I was wondering what opinions you have about multi-specialty groups. What advantages and disadvantages are there vs. single specialty? Any red flags about the latter situation I described? What should I ask or beware of? Also do you have any advice about working with a recruiter? Any advice you can provide would be greatly appreciated.
Great questions. Here's my thoughts:
I - Multi-specialty group
a - advantages include:
1 - built-in referral network
2 - built-in capital for setting up the practice
3 - often secure salary position
4 - generally a wide-range of resources esp in the larger groups
5 - usually an already well-demonstrated need for the new guy
6 - usually benefits are available--401k, health plans, etc.
b - disadvantages include:
1 - as a surgical subspecialist you end up subsidizing the group. In other words, you will be providing a greater profit margin than the PCP's will be, but as a partner, when you make it to that level, you get equal share of the profit. Thus, PCP's benefit more financially from the arrangement than you do. Now if there is a compensation built in so that your share of the profit is larger if your contribution to the profit is greater, it's a good situation.
2 - You're not the boss. And sometimes, a non-surgical person is the boss. And sometimes that non-surgical person is less interested in you than his own. Similar to the situation in which the ENT is not a dept with it's own chairman, but rather a division of general surgery.
3 - limited growth potential for salary
4 - less autonomy to set your own hours, your own OR schedule, your own clinic load. Often these are dictated to you or at least you are pressured into what's best for the group, not just you.
5 - less autonomy to get what you want, more often have to settle for what you need. Unless the MSG is loaded, then it's great.
6 - you'll always start as low man on the totem pole
II Regarding a small MSG with no ENT in place. Check hard into their resources. You want to make very sure that they are able to purchase or lease the basic equipment you need. Who oversees your clinic? Who is your boss? Is it a family practice doc? Do they already have some other surgical specialties? Or are you the first? What do they envision your role to be? What kind of staffing can they provide? Who runs your books? Will you have your own clinic, or will you share with a non-ENT physician? Can they do audiology? allergy? How much money do they have to get started? What is the reimbursement situation--eat what you kill or everyone takes an equal share of the pie? EMR in place? Are they planning on putting one in place? What happens if profits are short for payroll one month--do they have cash calls (where you have to give back a certain amount to make sure that you cover the salary for your receptionist)? What kind of benefits do they offer?Those are the questions I'd want to know.
III Be wary of recruiters. They get paid by getting docs hired. As Reagan said, trust but verify. They usually embellish, but rarely do they lie. They also tend to work for places that are more desparate which could be good or bad depending on why those places are desparate. It's just the truth that desirable locations and desirable practices just don't need recruiters.
