This article is sponsored by Careers by KevinMD.com.

After several months of intense discussions, “Dr. Joe Smith” thought he was headed from his successful two-physician practice to a respected practice with many more physicians. It was pretty much a “done deal,” until he was told that the senior partner decided he really didn’t want someone with an already-established and lengthy patient roster.

Instead, “Dr. Jones” wanted the new doctor to take over his existing patients when he retires. Dr. Smith wishes he’d known that in the beginning, or known where to find that answer before he was told, much to his disappointment, “We just don’t have room for you right now.”

It’s not that he isn’t connected, or that he didn’t ask a lot of questions—like, “How long do you think Dr. Jones will stay, and how much influence does he still wield when it comes to new doctors joining the practice?”

Of course, it’s impossible to know everything about what may lie ahead when a doctor moves on. But these days, making your next career move as an M.D. requires more than a cursory decision or, as Dr. Smith says, “a leap of faith.” Gone are the days when you might have thought, “Oh, heck. I’ll just take a chance and it will all probably work out.”

Not like flipping burgers

Sometimes, though, it may not work out. As a physician, changing course is not quite like leaving McDonald’s for a better position at Burger King. With the substantial investment you’ve made thus far in your education and training, you don’t want to take a misstep, says Russell B. Still, CVA, CHBC, and executive vice president of Medical Management Associates, Inc., a nationwide health care consulting firm.

“You’ve been taught to think independently for years now, to figure out problems yourself,” he says. “And there’s no place to go to get this kind of education, to formally learn how to choose your next employer.”

Sure, you can scour LinkedIn and Glassdoor, as well as medical student and physician members-only forums where experiences and opinions can be shared anonymously and “confidentially.” If it’s a hospital or health system, you might find a video of a potential department chair giving a presentation on YouTube. Look at the corporate website under “News” to see what’s happening in the C-suite, what’s written about the mission of the organization and about its own financial “health.” But word-of-mouth, aka “the horse’s mouth,” is still going to be your most reliable means of learning what’s up—and down—as you contemplate advancing your medical career.

Someone somewhere knows more about your prospective employer than you do, so you should strategize about how to access them and that information. It’s natural to be slightly hesitant for any number of reasons, but you owe this to yourself, especially as you assess the culture you may be immersed in if you join.

“I would encourage a candidate to talk to anyone they can,” Still says. “You never know who might be able to open a door for you.”

If you choose private practice

First, you’ve probably already determined out of the gate that you are either entrepreneurial, bound for private practice, versus a hospital or health system. Choosing the former means you have more direct influence over your future, and that you’ll be hired as an associate, work two to three years, and become a shareholder.

Here are basic questions you should ask if you’re joining a private practice, says Still. “If you’re the first hired into the practice, that’s one thing, but if not, how many others have been there? Why have they stayed? You’ll likely have a chance to talk to them, and they’ll be ‘carrying the practice flag’ so it may be more challenging to get a true picture.

“But if they left, and you can access them, why did they leave? Maybe the senior doctor is a jerk, the path to partnership was too long, or they stayed around too long thinking they could buy in and it didn’t happen—those are all critical things to know.”

Share and share alike?

Digging beneath the obvious surface has many benefits as you consider your move, he says. “Hopefully, you’re not going to work in a private practice for two or three years, and not know what the buy-in looks like. As an incoming employee, you need to know that and how the value of the practice is calculated. If you don’t know, and you get to buy in—several years away—and then find out it’s two million dollars, either you’re going to stay and not be a shareholder but be an employee, or you’ll leave and start over somewhere else.”

Still always recommends that buy-ins be sold in equal shares so that no one partner has more control than another. Senior shareholders can protect themselves in different ways. However, he urges you to fully understand the method the practice is using to calculate its value. Typically, these include three criteria:

• The stock value, i.e., assets minus liabilities
• Accounts receivable
• The goodwill or intangible value of the practice

Applying the formula to current financial information will help you understand how much your future buy-in will be. In addition, you need to understand how shareholders are compensated.

“This all helps you determine if you will make more as a shareholder than an associate,” says Still. “If it’s possible you’ll make less as a shareholder than you do as an associate, that’s not a good sign.”

Private practice investigation questions

If, after doing your “60 Minutes” investigative work, you’re ready to have that critical face-to-face conversation to get the answers to your long list of questions, don’t leave anything to chance, Still says. Include these as part of your “investigation” if you go the private-practice route.

• What’s your expectation for me as employee, and possibly as a shareholder, to contribute to the business?
• What’s my compensation ultimately going to be?
• What is my opportunity to earn more than base salary? How is that determined or calculated?
• Do I have any say-so in how my patients are scheduled?
• Regarding policy:
  • What kind of marketing do you expect me to do?
  • Will you assign me new markets to develop?
  • Will I do public speaking?
• What does the contract look like at this moment?
• Has it been used before and how many times?
• Is it negotiable at all, and if not, why not?
• We talked about buy-in, but what does the senior shareholders’ buy-out look like? For example, will you owe a departing shareholder a lot of money?
• What kind of benefits will I have and at what cost?
• Will my spouse or partner, and my kids, be included in those, or will we pay for them?
• Do you have a 401K or profit-sharing?

Hospital or health system queries

If you’re headed towards employment with a much larger organization, “the economics may look much like private practice, but benefits will likely be richer than those for a private practice,” Still says. You should still ask some of the same questions you’d pose when assessing a private practice but include these for this particular scenario:

• Who’s the chair of my department and what are they like?
• Who are my colleagues?
• Specifically, what other physicians in my specialty are working here? I want to talk to them.
• How did they come to work here?
• Did most come from private practice or another hospital, and how many have just come out of training? “When you talk to them, ask them about their personal situation and plans for the future, and how this current position fits into all of that,” Still says.

Chances are, your potential employer will do exhaustive research about you before extending an offer. You owe it to yourself to do the same on your side of this equation. You know what “they” say: “The more you know …”

Stephanie Stephens is a writer, Careers by KevinMD.com.

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