Private Practice Interview: First meeting etiquette

[White.Beard.Doc]

Zaphod wrote:

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.

Click to expand…

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.

Click to expand...

Zaphod, I am talking about small differences in pay.  Our practice likely pays around the 65th to 75th percentile for our area and specialty.  But in my opinion we really do have a better culture than 90% of the practices out there.  Is it worth it to join a toxic practice for 5% more pay?  I don't think so.  Being happy with your group and your colleagues is way more important than a small difference in pay.

[White.Beard.Doc]

When we interview new docs, we have them meet separately with leadership, with mid-career physicians, with young physicians and with administrative staff.  They get to hear the perspective of many different members of the group in office interviews, walking around to see the facilities, and then over lunch.  By meeting with lots of different folks at different stages of their careers, the applicants get to hear varied opinions and perspectives.  We also invite them to come spend some time working with another physician for an extended visit.

These types of experiences allow for a deeper perspective of the practice environment.  It is one thing for the boss to say there is a great practice environment, but when you get to discuss the practice with a whole range of docs in private, plus you get to spend time with docs doing their work before joining the group, you can get a better sense of what the practice is really like.

Every practice has struggles.  How open, direct, and honest are they when you ask about the challenges and struggles faced by the practice?

[Zaphod]

White.Beard.Doc wrote:

Zaphod wrote:

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.

Click to expand…

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.

Click to expand…

Zaphod, I am talking about small differences in pay.  Our practice likely pays around the 65th to 75th percentile for our area and specialty.  But in my opinion we really do have a better culture than 90% of the practices out there.  Is it worth it to join a toxic practice for 5% more pay?  I don’t think so.  Being happy with your group and your colleagues is way more important than a small difference in pay.

Click to expand...

Yes, I know, and your practice does sound nice. However, many are not that open, and all of them, all of them are convinced they are the best and some frankly lie. In some specialties with single docs you may not have the luxury of interviewing with other docs. Also, new grads are pretty naive, I know I was.

[Hatton]

White.Beard.Doc wrote:

Zaphod wrote:

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.

Click to expand…

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.

Click to expand…

Zaphod, I am talking about small differences in pay.  Our practice likely pays around the 65th to 75th percentile for our area and specialty.  But in my opinion we really do have a better culture than 90% of the practices out there.  Is it worth it to join a toxic practice for 5% more pay?  I don’t think so.  Being happy with your group and your colleagues is way more important than a small difference in pay.

Click to expand...

The culture is important.  I left the first practice I joined because of a toxic culture.  Almost a cult.  I took a 50% pay cut to move back to my home town.  I was able to establish myself and then left to start my own practice.  I ended up making twice what I was making in the toxic practice.  If you find yourself dreading Monday starting on Sunday afternoon then your practice is toxic.

[beagler]

What specialty is this? Are there other solo docs in the area? How high is hospital system based employment? Solo docs are like dinosaurs around here.

In my area, most specialists and primary care are hospital employed. Most of the new attendings are looking to be simple employees with guaranteed first year salary, vacation and hours.

My guess is there's not a lot of interest in taking over a solo practice. Gives you leverage.

There are pros and cons to solo practice - unlimited autonomy and unlimited responsibility. You don't have to put up with administration, but you have little leverage with insurance companies.  For the right person, it's great! For the wrong person, it can be a headache.

[Sid16]

Very true. That is my concern too...autonomy sounds good but I'm wary of unlimited responsibility. It's Endocrinology, there are a few solo docs and few group practices in the area. Most jobs are hospital employed. I'm planning to interview for both PP and hospital employed positions. Will keep you all posted.

Thank you for the suggestions.

[beagler]

He should probably give you the practice for his ability to work part time. Maybe pay for the value of hard assets.

If it doesn’t work out could you then sell/join the hospital group?

Most hospital employed primary care will refer to hospital employed endocrine. So if penetration is high you can see the writing on the wall.

[White.Beard.Doc]

Please let us know how things work out with the interview and practice.  It sounds like you may have some interesting choices to make.

[Sid16]

I have finished my interviews and trying to make a decision. I met the PP owner and feel like I could work with him. He plans to open a second clinic near our home and I have to split my time between his  and the new clinic. I interviewed at 3 other places. 2 are out as they are in downtown and commute is too long.

The other Private practice group wants to start a clinic in a new location with assistance from hospital. I am not interested in 4 year commitment plus the pay is low.

I received the contract and have to hire an attorney to get it reviewed. First year is income guarantee, second year: base salary plus 50% of collections minus my overhead and partnership in 3rd year.

I have not negotiated any of his terms yet. Few things which stand out are : malpractice is occurrence only(no tail coverage), non compete is 10 miles and termination without cause. Vacation is 3 weeks including sick days and CME.Partnership terms are not in the contract. He wants to add ancillary services and there is potential income from that in future but I don't know what exactly it is.

I want to ask for better vacation, tail coverage and termination with cause. Any suggestions/advice will be appreciated.

Thank you !

 

[billy]

Occurrence malpractice does not require tail at all; its the best malpractice you can be offered.

[Brains428]

I took the attitude that white beard doc looks for. I want to be happy where I work, so I cared that I was a good fit.

No amount of money can ensure happiness.

That being said. They offered me more than I anticipated, and were still willing to up the pay when asked. If I got burned from the financial end, maybe my attitude would be different.

Good luck.

[Sid16]

Want to give an update about this post. Sorry for the delay and I really appreciate everyone's valuable advice. I got the contract from the owner and found a lot of red flags. He was very persistent and talked about future real estate investment and potential lab revenue. I was not convinced and politely declined his offer. I was happy with my job and LCOL location but my spouse was not as he had a long commute. We moved midway to a better location  and split the commute...40 min each. We bought a bigger and nicer house(2X income) and sold our old one(<1X ).

Our realtor that sold the house was very manipulative and tried to charge us a lot for minor home repairs. We found a different handyman/plumber and got much better work done for 50% less than what he quoted. I wanted to do FSBO but was very busy with multiple other things. Hated working with him but hopefully I learnt a lesson for future. I'm currently in the same job and have good and bad days. I miss our small and simple home and short commute. But my family is enjoying the nicer house and spouse is happy.

I have some more decisions to make...regarding public vs private school, kids activities, potentially cutting down hours etc.

I occasionally lurk and find this forum very helpful. Hope to pay it back in future and reach a position where I can offer good advice.

[TheLocumsLife]

These were my questions when I considered private practice, I realized this is old thread but think this list could be very helpful to others!

 

Group

Number in group?

Ages?

Salary Range?

Interests/niches of partners?

Recently Departed (Why) (wary of solo MD with several departures)?

Is a senior partner “about to retire”?

Planned additions?

Any plans to merge with other groups?

 

Compensation

Base salary

1^styr?

2^ndyr?

Productivity bonus

Starts at what number?

Get what percentage (graduated scale)?

Any guarantees if productivity exceeds salary? When received?

Note: if groupreaches an incentive quota, you should receive your

percentageof that excess based on your contribution in receipts

(accounts receivable, not reimbursements)

When is productivity disbursement (usually 6-12mos)?

 

Expenses

Department overhead

Total amount?

Equal payments from each partner to cover overhead?

Expenses excluded from overhead that are individual’s responsibility?

How is gross income divided between net income and expenses?

How is net income divided between partners? (Equally?)

Meeting expenses paid? For everyone?

Note: usually annual allowance for travel to meetings.

Membership dues:, section specialty society?

Parking expenses?

Cell phones?

 

 

Benefits

Health, dental, vision (can be several choices)?

For dependents?

Pension?

Carved out from salary, or in addition?

 

Malpractice

Who pays mine?

If malpractice higher for certain partners, who pays difference?

 

Partnership

How many years (usually 2-3 yrs)?

Requirements to meet?

Buy-in amount? (may need to sign promissory note for this)

What does buy-in buy?

 

Contract

Restrictive Covenant

Range?

Note: negotiate for a restriction for facility/hospital ONLY, avoid

geographical radius restrictions

If terminated, no applicable restrictive covenant?

Pay penalty to void covenant (usually very expensive)?

Tail ?

Who pays tails of departing partners?

How many days notice for termination of contract (for both parties)?

 

Additional Income Stream?

 

Call Schedule

Who takes call during week?

How are weekends divided?

How does it change from 1^styear to 2^ndyear to partnership?

Total ERs covered?

Location of ERs?

Level I Trauma?

Additional pay for call?  Included in salary? Compensation for noninsured?

Can I moonlight or take more call for more income?

Who covers when partners are away (weedays/weekends)?

Do PAs take call?

 

Staff

Nurses?

PAs?

MAs?

Desk Staff?

Usage split equally?

Note: ask for 1) nurse/PA 2) scheduling secretary/message phone person

 

Clinic Time

Number and locations of clinics (satellites)?

Time spent at each is equal? Why not?

What are distances from offices to covered hospitals?

What is distance between offices?

When will mine be?

What staff will be dedicated?

In-office procedure availability (procedure room block time)? Same for everyone?

 

Consults

Who sees the consults/ER during business hours? At all locations?

Who sees the consults/ER during evenings/weekends? At all locations?

Divided equally during business hours? Why not?

During business hours are multiple MDs assigned to multiple locations?

 

OR Time

When will mine be (get block time)?

Dedicated staff (PA)?

 

How will I get patients

New patients divided equally?

New patients selectively distributed

By presenting disease?

By insurance status?

Volume available?

Current wait times?

 

Academics

Affiliated with any teaching institution?

Group conferences?

Weekly/monthly conference such as M&M, etc.

 

Non-patient responsibilities

What?

Time commitment?

Any expectations such as seeing partner’s in-house patients?

 

Hospitals the group operates out of

Is the equipment you need available?

Will the hospital obtain it?

How quickly can you get privileges?

Will you have privileges to perform all that you plan to?

Is there an affiliated ASC?

If so, will you receive percentage of the generated income?

 

Exclusive of Contract (I get all income)

patents, moonlighting, proctoring, speaking, consulting, research, locum tenens

 

On signing contract

Start date?

Signing bonus?

Moving expenses?

 

Things to know ahead:

Avg starting salaries in area

Avg physician salaries in area

Reps’ opinions of the groups/hospitals they operate out of

 

Financial Data to Ask For:

income statement, profit and loss (aka operating statement), balance sheet,

cash statement, accounts aging report, number of active charts, percent of managed care vs private insurance vs medicaid vs private pay

 

Hope it helps! Not needed much anymore as locums has whole different set of questions!

TLL

[Sid16]

Great list !!

[iUSeverything]

I just went on my first interview at a private practice and the recruiter basically told me that I should refrain from talking about money on the first visit. Refrain from asking about benefits and all the nitty gritty stuff. First ask them about their practice, where it’s going, how it’s different. Only after you think it’s a good fit do you “hash out the details”.