Questions to ask on job interviews

[maverick_pkg]

Hey guys

I tried to search but didnt find a similar thread. You guys have any thoughts on questions to ask during private and academic job interviews (vascular surgery to be specific) and during contract negotiations.... Most are obvious, but some may get missed such as a nice office etc. Please chime in with thoughts..... thanks

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[SLUser11]

Hey guys

I tried to search but didnt find a similar thread. You guys have any thoughts on questions to ask during private and academic job interviews (vascular surgery to be specific) and during contract negotiations.... Most are obvious, but some may get missed such as a nice office etc. Please chime in with thoughts..... thanks

Here's a book that I found helpful.

I think it's important to get concrete details on things that are important to your practice. For example, if you really need a certain piece of equipment for the OR or for your office, how are they specifically going to get it for you?

For CRS, there were some helpful articles in "Clinics in Colon and Rectal Surgery," and there were some helpful symposiums at the ASCRS national meeting. I'm sure there's something similar for vascular....

 

[Winged Scapula]

I also found the book above mentioned by SLUser helpful and have recommended here previously. It does a good job of laying out the basics of contracts and options.

Some things that might not occur to you to ask (because they didn't occur to me):

1) availability of block time - is it only offered after you have been on staff for a certain period of time or book a number of cases?
2) marketing - what is plan for letting the community know you are available to see patients, to introduce you to colleagues and referring physicians? Will they help with ads or taking you to practices?
3) how are patients divied up in the practice? Does the new guy get all the ****ty consults (perhaps that would be lymphedema in a Vascular practice) and the partners get all the high paying ones?
4) if you are on a salary guarantee/partner track, what happens to your AR when you (presumably) become partner? Do they give it to you, keep it all, or sell it to you at some percentage?
5) payor mix in the community - is it mostly private insurances, or high percentage of Medicare/Medicaid, uninsured?

There are others but its been a long month and I'm running out of steam...best of luck!

 

[Pir8DeacDoc]

I also found the book above mentioned by SLUser helpful and have recommended here previously. It does a good job of laying out the basics of contracts and options.

Some things that might not occur to you to ask (because they didn't occur to me):

1) availability of block time - is it only offered after you have been on staff for a certain period of time or book a number of cases?
2) marketing - what is plan for letting the community know you are available to see patients, to introduce you to colleagues and referring physicians? Will they help with ads or taking you to practices?
3) how are patients divied up in the practice? Does the new guy get all the ****ty consults (perhaps that would be lymphedema in a Vascular practice) and the partners get all the high paying ones?
4) if you are on a salary guarantee/partner track, what happens to your AR when you (presumably) become partner? Do they give it to you, keep it all, or sell it to you at some percentage?
5) payor mix in the community - is it mostly private insurances, or high percentage of Medicare/Medicaid, uninsured?

There are others but its been a long month and I'm running out of steam...best of luck!

These are all great things to ask. The answer to these questions can really change what sort of practice you are joining. It can make them squirm a little too when they answer which can give you more insight into the situation.

I'd add that you should be leery of a high income guarantee for multiple years. Under served areas do this to attract you. But what you really need to know is what the most recent jr guy made once the income guarantee was up. I'm in PP but the last two otos employed by our hospital got a guarantee for a couple years. Then when that was up they couldn't come close to meeting the productivity that was required to maintain their income level. They were offered a greatly decreased salary. Both left. It disrupts your family and can leave you in a bad spot trying to sell a house unexpectedly. It is very hard to adjust downward in terms of salary. Take a proper salary from the beginning. Not some hugely inflated number. Or at least be aware that you likely won't maintain that huge number.

 

[maxheadroom]

Good advice above.

The difference between PP, multi-specialty groups, and academic practice is huge, so some of the advice that you receive won't be helpful.

1. Big "guarantees" are usually hiding something. I have several friends who took a job with a 2 years $450K guarantee and then left when it was done. There's a reason for it.

2. How is overhead shared/calculated? I have a friend who was screwed on this -- his "partner" set it up so overhead was calculated based on billings. My friend did lots of reconstructive work on Medicaid and Medicare patients. His partner did primarily cosmetic. My friend's collections were terrible, so he was screwed on overhead because it was based on billing and not collections.

3. How are other office costs shared? If your partner wants an expensive piece of equipment that you don't plan on using, will you pay a share?

4. How are decisions made in the practice?

5. Is this a practice that has an established group or is it a solo practitioner bringing you on? Solo practitioners expanding their practices have a lousy track record -- they're used to making all of the decisions with little input from others.

 

[Winged Scapula]

Good advice above.

The difference between PP, multi-specialty groups, and academic practice is huge, so some of the advice that you receive won't be helpful.

1. Big "guarantees" are usually hiding something. I have several friends who took a job with a 2 years $450K guarantee and then left when it was done. There's a reason for it.

This cannot be harped on enough, IMHO. Most, if not all of us in practice for any amount of time have seen this. I've admitted that I was somewhat naively jealous of a friend who took what seemed to be a great job out of fellowship: signing bonus (somewhat rare in GS), generous moving allowance, salary, etc. 18 months in and she was referring to the partners as, "those bitches". Bitches, whom I might add, told her 2 weeks before her wedding that they had decided she wasn't partner material and that they would be letting her go at the end of that huge salary guarantee.

2. How is overhead shared/calculated? I have a friend who was screwed on this -- his "partner" set it up so overhead was calculated based on billings. My friend did lots of reconstructive work on Medicaid and Medicare patients. His partner did primarily cosmetic. My friend's collections were terrible, so he was screwed on overhead because it was based on billing and not collections.

Another excellent consideration. The only issue I had with how we calculated overhead is that my partner owns the building and I pay half of the loan; that would be great if she didn't buy the building at the height of the construction boom. In today's market, I am vastly overpaying for the space I share, but its not worth it to me to ask to pay "fair market value" although it might be as an employee.

5. Is this a practice that has an established group or is it a solo practitioner bringing you on? Solo practitioners expanding their practices have a lousy track record -- they're used to making all of the decisions with little input from others.

This is also huge and an issue my partner and I struggled with. Mostly little things in the beginning but it came to a head when she thought nothing of it when she decided to meet with another surgeon in town to talk about merging our practice. I suggested that that sort of meeting should include ALL the partners, not just her, even if it was just a fact finding mission. She was stymied but came to understand that it wasn't just her practice anymore and that big decisions needed to be shared.

The other issue that I have seen when joining a solo practice is that often times the office staff is related to the owner or have long-standing loyalties. How are you going to feel when its the partner's mother doing the books or his daughter who is the MA? Can you discipline family members? Will loyal office staff fairly distribute the work load, etc? Its worth assessing the staff as well as the new partner and seeing how they interact with you.

 

[maverick_pkg]

Thanks for all the input guys, its really helpful. Sorry for the late response. The fellowship just kills. I did buy the book and is fantastic. Regarding salary/reimbursement questions and call questions, is it appropriate to ask during the interview or is that left for second look etc?

 

[SLUser11]

Thanks for all the input guys, its really helpful. Sorry for the late response. The fellowship just kills. I did buy the book and is fantastic. Regarding salary/reimbursement questions and call questions, is it appropriate to ask during the interview or is that left for second look etc?

Why go for a second look if the salary/reimbursement/call is not a good fit?

I would ask those questions up front. It's not like residency, where you are pretending that those things don't matter, because you just want to get the best training possible.....those numbers are a huge part of your decision, and they need to be demonstrated clearly in writing.

 

[maverick_pkg]

that makes sense. thank you.

 

[Pir8DeacDoc]

I'm surprised a package wasn't shown to you outright. All the places I looked had a one page rundown of the highlights.

$ per year for how many years
X amount of vacation
X time till consideration of partnership
Etc

You need to know that up front. For me, the best location in the world doesn't trump being able to spend more time with my family. It's part of the reason I work 4 day weeks and have 6 weeks vacation. Everyone is looking for something different. But the chips should be on the table early.

 

[maverick_pkg]

havent interviewed private yet... just academics. maybe its different for both.4 day weeks and 6 week vacation sounds fantastic!

 

[SLUser11]

havent interviewed private yet... just academics. maybe its different for both.4 day weeks and 6 week vacation sounds fantastic!

Academic contracts are more uniform/standard, and academic physicians are sometimes less business-savvy, which can lead to less communication from both sides, but those numbers are still extremely important.