ENT/OTO Job Search

[ENTGooner1982`]

I'm a PGY4 in an allopathic mid-western ENT residency. Looking to do General ENT on the West Coast/Southwest/Pac NW (where myself and wife are from); no fellowship plans. Have started the job search and have narrowed down some practices/locations I am interested in. I am sending out CVs and calling people, but wanted some advice on some up front questions I should be asking about these practicing. Most practices look pretty good on paper, but I am wondering what are some good screening questions I can ask that will indicate any glaring red flags about practices that I should avoid or things that should look at as a positive. Any advice would be greatly appreciated.

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[DermatoFIGHT]

Are you allowed to see past 5 year financials of the practice? This could give you a really good idea of the direction they are going and how they are coping with changes in local business practices. If it is declining substantially year to year but partners still going up that would be worrisome.

 

[resxn]

If there's a practice willing to show you their books the last 5 years, either their absolute idiots or they have no competition witihn 50 miles (and they're still idiots). I've now hired 5 docs in 7 years. Here's what I expect a smart applicant to ask, and what I'll say. These are not in any particular order

Q - Can I see the P&L and Balance Sheet for the practice?
A - Hell no. And that's quite forward of you to ask. I will tell you what our overhead is and where our avg employed physician and partner physician income lands in relation to the AOA statistics for physician income.

Q - Have any physicians left your practice for any reason?
A - Great question. Yes. Here's why. . .

Q - How is your employed physician compensation arranged? Flat income? Incentivized?
A - We utilize a base guarantee with incentives once you meet certain practice milestones

Q - Is there any chance for income based on auxiliary services like HA's, allergy, or radiology?
A - Nope. Your incentive is to make partner so you can reap the benefits of those services

Q - What is your partnership track?
A - We want all docs to desire to be a partner. If you haven't met the min requirements in 2 years and you're doing your best to do so, you may be in trouble

Q - When I am approved to become a partner, what is the typical buy-in? Am I buying partnership in to hard assets? Real estate? Good will?
A - Great questions and I'll address each individually

Q - Is there partnership available in a surgery center?
A - Yes

Q - What business expenses do you cover vs what I have to cover?
A - We will cover all business expenses required for you to be a board-certified otolaryngologist in good standing in this state. We'll cover at the minimum, board certification expense (except travel), malpractice insurance for the state minimum, CME, travel to any presentations based on research or other performed as a doc in this practice, overhead to cover your MA/Front Desk/billing, Membership in the state medical society (required in this state), membership with the AAO-HNS. We do not cover cell phone, car expenses, or other variable expenses for you. We offer a health stipend but not health insurance. We offer a 401k.

Q - You mentioned your overhead. It seems to be on average for the national ENT practice. How will I impact that and what can I do to help improve it?
A - another great question. . .

Q - Where do you see this practice in the next 5yrs? 10yrs? Do you have any plans to sell it to outside groups/hospitals/insurance companies? Any plans to merge with any other groups?
A - now you're asking the right things. . .

Q - What questions would a really smart applicant ask that I'm not asking?
A - great question. . .

 

[ENTGooner1982`]

Thanks for your reply. That is some really useful info. Typically, how early in the game are these types of conversations taking place? If I call/email a practice, send in my CV and get a positive response is it fair game to immediately start asking those questions or do I have to wait for a formal "interview"?

 

[OtoHNS]

Thanks for your reply. That is some really useful info. Typically, how early in the game are these types of conversations taking place? If I call/email a practice, send in my CV and get a positive response is it fair game to immediately start asking those questions or do I have to wait for a formal "interview"?

Great post by Resxn as usual.

I would add:
1. Ask about the practice's current status and future plans for complying with Meaningful Use EHR requirements and PQRS.
2. Ask about any non-compete clause in your contract. Most practices will have one.
3. How are new patient referrals assigned to doctors in the practice? You don't want your senior partners cherry-picking all the sinus cases and you get the earwax and nosebleeds.
4. How are partners compensated? Eat-what-you-kill or a more complicated formula?
5. How many ancillary staff, nurses, MAs, billing people, receptionists are employed by the practice?
6. While you are interviewing, try to get an idea of how new/expensive all the equipment is. Brand new medical equipment is outrageously expensive, and used stuff works just as well for a fraction of the cost. Your potential future earnings as a partner are revenue you bring in minus expenses. Your compensation is increased just as much by reducing unnecessary expenses as by generating more revenue. I'd be wary of a practice in a palatial new office with sparkling new equipment.

In my opinion, you should be asking these questions in person at your interview with the practice. Prior to that, you'll likely be talking on the phone with an administrator or assistant and not the actual partner(s) in the practice.

Once you meet the partners, personality fit is obviously very important. First impressions are useful (especially for bad personality fits), but are not necessarily reliable as to how someone will be for months and years down the road. You should always have a backup plan in case things don't work out. I would recommend renting a house/apartment for the first 1-2 years until you feel more certain that you will become partner and stay long-term.

Good luck!

 

[clinicallabguy]

I want to resurrect this post a bit to ask some related questions/bring up the topic. I am an R4 who will likely be pursuing general otolaryngology positions (have been considering general vs neurotology fellowship for a while). I'm training on the West Coast, originally from the intermountain west, but willing to consider a large geographical area for potential positions.

I have searched for positions that are posted on google, NEJM, JAMA, AAO-HNS, etc.; placed my information on practice link and a few other similar sites; and have begun to compile a list of practices from my home state (though I'm not married to the idea of going back). I have been trying to find good reading material to help me navigate the job search, but so far have found books published >10 years ago with mixed reviews. I did come across this short article on medscape from 2015: Medscape: Medscape Access written by this guy (https://www.linkedin.com/in/leighpage/) who is a writer/reporter, and not a physician. But it still seems like an interesting perspective. He states mistakes job candidates make, in his opinion, are:
- Not casting a wide enough net (geographically he means, implying you may be overlooking opportunities by being determined to go back home or to the coolest Metropolitan area)
- Not allowing plenty of time for the search
- Gravitating toward Metropolitan areas (lower compensation, generally)
- Not understanding pros and cons of employment at a hospital
- Putting too much faith in recruiters (they have incentive to prioritize the hiring practices' interests over the candidates)
- Rushing to accept the first offer
- Failling to be a good negotiator

He talks about the goal of focusing on the "quality" of a position rather than geographical location, but that is a bit nebulous and determined by the priorities of the applicant.

So far it seems the way this system is set up is that only a small fraction of available (or potentially available) positions are on these recruiters'/journals/academy websites. In my mind there is probably a range of quality of these positions in terms of initial compensation and growth potential, quality of life, livable location, and personality-compatible co-workers and staff. If I am willing to consider the entire west coast, intermountain, southwestern, great plains, and Great Lakes areas then there are an overwhelming number of potential positions and most are not currently posted because the practices are not actively searching, though they may be willing to add someone if they knew someone was interested. It is a crazy big task to search the internet for all practices in this area, and contact them and get information about the quality of these potential positions. And to my knowledge, there is no place this information is compiled, or a specialized person who would work as a "position-recruiter" for me the way that recruiters work for practices. It seems much more simple to reach out to the manageable list of practices in my home state, call them, send them my CV, and see what they have to offer. But maybe it's the millennial in me (xennial more specifically ) and fear of missing out that there could be a higher quality position out there that I missed because I didn't consider it.

Did any of you who searched for your first position have these kinds of anxieties? I really appreciate you insight. Thanks!

Also, anybody have recommendations for good reading materials about this stuff? Specifically to learn more about pros and cons of hospital managed positions (ie Kaiser, Intermountain Healthcare, etc), large multi specialty groups, small single specialty groups.

 

[Dr McSexy]

I’m in your same position (pgy4) and have been starting the process of looking for a position/job as well. Some of the best - actual- information that I’ve encountered comes from this forum, you may just have to dig for it.

Aside from here I think discussing with previous residents from your home program will likely be helpful depending on what the recent trend has been. (Most of my recent co residents have been doing fellowships).

I, too, have opened myself up to a large geographical area, with caveat of wanting to be a somewhat decent size metro. From what I’ve come to learn is that it’s been pretty important to gauge actually where you want to be or for how long(no duh I guess). Intitially, I wanted something with a large signing bonus, loan payment assistance, etc. however most of those jobs are employee based scenarios or less desirable cities.

The idea of being an employee at the onset is nice in the sense of the immediate higher compensation and pay back benefits. But my gut feeling tells me I want more autonomy and less administration or my back in the long run. And if that’s what I want, I’d rather not waste time for a few years as an employee only to have to relocate again in a few years, then restart all over again in terms lower compensation until I get busy and I start meeting the collection goals.