In the previous blog article, I described three questions you should ask at your next job interview:
- Can I see the employee handbook
- Do you have an “offer sheet”?
- What type of practice dashboard do you provide partners?
These questions may “trigger” concerns about the practice with which you are interviewing, similarly to how the presence of brown M&M’S® backstage triggered safety concerns for members of the rock band, Van Halen. While the band requested that the promoter make M&M’S available backstage, the contract made it clear that no brown candies were to be present. Just as brown M&M’S triggered a serious safety check of the electrical, structural and other production components featured in a Van Halen show of the 80s, responses to the three questions above may trigger concerns on your part about how the practice is run.
Joining a new practice is like a marriage or other significant relationship, with emotional and economic investment by two parties, interdependence and, hopefully, endurance (minus any bad behavior from you or your future employer/partner). Just as in a relationship, some of the questions you need to ask in order to evaluate the practice will be difficult, pointed and direct.
Surprisingly, I find that few physicians approach a job search in the same way they look at finding a life partner or performing a thorough history and physical on a new patient. Interview candidates often fail to break the surface and really question future partners. I believe this is a huge mistake.
Ask probing questions at the beginning of the interview, so that the answers will tell you something significant about your potential future practice. While many physicians initially hold back, concerned about offending a potential partner/ employer, I find that well run practices are impressed, rather than put off, when the interviewee asks thoughtful questions.
Thoughtful, probing questions indicate that you understand what it takes to run a successful practice. Further, if your future partner is not willing to answer a tough question, do you really want them as a partner?
The questions in this article will help you investigate specifics about how your potential future practice is run.
How is patient distribution handled?
In a practice, patients equal revenue. Patients need to be able to easily schedule appointments with you.
While you may have some sort of income guarantee, a new practice setting requires that you build a patient base if you want to be successful. You need to understand how patients flow through your new practice setting and how you will acquire new patients.
Consider asking these follow-up questions for specific answers and better understanding of patient flow in your new practice:
- Will I be taking over some sort of panel of patients?
- Who gets new patients? Are new patients alternated between physicians or referred to the newest physician in the practice?
- Does the new physician in the practice get all the patients no one else wants to see?
- How does the practice attract new patients? How will you help me build my practice?
It is a very good idea to ask these questions of the partners and then also ask the same questions of the front office staff. If you hear different answers from the physicians and the scheduling staff, this is a red flag that needs to be investigated further.
How efficient are your billing, coding and financial practices? Why are you hiring now?
I have found it far more common for physicians to leave practices for reasons related to financial disagreements compared to not being able to get along with one another or practice differences. Nothing seems to anger physicians more than thinking they are not getting what they are due or that they are being treated unfairly financially.
Transparent policies and procedures surrounding billing, coding, and other financial aspects of practice are essential for efficiency in the financial aspect of your practice. If a family member of the lead physician is performing all of the business functions for your future practice, I consider this a red flag.
You risk your questions about a financial issue becoming criticism of the family member and you will always wonder if you are being treated fairly.
Likewise, practices that have never had an outside auditor look at their billing and coding procedures in order to help discover opportunities to maximize revenue may be behind the times and leaving significant dollars unclaimed.
While the size of the practice will dictate how much of the “business functions” of the practice are handled internally or externally, these follow-up questions will help you size up the financial procedures at the practice:
- How is billing done?
- Who does the billing?
- Who keeps billing and financial records (internal or external)?
- Who audits the practice books and records?
- To whom do I ask coding questions?
If your potential future partner says that “billing and coding audits are a waste of time” or “we will figure it out as we go along” think seriously about whether the practice is a good fit for you.
I place the “why are you hiring now” question here because this is ultimately a business decision. You want to know whether the practice is growing and needs more providers to deal with an overwhelming demand or if they are hiring simply to fund an outgoing partner’s retirement.
How are income and expenses divided? Am I expected to buy into the practice?
Ask your potential partner for a simple income and expense statement so that you can assess the financial health of your potential practice. If a practice cannot or will not provide this sort of information, I tell the physicians whom I mentor or advise to move on to the next opportunity.
Whether you are going to be a true partner from the beginning or considered to be an employee is one of the key initial evaluations you need to understand. Many practices will offer a base salary plus some sort of incentive plan that values your ability to manage patient volume and build your practice. You need to determine if the incentives seem reasonable and attainable.
If a buy-in is part of your agreement, the terms and conditions should be laid out at the beginning. One predatory tactic used by some practices is to offer a relatively low salary at the beginning and offer to “credit” the difference towards your buy-in in return. Be wary of this, as I have heard numerous physicians tell me they were then “let go” right around buy-in time.
Is the practice making major capital purchases like an EHR or other equipment? To what extent are you responsible for financing such capital improvements? This is especially important, I have had one former mentee leave a practice only to find out he remained responsible for part of the office’s EHR implementation.
How is the income from administrative and other roles handled? You may have opportunities to be a medical director for a hospice, nursing home, home health or a hospital department. These opportunities provide you with valued administrative time and can be financially lucrative, but will take you away from your practice. Additionally, these kinds of opportunities may take your partners away from the practice, leaving you to cover their patients and responsibilities. It is best to determine up front how the work and monies will be handled.
This article has focused on questions to ask about some financial specifics of a potential future practice. Next time I will focus on how you can examine professional relationships within a practice.
find Part 3 here