Recruitment season is my favorite time of year. The CVs pile into the database, and we sift through the resumes, searching for candidates that would make a great fit for our organization. Next, I get on the phone and assess their level of interest and try to sell them on everything we have to offer. We fly them out for a live interview, and the negotiations begin.

Last year was a great year for us. I’m hoping this year will be better. Graduating from residency is a huge accomplishment, but walking into the unknown of a new job is unsettling. It is estimated that over 50 percent of newly minted doctors leave their first job within two years. Having personally witnessed the naiveté of new graduates on the interview trail, this comes as no surprise.

Before starting the job search: Make a list of what your ideal job would be: practice setting (academic, private, large group), location, number of partners, compensation model, schedule, EMR system, call schedule, nursing support ratios, vacation time, practice model (i.e., collaborative practice with APCs, academic model), benefits, malpractice. Once you have your list, you should organize it from most to least important.

Next, you start your search. Before you hop on a plane, some red flags to consider:

Beware of fiefdoms. If you are looking at a large group, ask about the productivity of each partner in the group and how long their tenure is with the organization. If one or two providers stand out as high producers, but the others are struggling to stay afloat, you probably want an explanation. How are the referrals divided up? How are the new patients scheduled? Do providers share patient and panels? Is there enough business for more partners? Some practices will add another provider simply to reduce on-call duty load, but not to share the wealth. The last kind of setting you want to be in is where everyone is out for themselves.

Beware of pyramid structures. Some of the large single specialty groups have a pyramid structure in which senior docs are “skimming off the top” by charging high overhead and depositing percentages into their wallets. The worst I ever heard was a colleague who joined a group that charged her 66 percent overhead on her collections. She took home only 1/3 of what she collected, and she still had to pay malpractice on top of that. She stayed with the group for almost five years because she felt “trapped” as her malpractice tail would not be covered upon departure. She finally left and is happier for it.

Beware of a high turnover practice. High turnover often equals high provider dissatisfaction. If the practice has a constant revolving door of providers it could mean several things: The senior docs are cannibalizing the junior docs. The environment or culture is unfriendly. The compensation or benefits are not competitive. The work-life balance sucks.

I say this with a grain of salt as some of our practices have gone through transformation over the past few years. We have seen turnover of providers that self-selected out of the practice model and workplace culture we are creating. So, sometimes turnover happens when a new leader comes into place or an acquisition occurs. Sometimes turnover is opportunity. It is important to get a pulse on the future vision and culture of the practice. 

Beware of “buying in” to practices. Practices aren’t worth much these days. Almost monthly, I receive a phone call from a community doctor that is looking to “sell” me his/her practice, “sell” me his/her charts and “sell” me his/her equipment. Having survived a very long and painful consolidation and acquisition process in our market over the past ten years, I can safely say that we are no longer in the business of buying practices. At this point, making partner in a smaller practice or single-specialty group may provide you with some profit sharing and business expense write-off, but it will also provide you with liability. Recently, a single-specialty practice in our market went bankrupt due to a partner becoming disabled for a long period of time. The practice could not withstand the costs of disability benefits and a locums provider.

Stay away from a practice that will offer you “partnership” in two years, but won’t define the terms. The nebulous promise of the “ownership” once the junior doc pays their dues can be enticing.

“We will have the practice appraised after two years and then you can buy-in if you decide …”

I’ve seen this play out over and over and over again. The constant churn of chewing up and spitting out the junior docs. It makes me sad. The reality is that many of these practices have no intention of bringing on a new partner. The “appraisal” process generally results in an outrageous number for buy-in. I’ve heard as high at $2.2 million for an OB practice.

If you are planning to join a practice on a partnership track, ask for the buy-in cost before you sign on the dotted line.

Beware of the bad boss. You want a boss that is watching out for you. While I love patient care and taking care of patients, one of my greatest joys is watching my new hires grow, blossom and be successful. One of our newbies recently completed her robotic surgery training. I signed off on her third proctored case, and she literally leapt out of the OR at the end of the case with a smile from ear to ear. She’s booking four cases a month now and her clinic template is six weeks out. She moved onto our productivity compensation model after just eight months of employment. She did this because all of the partners supported her in becoming busy and successful. The culture of our practice is teamwork – for our patients, for our staff, and for our wellness.

Eve Shvidler is an obstetrician-gynecologist and author of Burning the Short White Coat: A Story of Becoming a Woman Doctor.  She blogs at burning the short white coat.

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