Saturday, January 26, 2008

A Physician's View of Job Search

A colleague of mine wrote this comprehensive piece on job search, short and to the point. Wise. True. You will see why physicians always will give you more and better information than any recruiter.

The best jobs are with:

1. People you know
2. People recommended by the people you know
3. People who know the same people you know (listen carefully to the people you know)

You have to know what YOU want first:

academic versus private versus mixed
solo, small group, big group, employee of a large concern
small town versus metropolis
Coasts versus center
North versus south

Once you decide on the above, you have to do the market research. Get a directory from your society, count the number of society members in each state (this takes some time). Then take go to US census site and take population in that state for your target population (Pediatrics, young adults, middle aged, Medicare). Then figure out practitioners/100k target population. The places that have the lowest number are the places where you will likely do best in solo or small group practice. The places that have the higher numbers generally are the more desirable places to live, and you should consider joining a group. Another good resource is the Dartmouth survey of medicine which has a listing of specialists/population for almost every burg in the city. For example, in White Plains, NY, if you hit a pedestrian, you just hit a doctor. Also, do this for the major referring specialties for your practice - you need feeder fish.

So, if you are a shark, you need to know where the feeder fish are, and if there are already a bunch of sharks there.

Watch for signup bonuses - contract may say it is a "zero interest loan", or part of your buy-in, or other nonsense.

Watch for dictators - they are the majority partners and have the practice of burning through young people to keep costs low. Don't be a slave.

Get a handle on what is the MGMA average for your intended practice situation - your department should provide you with this. Negotiate starting above the mean.

Don't get enamored of the metropolis - you'll probably never afford housing. Better is if you work in a friendly, but out of the way place (much more doctor friendly) - then you can buy a pied-a-terre in San Francisco, Manhattan, or Aspen, or all three, if you invest in carwashes, gas stations, or become a slum lord in your small town.

If your spouse can't go where you must go, it's easier to divorce at your stage than at later when your net worth is higher (not from personal experience, but from watching a lot of car crashes).

Also, consider this: if you can find one or two other people to form a practice and commit to a three year business plan, and find a hospital willing to finance you (joint venture), you can start your own practice from scratch and make your own rules. You'll be hungry to start, but you won't beholden to a dictator and can become one yourself! (don't). If you find a partner, and you see an ad for more than one of your positions in Montana, go and stick up that hospital in Montana. If you don't have a partner going there with you, tell the hospital that you'll do the work of two and that you'll hire your own partner, and have them give you that other position's salary for all that extra work you're promising.

Actually, if you want to make money, go into hedge funds. You have no business in medicine.

In your specialty, you have billable services tied to revenue generating activities. Take the 10 most common activities and figure out ~how long it takes and ~how much it reimburses. From this, order these in terms of revenue density (reimbursement/average time). The priority from a purely financial viewpoint is to maximize the revenue dense items and minimize the revenue diffuse items. Things like GETTING TO KNOW YOUR PATIENT is probably why you went into medicine and is not billable, but necessary to generate the revenue dense items.

Rounding on inpatients and hanging out at the hospital and volunteering for committees are also revenue negative. In your figures, then budget a workweek and figure out how you wish to spend your time. For all the revenue negative or less dense times, figure out the opportunity cost compared to what would happen if all you did was the revenue densest activity. The difference between the balanced scheme and the fully revenue dense scheme is the money space that you should negotiate under.

You can then structure a business plan that includes using residents, physician extenders, and MLP's (slaves, slaves, and sharecroppers) to soak up some of the revenue less dense and negative activities and let you spend more time doing the revenue dense activities. Better yet, get the hospital to pay for these functionaries so that you are set free to sit in a windowless room and read EMG's day and night or whatever revenue densest activity it is you have.

Grim, but the hospitals and more knowledgeable practices crunch these numbers, and so should you. Radiology - pure revenue, no wasted motion of the jaw or ask me what - just neurons firing - is the extreme example. But again, money is not why you went into medicine, so let's step away a bit and get real and budget your ideal week of work. You have to know what it is that will keep you running on that wheel and how much it is worth.

If you find that the chairman - recommended jobs are not exactly what you want, you then have the recruiting industry. As long as you are mobile and not wed to absolutely having a metropolis with a Chinatown, and you realize that first jobs are like first wives, the recruiters are not so bad if you know what they're good for.

Matchmaker, matchmaker, make me a match! Typically, a practice makes a contract with a recruiter on contingency of a hire - typically this fee runs about $15-20k. If they hire you without a recruiter, the practice keeps that $15k - which is good negotiating room. Recruiters are then like a real estate agent and use their own ad language. But if you must, you should USE them. If you are a good candidate, their relationship just became worthwhile - to the tune of 15k. That's like a $300,000 house.

Don't be an easy mark. Let them know you are looking at other positions with other recruiters. Get them to pitch more than one position at you. That way, you can ask compare and contrast questions. They are your job-finding assistants and make them earn their keep. Get data - how many hip replacements at that hospital? How much trauma? How many orthopods? How many primary care physicians? Who else is practicing in your field there? The good recruiters will have this info.

Find out specific locations and do your homework. The web makes it very easy. Is that Lexus dealership in another state? Are there more WalMarts than Targets in that town? Is Applebee's haute cuisine in that burg? Get staff lists of that hospital and figure out where people trained and where they are from.

Check out the real estate in that town - you can get a baronial estate in North Dakota for what you pay for a studio in Manhattan. Know the school system if you have lil'uns. Is the place on Craigs list (or in really nowhere)? If so, what are these people buying and selling from each other? Woodcarvings of bears or antique Shaker dressers? Crossbows and used computers from the 90's or timeshares in Cozumel and slightly used Espresso machines? Unspeakable acts with fat strangers or skinny ones? Check out the symphony if they tout one - does it thrive (count number of different shows, less than 4 and you recognize all of the pieces and this is a symphony in trouble). Check out the Broadway shows they tout and see what the locals like (Mamma Mia or the Rockettes Christmas Extravaganzapalooza). Count the number of Starbucks, and you get a general count of New York City blocks this town is equivalent to.

At interview, look at the people you'll be working with. You'll spend most of your time with them rather than the people and activities that you love. Check out their teeth. Do they have a singing fish on the wall? Who is going to drive you crazy?

Negotiating - get a number and tell them you'll get back to them. Collect at least two offers.

Have a medical contract lawyer review - costs between 300-1000 bucks and is worth every penny if you have a good one. Make sure your malpractice is covered, including your tail and your next tail (cost of leaving - is it impossibly high?).

And finally, unless you're married to a woman (and then she decides), you decide by going eeniee meenie miney moe, and go with the place that gives you the most peace of mind.


Dee said...

We are looking to add two physicans to our practice. Board Certified with 5+ years experience.


Please feel free to contact me.

Dee Gulati

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