transition from fellowship to practicing spine surgeon
TRANSCRIPT
“Oh The Places You’ll Go”: Creating a Successful Transition
from Fellowship to Attending Physician
Nicola Hawkinson DNP, RNFA, RNCEO & Founder of SpineSearch
November 3, 2016
The Reality
“60 % of all spine fellows will leave their first job in the first 1-3 years.” (beckersspine.com)
Introduction Choosing a practice is amongst the most difficult but important decisions of your career
Making an informed decision requires participation Remember: you are interviewing them as much as they are interviewing you
Bring the same degree of focus to your job search as you have brought to your studies and training
Introduction
5 things to consider when looking for a job Location, Location, Location Academic vs. Private Practice Know Yourself Know the Practice Contract Issues / Negotiation
LOCATION, LOCATION, LOCATION
Location, Location, Location
Do not underestimate the importance of geography Practice location has significant impact upon personal life, patient population, payer mix and practice growth Give special attention to your familiarity with the location
Location, Location, Location
Any location or part of the country can seem appealing after a quick glance The main impact of geography is on your ability to raise a family and your personal life Be cautious when considering a major shift in geography Happy family = Happy Doctor
Location, Location, Location: Factors to Consider
Climate Type of Terrain Region of the Country Town/City Size Coastal vs. Inland City vs. Suburbs vs. Rural
Proximity to family Proximity to friends Access to cultural & recreational activities Schools Religious needs
PRIVATE VS. ACADEMIC PRACTICE
Private Practice Typically more financially lucrative You are running your own business
Business acumen is extremely important Ex: Overhead, office setting, staffing issues, malpractice insurance, reimbursement
May work longer hours Solo vs. Group practice
Academic Practice Employed by hospital or university
Often little involvement with business management Receive a salary with or without incentives
Academic / Chair / Chief / Research Days Employer provides office, insurance, staff, and cost of operation Requirements for research and teaching as well as clinical care
KNOW YOURSELF
Know Yourself The most difficult part of the process is identifying the factors that are important to you Access your needs and desires to ensure financial and/or academic success Your happiness will be the driving force behind the growth of your practice Do not be afraid to make lists, talk to others, and seek guidance from your mentors
Know Yourself: Questions to Ask
What is your practice/medical philosophy? Does it match with the philosophy of the group? Is there consistency among the group members?
How much autonomy will you have?
How many days per week in office?
Know Yourself: Questions to Ask
How much mentoring do you want/need? How much can you get?
Do you believe that you will be happy in the group/practice?
Will your spouse/significant other be happy?
KNOW THE PRACTICE
Know the Practice Invest significant time and effort getting to know the practice
Don’t be afraid to ask tough questions of the doctors, practice manager, and staff
Visit the group more than once if you are considering accepting an offer
Know the Practice Establish the Need!
Do they need someone with your expertise? How many patients being referred elsewhere? Do the numbers support their ability to bring on another physician?
Spine status within the practice Are other doctors doing spine? What is current patient volume? What is their surgical volume?
Know the Practice
Are there other spine surgeons in the area? How busy are they? What is their reputation in the community? How long have they been in the area?
What is the payer mix? Do you have to participate in all plans? Current patient population/demographic
Know the Practice How many hospitals are in the area?
Know their structure and financial health How many institutions will you have privileges? What is the availability of operating room time?
How many office locations? How many will you go to? What are the differences: staff, patient demographic, payer mix?
Know the Practice How will the group support the growth of your practice?
What is their marketing plan? Will the practice provide ancillary staff (NP or PA)? What is the path to partnership?
What other services (PT, MRI, ASC) does the group provide/own?
Can you buy in? When? If none, do they have plans to develop these revenue streams?
Know the Practice What is the structure of the call schedule?
Frequency? How many ER’s? Do you cover a trauma center? Is call general or just spine? Are you compensated for taking call? How many members of the group take call?
Know the Practice What percentage of revenue goes to overhead?
How is your portion of overhead calculated compared to other members of the group?
What type of malpractice insurance? Occurrence vs. Claims Made Who covers the tail if you leave? How is the cost factored into your compensation?
Know the PracticeMeet all the other doctors and the staff
Are they happy? How long have they been working for group? How many doctors are part-time or semi-retired?
Ask to speak to other potential candidates and doctors who have left the group
Be extremely cautious about groups who will not share this information with you !!! You do not want to work for a group that has something to hide
Develop Your Edge Differentiating Factor
Surgical expertise Community outreach All OON or INN model
CONTRACT ISSUES / NEGOTIATION
Contract Issues: Some Basics Remember: you are not a lawyer or accountant !!!
Ask for help from experts who can help you Do not attempt to negotiate or review your contract alone Find an attorney with expertise in medical contracts and practices Read the fine print…. You must be your own advocate
Contract Issues: Some Basics Ask about the current financial status of the group
Failure to disclose financials to you is a major RED FLAG What is your salary structure?
Guarantee, Loan/Payback, or “Eat What You Kill” Income distribution Bonus/Incentive Structure
How is compensation determined if you become a partner?
Contract Issues: Some Basics How do you buy in? How do you buy out? This can be more important! What is the retirement policy? What are the practice assets?
Do they own the office or building? What ancillaries? Other assets or investments?
Is there a non-compete clause or restricted covenant? What are your contracts with each carrier?
CONCLUSIONS
Conclusions Choosing a practice is a big decision requiring great time investment
Don’t jump in without knowing your intended partner
Know the facts Do the Research
Don’t Be A Statistic!
