How to Avoid the Pitfalls of Choosing a

PracticeSigsbee W. Duck, M.D.

Location, Location, Location…

Political trends specific to distinct geographical locations

Population Subset:

What types of patients do you want to see?

Average age of population at desired location?

What percent Medicare, Medicaid, uninsured, and third party payors?

Numbers, numbers, numbers…

Number of patients

Have to see more to maintain income

Defining Different “Types” of Practices

Practice Types

Solo

Multispecialty

Established Group practice

Hospital employee

Academics

Military

Practice Politics

Who is running the practice?

What is the hierarchy?Who is your boss?

Office managerCEOClinic DirectorEtc.

Who is getting the higher income…and why?

Who does the coding?Are you involved?

Benefits and ExpectationsWhat are the benefits and/or expectations of each scenario?

Salary and payment schedule?

What equipment do they have?Go look and know

What equipment will they purchase for you? When?Who chooses said equipment? Does it matter to you if they own equipment?

It should not come out of your overheadIf in a group practice: what is the buy in and how is it structured?

Guaranteed salary with or without payback?

Overhead:How much and why in both primary and secondary clinics?

Buy-ins and buy-outsWhat does your buy-in encompass?, i.e. surgery center, CT Scanner, Lab?Is the buy out capitalized?

Benefits and ExpectationsContinued…

Benefits:Time off

CME

Reimbursement for meetings and expenses

Tail coverage

Disability

Type

Policy owner

Beneficiary

Separate policy for stop-gap coverage

Paid with pre-tax versus post-tax dollars

RequirementsDays worked

Know your hours and days

Week-hours required

Practice mandated meeting requirements

Satellite clinics

Call Requirements

Pass the Boards…

The patient always comes first

What are my responsibilities?Productivity requirements?Who reviews your work?

Contract Specifics

Contract length

What happens after contract expires?Automatic contract renewalCan I become an employee and not a partner?

Get an attorney!Preferably a local attorney so he or she knows the particular state law ramifications

GET IT IN WRITING!

Non-Compete

Slow down plan or are you just put out to pasture…

The Fear of the Unknown

Healthcare reform…

How will new changes affect you? Your practice?