Q:I am finishing residency in June and have a few job offers to consider. What should I look for besides a competitive salary?

Keith Borglum, CHBC

A: Most new physicians join a practice without first giving it a thorough "history and physical exam." Asking pertinent questions will help you avoid joining the wrong practice, and knowing your rights in the practice ahead of time will help you and your employer avoid dragging each other to court in the future.

Location. The most important issue is deciding where to practice and live. You can earn a living anywhere, and it's better to start where you want to end up rather than relocating to another community or state later. Many physicians spend years building a practice in one location, then waste the fruits of the effort when moving closer to family later.

Compatibility. 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."

References. Call the medical director or chief of staff of the hospital where the employer has privileges, and say that you're considering joining the practice. Listen "between the lines" to their answers. To avoid "revolving door" practices, ask around to find out whether other associates came and left before you.

Financials and systems. Have an accountant or independent medical practice management consultant (find both at nschbc.org) perform a practice survey and tell you whether the offer is a good opportunity or whether the practice is going broke. Check the schedule, computer, labs system, hospital and IIPA relationships, medical records, accounting, and everything else to see whether the practice is organized and up-to-date.

Income. Current salary surveys are available at mgma.com and nschbc.com. Are the productivity incentives reasonable, or are they so unrealistic that no newcomer could expect to reach them? Are other associates achieving incentives?

Managed care contracts. Don't just assume that you will be accepted into the managed care plan. See it in writing from the plan itself, particularly in specialty practices.

Ownership opportunities. What income and other benefits will ownership provide, and at what cost? Get it in writing in advance, including the buy-in price or formula. You don't want to find out later that the owner wants $1 million for the buy-in.

Security and risk. What kind of plan is there for you if things don't work out? If you decide after a few months or years that the practice is not for you, can you walk away without major obligations? Is there a non-competition clause that would force you out of town?

Governance and management. Who is in charge of the practice, doctors or the owner's spouse? Will you have a voice in how the practice is run? What if you want to bring in electronic medical records, for example? Remember, many times, staff members really run the practice and often know more than the doctors about what is going on, especially in larger groups.

Medical Economics Consultant Keith Borglum, CHBC, of Professional Management and Marketing, has been a licensed practice broker, appraiser, author, and management consultant to physicians for more than 25 years, is based in Santa Rosa, California, and practices nationally. Send your practice management questions to mepractice@advanstar.com
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