New physicians just finishing their residencies have a variety of physician practice opportunities in front of them. Each presents a number of different factors, appealing to different personality types, as we've discussed in recent articles here at the Locums Link Blog. (In case you missed 'em, check out New Physician Practice Options: Choosing Your Practice Setting and Physician Job Search Considerations: 4 Keys to Practice Selection.)
As a resident or recently trained physician, you've probably already received a number of solicitations from various parties trying to recruit you for a practice opportunity. As you review these offers, you should ask yourself a key question — is this a physician practice opportunity where my skills are truly required?
In other words, as you consider various practice opportunities, how can you tell if you're truly needed in a particular practice or community?
Why is this an important question? Any physician testing the employment market needs to gauge how the ongoing shift towards hospital employment and away from smaller, independent practices affects their career prospects, as well as the actual need for care in any given community.
If current physician practice trends continue, chances are good that you'll be employed by a hospital or medical group. In either case, you'll likely receive a salary or an income guarantee for the first year or two. After that, most of your income will be based on your production, measured in general by how many patients you see.
Even in your first year, production may be an important part of any financial bonus you're eligible to receive. Of course, if you are receiving an income guarantee, then the number of patients you see will directly determine your ability to "earn back" the guaranteed amount.
What are we getting at? It will ultimately be extremely important, wherever you go, that you have enough patients to sustain a viable physician practice. Unless you're working on a straight salary — as you might in a staff model HMO — how much you're actually "needed" in a new practice will matter as much as whether you are "wanted" there.
This isn't just a matter of securing a viable practice: The federal government has regulations about the types of recruiting incentives hospitals can offer to physicians, as well as the types of incentives that physicians can accept. In many cases, hospitals must demonstrate that filling a true community need for a physician, rather than merely competing with another hospital down the street.
There are also the political implications of "being needed." You'll be joining an established medical community, and whether or not you are accepted may depend on the extent to which a new physician in your specialty is actually needed. Rarely are established physicians unanimous in their support of recruitment, but in some cases they can certainly be more supportive than in others. Either way, it's extremely helpful to know precisely where you stand.
These points can be distilled into three questions to ask at your next job interview — namely, how you can tell whether:
- There exists a real community need for your services?
- The hospital is following federal physician recruitment guidelines?
- Your fellow established physicians are likely to support you?
Assessing a Physician Practice Opportunity: 9 Crucial Interview Questions
A typical physician interview can last for 24 to 48 hours, and it can be some of the most intense time of your entire career! During an interview you'll meet with a number of people, and topics will range from equipment, to compensation, to schools, to recreation, to the availability of piano lessons for your children. In all the excitement and pressure, one fundamental question can be too easily overlooked: Are you really needed? And the nine questions below will help you answer that one question in the most informed way.
1. Why are you recruiting? Is it to keep up with the hospital down the street, or is it because there's a real need in the community for additional services in your specialty? In most cases, hospitals or medical groups recruit for reasons that are not fundamentally altruistic. Obviously, they want patients. But that doesn't negate the fact that their recruitment efforts should coincide with community need.
2. Why do you think there's a need for my specialty? This is where answers can get vague, and where you may need to press a bit to receive the information you need. The fact is, many hospital and group administrators may not really know how many physicians their community needs. Determining community need for physicians isn't an exact science, even when you do all the necessary research. And when you don't, it's pretty much a shot in the dark. The hospital should be able to show some data indicating that a need exists for your specialty — and you shouldn't be afraid to dig a little bit to get it. After all, your prosperity at a given physician practice opportunity may well depend upon it.
3. How large is your service area, and how many physicians in my specialty does it currently include? There are a variety of ratios that suggest how many physicians in different specialties are needed by a given population. The hospital or medical group should be able to cite one or more of these ratios in explaining the need for your services. And it's essential that this information accounts for all physicians in the community, not just those on the hospital's staff, because a need for the specific staff doesn't necessarily mean a need exists in the community, which is the real litmus test. A useful reference book, The Dartmouth Atlas of Health Care, lists hundreds of hospital referral regions and cites the relative number of primary care physicians and specialists per 100,000 residents in each of them. This data can be a big help when determining which communities have a higher-than-average number of physicians per population, and which communities have a lower amount than the average.
4. Have you conducted a physician needs assessment study? An increasing number of hospitals are conducting formal physician needs assessment plans that gather a variety of data. These plans help keep hospitals compliant with recruitment laws, and they can also serve as effective recruitment tools. If a hospital does have such a plan in place, ask to review it — or at least, to review the data that applies to your specialty.
5. Are you familiar with federal physician recruitment regulations? Hospital administrators should be pleased to be asked this question. It shows that you, the candidate, want to be a part of a good faith effort to bring needed services to the community, and that you have the hospital's best interests in mind. Hospitals should demonstrate that they're fully aware of these regulations and committed to abiding by them.
6. How do existing physicians feel about the prospect of my recruitment? Hospitals are becoming increasingly attuned to the notion of gaining physician support for new recruitment efforts. During your interview, it is important to meet with as many staff physicians as you can to gauge their level of acceptance. In addition, some hospitals conduct medical staff surveys asking physicians to indicate what physician specialties are needed in the community. Established physicians can be reluctant to support new recruitment efforts; therefore, if more than 30 percent of physicians surveyed see a need for a particular specialty, chances are great that a need really exists.
7. What are my specialty's current wait times for new patients? It isn't unusual for primary care physicians to be fully booked two weeks in advance, and for specialists to be booked 10 days out, too. In some communities, new patient wait times can be considerably longer. Want to test this yourself? Call a few medical offices in the community and ask how long you'll have to wait to book a new appointment.
8. What is the disease incidence in my specialty? Naturally, some patient populations are healthier than others. Can the hospital demonstrate what the disease incidence rates are in your specialty, relative to the national averages? This will have a good deal to do with how old the service population is, which leads us to the final question in assessing a physician practice opportunity:
9. Who are my patients, and where will they come from? The recruiting hospital or medical group should be able to provide you with specific demographic statistics describing your service area. You should be able to see where most patients live, where physician offices are located, what patient income and education levels are, and what the patient payer mix is. With all this data at hand, you should have a pretty good idea of your patients' age, insurance status, and general incomes.
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Adapted from an article originally published on NewPhysician.com.