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Practical Management

Reality Check for Joining a Group

Open communication, assessment of monetary issues and multiple visits to a group are all key to deciding whether it's right for you.

By judy capko Unique Opportunities, March/April 2008

How do you prepare to practice the trade for which you have spent years preparing? Those years were consumed with education and training; dedication and sacrifice; exhaustion and relentless demands that had one purpose—to prepare you to practice medicine and provide a service to the community.

Now you must carefully plan, examine each opportunity and make realistic decisions for the future. There’s no shortcut on the opportunity highway: When it comes to examining prospects to join a medical group, you’ve got to do your homework!

Location, location, location

A search for the right job begins with location. If you’re not realistic on the front side, the location of a practice can end up being the downfall. I’ve seen many physicians move on after a year or two when they realized this wasn’t the community where they (or sometimes their families) wanted to spend the rest of their lives.

If you and your spouse love the symphony and the excitement of a big city, discontent might emerge early in a country setting thats serenity initially had appeal. The importance of community should not be underplayed. This includes everything from the quality of the schools to the versatility of culture, economics and recreational activities. Sometimes it’s a matter of weather. If you’ve spent your entire life on the sunny California coast, moving to the northeast could require more change and flexibility than you anticipated. Don’t convince yourself it’s a fit if it doesn’t meet your lifestyle needs. Limit your search to areas you and your family can envision living in for the next 25-30 years.

Establish open communication

The practice’s stability is a big issue. Find out if there have been other physicians who came on board and left within a few years. “Everyone is on their best behavior during the recruitment process,” says Randy Bauman, consultant and president of Delta Health Care in Brentwood, Tennessee. “What a young physician should be looking for is the ‘fit’—the feel of comfort to work with physicians that share a similar philosophy and goals.” If you and the practice are at odds about

Look at the practice with a critical eye. Start with how you felt the first time you went there—everything from the appearance of the facility to the attitudes.

what you think is important, how willing you are to accept financial risk and how staff should be treated, it will create a division that will head you in the wrong direction.

During the initial interview openly communicate your needs—what you are looking for in an opportunity and what expectations you have for the first, second and third year, and what your suitors expect from a new hire. Find out as much as you can about what it takes to become a full partner. Ask the physicians what they see as the practice’s strengths and weaknesses and how they differ from the competition. If you and the physician partners decide to continue the pursuit you’ll want to gain a lot more knowledge about the practice.

“Having realistic expectations is not easy, it requires careful and unemotional investigation and analysis. Unhappiness thrives in the gap between expectations and reality,” says Tim Boden, administrator for Starkville Clinic for Women in Starkville, Mississippi.

Talk to those that have gone before you. “High physician turnover in the past can be a red flag,” says Bauman. Ask if the practice has had other physicians come on in recent years who didn’t stay, and if so, why did they leave? In fact, it would be smart to talk to one of these physicians who left. The story he or she tells may be quite different from what you are getting from the practice’s leadership.

Look at the practice with a critical eye. Start with how you felt the first time you went there—everything from the appearance of the facility to the attitudes. Once you’ve had your first interview you’ll want to go back again to further assess the opportunity. It’s important to visit the practice during office hours. This can be very revealing. You will discover how staff and physicians treat patients and each other. If there is a reception room full of patients it could be because the schedule is not well managed.

Staff’s actions and opinions can tell you a lot about a practice. “Talk to support staff,” suggests Rosemarie Nelson, an MGMA consultant in Syracuse, NY. They are at the heart of the practice, working in the trenches every day. What they know or don’t know about the practice’s plans to add another physician will also tell you a lot about how the practice communicates. Conversations with referring physicians can also be helpful in forming your final opinion about a practice opportunity. “Engage folks in conversations about reliability, dependability and follow through,” advises Nelson.

Finances are a big consideration. Everything from what and how you will be paid to productivity expectations and how a bonus is calculated. Of course the foundation of finances is the economic stability of the practice. “It’s important to understand how much full partners make,” says Bauman. “A high performing practice typically provides partner income significantly above the starting salaries for new recruits.” If not, this practice may not have the financial potential you are looking for.

Look at the numbers. If you get even close to pulling a deal together you are entitled to look at specific number regarding the practice’s performance. How does the practice compare when measured against industry standards for full time equivalent, FTE, physicians in this specialty. Industry standards can be obtained through Medical Group Management Association’s annual cost survey, www.mgma.com and the National Society of Certified Healthcare Business Consultants’ annual statistics on physicians and dentists, www.nschbc.

Examine the charge, receipt and adjustment patterns for the prior year, as well as accounts receivable performance—how much money is “typically” on the books. Compare revenue after operating expense for FTE physician and the operating costs as a percentage of revenue,” mentions Nelson, “as well as the number of FTE support staff per physician.” If you need help understanding and analyzing the numbers, turn to an accountant that has a medical group practice clientele or contact a practice management consultant.

Where the practice is headed is just as important as its past performance. “Look at the business plan and ask what the plan is for integrating technology at every level of the organization,” recommends Bauman. Technology advances are important in both the business and clinical area, and will play an important role in measuring and monitoring outcomes in the future.

Before you finalize plans, inquire about

this practice’s execution plans.

• Will you be shadowing a physician for awhile or will you be expected to start seeing patients immediately?

• How will patients be funneled to you?

• Will you have your own nurse?

• Is an administrative person going to be assigned to walk you through the workflow processes and educate you on how to report your services?

• Are there standards for timely documentation, response to phone calls, etc?

“All other elements being equal, go for the practice that does the best job of outlining (in writing) what it expects from employees and what you can expect from the employer,” advises Boden. You’ll want clarity regarding financials benefits, schedules and the chain of authority. “Then look for additional promises, including how you will ascend to partnership, when and at what costs—and what are the benefits?”

Partnership isn’t the only consideration. What happens if it doesn’t work out? Find out exactly how and when you can leave the group.

There’s certainly a lot to think about before you make a decision to join a practice. Feeling confident about the practice and the integration plan to bring you on board and make you part of the medical community are vital factors.

If you’ve gathered the critical data and completed an in depth exploration of each opportunity, your choice should be based on rationale.

It’s your future. So even when it looks like the opportunity of a lifetime, keep in mind that the most important ingredients in being a strong group practice are a shared value system—the trust and integrity. n

Judy Capko is a healthcare consultant with more than 20 years experience. She is the author of the top-selling book “Secrets of the Best-Run Practice.” Her focus is practice operations, staffing, finance and marketing. Judy is a national lecturer, presenting at many executive management and physician specialty conferences. She is based in Thousand Oaks, CA, www.capko.com and can be reached at (805) 499-9203 or e mail: judy@capko.com