What do private practices look for when hiring?

[pandoraone]

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Hello all,

I was talking to some of my classmates about private practices and as we talked we all realised we had no idea what they look for when hiring after residency/fellowship.

What are the looking for? High Step scores? Board certification? The location you did residency (Harvard grad gets more $$$ is more attractive then someone from say, Iowa)?

What factors go into this?

Thanks
Comrade Pandoraone

 

[cowme]

The best jobs are usually all filled through personal connections (who you know trumps all else).

Other jobs are usually filled through traditional routes. Post an opening, apply, use recruiters, etc.

An impressive cv can help you get interviews nationwide, but won't make a difference in your salary. That is determined more by location and volume than anything else

 

[Smurfette]

Hello all,

I was talking to some of my classmates about private practices and as we talked we all realised we had no idea what they look for when hiring after residency/fellowship.

What are the looking for? High Step scores?

NO, no one will care or even ask for your scores. They just want you to have passed. They will likely care if you passed on your first attempt though.

Board certification?

Yes, the vast majority of jobs require you to be BC or BE (board eligible).

The location you did residency (Harvard grad gets more $$$ is more attractive then someone from say, Iowa)?

Some places may care, but in general they are looking for you to have graduated from a reputable school and solid residency program. Academic positions care about your pedigree more than PP. Keep in mind that places want someone well-trained who will stay in that location; if your pedigree looks like someone who would prefer academics (i.e. heavy in research at top tier places) over PP, a practice may not be interested in hiring you.

They want good references and assurance that your training reflects the type of practice you are joining, to seem to get along with others in the practice, and overall professional interests to be in line with other physicians in the group.

 

[Winged Scapula]

Since we are looking for someone to join our (surgical) PP, here's what we want:

1) we don't care (and don't ask) about your Step or ITE scores

2) you have to BE/BC

3) you have to be fellowship trained

4) you have to be willing to market yourself and not sit back waiting for referrals to come in; you are responsible to meet your overhead once your salary guarantee is over and to understand what you have to do to meet those goals

5) you have to realize that PP is a business and that means you have to be involved in HR decisions, billing etc.

6) we do not want an employee; thus, although there is a salary guarantee to get you started, we only offer partner tracks. You have to be as interested in the success of the practice and all the partners as you are in your own.

7) we don't care where you went to medical school or residency or whether you are a DO or MD

8) you have to work full-time; ie, no "mommy" part time tracks

9) must be computer literate/able to work an EMR

10) must be clean, well dressed, and compassionate

11) you must "play well in the sandbox with others"; in PP you have to be cordial to your colleagues, anesthesiologists, radiologists and pathologists as well as referring physicians

12) most importantly, you have to FIT; we have to like you and you have to have glowing references

NB: in PP, most new employees start with a salary guarantee which is funded by a local hospital (rather than the group). The salary and benes are set, with some wiggle room. Unless there is some great bidding war, I would consider it unlikely that say a Harvard grad would be offered more than someone from Random Residency program. At least we won't.

 

[pandoraone]

Since we are looking for someone to join our (surgical) PP, here's what we want:

1) we don't care (and don't ask) about your Step or ITE scores

2) you have to BE/BC

3) you have to be fellowship trained

4) you have to be willing to market yourself and not sit back waiting for referrals to come in; you are responsible to meet your overhead once your salary guarantee is over and to understand what you have to do to meet those goals

5) you have to realize that PP is a business and that means you have to be involved in HR decisions, billing etc.

6) we do not want an employee; thus, although there is a salary guarantee to get you started, we only offer partner tracks. You have to be as interested in the success of the practice and all the partners as you are in your own.

7) we don't care where you went to medical school or residency or whether you are a DO or MD

8) you have to work full-time; ie, no "mommy" part time tracks

9) must be computer literate/able to work an EMR

10) must be clean, well dressed, and compassionate

11) you must "play well in the sandbox with others"; in PP you have to be cordial to your colleagues, anesthesiologists, radiologists and pathologists as well as referring physicians

12) most importantly, you have to FIT; we have to like you and you have to have glowing references

NB: in PP, most new employees start with a salary guarantee which is funded by a local hospital (rather than the group). The salary and benes are set, with some wiggle room. Unless there is some great bidding war, I would consider it unlikely that say a Harvard grad would be offered more than someone from Random Residency program. At least we won't.

Does research play a role at all? Applicant A with 15 pubs vs. applicant B with 2?

 

[cowme]

I would think that 15 publications would raise some question marks as to whether or not you'd really be happy in private practice, where there is usually no research.

The one exception would be some health care economics, quality assurance research. But even this would probably be #20 on the list of importance

 

[IWillChangeHC]

Great response. I would also add how well you will fit the culture of the practice. If it's a group practice, they're going to want to make sure you will be a good complement to the team. This requires as the quoted mentioned, personal connection or inside knowledge to demonstrate you as a value-add and why.

I would also input how you can generate business for the group. What in particular do you add that they need. This is critical. All the rest is simple check marks on a list of requirements.

Since we are looking for someone to join our (surgical) PP, here's what we want:

1) we don't care (and don't ask) about your Step or ITE scores

2) you have to BE/BC

3) you have to be fellowship trained

4) you have to be willing to market yourself and not sit back waiting for referrals to come in; you are responsible to meet your overhead once your salary guarantee is over and to understand what you have to do to meet those goals

5) you have to realize that PP is a business and that means you have to be involved in HR decisions, billing etc.

6) we do not want an employee; thus, although there is a salary guarantee to get you started, we only offer partner tracks. You have to be as interested in the success of the practice and all the partners as you are in your own.

7) we don't care where you went to medical school or residency or whether you are a DO or MD

8) you have to work full-time; ie, no "mommy" part time tracks

9) must be computer literate/able to work an EMR

10) must be clean, well dressed, and compassionate

11) you must "play well in the sandbox with others"; in PP you have to be cordial to your colleagues, anesthesiologists, radiologists and pathologists as well as referring physicians

12) most importantly, you have to FIT; we have to like you and you have to have glowing references

NB: in PP, most new employees start with a salary guarantee which is funded by a local hospital (rather than the group). The salary and benes are set, with some wiggle room. Unless there is some great bidding war, I would consider it unlikely that say a Harvard grad would be offered more than someone from Random Residency program. At least we won't.

 

[Winged Scapula]

Great response. I would also add how well you will fit the culture of the practice. If it's a group practice, they're going to want to make sure you will be a good complement to the team. This requires as the quoted mentioned, personal connection or inside knowledge to demonstrate you as a value-add and why.

Yep, that's number 12 on the list. We are a small group, so liking each other and valuing each other's contribution to the practice and the field as a whole is very important to us.

I would also input how you can generate business for the group. What in particular do you add that they need. This is critical. All the rest is simple check marks on a list of requirements.

Perhaps that is important in a multispecialty group, ie, "we need someone who does robotic colons or hepatobiliary". Since we are all the same specialty the required skills are inherent in the job description; we are looking for is someone to cover a certain area of town where we don't currently have coverage.

 

[Winged Scapula]

Does research play a role at all? Applicant A with 15 pubs vs. applicant B with 2?

Not really.

As noted above, with someone with a lengthy published academic practice, you'd have to wonder how happy they'd be in PP. It really is a different beast.

However, our field has a lot of people in PP who do a great deal of research and its certainly possible to do. Our work in breast brachytherapy was presented last year at ASCO and many in PP write chapters in textbooks and lecture at annual conferences.

We don't require that anyone does research but they should be interested in participating in national data registries and letting patients know about available trials. But the amount of research someone has done is not important to us and having more pubs is not necessarily better.

 

[mimelim]

Thanks WS, very informative.

 

[Winged Scapula]

Thanks WS, very informative.

👍

 

[armybound]

Do you take them to the OR at all, WS? See what kind of skills they have?

 

[Winged Scapula]

Do you take them to the OR at all, WS? See what kind of skills they have?

No you really can't - unless it was someone already in town with hospital privileges and in that case, word of mouth is sufficient. Otherwise getting them temporary privileges is difficult and time consuming,

 

[pandoraone]

Not really.

As noted above, with someone with a lengthy published academic practice, you'd have to wonder how happy they'd be in PP. It really is a different beast.

However, our field has a lot of people in PP who do a great deal of research and its certainly possible to do. Our work in breast brachytherapy was presented last year at ASCO and many in PP write chapters in textbooks and lecture at annual conferences.

We don't require that anyone does research but they should be interested in participating in national data registries and letting patients know about available trials. But the amount of research someone has done is not important to us and having more pubs is not necessarily better.

Got it. It seems as if getting into a "good" PP firm is vastly different from getting into a "good residency/fellowship" program.

Is there anything we can do as med students to enhance our CV for PP? I know its many years down the line but do you guys ever look at anything from med school time?

 

[Winged Scapula]

Got it. It seems as if getting into a "good" PP firm is vastly different from getting into a "good residency/fellowship" program.

Is there anything we can do as med students to enhance our CV for PP? I know its many years down the line but do you guys ever look at anything from med school time?

Bear in mind that what I've written above is what WE want; YMMV with a different specialty, a different practice.

I can't imagine anyone looking at your medical school records.

Think of PP like a marriage. It is a long term contractual obligation with a group of people. Therefore, you want anyone who joins the practice to be someone whom:

a) you personally like (that really solves a lot of problems; when I first became partner, there was a lot of hashing about amongst the attorneys which created a lot of friction between my partner and I. At the end of the day, she and I really liked each other as people and were able to solve the problems ourselves.);

b) you trust - to do the right thing for patients and for the practice;

c) is fair (we don't want someone who whines about the call schedule; we all take our share; or tries to get special privileges)

d) has a good business sense; who recognizes practices that will increase *our* revenue

e) is willing to accept a little bit of uncertainty; ie, as reimbursement and referral patterns changes, so will your yearly income. You've got to be able to "roll with the punches" as it were.

I'm told that one of the reasons I was offered my current job in the first place was that I was not insistent on a "100% guarantee" that I would be successful and that I would make "x dollars". I had the attitude of "let's roll and see what happens". Many new grads are nervous about doing that and the employee model is more attractive. That is, until Big Brother hospital decides they don't need you anymore (2 of my friends recently got fired with 4 weeks notice after the hospital decided they no longer wanted employed surgeons...that's tough).

So these aren't things I can teach you as a medical student to DO. Its who you ARE.

 

[Impromptu]

Anesthesiology groups look a a few different things, but most are similar to what has already been posted. Groups and applicants are looking for many of the same things in each other. Do I want to work with them? Could I like them? Could I like working with the surgeons, nurses, and everyone else involved in the ORs. Reliability. Lack of whining. Equality in work distribution.

Finally, and maybe most importantly, will my wife be happy there?

 

[Socrates25]

I would caution everyone on the future of private practice, at least in terms of what traditional "private practice" entails, which is a small group of doctors partnered together. IMHO it is going away within the not-too-distant future (10-20 years). I'm currently a private practice pediatrician going into a cardiology fellowship next year.

The problem is the new healthcare law with its ACO-centered focus. Eventually whats going to happen is that you are going to be an employee REGARDLESS. If you arent an employee of the hospital, you will end up being a de-facto employee of an ACO group.

Healthcare is moving to a model where doctors dont get reimbursed as individuals, they get reimbursed only under the ACO umbrella. It will start only with Medicare/Medicaid first, but IMO the private insurance companies will eventually follow them.

In the future, the only "private practice" that resembles today is extraordinarily large physician groups with dozens if not hundreds of docs. I think the days of smaller groups of 10 or less doctors are going away, because they wont be part of an ACO, the payors wont reimburse you unless you are part of an ACO.

 

[Socrates25]

6) we do not want an employee; thus, although there is a salary guarantee to get you started, we only offer partner tracks. You have to be as interested in the success of the practice and all the partners as you are in your own.

8) you have to work full-time; ie, no "mommy" part time tracks

#6: Whats the general structure on your partnership buy-in? Do you forego a certain percentage of your reimbursement to be invested into the group or what?

#8: IMHO the labor department under Obama is going to frown upon this -- there are a few cases of employers being dragged to court for "gender discrimination" for practices such as this. I dont agree with it -- but it is what it is.

 

[Winged Scapula]

In the future, the only "private practice" that resembles today is extraordinarily large physician groups with dozens if not hundreds of docs. I think the days of smaller groups of 10 or less doctors are going away, because they wont be part of an ACO, the payors wont reimburse you unless you are part of an ACO.

That's probably true. We have joined several local ACOs, and are currently the only group in our specialty in most of them (which are now closed). Time will tell what is going to happen but I agree that practice as we now know it will change.

#6: Whats the general structure on your partnership buy-in? Do you forego a certain percentage of your reimbursement to be invested into the group or what?

Surgical practices are generally not valued very highly; therefore, buy-ins are either negligible or non-existent. There will be some local variation of course, as to what is generally practiced in your community. Anyone joining our group is told up front what the buy-in calculation is and they can elect to have it taken "off the top" or just pay a lump sum at the time they are made partner.

This is a common area where groups try and rip off the young partner, coming up with exorbitant buy ins which are not based on practice value. I see it mostly in practices where the partners support the new grad's salary without any assistance from a hospital and subsequently, they feel entitled to some of that money back when the newbie becomes partner. Bear in mind, that once the newbie has gotten up to speed, they HAVE been getting that money back in reimbursement over and above what the new guy is being paid, but that seems to get lost in the equation.

#8: IMHO the labor department under Obama is going to frown upon this -- there are a few cases of employers being dragged to court for "gender discrimination" for practices such as this. I dont agree with it -- but it is what it is.

I understand that although I'm not sure how it would be gender discrimination when it applies to both men and women joining. The job is full time, take it or leave it.

What is their solution then for someone who works part time but does not get a rebate on their malpractice insurance (ie, there is no provision for part time malpractice coverage), health and disability insurance, license fees, hospital dues, etc and other overhead which is not contingent on number of hours worked?

I know we have some contingencies in our operating agreement in regards to a partner who wants to go part time before retiring or needs to in terms of health, but that is different than bringing in a new person. I am not really aware of any surgical practices which offer part time work, without expecting full time overhead.

 

[Xlorgguss]

Since we are looking for someone to join our (surgical) PP, here's what we want:

1) we don't care (and don't ask) about your Step or ITE scores

2) you have to BE/BC

3) you have to be fellowship trained

4) you have to be willing to market yourself and not sit back waiting for referrals to come in; you are responsible to meet your overhead once your salary guarantee is over and to understand what you have to do to meet those goals

5) you have to realize that PP is a business and that means you have to be involved in HR decisions, billing etc.

6) we do not want an employee; thus, although there is a salary guarantee to get you started, we only offer partner tracks. You have to be as interested in the success of the practice and all the partners as you are in your own.

7) we don't care where you went to medical school or residency or whether you are a DO or MD

8) you have to work full-time; ie, no "mommy" part time tracks

9) must be computer literate/able to work an EMR

10) must be clean, well dressed, and compassionate

11) you must "play well in the sandbox with others"; in PP you have to be cordial to your colleagues, anesthesiologists, radiologists and pathologists as well as referring physicians

12) most importantly, you have to FIT; we have to like you and you have to have glowing references

NB: in PP, most new employees start with a salary guarantee which is funded by a local hospital (rather than the group). The salary and benes are set, with some wiggle room. Unless there is some great bidding war, I would consider it unlikely that say a Harvard grad would be offered more than someone from Random Residency program. At least we won't.

So if you don't mind me asking, what sort of fellowship are you looking for? Something specialized, or something more geared towards general like MIS?

 

[Winged Scapula]

So if you don't mind me asking, what sort of fellowship are you looking for? Something specialized, or something more geared towards general like MIS?

We do Breast Surg Onc only. Despite patients asking for a "laparoscopic" or "laser" lumpectomy from.time to time, an MIS fellow wouldn't be particularly useful, 😆