is a good fit.  Who cares if the compensation package is good if you are going to be miserable practicing with someone who has a different practice philosophy.

A doc in our group recently left for a slightly better pay package elsewhere.  After a few short months, she was right back to us asking for her old job back.  She says she loves the way our group emphasizes patient care as our first priority, and that we focus on our collective success as a group, on working together, on supporting one another, on creating a culture of caring for patients and for colleagues.  The daily satisfaction I get by working with a group that shares my practice philosophy is worth so much more than a couple of extra bucks.  Everyone in our group is very highly compensated anyway.  That is a given.

[Zaphod]

White.Beard.Doc wrote:

In my mind it is most important to discuss the clinical aspects of the job and the practice philosophy first to see if that is a fit.  There is no point in discussing compensation and paid time off if you are not a match in terms of practice style and philosophy.  When we are interviewing candidates for our group, it is a huge turn off when the first question asked is about pay.  It is way more important that the practice style is a good fit.  Who cares if the compensation package is good if you are going to be miserable practicing with someone who has a different practice philosophy.

A doc in our group recently left for a slightly better pay package elsewhere.  After a few short months, she was right back to us asking for her old job back.  She says she loves the way our group emphasizes patient care as our first priority, and that we focus on our collective success as a group, on working together, on supporting one another, on creating a culture of caring for patients and for colleagues.  The daily satisfaction I get by working with a group that shares my practice philosophy is worth so much more than a couple of extra bucks.  Everyone in our group is very highly compensated anyway.  That is a given.

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It shouldnt be, this is business. That idea overall, is pretty dumb. If you're pay is 10% of standard, I dont care what your practice model or philosophy is, Im not taking your job. Pretending it isnt near the unanimous number one priority for everyone is a huge mistake. There are thresholds where you wont work at the best places if they dont pay enough and where you'd work for the devil if pay was enough.

Obviously, you're not talking about such a discrepancy, but you have to realize how important it is and the pressure a recent grad may be feeling (real or imagined). Every position says they have as great environment and its impossible to tell what bs and whats true until you've done it a while. Its a great idea but very difficult to know in advance.

Its just a typical doctor attitude that isnt representative of the rest of the working world, and everyone should be less sensitive about it. Its really a continuation of the taboo to talk about money as a physician mindset that has hampered so many. Playing coy and acting as if anyone is truly hearing, understanding, or caring at all about your practice pitch without a hint of pay/benefits is just kidding themselves.

Now, you're practice and philosophy sound great, and was caricaturized for example purposes only.

If you can suffer through residency you can suffer through a bad culture if the pay is significantly better. Stack it up and move on.

[Hatton]

I think you just need to check it out. You don’t mention what type of practice we are talking about but I am thinking internist or fp.  You need to see if you like him and the PA.  Do you like the facility. What about the call schedule.  If all these are positive then you ask about money and benefits.  Then you look at the books.  Those are my thoughts.

[VagabondMD]

Sid16 wrote:

Thank you Vagabond. That is a very good question. He has been trying to recruit for quite some time. I know one other person who did not take up the offer and chose a hospital employed position. There was another physician who almost signed the contract but instead chose a part time job in an academic setting. He is quite desperate as he wants someone to join him ASAP so he could devote 50% of his time to another profitable venture. At the same time, I feel this may be a good fit for me. I don’t have the motivation to start solo practice, am tired of hospital employed positions( have previous work experience as a hospital employee prior to fellowship) and find the idea of building a practice, becoming a partner exciting.

 

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In that case, break out the Trivial Pursuit board.

He needs you more than you need this job. You can ask what you want and demand what you need. It sounds like his offer is too low if you need to take a pay cut AND leave an academic job (!!!).