If you could do it over . . .

[Medman2737]

Hey there forum,

I am currently looking for a new position and will be interviewing for four potential landing spots this week.
The purpose of this thread is to pick everyone's brains as to what questions you all WISHED you asked before you started in the position your in (or any previous job for that matter).

I know enough to ask the "classics": How many years to partnership? What is the structure of the buy-in? What is the policy on opiate prescribing (more importantly, their expectations of me)?, Will I be able to look at the practices "books" in order to verify revenue generated?, etc.

What other questions do you all think I should I have at the ready?

What things did you WISH you knew about your position that you would have asked during your interviews?

I'm sure a question like this will get everyone's snarkiness peaked, but please try to stay on point- I need a job!

Thanks everyone!!

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[hyperalgesia]

The main thing at this point is the general mission of the practice and if it vibes with your personal goals.
Where is it compared to you on the spectrum of money factory -> free charity clinic?

A lot of info is gleaned from your observation rather than their intentional disclosure. If you can get them to talk about a case or two, you might find common ground or WTF.

How much control will you have shaping the policy of the clinic? For example with regard to opioid policy, etc.
Are you able to review pt consults before accepting into the clinic?
Do they do a lot of disability work, workers comp, etc?

You don't have to ask this at the interview but the final contract will obviously contain important "non-compete" info.

 

[SommeRiver]

One thing is absolute clarity for incentives and bonuses. My current contract was murky in that regard, and I actually didn't understand my incentives and bonuses until 10 months into my contract.

 

[lobelsteve]

We are the sum of our experience, education, training, and life.

I would change nothing but how I sometimes dealt with the adversity poorly.

 

[Ronin1]

I would probably say to go to the area that has the least competition that you think you can accept living in. And go solo.

Regarding entering into partnerships. Do as much due diligence as possible. Find out about the new patient assignment process. Try and see what each partner bills and collects as opposed to an average. Find out the specifics of any possible ASC deal. And spell out the exit arrangements in detail.

 

[NJPAIN]

We are the sum of our experience, education, training, and life.

I would change nothing but how I sometimes dealt with the adversity poorly.

Very insightful. Age is softening you up.


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[RM38]

A couple of things I wished I knew where:

1) If patients get sedation for procedures, which procedures are considered ok for that and which ones are not? And also if you don't want to sedate at all would that be ok?
2) If a patient gets one epidural, are they really committing to 3 and will you also be expected to do that as well? And how many levels are typically done at once?
3) I would also want to know about any active/past lawsuits/fines/suspended licenses against the practice and physicians
4) I would also recommend asking to talk to previous physicians whom left if relevant to see why they actually made a move. I would also want to know how long each of the previous physicians were employed before they left.
5) What specialty is the primary referral source?
6) How often to they UDS?

I also went and watched how several practices operated during an actual day which was good to see. I stayed away from one or two due to some obvious really bad technique and other questionable practices. Additionally I agree with asking about your ability to review consults and shape clinic policy as well as clarifying bonus structure. I didn't understand that well when I signed my contract and now I realize I will have a really tough time getting to MGMA in my current set up. I am also looking for a new practice due to this and several other issues.

 

[Piebaldi]

The main thing at this point is the general mission of the practice and if it vibes with your personal goals.
Where is it compared to you on the spectrum of money factory -> free charity clinic?

A lot of info is gleaned from your observation rather than their intentional disclosure. If you can get them to talk about a case or two, you might find common ground or WTF.

How much control will you have shaping the policy of the clinic? For example with regard to opioid policy, etc.
Are you able to review pt consults before accepting into the clinic?
Do they do a lot of disability work, workers comp, etc?

You don't have to ask this at the interview but the final contract will obviously contain important "non-compete" info.

How about whether you have to do narcotic management? There is a clinic I know where the pain docs do only procedures, and then they have one doc who does the narcotic management - but no spine stuff.

 

[hyperalgesia]

How about whether you have to do narcotic management? There is a clinic I know where the pain docs do only procedures, and then they have one doc who does the narcotic management - but no spine stuff.

OP already mentioned that but I agree, that's in the top 3.

 

[Piebaldi]

OP already mentioned that but I agree, that's in the top 3.

Sorry I guess I didn't read completely

 

[Gauss]

I would spend a week in their clinics & procedures shadowing. See firsthand their payor mix, referral patterns, diagnoses, treatment styles, procedural methods, personalities, and also probe them on their expectations for your practice

 

[RM38]

How about whether you have to do narcotic management? There is a clinic I know where the pain docs do only procedures, and then they have one doc who does the narcotic management - but no spine stuff.

In this situation I would also want to know whom is actually ordering the procedures. If it is not you and it is somebody else whom has very limited knowledge of what is proper to order, you could end up in a bad spot if you just show up and stick.

 

[melodic minor]

In todays game, the most important question you can ask is “ do you have any intention of selling your group to private investors”. If they give you anything but absolutely no as an answer, run, don’t walk away immediately.

I left my first practice which was owned by an anesthesiology management company over issues of my compensation and went into a private practice in another state that seemed like a great fit. Wonderful colleagues and I busted my rear end to do anything that was needed. Then the partners decided to merge us with another group and sold to private equity. I won’t give you the details, but will just say how wonderful it is to be talked down to by a “business man” who thinks because he has money, he knows everything and you know nothing.

Unfortunately this is a trend that is spreading throughout medicine. Pain is already fully infiltrated, and from what I have heard these “sharks” have made inroads into other specialties... urology and optho.

 

[jsaul]

these private equity firms only buy pain practices that have several docs and mid levels in them and are heavy in both procedures and opioid mgt. These practices churn out UDS testing and other ancillaries.