Keys to success when adding a new doctor to your practice

This helpful checklist will guide you in finding a new colleague.

Issue: February 1, 2005

ByJohn B. Pinto

Marching into the first hopeful months of a new year, several thousand ophthalmologists can anticipate being on one side or the other of a new doctor hiring event in 2005.

Fingers crossed, we can all march with a small measure of optimism after the past few soft, post-Sept. 11 years. The election is behind us, and irrespective of the color of your state, as of this writing, consumer confidence is finally back up after several months of declining figures. General employment figures are also rising. We can anticipate that the improving economy, if it lasts, will at least mildly boost ophthalmic labor markets this year. I predict that doctors who are starting their careers or are ready to move on to their next posting will find more opportunities in the coming year.

If your practice will be hiring a new associate or partner this year, here is a helpful checklist of success factors and guidelines.

Do you need another doctor?

There are numerous reasons for adding a physician to your practice, including retirement/succession planning, loss of an existing provider, the need to provide new subspecialty services, expansion into a new satellite office and an overabundance of patients. Each of these needs can be measured objectively. There may also be subjective needs that can feel equally valid; some solo surgeons decide they want to add a doctor out of a simple desire for professional companionship, even if patient volumes do not demand greater capacity.

Of course, you need to ask this question both in the context of the needs of your practice and of the overall community. For example, your practice may be on the verge of being able to support a new surgeon, but if your service area has markedly fewer citizens per ophthalmologist than the nation (now about 20,000) or a younger population than the country at large, it may be appropriate to hold off on hiring.

Forecast post-hire financials

The most common hiring error I observe is not so much the wrong choice of candidates but the absence of financial and clinical volume performance data to substantiate a hire in the first place. There is no need — and in today’s more sophisticated management world, even less excuse — to proceed blindly in this area.

Start simply. Use your current accounting software or a spreadsheet program with a baseline budget for the practice to show the expected month-by-month collections and expenses by category over the next year or longer. Then redraft this baseline forecast with new revenue and expense figures corresponding with the new doctor’s arrival. Remember that expenses (for recruiting, relocation, insurance, memberships, wages and benefits) will be front-loaded, while collections will be delayed.

Some time in the first 12 months you will likely be able to forecast a so-called “peak negative” month, when the cumulative losses associated with your hire will peak, and you will be on the way to making a profit on your new hire. Meanwhile, you must be prepared for a substantial drop in personal income, unless you have a large practice and the transitional costs can be shared widely.

Add the right kind of doctor

Should you add an OD or MD? Surgical or medical? Generalist or subspecialist? A permanent associate or partner track? Sometimes the choice is clear, as when you have a clear subspecialty niche to fill or need a doctor to take over for you in the near term. At other times, your choice is somewhat more complex.

If you are a younger solo general ophthalmologist with no succession planning, call-coverage issues and you are overburdened with patients, it may be smarter in financial terms to recruit an optometrist rather than a fellow surgeon. If you have an abundance of glaucoma patients but have not recently trained in this subspecialty, it may make sense to recruit a graduating fellow in this subspecialty. The bottom line? Seek out someone with a complementary skill set who can add a new service line to the practice and who will not crowd your pet patient-care interests.

Clarify long-term goals

In an effort to sell a prospective associate, it is easy — and human nature — to omit the details of where you want to take the practice in the future. But one of the real success factors as you and your new colleague work together will be how much your respective dreams for the practice overlap.

By writing out, “We are on our way toward building a three-surgeon practice with two locations and an ambulatory surgery center,” you will screen out candidates whose ambitions are significantly lower or higher than yours.

Share the facts

This recruiting ad ran a few years back: “Ophthalmologist Wanted, Vicinity Palm Springs.” In truth, the practice was located in the hardscrabble desert, more than 70 miles from the nearest golf course.

To the extent possible, you should lay out both the wonders and the warts of your job offering. Let candidates know if there are occult partner tensions, wobbly managed care contracts or if the new doctor will have to build his own practice rather than find one ready-made.

Get help if you need it

In the most attractive coastal markets, finding a new doctor to join your practice may take nothing more than sifting through this month’s unsolicited applications. But for the rest of the country, it remains a seller’s market for talented doctors.

In secondary markets in the interior of the country, most of my clients find it necessary to be lucky, be patient or hire the services of a recruiting firm.

Deeply interview candidates

You have one or more solid prospects in contention. How should you select the final candidate? First, trust your instincts. It is interesting to note that when my typical client needs to fire a doctor, he is likely to say with a fatalistic sigh, “You know, I somehow sensed this wouldn’t work out. I simply jumped the gun on this one.”

Second, conduct 360° interviews, allowing each candidate to meet with your practice staff. Lay staff is uncanny in its ability to sniff out a “Dr. Turnoff” who will not be successful in building his own following or who will not work out with the rest of the practice team. This caveat notwithstanding, good or bad, do not rush to judgment in hiring or rejecting a candidate.

In many situations with an equivocal candidate, it is best to exert special efforts. I advise in an increasing number of settings that the lead physician of the hiring practice fly out to observe the candidate in his natural environment, which is much more instructive than merely observing cataract videos and taking the candidate at his word for everything else.

Employment contract

Whether your new doctor is a physician or optometrist, partner track or durable associate, you will want to develop an employment contract spelling out responsibilities, authorities and expectations. Do not just speed-read your attorney’s boilerplate contract and sign off. Try to anticipate every adverse fork in the road, including:

A practice that falters, no longer requiring the services of your associate;
A practice that delivers fewer patients or surgeries than the associate was expecting;
A doctor who resists company policies or agreed patient care pathways;
A doctor who provides shoddy patient care or who fails to keep a full work schedule;
A doctor who harasses staff or patients;
A doctor who loves your practice and community but whose spouse is just not happy; and
A doctor who might potentially leave to compete in the same community and even recruit away staff to work in this competing practice.

Start early

Once you have selected a new doctor to join your practice, one person should be in charge of overseeing the housekeeping details of his introduction to the community. Inattention to these details can result in many months of cash-flow delays.

In smaller practices, the office manager is in charge of these critical steps. In larger practices, it is common for a dedicated administrative assistant to attend to these details.

Set realistic expectations

Nothing is more dispiriting to a new associate than the perception that his personal practice is faltering. It is important to manage the expectations of new associates. This is especially important in settings where “Dr. Young” is not immediately taking over for “Dr. Old” but has to build his own following of patients.

At the same time, do not be overly lax in setting standards and expectations. Setting “push goals” — revenue or patient volume goals that are feasible but a real stretch — is appropriate in most practices.

Introducing your new doctor

Remember that “Welcome to Our Practice” advertising serves two purposes: the practical, immediate purpose of gaining new patients and the secondary gain of showing your new doctor that you are exerting best efforts on his behalf.

Actively lead and coach

New associate doctors in your practice should have one clearly defined supervisor. In nearly all cases, this supervisor should be the medical director or managing partner of the practice. This supervisor should review associate doctor charts, observe clinic and surgery and meet regularly with the associate for at least the first year of employment.

Associates should be told clearly to whom they report and the appropriate frequency and venue for such reporting. If you want high output and performance, you are going to have to invest the meeting time to counsel and track key performance indicators. Such meetings should be at least monthly and include:

A close review of graphs that show the 12- to 24-month financial and volume performance of the overall practice and the associate’s segment of the practice.
Graphs that should show patient visits, surgical density, overall collections and collections per average patient encounter.

Making mistakes

It is not reassuring to remember that about half of all the doctors you hire will not work out. If you feel you have hired the wrong doctor, reach that conclusion as soon as possible and cut your losses. Learn from the mistakes you will inevitably make. And when you lose, do not lose the lesson. Did the doctor lack your work ethic? Check for this more closely next time. Is his or her spouse unhappy? With the next hire, interview not only the doctor but also the spouse. Is the mistake one of faulty economic forecasting? Be more careful and conservative next time.

While you may think your practice success depends entirely on your clinical and surgical judgment, as your company grows, practice success will increasingly depend on your judgment about the people you select to join you in practice. None of these hires is more important than the associates and partner-track doctors you select. Wise choices in this arena will make management of the rest of your practice infinitely easier and more successful.

For Your Information:
John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. Mr. Pinto is the country’s most-published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement, Cashflow: The Practical Art of Earning More From Your Ophthalmology Practice and the new book The Efficient Ophthalmologist: How to See More Patients, Provide Better Care and Prosper in an Era of Falling Fees. He can be reached at 619-223-2233; e-mail: pintoinc@aol.com; Web site: www.pintoinc.com.