8 Questions to Ask Before You Join a New Practice

The following article is tailored for medical doctors but certain aspects may be applicable for young professionals in other fields.

Starting a new job can be nerve-wrecking and exciting. Along with negotiating salary and benefits, you should also ask about a few other factors to make sure you know what you are getting into. Here are 8 questions to ask before you join a new medical practice.

1. Why are you hiring? Some practices are hiring because they are growing. Other practices are hiring because people are quitting. What is the case at this location? Are people getting promoted which creates new openings? Or, have multiple people decided to leave the practice for one reason or another? Don’t just take their word for it. Ask to speak to a couple of the physicians at that practice. Find out what they like about the place they work and also ask what they would like changed. Speaking to other physicians will help you get an idea of what working there would be like. You want to go into your new job with your eyes wide open.  

2. What is the turnover rate of staff? Reliable support staff is key for a good work environment and quality of life. Find out what it is like at this practice. Have most doctors had their support staff for years or is there frequent turnover? How many medical assistants and nurses are there per doctor? Is there someone to assist with portal messages, medication refills, and patient forms? Many doctors get burned out due to lack of support and increasing administrative tasks so be sure that you understand the workload and have reliable support needed to get it done. The recruiter may not know this information offhand so reach out to the nurse manager or clinic manager, if needed.

3. Am I expected to supervise or work alongside mid-level providers? There has been an influx of physician assistants and nurse practitioners in the medical field. Are they hired at your hospital or clinic? If so, what is their role? Some practices have the mid-level discuss every patient with the physician. At other places, the mid-levels seem to practice independently. Find out how they are utilized where you are. Also find out if you are expected to supervise them. If you are, realize that you are now taking on more medical liability. Is the practice compensating you more for this risk? If you are expected to review their charts, are you given more admin time to accomplish this goal? Make sure you clarify this BEFORE you sign the contract.

4. What happens if I leave? No one goes into a marriage, expecting to get divorced. Nevertheless, break ups happen, especially when it comes to jobs. It is much easier to discuss terms ahead of time so make sure you ask. Inquire about the notification policy. Who do you need to tell and how far in advance must this be done? Also clarify if there is any money you will have to repay if you leave before a certain time frame? Are you expected to payback the full sign-on bonus or just a part of it? Also ask about malpractice and health insurance coverage. How does malpractice work if you leave? How long do you keep your health benefits? Lastly, clarify any rules or stipulations. Is there a non-compete or are you able to take a job nearby if you desire? Make sure you have all of these terms in writing in a place that is easily accessible.

5. Am I able to work part-time? Not every practice or healthcare system has kept up with the times or is structured in a way to handle part-time workers. Make sure you ask. Just because you plan to work full-time now, does not mean you won’t want to cut back to part time at some point in the future. Will this practice accommodate that? If so, what would be the pay difference? If you work part time are you still eligible for health insurance benefits? Will you have to repay part of your sign on bonus? Will you be given a different productivity threshold to reach? Understand the rules in place for part time workers and get a sense for how accommodating they will or won’t be with this schedule change if you were to desire it in the future.

6. What is the patient panel and insurance payer mix? Patient panel and insurance mix can drastically impact the revenue of the practice and your own personal satisfaction so be sure to ask about it. What are the patient demographics? Do you serve a diverse group of patients (in terms of gender, race/ethnicity, economic status, etc)? What percent of billing does the practice get paid for on average? Is this practice located in an underserved community with lots of Medicaid patients? Or, does the practice serve a more affluent population that tends to have private insurance? The type of insurance patients’ have will impact clinic reimbursements and your overall pay.

7. What are the clinic policies? Get a feel for the operations and interworking’s of your clinic. Is there a late policy for patients? Who handles forms like FMLA, prior authorizations, and work/school clearances? Also, understand how holidays work. Is your clinic open or closed for certain ones? Is there a chance you could be on-call? Make sure you understand how time-off works. Do you have to ask for it months in advance? Do you have to take it in 1-week chunks or can you request each day as needed? These are some of the intangible factors that can heavily influence your qualify of life.

8. How are bonuses structured? You deserve to be paid well for the work you do and rewarded for the efficiency you provide. Be sure to understand how bonuses work and clarify which milestones are required. For example, if you get a sign-on bonus find out if you get all the money up front when you sign the contract or if you have to wait until you start working. Also clarify if it is given in a lump sum or dispersed evenly over time? Along with the sign-on bonus, ask about productivity bonuses. Usually this is extra money you get for hitting a certain RVU target. Figure out what that RVU target is and whether or not it is feasible for you to reach. Healthcare systems may even have additional bonuses based on the practice revenue or patient satisfaction scores so ask about those as well. Lastly, inquire about a longevity bonus or a reward for staying with the same organization for a certain length of time. Is there some sort of reward for your loyalty in terms of an increased retirement match, a higher bonus, tuition reimbursement for your kids, a partnership promotion, or a cost of living adjustment? Their answer may be “no,” but it certainly doesn’t hurt to ask or negotiate something like that into your contract.

8 Things to Negotiate Besides Salary

The following article is focuses mainly on physician contract negotiation

Whether we are considering a new job or up for review at our current place of employment, there are several things we should negotiate. Many of us focus solely on salary, but there are other things we should be sure to negotiate as well:

1. Benefits and Insurance: One of the first things to consider besides salary is benefits. For physicians and other young professionals with college degrees, student loan forgiveness may be one of the top things to look at. Some jobs offer direct loan forgiveness. Other jobs qualify for federal loan forgiveness through the public service loan forgiveness program. Be sure to see if either is offered at your job. Along with loan forgiveness, also look at retirement matching. Retirement matching is when your employer gives you extra “free” money to invest in your work retirement accounts. They may “match” the amount of money you invest up to a certain amount, which can add up to tens of thousands of dollars per year. I’ve seen some jobs in which the salary was $10-$15K less than another place but the retirement matching was so good that it more than made up for it. Another benefit to look at is malpractice insurance. Ensure that your job covers you if a patient or client tries to sue and that the insurance in place will cover you for claims made while you work for the organization AND even after you leave.

2. Sign-on bonus: One of the initial bonuses doctors get when they sign their first attending physician contract is a sign-on bonus. There are many nuances involved with a sign on bonus that doctors should be aware of but in general, a sign-on bonus is a 4 to 6 figure amount of money that many businesses provide to newly hired doctors. It can be given in one lump sum or in smaller installments. It is usually structured as a loan that gets “forgiven” after you work at the company for a certain period of time. This free money can be great, but the first amount they mention is unlikely to be their best offer. Ask for more.

3. Productivity Increases: Along with a sign-on bonus, it is also important to inquire about productivity bonuses. Most places want you to be as efficient as possible since increased efficiency leads to increased profits. If you’re actively increasing the business’s revenue because of your efficiency, then you should get a share of the profits. Be sure to negotiate this ahead of time and be aware that the amount they offer may differ for people in certain specialties. Some places will pay you a flat salary until you hit a certain work productivity threshold. Other places will pay you based on productivity from the onset. There are even businesses that offer a set monthly pay but provide annual or semiannual bonuses to employees based on the total company revenue. The exact structure of the productivity bonus can differ. Make sure you understand what other folks in your profession are getting so you can ensure you are being compensated adequately for the efficiency you provide.

4. Vacation and Personal Leave: Whether you love your job or not, everyone needs periodic breaks to step away and recharge. Do not forget to negotiate paid vacation time. While 3 weeks may be standard at most places, who says you have to settle for average? Why not ask for more? Aim for 4 weeks or negotiate additional vacation time after you have been with the organization for a certain length of time. Many jobs like to lump vacation time and sick time together as “personal time off” but try to keep this separate if you can. If you or a loved one gets sick or diagnosed with an illness, you shouldn’t have to use all of your vacation time dealing with medical issues. See if you can get at least 5 days of sick time in addition to your vacation time. If you’re a parent or plan to be, be sure to ask about parental leave for the birth or adoption of a child. Although FMLA holds your job while you are out, you may not get paid during that time. Negotiating paid family leave is vital.

5. Work Schedule Flexibility and Expectations: Along with personal time off, it’s also important that you negotiate a healthy work schedule that allows you to be productive without causing you to burn out. Perhaps you decrease the frequency you are on call? Maybe you negotiate a 4-day work week. Or perhaps you consider starting and/or ending work a little earlier or later some days to accommodate your family needs. You have the power to create the work schedule you desire. Figure out what type of work schedule you want and negotiate for it. If you can articulate how you will maintain productivity with your desired schedule, employers will be more likely to consider your requests.

6. Automatic increases: I am amazed by the number of physicians and other young professionals who don’t get automatic raises each year at their job. Because of inflation, things get more expensive each year. If you don’t get a cost-of-living adjustment to account for inflation, then you may actually be losing money year after year. Cost-of-living adjustments may not be standard at many places, so be sure to negotiate that in the contract if you don’t see it. It may also be wise to negotiate general productivity targets or a longevity increase. The goal is to get an automatic increase in pay after working for the organization for a certain length of time, like 3 years, as well as an automatic increase for bringing in “X” amount of revenue for the company. These types of automatic increases help you continue to be paid your worth over time and ensure that people hired after you don’t start off making more than you.

7. Licensing and Continual Education: As physicians, this is an important expense to inquire about. State medical licenses (to practice medicine), DEA licenses (to prescribe medicine), and board certifications (to maintain your medical credentials) can cost thousands of dollars in fees. It’s standard that the business pays for these expenses so if you don’t see it in the contract, ask for it to be added. Along with getting these fees covered, most medical societies require you to stay up to date on new medical treatments by doing a certain amount of continual medical education (CME) each year. Ensure that your job provides you with an adequate amount of CME funds to attend conferences and programming that provide these CME credits.

8. Autonomy (Intellectual property and non-compete clause): A surprising number of physicians do not have autonomy over their work. Don’t let that be you. Ensure that your intellectual property (ideas, products, or services that you create) are yours and not the job you work for. Be sure that you have the freedom to do other projects and work at other places outside of your job should you choose to do so. Lastly, watch out for non-compete clauses. These phrases in contracts prevent you from doing similar work at a nearby organization if you were to leave your current job. As you can imagine, they can cause a huge problem because they may require you to uproot your entire family or drastically increase your work commute if you were to quit your job since these non-compete clauses prevent you from getting another job at a different location in the same city. Try to avoid non-competes if you can.

Was this helpful? Do you plan to negotiate these things in your physician contract? Are there other things you plan to add?