Starting a new job can be nerve-wracking and exciting. Along with negotiating salary and benefits, you should also ask about a few other factors to know what you are getting into. Here are eight 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 ask what they would like changed. Speaking to other physicians will help you understand 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 to 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. In 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, breakups 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 pay back the total 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 health care system has kept up with the times or is structured 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 for part-time workers and get a sense of 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? The patient panel and insurance mix can drastically impact the practice’s revenue and your satisfaction, so be sure to ask about it. What are the patient demographics? Do you serve a diverse group of patients (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’ will impact clinic reimbursements and your overall pay.
7. What are the clinic policies? Get a feel for the operations and interworkings 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 one-week chunks or can you request each day as needed? These are some intangible factors that can heavily influence your quality of life.
8. How are bonuses structured? You deserve to be paid well for your work 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 upfront 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 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. Health care 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 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.
Altelisha Taylor is a family medicine resident and can be reached at Career Money Moves.
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