To Join a Competitive Private Practice Group

[sensejae]

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I saw few members mention that certain programs like Utah would prepare the residents well for private practice. That made me curious. If a popular private group receives many applications for an open position, what do the partners look for in the applicants? If a resident wants to join a competitive private practice group, how should he or she prepare her application?

My guesses:
- Networking
- Residency programs that are known to have big volume and autonomy for surgical and clinical training like Utah.
- Big name residency program for branding of the practice? Would they care to advertise that a doctor is from Harvard or Johns Hopkins?
- Great letter of recommendation from someone the partners trust regarding the applicant's clinical and surgical skills
- Perhaps, recent graduates don't have a strong shot at joining a competitive group. Must gain experiences elsewhere and apply later?

I would love to know more about the process.

 

[LightBox]

I'm a partner at a pretty busy group, and until recently, thought I was relatively young as well 🙂 Here is what we (as owners) typically look for in a private practice applicant:

- Surgical skills. As an anterior segment practice, our revenue is made in the operating room. So you have to be fairly efficient in the OR and not have too many complications. Obviously, complications are not good for our referral base. With this in mind, this is probably the reason many private practices prefer experienced eye surgeons. It doesn't matter if you went to Utah or some other "high volume" place -- as a new resident you will never have as extensive an experience compared to someone who has been out for 5 years, doing 1000-1500 cataracts a year.

- Pleasant demeanor. No one wants to work with someone who is hard to get along with. If a young associate fights me on every little issue, do you really think I'm going to extend partnership to this person? The same goes with patient care. Do you think patients are going to want to see some arrogant prick, just because he went to so-and-so university? As you might have guessed, patients, for the most part, don't really discriminate their eye doctors based on where they went to "school." But they will remember if you took care of them as an individual or were instead dismissive.

- References. Any sane employer will call your former mentors and other people that may know you. So if you didn't play nice during training or your previous jobs, chances are you won't get hired by us. Owners of a practice put in ALOT of effort in hiring a new associate, and all of the financial risk is borne by us. We aren't going to risk losing a few hundred K on someone that alienates our referring doctors, patients, or makes our life unpleasant.

- Work ethic and modesty. This goes without saying. We want someone that will take care of our practice's patients, be friendly with our staff, etc. Don't come into the interview (or your first job) complaining about every little thing or demanding partnership from day #1. Remember: medical practices, like Life, are not perfect and the world does not revolve around you. You haven't proven your worth to us at all, until after at least a few years working for us. Being part of a private practice is not like working for Kaiser or the VA -- "you only eat when you kill."

- Entrepreneurship. We are looking for someone who wants to expand our practice -- not someone who just clocks in and clocks out to get their biweekly paycheck. Yes, one of the reasons owners of practices want to hire associates is so that we can profit off of you for a few years before letting you be "part of the club." Your goal is to expand our revenue stream and you have to be a go-getter to achieve this. This is the trial by fire that most all partners/owners had to go through, so be ready to do the same. You will appreciate the same of your own associates when you become an owner.

 

[sensejae]

I'm a partner at a pretty busy group, and until recently, thought I was relatively young as well 🙂 Here is what we (as owners) typically look for in a private practice applicant:...
.

Thank you for sharing your insights. I appreciate it!

 

[LightBox]

Thank you for sharing your insights. I appreciate it!

No problem. I think the problem with this SDN message board is that not many young ophthalmologists with "real world experience" are posting their advice here. Maybe it is due to being too busy, or not wanting to give the "competition" an advantage 🙂 Many of these posts on here are from current trainees who do not have first-hand experience with the world after residency/fellowship.

Though I have great admiration for my attendings/mentors during training, the vast majority of them know nothing about the ins-and-outs of practice management. Fortunately for them, they don't have to know the details to earn their keep.

 

[clayito]

great post above by LightBox with some good points, almost all with which I agree.

I'm in my first year of general practice and disagree, however, with one point above - that it doesn't matter which program you trained in when applying for a job. I am part of a fairly large multi-subspecialty (includes retina, oculoplastics, glaucoma, strab/peds, cornea) private practice and am the only comprehensive eye MD in our group. I mainly do cataracts when in the OR at our (rural) satellite location and will do about 500 cataracts in the first year (have done ~225 in first 5-6 months). Our group told me they hired me because I seemed easy to get along with and wanted to grow the practice (confirming the points by LightBox above) but mainly because I trained at a place with high clinical/surgical volume and tough surgical cases (complex cataracts, etc.).

While I agree that ideally a group would hire someone with 1000s of cases under his/her belt, this is not possible in most situations. Even when such a person can be found, a group has to concern themselves with why such an experienced person would be changing jobs mid-career (personal problems, legal problems, etc.). So when looking at someone just out of training, who do you prefer to do your cataract - someone with 250 cataracts with several complex cases mixed in or someone with 125 with a few complex mixed in? The literature actually supports the fact that complication rates go down significantly after 160 or so cases (http://archopht.ama-assn.org/cgi/reprint/125/9/1215.pdf), so I'm not simply shooting from the hip on this. Plus, I know several surgeons with only a few hundred cases under their belts that I would much rather do surgery on my eye than a couple others I know with a few thousand but still relatively high complication rates.

Maybe where you train is not important in all cases, but I think it's important for most job applications - just my 2 cents. Cheers.

 

[LightBox]

Oh, I didn't say that where you trained doesn't matter at all. Of course, all other things being equal, it is great if you went to a more "reputable" training program. However at least in my eyes, it matters much less than some of the other traits I have listed. There are good and bad surgeons coming from every training program, so I take a program's "name" with a grain of salt. Ideally, I would want to see a video of the applicant's last 10 consecutive phacos to determine if they are reasonably competent in the OR.

One other thing that people obsess about (I know I did) during training is the # of publications they have produced. For most p.p. docs out there, this is very low on their list of priorities for a new associate.

This may be offensive to some, but there is an old adage out there: "Someone's surgical skill is inversely proportional to how many publications one produces!"

 

[MstaKing10]

This is a great thread. I really appreciate Lightbox's comments as I think they are spot on. I'm in an all retina group and just started my partnership after 3 years of employment and can tell you that those criteria listed by Lightbox are absolutely critical. I have since been involved in the hiring of another associate and these were the kinds of things that were discussed. Additionally, there are a few others to consider:

Need: does the group you want to join need a new associate? Need can be defined and considered differently by the group. You may luck out and graduate at the right time when the practice just opened up a new satellite office or perhaps one of the older partners is slowing down. Conversely you may come out just after the group has hired someone or be dealing with other issues where hiring a new associate is not feasible. There is a bit of luck involved with this, though, it is not uncommon for groups to hold out for several years for the right fit.

Niche: do you have a skill that the practice is in need of providing? We recently hired a uveitis trained specialist because we didn't have that in our practice and there was a big need in our area. What can you offer to the practice that may help fill a niche to complement those already in the practice.

Connections: I think this is critical. Most good jobs are not listed on websites, rather, word of mouth goes a long way. Managing partners tend to be well connected, and ophthalmology is a small, close knit group. Keep that in mind as you reach out to your attending and mentors and during training. Having those interpersonal skills that Lightbox mentioned should help a lot in this regard. This is especially true in fellowship, as you build very strong and close relationships with your mentors.

Training: again, word of mouth is critical here. If your attending is raving about your abilities in the OR and clinic, that goes a long way. I'm not sure that coming from a "top 10" training program or having more than X amount of cases under your belt is as important as having the support and admiration of your attendings.

As an aside, I did my fellowship at a solid program that was private practice based with a strong academic affiliation. I knew I wanted to go to private practice so wanted to train somewhere that would prepare me well in this regard. I didn't publish a million papers but I was VERY surgically and clinically busy. I was also exposed to some of the ins and outs of private practice which has served me well transitioning to the real world. I'm not sure, though cannot say this for certain, that a purely academic training program would have prepared me as well for that transition.

 

[Bgladney]

My humble opinion:

For the most part, most folks finishing training have roughly an equal skill level and experience level. Some will be better than others, but for the most part, fairly equal.

Personalities, work ethic, and personal/professional expectations seem to really drive a lot of the hiring decisions.

Practices consider if the person will be a practice builder or someone who is happy with what they are given.
Why does this person really want to live where we are located?
Is this a stepping stone position for them?
Can we get along for the next 20 years?

I would also recommend tempering demands when searching for a position. I have had candidates expecting 4-5 weeks of vacation from the start. This does not happen until later in one's career if ever.

Remember, the decision for a group to offer partnership begins during the initial employment negotiations. When you choose to nitpick a contract before ever starting work for the practice, you are planting the seed of what life will be like when you are actually working for the group.