This is part one of a three-part series. Find part 2 here and part 3 here.
Van Halen, one of the most outrageous rock ’n’ roll bands of the 80s, included a requirement in their performance contracts that M&M’S® be present backstage. There was also a contractual rider (like a non-compete that might show up in a contract you are considering) that if the band found any brown M&M’S, the promoter would forfeit 100 percent of their fee.
While for years this was thought to be another example of typical rock star prima donna behavior, the brown M&M’S actually present a metaphor that will help when interviewing for your first, or next, job.
Van Halen was a pioneer—one of the largest, most progressive, high tech touring bands of the time, with the equipment and complexity to go along with it. As a result, Van Halen contractually required that certain structural, electrical and other production components were to be provided by the promoter and the concert site. One of the problems was that promoters often did not read the full contract or make sure that all structural, electrical and other demands of their contract were met.
This represented a significant safety hazard for Van Halen and its crew. Van Halen used the presence of brown M&M’S in the backstage area to indicate that a serious line check of their concert specifications needed to be performed to ensure their safety. The thought was that if this simple part of the contract was ignored, more serious aspects were likely ignored as well.
M&M’S acted as a “trigger” to indicate the potential for serious safety concerns. Who would have thought of brown M&M’S as a safety measure or that they might help you with an interview?
I think the questions I propose in this blog article act as a similar “trigger” for you during the interview process. If a practice you’re considering for employment fails to provide an employee handbook, an “offer sheet” or a simple financial dashboard, you should be concerned about how that practice is being run. Like Van Halen doing a total line check of their production if brown M&M’S were found backstage, practices without these items in place need to be examined closely before you decide to join.
While there is some finesse and timing in knowing what question to ask when, I find that the questions I will outline over the next several posts and their associated answers will tell you a lot about a practice, how it is run, and the values of your future employer or partner.
Can I see your employee handbook?
While residents look at me oddly when I tell them to inquire about and review the employee handbook, it tells you a great deal about how a practice is run and managed, and how employees are treated.
Employee manuals spell out the obligations, procedures, and policies of the prospective practice. In my experience, lack of an employee handbook is one potential indicator of a poorly run practice or one that is not operating in the modern business world. While some practices may have different documents for staff and providers, an employee handbook should cover topics such as a description of the office work week; sexual harassment, disability and medical leave policies; employee benefits; discipline policies; vacation, holiday, family-medical, jury duty and military leave; and other paid time-off policies.
Finally, an employee handbook should outline how staff is expected to treat the patients in a practice. Attention to detail in an employee manual, such as how patients are greeted, how the phones are answered and how patient questions are addressed, indicate that a great deal of thought was put into the management and patient experience of your future practice.
Do you have an “offer sheet”?
An “offer sheet” is a simple one-page explanation of what a practice is offering to a potential new partner, including what is, and is not, negotiable. It provides a framework for the employment discussion and indicates a practice’s desire to be straightforward and direct.
While I find the best practices provide “offer sheets” directly to candidates early on in recruitment, this is not always the case. However, some of my residents have proactively asked for an “offer sheet” from a practice without any sort of detrimental effect to the recruiting process.
I am always surprised when I hear about recruitments that go on for months at a time without a concrete offer being made, as prolonged courtships that never lead to fruition are a waste of everyone’s time.
An “offer sheet” establishes salary, work expectations and hours, incentives, night call, benefits (health, life and disability insurance), vacation, CME, holidays, the partnership track and any restrictive covenants. When a practice provides an “offer sheet” early in the process and puts all of the recruitment issues in writing, it not only indicates that the practice is serious about hiring you, but it allows you to have something in writing that you can discuss with a significant other, attorney or accountant.
What type of practice dashboard do you provide partners?
Dashboards allow physicians to quickly examine the business success and financial well being of their practice. Asking to see a dashboard before joining a practice does not mean you are asking for specifics about the immediate practice opportunity, such as salary and benefits. Rather, a physician dashboard is how the practice communicates financial information to you after you are done with your initial guarantee.
Think of a financial dashboard as a hemoglobin A1C for the diabetic. If your prospective employer offers you a 20-page dissertation, more difficult to understand than your house plans, your prospective partner/ employer has trouble getting data out of their practice management system. Not having a dashboard at all, or one that is difficult to understand, is a serious red flag.
Your prospective partner/employer should be able to deliver several key indicators that provide a quick idea about the financial health of the practice. The best indicators are ones that allow you to also quickly take action if problems develop.
Most practices should be able to produce a two- to three-page document that contains key indicators used to examine the practice’s financial health. Examples of items on a dashboard include:
- Individual and practice payor mix comparison
- Individual and practice RVUs
- Impact of time off on revenue and RVUs
- New patient visits and consultations for current month and year to date
- Next available new patient appointment
- Non contractual adjustments, such as bundled services, cash discounts or bad debt
- Individual, practice and MGMA indicators, such as the gross collection rate, net collection rate, days in accounts receivable (A/R) and percentage of A/R greater than 90 days
A document like this will quickly allow you to see where you are performing well and what areas need to be addressed in order to improve your performance or the financial health of your practice.
The three questions we focused on in this blog are very simple and straightforward. You are basically just asking if these three items exist. The answers, on the other hand, provide you with a wealth of information about a practice and how it is run.
One strategy I advise that eliminates time wasted interviewing at poorly run practices is to ask for copies of these documents at the conclusion of a phone interview. I believe that a lack of these three documents is a “trigger” that the practice is not for you. At the very least, lack of these documents indicates that you need to take a serious look and ask many more probing questions before making a decision to join.
Find part 2 here