The single most important factor for physicians in choosing whether or not to join a practice should be the quality of the practice - not its location, the compensation or any other factor. After all, most physicians will spend far more waking hours at work than at home. This is not a novel notion, but it does raise a key question: What makes a quality practice?
There is certainly no single correct answer to this question, and diverse personalities and skill sets will fit differently into a variety of practice cultures. There are, however, certain factors that indicate how well a practice is run (regardless of the market, size or specialty) and whether or not it may be a good fit for you. Spot any red flags upfront by considering these factors when evaluating a practice.
There are typically two reasons a practice brings on a new physician: growth or the need to replace another provider. Either reason is certainly legitimate, but in the case of replacement, it’s key to get to the reason behind the vacancy. If the previous physician didn’t retire, the practice should be honest and specific about why he or she left. In many scenarios, it is reasonable for the practice to allow you to contact the physician who left. Additionally, it’s a good idea to find out whether the practice is replacing multiple providers in a short period of time, which may speak to a problem.
Though joining a growing practice is generally a good move, the practice should still be able to articulate their growth strategy and provide detailed projections about finances and patient volume that demonstrate that it is indeed smart growth. If it’s a new clinic in a new area, have they spent the time and money to conduct a formal market analysis? Have they set aside the capital needed to ramp up over the course of a two- to three-year period?
By the time you complete residency or fellowship, you should have a pretty good idea of how patient volume translates into time (if not, speak to your attending and mentoring physicians). Though this does vary by specialty, the number of patients you see each day directly affects your ability to achieve the work-life balance you desire - and it relates to your risk of burnout.
This may seem like a simple, obvious fact, but two things may happen during the interview process that can cause you to lose sight of it. First, you may have an idea of the number of hours per week you would like to work but no idea of the number of patients or cases that translates to. Second, the practice, though well-intentioned, may try to sell you on taking a higher volume. Practices often promise that various efficiencies they have in place will help you see more patients in the same amount of time. In reality, this is rarely the case. Even a robust, well-trained support staff can’t make caring for 30 patients per day the same as caring for 22 patients per day.
Whether a practice has an onboarding process in place can be an important predictor not only of how long you stay at the practice but also of your early career satisfaction. Onboarding processes will differ from practice to practice, but every practice should be able to explain what the process will be if you come onboard. You should never feel as though you’ll be thrown into the fire.
If a practice, for instance, would expect a new physician to see patients on his or her first day, it may be a sign of a chaotic work environment. Ideally, the onboarding process should include: shadowing one of the experienced physicians; learning practice workflows for scheduling, ordering supplies, billing, etc.; being trained on the EMR and any equipment; meetings with key staff members who head finance, operations and staffing; and general orientation (especially for large organizations).
In organizations with robust onboarding programs, it may be weeks before you see your first patient.
An established practice without an established staff is certainly cause for concern. During your interview, ask how long the administrative and clinical staff have been with the practice - and how many staff have been with the practice for less than a year.
There are several other critical questions whose answers could also reveal staffing issues: Is there a nurse or medical assistant for every physician in the practice? How much of the work-up and charting are nurses and assistants allowed to do? Are credentialed support staff (registered nurses, medical assistants, nurse practitioners, etc.) practicing at the tops of their licenses - meaning are they carrying out tasks to the full extent that their education, training and certification allow?
The answers to these questions can reveal a lot about the efficiency of a practice and its ability to manage patient flow while taking as much busywork as possible off your plate.
You might also ask if there is a practice administrator on-site every day or most days. Is the administrator responsible for a number of other practices and therefore rarely seen? The only way to know a business is to be there. And in an increasingly complex practice environment, having someone to manage the day-to-day business operations is vital to improving the practice and the bottom line.
Healthcare is consistently rated as the highest-stress industry in the U.S., and it’s in a time of great transition. Every provider will have some frustration about their work. Asking about those frustrations starts an important conversation, and the practice should share those frustrations with you without hesitation. Whether a practice is willing to reveal its providers’ frustrations speaks to its transparency and culture. The frustrations you learn about may be a deal breaker or non-issue, but they’re something both parties should want you to know before you sign a contract.
No practice is perfect. Working to spot these five red flags can ease the path to finding the right fit. Choosing the right practice the first time can have a lasting impact on your career satisfaction and earnings.
Keith Herl, MHA, MBA and Matt Mingenback have more than 20 years of combined physician placement and retention consulting experience. They provide executive leadership for the career services team at Afferent Provider Solutions.