Do your due diligence!

[LightBox]

As the AAO meeting approaches, many of you will be interviewing for jobs for next year. Make sure you do your "due diligence" and ask for previous associates' contact information. If there is any hesitation to giving you this information, that is a big red flag.

If the prospective employer will not give you this information, then ask other health care providers (e.g. PCPs, optometrists) in the area what the reputation of the employer and practice are.

Best of luck!

---

Members don't see this ad.

 

[JBurns]

As the AAO meeting approaches, many of you will be interviewing for jobs for next year. Make sure you do your "due diligence" and ask for previous associates' contact information. If there is any hesitation to giving you this information, that is a big red flag.

If the prospective employer will not give you this information, then ask other health care providers (e.g. PCPs, optometrists) in the area what the reputation of the employer and practice are.

Best of luck!

I agree with this. There are many abusive, unethical employers out there ready to take advantage of you. I've had several friends with horror "boss" stories. Most of us trainees are relatively naive and just assume everyone practices good medicine and are not looking to screw "the new guy." I would also be highly skeptical of an employer if he or she is very vague on the details of the buy-in or tells you that "this is our standard contract for the practice" (i.e. an excuse for not negotiating certain terms of a contract). Everything in a contract IS negotiable.

 

[MstaKing10]

A lot of the interviews I did at AAO were quite sketchy. Some did not offer to do an onsite interview and made offers a few weeks later without visiting the practice first. Make sure you ask for prior employees that left the practice, why they left and ask for contact information. Partnership track should be well defined. contract terms are negotiable for sure. Make sure you visit the practice, get to meet all of the partners. Get a sense as to why they are hiring and if you'll be busy and integrated into the practice quickly. Ask about satellite offices and if you will need to visit all of them. Find out how call works and where you operate. Finally, buy in terms and salary should be discussed in very general terms. This is finalized later on in the negotiations. There's a lot more to it than that, but these are general principals. Would be interested in hearing other opinions. A sticky for this kind of thing would be quite useful for residents and fellows applying in near future as we do not hear much about this during training until it's time to actually negotiate.

 

[Bgladney]

Good tips on here....however, few practices are going to be able to give you the exact terms of the buy-in. They should be able to tell you how it will work and how they will come up with the buy-in costs but no one knows where the practice will be in two years. Could be worth more.....could be worth less.

 

[Visionary]

I'd advise you to not overestimate your power in the negotiations, particularly if you are interested in a specific area. As someone who has gone through this recently, you're going to find that a lot of times (at least with large, established practices), there is actually not a lot to be negotiated. If the practice has done things a certain way for multiple prior associates, they are unlikely to change much, if anything. That doesn't mean it's a bad deal, though. Ask yourself why should current partners, who were once associates like you, offer you a sweeter deal than what they had (cost of living, reimbursements, etc. being equal)?

 

[Bgladney]

Great advice Visionary! I see that often. Along those lines....don't expect to receive a high guarantee because a location is more expensive. So often I hear folks complain about the incomes offer in California and how since it is more expensive to live, they should be offered more. Doesn't work that way.

Supply and demand.

 

[orbitsurgMD]

I'. . . Ask yourself why should current partners, who were once associates like you, offer you a sweeter deal than what they had (cost of living, reimbursements, etc. being equal)?

OK, I'll ask. Times change. What may be a good deal for one type of subspecialist might be a really unfair deal for a different subspecialist. A high-volume cataract doctor might use a lot of staff and see a lot of patients and be able to tolerate a bigger overhead than a subspecialist who relies less on technical staff and whose services take longer to perform. A flexible practice will go into the search process understanding that all of the features may have to be negotiated because the requirements do vary, one subspecialty to another. Expecting a plastics doc to eat the overhead of a high-maintenance senior cataract doc might not be reasonable at all. A group that wants to shoe-horn all its new associates into the same contract might be driving away very perceptive and knowledgeable candidates.

Good practice leaders know their deal might not be the best deal for their associates.

 

[orbitsurgMD]

Great advice Visionary! I see that often. Along those lines....don't expect to receive a high guarantee because a location is more expensive. So often I hear folks complain about the incomes offer in California and how since it is more expensive to live, they should be offered more. Doesn't work that way.

Supply and demand.

True not just in medicine.

 

[Visionary]

OK, I'll ask. Times change. What may be a good deal for one type of subspecialist might be a really unfair deal for a different subspecialist. A high-volume cataract doctor might use a lot of staff and see a lot of patients and be able to tolerate a bigger overhead than a subspecialist who relies less on technical staff and whose services take longer to perform. A flexible practice will go into the search process understanding that all of the features may have to be negotiated because the requirements do vary, one subspecialty to another. Expecting a plastics doc to eat the overhead of a high-maintenance senior cataract doc might not be reasonable at all. A group that wants to shoe-horn all its new associates into the same contract might be driving away very perceptive and knowledgeable candidates.

Good practice leaders know their deal might not be the best deal for their associates.

Fair points, but I was making and apples to apples comparison. When you're talking about different subspecialties within the same group, there will obviously be expected differences.

 

[odieoh]

I think this is a great resource for anyone looking at signing a contract soon. John Pinto is a well known and respected consultant in the ophtho world.

http://www.healio.com/ophthalmology...-terms-for-partner-track-associate-physicians

 

[Bgladney]

@orbitsurgMD: Your example is very true. I see it all the time with retina surgeons. There can be a 30% difference in overheads. Seeing more general practices address the differences when adding retina but still makes it less attractive for VR surgeons.

@odieohThose numbers he is quoting are on the extreme high end. I have only heard of a handful of retina opportunities where they are offering $350+ in a guarantee. These are in remote extreme locations. They essentially must "buy someone". Retina guarantees are more in the $250-275K base range. If he is speaking of total compensation for the year....he is in the right ballpark at the $400K level.

35% of collections as a bonus is high. Average ophthalmology practice typically runs about a 60%-65% overhead. That leaves next to nothing for the owner to have some ROI.

 

[odieoh]

@orbitsurgMD: Your example is very true. I see it all the time with retina surgeons. There can be a 30% difference in overheads. Seeing more general practices address the differences when adding retina but still makes it less attractive for VR surgeons.

@odieohThose numbers he is quoting are on the extreme high end. I have only heard of a handful of retina opportunities where they are offering $350+ in a guarantee. These are in remote extreme locations. They essentially must "buy someone". Retina guarantees are more in the $250-275K base range. If he is speaking of total compensation for the year....he is in the right ballpark at the $400K level.

35% of collections as a bonus is high. Average ophthalmology practice typically runs about a 60%-65% overhead. That leaves next to nothing for the owner to have some ROI.

I don't know much about retina salaries, but what did you think about the numbers for general ophtho? I think the 35% he mentioned was just part of an example of what a bonus structure looks like, not so much a recommendation on a %. But in general I think his numbers for general ophth were reasonaable.

 

[Bgladney]

They are on the high side. I am really seeing guarantees in the $150-200 range for general ophs coming out of training. The lower side the more desirable the location.

He might be talking about total compensation at the end of the year. That would be over the $200K mark in many cases. There are many practicing physicians out there who are only earning less than $300K per year!

 

[JBurns]

Any other pearls anyone wants to share regarding "horrible bosses?" Curious to see what people's experiences have been.

 

[guttata]

Just to echo the excellent suggestions above.

1. Ask how many prior associates were with the practice. Ask why they left and for their contact number/information. If the practice is unwilling to give you the contact information, that is a major red flag. The practice almost always has this information (unless the departure was very nasty).

2. Contact ALL prior associates. Ask them why they left. The prior associates will be brutally honest with you.

3. If unable to get prior associates information, ask local optom/ophthalmologists/drug reps about the practice's reputation. You would be surprised, some the drug reps often have good insight into well-run vs malignant practices. Word gets around.

4. Ask for financials. It is commonsense that the more you bill, the more you should collect. In retrospect, when I looked at the financials, I found that I was collecting less than the senior partner, even though I billed more. I looked at prior associates' financials and found the same thing. If you are just starting out, the financials may be difficult to evaluate. Another trick is to have the young associate see low-paying insurances (medicaid or even vision insurance like VSP/eyemed) while the owner sees well-insured patients. Also, VSP/eyemed patients are usually younger and healthy - and you will not generate any surgeries from them.

5. Do not be seduced by a fancy dinner. Anyone can put on a game face for a day. Be more cynical (unfortunate, but true). I bet most desirable positions fill by word-of-mouth and not by an AAO/recruiter listing.

6. Talk to the techs. They are often a good judge of character.

Let me know if you want more information. I wasted three years of my life with a predatory practice (I did not follow my advice).

 

[orbitsurgMD]

All good suggestions. Financials deserve a careful look. One practice I interviewed with showed me a spreadsheet of the overhead as allocated by doctor. Sticking out on one cost line was a charge being applied to one doctor only. It was not for a small amount. I discovered that particular "doctor" was the position I was interviewing for, and the charge was the cost of the professional job search to fill the position. They were expecting to charge 100% of the headhunter charges to the gaining doctor instead of treating the charge as a general business development expense to be divided into the practice overhead. Nice try.

Ask to see the financials. If they refuse, politely explain your concern about the practice's capacity to produce the kind of income you are hoping to earn. A smart and honest practice will have already anticipated the need to answer that request in a way that doesn't seem evasive. They should already understand that their job is also to persuade and reassure. If they appear reluctant or evasive, that should raise concerns.