T. Anthony GiaQuinta, M.D.

Fall 2012 | Snapshot


“Get ready for this…you are wanted! Getting into medical school and residency was such a humbling process, I sometimes felt like I was begging for acceptance. My job search wasn’t like this at all.”

EMPLOYER: Hendricks Regional Health  (A Suburban Health Organization), Indianapolis

RESIDENCY: Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville

GiaQuinta enjoys spending time with his wife, Sarah. They enjoy camping, music, concerts and hiking with their dog, Murray. He also likes to run and play the guitar.

What’s your advice for residents who are beginning their job search?
Take a deep breath and be patient! After all the years of studying and late nights on call, the realization that my lifelong goal was in sight can be a little surreal. Why rush now? There is a lot that goes into finding that ideal job: location, lifestyle, salary, patient population, etc. Keep these in mind as you are approached with different job offers. I found that I needed to refocus from time to time the type of doctor I always imagined myself as, and which practice would best shape that vision.

What surprised you about your first post-residency job?
Get ready for this… you are wanted! Getting into medical school and residency was such a humbling process, I sometimes felt like I was begging for acceptance. My job search wasn’t like this at all. You’ve worked hard; be proud of your resume, and let it go to work! It was such a great feeling realizing that jobs were looking for you, too.

What do you wish they had taught in med school but didn’t?
I always wish I had a better understanding of my debt situation, and how much that debt would accumulate in interest during residency when my loan went into forbearance. There are repayment strategies during residency, such as income-based repayment, that are reasonable payment options and can help alleviate the interest that re-capitalizes onto your principle loan amount. Even better, some loan repayment options offer loan forgiveness options if you work in underserved or academic centers, which includes residency.

Anything particularly unique about your job search?
Be careful signing up with too many search firms. Though it’s nice having others bring jobs to you, it’s important to stay in control of your job search. Be honest with your intentions and goals, and if not interested, it’s OK to politely say so. I always felt so humbled and flattered to receive a job offer, that I almost felt it rude to decline an offer. If not interested, it’s better to let them know so they can focus their efforts elsewhere.

Dr. GiaQuinta used PracticeLink in his job search: PracticeLink untangled my job-search spider web and helped me find the job I was meant for.”



Workplace Clinics

With a focus on prevention, this physician found his balance

By Marcia Travelstead | Career Move | Fall 2012


NAME: William Bray, M.D.
TITLE: Family practice physician for WeCare TLC
Medical school: Indiana University
Residency: Ball Memorial Hospital in Muncie, Ind.
As a workplace clinic physician, who specifically do you work for?
My employer is WeCare. They are a Florida-based company that specializes in employee-based clinics. There are others out there that do similar things. WeCare manages the on-site clinic for Subaru, which has a very large automobile production facility in Lafayette, Ind. Subaru employees and dependents are eligible to use the clinic.

What do you like best about being a workplace clinic physician?
I like the focus on prevention. I also like that it’s not necessarily a production-based environment. I like that I can spend more time with patients and I can focus on keeping them well. I have the resources and support to do that effectively.

Is there anything you don’t like about being at a workplace clinic?
So far, no. It’s a really nice blend of disease management and preventative care. Personally, it’s not as demanding on my time because it is more productive. I’m not dealing with insurance companies and collections. It’s an employer-funded operation, so instead of spending time with insurance companies, I’m spending the time with the patients.

Why did you choose to join a workplace clinic?
There are a number of reasons… such as a chance to get back into family medicine. I previously was in a practice that was occupational medicine and family practice. It soon became full-time occupational medicine. This was really a chance to be part of something where I see health care needs to go. That is, with the focus on prevention versus a system that’s motivated by illness, if you will.

Have you always been located in Indiana?
Yes, I have, except for the five years I was a flight surgeon for the United States Air Force. That was the only time I was out of Indiana. I was stationed in Florida and Germany at that time. I continue to serve as an Air Force Reservist. My employer has been supportive of that.

What’s your advice for physicians who are interested in joining a workplace clinic?
Stick with the things that make you happy in life and you enjoy doing. I’d take a long look, especially for younger physicians, at where health care is headed in our country and weigh that into the decision. There’s something to be said for being in a private practice, going into that model. Maybe the rewards are there for some people. I think this is a neat change and I’m looking forward to a future with it.

Was there anything that surprised you about your career choice?
I was surprised I finally accepted this model. It’s a unique and different way of delivering health care. I was a little surprised at myself after years of doing things a certain way that I came to accept that this could work.

How would a physician get started on the path to becoming a workplace clinic physician?
Do your research. Not only on the company that you are providing a service to but the company you will be actually working for. Be prepared to accept the different model and delivery of this health care. Think outside of the box.

Would a workplace clinic physician be a model a new physician could go into immediately out of residency?
Yes, in fact in a way, it is almost ideal because in residency, you get some training about the business of medicine but many times, it is limited. In this particular model, you can focus on patient care fresh out of the program, which is primarily what you did the whole time in residency. I think it would be an easy transition for a young resident coming out of the state residency programs to embrace. It’s a model that requires very little business savvy or business sense because you are not dealing with insurance companies, collections or worried over bad debts. It’s a completely patient-centered medical environment.

Anything else you’d like to share?
I’m very happy and pleasantly surprised with the opportunity and I think as with anything, this is a novel concept to a lot of people. Time will tell if this is the direction health care will go. I don’t know if the government will be able to solve our health care dilemmas and I don’t know if physicians as a whole are motivated to change. It might be the employers in the country that force the reform. I think when the employers push, that’s when things will happen because ultimately employers pick up a lot of the health care tab.

– By Marcia Travelstead



Apps increase knowledge, enable intervention

Put your phone or tablet to good use with these apps for physicians.

By David Geer | Fall 2012 | Tech Notes


The mobile medical software market is proliferating with apps that fill various niches in the physician’s professional landscape. In this installment, Tech Notes highlights mobile apps that address domestic abuse screening and continuing medical education.

QuantiaMD, the app and network that keep physicians current

The medical community is well within the blast of the knowledge explosion.  New information bombards doctors, and it’s difficult for them to keep pace.

The QuantiaMD app accesses a learning network that engages physicians with brief, interactive presentations of four to eight minutes on topics of interest to their specialty. The physician can ask questions during a presentation and participate in discussions with other physicians.

Through QuantiaMD, physicians enjoy these presentations anywhere and anytime they have a connection on their mobile device. Physicians learn on their schedule, when they have a few free minutes. They simply log on to the QuantiaMD network where they have set up their profile. The app offers them open community discussions, private discussions and opportunities for one-on-ones with colleagues to learn critical information for their practices.

Access interactive presentations in your specialty and connect with colleagues and a faculty of 500 medical experts even with just minutes to spend.

In addition to interaction with the app’s other users, QuantiaMD has its own faculty of 500 medical experts. These experts monitor each of the special interest groups in the network and answer physicians’ questions.
The network currently serves 150,000 physicians.

QuantiaMD is compatible with iOS (Apple) devices version 4.0 and later and Android handsets running version 2.1 or later. The app is free and available for Apple devices on iTunes.

Steven Sandler, M.D., sees 80 to 90 patients per week at his cancer treatment centers in Chicago and Skokie, Ill. Sandler is involved in protocol research, though not with any academic institution, and participates in clinical trial studies to determine whether new drugs are beneficial.

Sandler must stay ahead of a broad array of medical developments. But emails, mailings, and representatives who come by his office inundate him. He also attends a lot of conferences and listens to audiotapes to keep up.
“I needed an application for medical education that would be thorough but not overwhelming, something I could apply to my practice needs,” Sandler says.

Those needs range beyond just working with cancer. The typical person with lung cancer or prostate cancer is around 70 years old, and some have also had bypass surgery and other procedures. “I need a way to deal with oncology and the patient’s other medical problems,” Sandler explains.

“QuantiaMD provides a user-friendly environment for keeping up with case presentations and lectures by notable experts,” Sandler says.

QuantiaMD presents cases and asks the physicians what they think a particular malady is. “It is fun because there is actual feedback,” says Sandler. “They give you the correct answer and after three to four cases, you see how you did and how your colleagues did.”

Using QuantiaMD, Sandler can easily select the topics he is interested in, including mental illness.

“Some patients come in with mental stress due to all the maladies they have. I can’t think of any other avenue I would use to look at this topic,” he says.

Other topics covered by QuantiaMD include HIPPA regulations and legal issues that are important to a medical practice.

“I have shared it with several colleagues,” Sandler says about the app.

“When I have called for support for minor issues, Quantia has been very helpful.”

The R3 App, a HITS-based screening instrument

Society has its failings, including domestic abuse. Physicians recognize symptoms of mistreatment but need better ways to communicate questions to those affected.

To meet such challenges, Harbor House of Central Florida, Inc., a successful domestic violence shelter and counseling program, created the R3 App, a domestic abuse screening app that uses the HITS screening tool recognized by the CDC. The app is compatible with the iPad and iPhone, enabling physicians to hand the tool to their patients for self-screening.

The app, which includes a comprehensive list of domestic abuse resources in the U.S. by their zip codes, is freely available for both Apple and Android devices.

Ademola Adewale, M.D., is an emergency medicine physician at Florida Hospital, East Orlando, and a fan of the R3 App. Adewale interacts with a diverse population of some 79,000 patients per year in the emergency department, too many of whom fall prey to their partners.

“We identified that intimate partner violence is prevalent in our population. Data suggests that it is under reported,” Adewale says. Due to the awkwardness that doctors confront when inquiring about abuse, Adewale sought a self-reporting application he could readily insinuate into treatment.

“This application makes the screening process seamless,” he says.

When the physician has evaluated someone and finds evidence of intimate partner violence, he or a nurse can load the R3 App on the iPad and hand it to the patient to fill out in private. “The application is self-explanatory, the questions are formatted in a user-friendly format, and the patient can use it with or without the physician present,” Adewale explains.

The app follows a format in which it presents the patient with weighted questions and then tallies the numbers associated with the responses. “The cumulative score helps us to classify the patient as low, medium or high risk,” says Adewale.

Adewale and his emergency department are conducting a prospective observational study to validate the use of the app in the ER.

MedPage Today app keeps CME within reach

The MedPage Today app combines award-winning medical news from the MedPage Today editorial staff, CME activities that are peer reviewed by the University of Pennsylvania Perelman School of Medicine, and best in class drug reference information from Thomson Reuters. Once physicians register through the app and note their profession and specialty, the app uses this data to direct them to the news that is most relevant to their interests.

Through its relationship with the University of Pennsylvania, the MedPage Today app offers real-time CME that covers breaking medical news.
Physicians completing CME activities can refer to their CME history within the app to fulfill their ongoing CME requirements for licensing. Access to historical CME activity and breaking news coverage are part of what set this app apart. The Thomson Reuters Micromedex drug data further enhance the app and increase its utility.

The free app is compatible with iOS (Apple) devices (it is optimized for the iPhone and iPad) and the Android platform (some design and functionality features work only on iOS devices).

Richard Savel, M.D., Medical Co-Director, Surgical ICU, Montefiore Medical Center, Bronx, N.Y., is a full-time ICU physician who makes continual use of mobile technology. “I use my iPad in a lot of ways, including for teaching and viewing X-Rays,” says Savel.

One of the gaps Savel noticed was the lack of an app to keep him updated on medical news. Savel tried other medical news apps but found that these did not meet his needs. “The app from MedPage Today is a real-time medical newspaper. They have integrated it with CME and built it up around the strengths of the iPad,” he says.

The app helps Savel meet his CME requirements for the hospital and for his academic appointments (he is also Associate Professor of Clinical Medicine and Neurology at the Albert Einstein College of Medicine) without disrupting his day. ‘The app breaks down CMEs to a quarter of an hour so that I can do them when I have time,’ Savel says.

The app enables him to digest and integrate new data including teaching data related to the ICU and the critically ill. “I take care of patients who come in on thrombotic drugs and have untoward effects from them. The information about this on MedPage Today is easier to digest than a flood of information. I particularly like the articles about cutting-edge therapy and atrial fibrillation in the ICU,” he says.

This grouping of apps helps physicians address broad and specific knowledge areas and medical issues.

David Geer is a frequent contributor to PracticeLink Magazine’s Tech Notes department.



Enough about call…What about vacation?

When it comes to your contract, don't forget to review the benefits package.

By Jon Appino | Fall 2012 | Legal Matters


Let’s face it: Physicians’ contracts are complicated! You can spend hours poring over your contract in an attempt to figure out compensation structures, call schedule, wRVU schedules, collection rates and overhead ratios.

In the midsts of sorting through the legal aspects of the contract, such as the non-compete clause, intellectual property rights and Stark Law provisions, physicians might overlook something very important‹the employment benefits in the contract.

More often than not, benefit packages are pretty vague. Items usually included in a benefit package are: medical, dental and vision insurance; life and disability insurance; retirement savings or investments; vacation and sick time; CME funds and time off; malpractice insurance; board certification fees and support; paternity/maternity leave policies and loan assistance, to name a few.

We’ll break down some of the more complicated aspects of your benefits so you know what to look for.

Malpractice insurance

Most employers provide medical malpractice insurance for physicians.

There are two main types of malpractice insurance that you need to know about: occurrence-based and claims-based.

“Occurrence based” policies are more expensive and less common. Occurrence malpractice insurance will cover you for whenever the claim occurred, not when it is filed. With occurrence malpractice insurance, you would still be covered even if you are no longer employed at the clinic where the claim occurred. Occurrence malpractice insurance does not require the purchase of an extended reporting endorsement, often called a “tail” policy.

“Claims made” insurance is the other main type of malpractice insurance. It is less expensive and therefore more common (we see around 75 percent claims-made policies). These types of policies will cover you if a claim is made during the policy. In order to be covered in the event that you leave your position where the claim occurred, you need to purchase “tail” insurance.

Tail insurance is priced specific to your specialty and history and can be quite expensive. We have seen neurosurgery tail policies of over $93,000 that are the sole responsibility of the physician. These amounts are not financed, and are usually due in full when the policy is purchased and employment terminated.

There are many clauses in a contract around malpractice insurance. The contract should clearly state which type of insurance is being provided, who is responsible to purchase “tail” if required, and the limits of the insurance policy.

Vacation time

Vacation time is important! When looking at your contract, pay attention to the way your vacation benefits are stated. Will you have specific days for vacation, illness and CME, or are you given a lump sum of PTO (paid time off)?

Will your vacation time be paid out on termination? Will it be rolled over to the next year if you don’t use it all? You may look at your paid time off differently if it’s a “use it or lose it” policy.

When reviewing your contract, request any specific vacation policies to which it refers. Certain policies may require specific notices by physicians when requesting days off or limit the number of consecutive days a physician can be absent from clinic.

Retirement savings

Many contracts lack any specific details around retirement saving plans. Often the contracts will refer to a retirement plan policy that you haven’t read.

Retirement benefits are a very important part of your future. If there is a plan offered by your future employer, you’ll need to know the specifics and details regarding contribution and match limits, vesting schedules, investment choices and potential tax implications.

Not fully understanding the retirement package your employer is offering could cost you in the long run. Physicians who do not understand vesting schedules may sign a five-year employment contract with a seven-year retirement vesting schedule. If you leave the position in five years, you may not be able to take all of your retirement savings with you.

It’s important that you know and understand the various retirement vehicles available to you so you can make informed decisions about your future.

As you can see, the benefits section of a contract is very important. There are many consequences to not fully understanding all the benefits being proposed by your potential future employer. Don’t simply look at the compensation and sign‹make sure the benefits section is up to par as well.

J. Appino is the founder of Contract Diagnostics (contractdiagnostics.com), a national company that specializes solely in physician contract reviews.



The financial mistakes new physicians make

Your compensation package is only part of your wealth plan. How you manage that income is crucial.

By Brian Luster and Steven Abernathy | Fall 2012 | Financial Fitness


In the past, it was simple: Get through the rigors of a medical school education, training, interning, residencies. Become a physician. Earn a great living. Right? Not so these days. Being a physician just isn’t as “easy” as it used to be.

The Physician Family Office recently completed an extensive study that confirmed what we all know to be true: Reimbursement is falling while the costs of operating a practice are rising.

And the latest Medical Malpractice Insurance Survey conducted by Medical Liability Mutual of New York shows dramatic increases in malpractice insurance rates across the board: they rose 54 percent for OB/GYNs, 54 percent for internal medicine, and an astounding 70 percent for general surgeons. Meanwhile, the National Practitioner Data Bank shows litigation rising significantly over the past two decades. The cost of resolving this litigation has risen 66 percent, with the average cost of resolving malpractice suits approximating $330,000.

Physicians must now see more patients and perform more procedures just to maintain their current income level.

“A lot can happen, and no one attains mastery of business management and wealth management skills–including portfolio management, legal asset protection and estate planning in medical school.” says Physician Family Office Advisory Board Member Steven Almany, M.D., an interventional cardiologist and partner of the Michigan Heart Group.

So with all of these challenges, and the added possible burdens of debt, how can a new physician avoid common financial pitfalls? It turns out that for many physicians, it’s the choices made outside of the practice of medicine that are responsible for their failure to realize their full wealth potential.

Today the average M.D. with a specialty or subspecialty makes approximately $350,000. If they can save just 25 percent of their annual income, by the time they are 60, there should be over $7 million saved for retirement. Sounds easy enough, but this is an outcome that few are able to realize.

Here are what we found to be the six most common wealth preservation mistakes made universally by medical doctors–and how to successfully avoid them.

1. Successful physicians are failing to integrate their advisors.
Typically, a physician surrounds himself with financial advisors, brokers, an accountant, an estate planning attorney, an insurance agent, a tax planning attorney and many others. If each one isn’t communicating with the other before dispensing advice, chances are their advice will either negate the effects of the others, or they will give you counsel that will actually destroy wealth.

Solution: In order to be effective, your advisors must be integrated, in communication and working toward common and clearly defined objectives.

2. Less than 1 percent of all financial advisors are acting as a fiduciary.
This alarming fact comes directly from the National Association of Personal Financial Advisors.

In most instances, advisors are your adversaries, legally obligated to hold their employer’s financial interests ahead of their client’s. Perhaps this is why there were more than 3,200 investor complaints and nearly
5,000 new arbitration cases against brokerage firms in 2011, according to CEG Worldwide LLC. That means that there are 23 new complaints and arbitration cases reported every day. If that’s not disturbing enough, often buried in the fine print of legal jargon on standard non-fiduciary agreements, people are advised: “Our interests may not always be the same as yours.”

So unless a doctor has reviewed literally all of the lines with an attorney or other fiduciary who will act in his best interest, it is highly likely that he will be wasting money.

Solution: Have your advisors sign a Fiduciary Oath that assures, in writing, their actions will be aligned with yours and they will prioritize your wealth interests and goals ahead of their own.

3. Seeking counsel from salesmen.
Even if you found one of the 2,500 U.S. advisors upheld to the fiduciary standard, what are the chances that their advice is of any value? It’s actually quite low. The problem is that most of the advisors out there are not experts; they are salesmen or relationship managers.

Solution: Seek out professionals who have been managing funds (in addition to individual client accounts) with audited track records for at least a decade, with proven results. These advisors should have a client base similar to you so your needs are best served.

4. Taking on too much portfolio risk.
The concept of “keeping up” with the stock market is a Wall Street myth. The stock market has averaged 7 percent per year for the past 140 years, and the median investor expected to earn between 10 and 33 percent during the past decade. Yet the median stock fund investor only earned 1.9 percent, according to Securities Industry and Financial Markets Association (SIFMA) Annual SIA Investor
Survey: Attitudes Toward the Securities Industry.

Solution: Investors should take on only as much risk as they need to meet their goals. Unfortunately for your advisor, this means fewer commissions and fewer fees.

5. Lack of education among your heirs about preserving wealth.
In two generations, 60 percent of wealth is destroyed; 90 percent of all family wealth is destroyed in three generations, according to The Family Business Institute. William Vanderbilt left his heirs the equivalent of
$4.8 billion (in current dollars), yet not one ranks among America’s most affluent today.

Solution: Begin educating your children about money management, wealth, taxes and financial responsibility early. As soon as your child has a grasp of basic arithmetic and can follow an adult conversation, it’s time to start. Take time to explain the role of your advisors, their strategies, and the lessons of capital budgeting, saving and investing. Your heirs will receive the best lessons in responsibility and preserving an inheritance directly from you.

6. Not creating and living by a written budget and comprehensive financial plan.
Articulate your family’s goals and objectives, project cash flows out into the future, and manage spending and your investments accordingly. Monitor progress against goals, and as circumstances change, adapt your behaviors accordingly–even if this means sacrificing in the short term or postponing retirement.

Solution: Have a clear, written budget. Review it and update it as needed.
This is a step that many highly educated people avoid because they do not like the idea of “budgeting.” Planning creates clarity; do not skip this vital practice. Just as with little or no planning, bad advice, or working with non-fiduciary entities, physicians can easily erode their wealth. With the right planning, young physicians can grow their practices, increase their wealth and enjoy their lives more fully.




Till work do we part

Physician couples conducting a simultaneous job search need to be patient, open-minded and willing to compromise.

By Vicki Gerson | Fall 2012 | Feature Articles



The right location is key
Michelle A. Potts-Griesser, M.D., MPT is a Pediatric Physiatrist at Nationwide Children’s Hospital in Columbus, Ohio. Her husband, Michael J. Griesser, M.D., is an Orthopaedic Sports Medicine Surgeon at Clinton Memorial Hospital in Wilmington, Ohio.

“Whether you are seeking a residency position or a job, the couple has to determine who will have a more difficult time finding the position and give that person priority.” —Michael Griesser, M.D., and his wife, Michelle A. Potts-Griesser, M.D., MPT, at Nationwide Children’s Hospital

“We were both looking for a job at the same time,” says Potts-Griesser, “but I knew where I wanted to be. I wanted to stay where my fellowship was, at Nationwide Children’s Hospital.” Potts-Griesser found her dream job and was offered her position in October 2011. Potts-Griesser also has a faculty position at Ohio State University Medical Center.

Griesser started his job search as soon as his July 2011 fellowship started. He went on seven interviews and narrowed it down to three reasonable possibilities within a negotiable distance from the hospital where his wife would work. He had five job offers by February 2012, all within Columbus and surrounding areas. He signed his contract at Clinton Memorial Hospital in April 2012, and will be a hospital employee with an orthopedic practice within the hospital.

How they interviewed

This couple did not tell recruiters they were both looking for jobs. They conducted totally individual job searches within their geographic boundaries. Initially, they didn’t go on joint interviews or send out joint CVs to potential employers. Ultimately, they did two joint interviews, but only after they had gone though the individual search process.

One of the main questions that always comes up in two-person job searches is, “Whose job gets priority? Why?”

In this case, Potts-Griesser’s job search took priority because she is in a more specialized field with fewer jobs available. She had the opportunity to get a job where she was doing her fellowship, so Griesser adjusted his job search accordingly.

“Whether you are seeking a residency position or a job, the couple has to determine who will have a more difficult time finding the position and give that person priority,” he says.

Job-search advice

Potts-Griesser and Griesser advise candidates to be open and honest with potential employers in terms of your family’s location constraints.

“Be patient. Be open. Take your time, and ask questions,” says Griesser.
“Try not to get frustrated or jealous or feel you have to rush to find a job because your spouse has one. Employers may try to rush you because they want an answer, but don’t be rushed.”

On a few occasions, the couple was recruited by the same employer.

Even when this happens, Griesser recommends that physician couples evaluate each opportunity separately.

“What I’m clarifying is that you shouldn’t adjust your opportunity in order to work at the same hospital,” says Griesser. “It’s much better to find the best individual job for you within the location.”

The key point is that you both agree to the location.

“That is the one factor you can’t compromise on,” Griesser says.

Once the couple agreed on the general location where they’d conduct their job search, they were able to canvass one specific area for opportunities.

Griesser ended up selecting a job about 45 minutes from home. That leaves Potts-Griesser with the responsibility of getting the children to daycare and school.

“You may have to accept that, within your geographic limits, you may not find your perfect job…the job you were dreaming of while you were growing up,” Griesser says. “But you will be able to find something pretty darn close. Adjustments are in order to make it work as a couple.”



Small-town living provides a perfect fit

Lindsy Alons, M.D., is an OB/GYN at Ottumwa Regional Health Center in Ottumwa, Iowa; her husband, Sandro Younadam, M.D., is an Internist. Their new practices suit the couple, whose goal was to work together.

Alons is joining the hospital employed OB/GYN group. The group is aging and had been looking for the right fit for a new physician. Younadam will be establishing a group practice in Ottumwa to which the hospital is currently trying to recruit more physicians.

Ottumwa Regional Health Center is a trauma and referral center with 217 beds providing medical care to the residents of southeastern Iowa and northern Missouri. There are 70 physicians representing 30 specialties of medicine. The city is in a family-oriented community with a population of
25,000 in the city and a service area of 125,000.

Initially, the couple focused on practicing medicine in Jacksonville, Fla., where Younadam’s parents live. They soon realized it was important to expand their search due to better job offers and a better call structure elsewhere.

How they interviewed

Alons and Younadam each had three interviews. They always brought their two children to the cities where they interviewed and arranged for family to watch the children during the actual interview time.

The couple informed recruiters and prospective employers that they were searching for work together. They always asked if there was a need for each of their specialties and sent in their CVs at the same time.

“We arranged our interviews to occur on the same day so we would both go together,” says Younadam. “We visited as a family. We felt it was important.”

The couple didn’t have any friends who were physician couples and didn’t ask in-house recruiters for any advice. As a result, “we figured out what we should do on our own,” says Younadam.

The couple started their search in Alons’ last year of residency. “We felt it would be wise to search for both of our jobs at the same time so we could obtain work in the same city,” Younadam says. “Neither of us wanted to commute long distances. We were lucky because we got our jobs at the same time.”

Job-search advice

Alons and Younadam recommend that physician couples start their search with wide parameters. Initially, they limited themselves to a small region. Their philosophy changed when they realized there were numerous opportunities they would be missing if they didn’t expand their search.

Younadam advises to not judge the job before interviewing or visiting the location. After visiting a place, you may realize that you like the area more than you thought you would.

It’s also important to know what is important to you and your family, and know what amenities you need. Do your homework. Research the area so you know what it has to offer.

“Always look for a place that will make you happy in all aspects of life:
work, play, relaxation, family and hobbies,” Younadam says. “It is not just about the job, but rather the whole picture.”



An island job may be the perfect place

“Talk and share the thought process. It’s never healthy to ‘play the martyr’
or to make sacrifices thinking you are making it better for your spouse or the
family. If you’re not happy with your decision, it will likely lead to resentment later.”
—Li-Duen Clark, M.D., on the shores of Oahu with her husband, Jean-Paul Clark, M.D.

Jean-Paul Clark, M.D., and his wife, Li-Duen Clark, M.D., are both OB/GYNs who practice together at Windward Obstetrics and Gynecology LLC in Kaneohe, Hawaii.

How they interviewed
Although the couple graduated in June 2011, they started their job search in the fall of 2010. Focusing exclusively on finding two positions, they either wanted jobs in the same place or geographically suitable so they could at least live in the same house. In addition, they didn’t want a commute that would be more than 30 minutes.

Without any strong geographical ties, Hawaii seemed like the perfect place to live. The couple looked at the other Hawaiian islands, but it became apparent that Oahu, with its denser population, would provide the greatest opportunity.

“When it’s harder for one of you to find a position, then it¹s fine for one of you to have a permanent position while the other takes a temp position and continues the search,” says Li-Duen Clark. “Talk and share the thought process. It’s never healthy to Oplay the martyr” or to make sacrifices thinking you are making it better for your spouse or the family. If you’re not happy with your decision, it will likely lead to resentment later.”

The couple stated their goals to potential employers in a cover letter that introduced both of them. However, they kept their CVs separate. They stayed together for all but one interview. If they weren’t together for the formal interview, they had dinner together with the potential hiring doctor.

“Some recruiters/employers think when a couple is presented, they have reasonable concerns,” she says. “They don’t know if the couple gets along, or what happens if there is a later dispute. Employers wonder, will they lose both of them or create an awkward work situation?”

Private practice was the Clarks’ answer.

The couple spent one week in Hawaii doing interviews. The final interview was the right fit, and from there they moved forward, using hospital assistance to set up a private practice together.

“In a way, we both thought we were crazy for starting a private practice, which we had not experienced or had any training for,” says Jean-Paul Clark.

Their typical agreement consisted of a period of guaranteed income followed by a promise to stay in the area for a certain amount of time while repaying the amount of Castle Hospital assistance. “The hospital had every incentive for us to succeed,” says Jean-Paul Clark. “The hospital was making a judgment in recruiting us, believing it was an opportunity for a win-win situation.”

The couple saw their first patient on Sept. 6, 2011, and have no regrets.

Job-search advice

There is little preparation for simultaneous job searches in residency. Get all the help and advice you can from people who have completed these steps.

Private practice, for example, is not for the faint of heart, but perfectly possible for a couple with strong determination.

Most importantly, don’t underestimate the “feel” of a work environment. It can affect not only your day-to-day life, but also shape your future. Trust your gut and ask around.

When you’re working together, divide and conquer as much as possible. Try to avoid overlapping work, which can reduce friction. “If you feel as if you can each run the clinic without the other, that’s a success,” says Jean-Paul Clark. “The clinic is not dependent on either of you, and you’re not overly dependent on each other.”

“Not everything will go smoothly,” says Li-Duen Clark. “It’s important to keep communication open through the process. It’s hard enough for one job search; it’s harder for simultaneous job searches. Be open and flexible, and be sure to support each other during this stressful process because no one else understands the situation better than the one going through the exact same process.”

Survey says…

“Attracting a newly trained physician also means that the community must meet the needs of his or her family. In an increasing number of cases, that may include another physician.

67%  More than two-thirds of the respondents said that their practice opportunity choices are dependent on the interests of their spouse, significant other or family member.

24%   Nearly one-quarter of respondents have a spouse or significant otherwho is also a physician.”

Source: Cejka Search 2012 Resident and Fellow Survey


Your same-time job search

To find the right or “near perfect” job opportunity for both you and your other half, Erin Wainwright, a physician recruiter at RegionalCare Hospital Partners in Brentwood, Tenn., has this advice.

Couples searching for physician opportunities with different specialties need to make one search the priority and focus on that one first. The priority usually goes to the specialty for which opportunities are harder to find.

“For example, at a facility in Iowa, RegionalCare Hospital Partners was able to successfully recruit an OB/GYN and an Internist. The couple knew the area was looking for both specialties and contacted us, but the OB/GYN was the priority,” she says. “They wanted to make sure that the OB/GYN opportunity was a good fit because there was only one practice to join.

There were several Internist/Hospitalist opportunities in the area for the Internist to select.”  Recruiting couples for physician job opportunities is not much different than recruiting one physician. Typically, recruiting the spouse physician is just as important to the organization. Wainwright’s goal is to find physicians ready to commit to the area and who are looking for a place to call home.

When Wainwright interviews one physician, she often interviews the second physician also seeking employment opportunities. Whenever possible, her organization tries to recruit both. Therefore, both physicians should always submit their CVs when looking for jobs together.



A Physician’s Guide to Employment Contracts

Getting a contract - then evaluating it with confidence - are the important steps in your employment journey.

By Bruce D. Armon | Fall 2012 | Feature Articles


Today is your day.
You’re off to Great Places!
You’re off and away!”
–From “Oh, The Places You’ll Go!” by Dr. Seuss

Dr. Seuss had it right. The journey relating to a new job can be just as exciting as the job itself. For residents and fellows in their final year of training, the fall is the time of year when there is no shortage of optimism about the wonderful opportunities that await when summer arrives.

For those physicians who have more than a year left before their training is complete, the time between now and when you start that first job will come sooner than you think, and there will likely be lots of twists and turns on the way.

If you are already employed as a practicing physician and considering a change in jobs (hopefully by your own choice and not that of your employer), you have already been through this drill and may have a bit more savvy and a bit more apprehension because of your current experience.

There is no one right job, no one way to get a job, and no one thing that makes any physician the perfect candidate for a particular job. Though being in the right place at the right time is certainly important, there are certain things any physician looking for a job should do to put themselves in the best position to land the ideal job.

It is very important to set your expectations early and to know, in advance, what is most (and least) important to you as it relates to job responsibilities and what is included in your employment contract.

In every negotiation, it is important to understand what the other side is looking for and hopes to achieve. Though not every term is negotiable, you may be surprised by the compromises you can achieve that can help you in both the short and long term.

Understanding certain basic principles can make you a more attractive candidate to a prospective employer when you are preparing for and then going through the interview process.

There are two parties to every job negotiation‹the employer and the employee. Your job is to give the prospective employer the comfort in knowing you are the right candidate for the job. This is not always an easy proposition.

Getting a new job is exciting and exhilarating‹and can be physically and mentally exhausting for both the employer and the prospective hire.
Understanding the motivations and sensitivities of the prospective employer is critical.

There are three typical employers for physicians: private practices, hospitals and private practices in hospital-based settings. There may be different opportunities and challenges in negotiating for employment in each of these settings. Each of these employers has different relationships it needs to nurture, and prospective physician hires need to do their homework to prepare accordingly.

Before you get to the contract stage… Have you completed the fundamentals?

 “You have brains in your head.
You have feet in your shoes.
You can steer yourself
Any direction you choose”

In many respects, getting the proposed employment contract is the last step before you can accept the opportunity.

Before you even step foot in the door of a prospective employer for an interview, you will be screened in multiple ways.

Depending on the size of the prospective employer and the type of health care provider, the mechanisms employers use to screen candidates may be very different.

However, the items a potential employer wants to know about you before bringing you to meet them are likely going to be very similar.

Drea Rosko, Assistant Vice President of Physician Services for St. Luke’s Physician Group, St. Luke’s University Health Network in Bethlehem, Pa., is responsible for screening the qualifications of potential physician hires.

One of the mechanisms Rosko uses to determine if a candidate might be a good match for an opportunity is a Physician Applicant Qualifications Report adopted from a form prepared by the Association of Staff Physician Recruiters (ASPR).

St. Luke’s reviews a prospective hire’s CV with regard to four specific criteria: 1. Is the applicant an M.D. or D.O. from a United States recognized or ACGME accredited medical school? 2. Has the applicant completed both an internship and residency in the United States? 3. Has the applicant completed a residency or fellowship in the specialty for which the candidate is applying? 4. Is the applicant board certified or board eligible?

Rosko studies the candidate’s CV and supporting materials to identify “red flag items.”

Some red flags are gaps in education, multiple moves in a short period of time, a poorly formatted CV or grammatical errors in the cover letter.

If the candidate passes this initial test, she calls the candidate to get answers to questions that may not appear on the CV. Assuming that telephone interview goes well, the hiring process continues.

Just as employers investigate your “red flags” before extending an offer or contract for employment, so should you, too, consider any red flags you encounter regarding the potential employer.

These may include: excessive professional and administrative turnover; inability to grow a practice; and lack of commitment to capital and equipment improvements. Be prepared to ask questions of a potential employer so that you understand their vision for the future and that it is compatible with your expectations.

Related: What questions should you ask? ow.ly/dOhvG

Your employment contract may be influenced by the practice’s location. “We make sure candidates realize that we actually get busier during the summer and peak vacation time because of the influx of visitors and urgent urological needs that cannot wait until the individual returns home,” says Frank Wren, M.D., president of Jersey Urology Group, which has offices near Atlantic City.

Frank Wren, M.D., president of Jersey Urology Group, a large urology practice based in New Jersey with several offices near Atlantic City, says his group tends to rely on referrals when screening candidates.

Because urology is a fairly small specialty, a person’s reputation–good or bad–can travel far and wide. “Knowing where the candidate trained and who trained the candidate is critical to our analysis,” he says. “We believe we know who has a good reputation and that helps us effectively winnow candidates.”

 Location’s role in your contract

“You’ll look up and down streets.
Look ’em over with care.
About some you will say,
‘I don’t choose to go there.'”

Once you pass the initial screen, the prospective employer will likely bring you to the community.

If the opportunity is in a community that’s a temporary stop en route to your ultimate desired living situation, you may not be concerned with a contract’s post-employment restrictions such as restrictive covenant and non-solicitation provisions.

If location is your main priority, understand how broadly the prospective employer defines the “community” and what options will remain if you are no longer employed by that organization.

If your spouse is also a physician, you’ll also want to make sure that a non-compete restriction that one of you has does not mean both of you will be forced to switch jobs if one of you changes employment.

Employers, too, try to ensure that their location matches a candidate’s goals before the contract stage.
“We know we are not the ideal location for every candidate” says Teresa Mitchell, executive director for Lafayette Radiology, a hospital-based medical practice in Lafayette, Ind. “It is very important to us in a buyer’s market that we only make an offer to a candidate who we think wants to be in our community for the long term for the right reasons.”

Your contract may include provisions relating to special geographic circumstances.

Wren’s practice is located minutes from the New Jersey beaches.

“We enjoy being a part of a great community and do not take for granted our proximity to the beach,” he says. “At the same time, we make sure candidates realize that we actually get busier during the summer and peak vacation time because of the influx of visitors and urgent urological needs that cannot wait until the individual returns home.”

Taking extended vacation in the summer may not be a realistic option in a beach community. Similarly, an employer may place restrictions on you taking extended vacation in a skiing community in the middle of winter.

Assuming the prospective employer believes you want to be a part of the community for the right reasons and they find you acceptable professionally, personally and socially, the next logical step will be offering you employment.

 What should be in your employment contract?

“I’m sorry to say so
But, sadly, it’s true
that Bang-ups
and Hang-ups
can happen to you.”

First, make sure you get an employment contract. A handshake is not sufficient. A properly drafted contract will protect both you and your employer. The contract delineates your respective rights and responsibilities.
“We have given a lot of thought to what we include and do not include in our employment contract,” says Wren. “As we have grown over time, we have made modifications to fulfill expectations and protect our practice.” There are certain key elements that you should look for in any contract you receive:

√ Term and termination
√ Salary and benefits
√ Work schedule
√ Post-employment restrictions

“Our contracts are carefully drafted. Every section is included for a specific reason,” says Robert Wax, senior vice president and general counsel for the St. Luke’s University Health Network.

Term and termination

Term and termination is important to you and the employer. Though a job could theoretically last “forever,” the reality is often different. From your perspective, you should understand the length of the initial term and any renewal terms. Understanding how and when you can leave an employment situation is important.

Assuming you do intend to stay, and your employer wants the same for you, the term and termination provisions may help clarify opportunities for advancement by job title and/or by compensation.

For instance, an initial contract with a term of three years may delineate whether you become an “owner” of the practice at the end of the initial term, or promotional opportunity if you are in an academic medical center

From the employer’s perspective, they want to ensure a timely separation if the agreement is not working as expected. It can be awkward for everyone if it is clear you are no longer welcome and your continued presence affects office dynamics, patient relationships or referral patterns.

Salary and benefits

Do your homework to ensure your salary is competitive for your specialty and the geography. Supply and demand becomes an important consideration with respect to salary.

“As a large employer, our employee benefits are worth thousands of dollars a year,” says Rosko.

You should understand the scope and effective date of each benefit. Is family health insurance provided, or is it only for the individual employee? Is short-term and long-term disability insurance available? What sort of retirement benefits are provided?

Will the employer reimburse you for your moving expenses or provide a signing bonus? What is the annual vacation and continuing medical education allotment?

There are no guaranteed benefits that you should expect to receive. Keep in mind that the cash equivalent value of the benefits offered combined with a “mediocre” salary can make for a very generous job offer.

An important (and expensive) benefit is professional liability coverage. Depending upon whether the insurance is occurrence-based or claims-made, you will have different considerations regarding professional liability coverage if this employment ends. In addition, many states require a physician to have certain levels of professional liability coverage and coverage during the period of time covered by the state’s statute of limitation in which a suit can be brought. Your contract should specify the type of coverage offered.

Work schedule

Understanding your expected work schedule and call coverage is an important part of your contract.

“We pride ourselves that each physician‹no matter how senior or junior‹has the same work schedule and call obligations,” notes Wren. “It shows that we are all in it together.” You should know the locations where you are expected to work and the “regular” office hours and rounding responsibilities.

Post-employment restrictions

No one should knowingly start a job expecting to leave that employer and then stay in the community as a competitor.

An employer has a legitimate right to protect its business interests. You should understand the length of restrictive covenant and the scope (e.g., miles, zip codes, counties) and the impact that it will have on whether you need to move your residence if you leave that employment.

If your spouse or significant other is also a physician, you may have two sets of noncompete provisions that you need to consider.

Getting help on the employment contract

Wax, Rosko, Mitchell and Wren agree that it is important to have an attorney involved in the contract process for you and the employer.

“We use our attorney to draft our employment contracts because we want to make sure we draft the document correctly and are acting fairly,” says Wren.

Each of the employers also expects that the prospective hire may contact an attorney to review the employment contract.

“We have no problem dealing with a physician’s attorney,” says Wax. “We do find it preferable if the attorney has real health care experience and is genuinely interested in looking for opportunities to make the deal work as opposed to finding reasons to nix the deal. That works to the benefit of the prospective hire in the short term and long run.”

Related: How to negotiate like a 5-year-old ow.ly/dgiIB

A physician looking to hire an attorney should ensure the attorney understands health care legal issues and physician dynamics. In addition to appreciating the details of the contract, your attorney should serve as your advisor to help guide you in making the correct decisions.

“If someone is completely distrustful and skeptical of every provision in a contract, we question whether that individual really wants to be a part of our health care family,” says Rosko. “Establishing trust is a two-way street, and the attorney can be helpful in that regard.”

As you consider hiring an attorney, talk to colleagues for recommendations. Hire someone who you want in your corner to explain the contract terms and who can negotiate on your behalf if you choose.

You should feel comfortable asking the attorney how he or she charges for their services and an expected price range for the engagement. Dealing with an attorney whose specialty is health care law and who has negotiated physician contracts is essential. An attorney who does not understand health care fraud and abuse laws, appropriate scope of a noncompete and licensure and bonus provisions will not serve you well.

The attorney you hire should not be someone looking to kill the deal, but should be comfortable telling you if something is a less-than-ideal opportunity. There may be situations where it is better for you to walk away from the offer and bide your time until a better opportunity presents.

Your attorney should be able to put you in the most competitive position and prioritize the contract issues that are most important to you and your family.

 Taking the journey

“And will you succeed?
Yes! You will, indeed!
(98 and 3/4 percent guaranteed.)”

Depending on when you are actually offered employment, the process may only take days or a few weeks.

Ideally, you are considering multiple opportunities at the same time so you can weigh the advantages and disadvantages of each offer. The earlier you get the opportunities in the job cycle, the more latitude you may have in negotiating terms that are important to you. Though nothing has to be forever, you ideally do not want to be switching employment multiple times in a rather short period of time.

Despite Dr. Seuss’ good wishes and unbridled optimism, you may not reach the level of success in Oh, The Places You’ll Go. You will increase your opportunity for success, however, by understanding the goals and objectives of your prospective employer in looking to hire you, applying for jobs that truly interest you, and making a great first and lasting impression with everyone with whom you interact during the interview process.

Understand each element of your proposed employment contract and use an outside advisor to help guide you through the process.

With each of these tips in mind, you will find plenty of opportunities for the places you can go.

Bruce D. Armon, Esquire (barmon@saul.com) has helped negotiate and draft hundreds of employment contracts for physicians and employers. He is co-chair of Saul Ewing LLP’s health law practice and managing partner of its Philadelphia office.

Personality matters

No one wants to hire a horror story waiting to happen.

“We do not want to have belligerent or unprofessional physicians employed by our organization,” notes Robert Wax, Esquire, senior vice president and general counsel for the St. Luke’s University Health Network. “Respect for one another and for yourself are hallmarks of our organization.”

“We need to make sure the prospective hire’s clinical skills are at the level we expect. However, the evaluation does not end there. It is very important that we understand their personality, their extracurricular interests and their sense of stability,” says Teresa Mitchell, executive director for Lafayette Radiology in Indiana.

Mitchell generally meets with a candidate first. Then the candidate meets with each partner in the group and key hospital administrators, and tours the hospital space. “Everyone’s impression counts when we interview a candidate,” she says.

Since the practice is intrinsically connected to its hospital through a services agreement, the practice cannot risk having a physician as one of its employees who would or could do anything that would jeopardize that relationship.

“I remember one candidate who I took to lunch and I could not find anything which we could discuss, regardless of whether we even agreed upon the subject. The lunch was socially awkward, and I recommended to my physicians that we not extend an offer,” Mitchell recalls.

You have to sell yourself and realize your clinical skills alone do not make you an ideal candidate. There may be multiple candidates interviewing for the same position. Personality matters.


Download and share this helpful sidebar at ow.ly/dPUmi
Negotiation tips

By Kyle Claussen, JD, LLM

Negotiating an employment agreement can be a nervous and stressful time for many physicians. These agreements are worth hundreds of thousands of dollars and will define when and where you practice medicine. Here are a few tips that will reduce your anxiety.
Negotiations start immediately.

The moment you begin speaking to a recruiter, you are negotiating your position. It is important to be open and honest with an employer. You should not commit to any specifics regarding salary requirements or work schedule until you have evaluated the offer as a whole. It is best to discuss compensation only after an official offer has been made and after you have evaluated the facilities, support staff and benefits package.
Remember that even “standard” contracts that “every physician has signed” can be changed.
Prioritize your needs.

Every physician has unique needs in their employment. A four-day workweek may be the most important factor for a new mother. A resident with large amounts of student loan debt may need to maximize compensation. Only you know what your needs are, and you should communicate to the employer which terms of the proposed agreement are truly “deal breakers” during your first round of negotiations. Contract terms to consider include:

€ Compensation
€ Call schedule
€ Malpractice tail coverage
€ Equipment
€ Non-competes

Know your value.

Underestimating your value can substantially reduce your compensation. It is rare that the first offer made is the best you can receive. Conversely, overestimating your value can lead to an offer being pulled and a relationship with the organization destroyed. To determine your value, consider geographic specific salary data, competing offers, length of time the position has been open, total revenue you will generate, and the number of candidates being considered for the position.
Keep “Plan B” alive.

As Yogi Berra said, “It’s not over til it’s over.” You should never turn down an offer until you have determined with 100% certainty that you will not be accepting the position. Negotiations can take many weeks and occasionally will turn sour. If this happens, you will need to have another option or two for consideration.
Get professional guidance.

Any contract (employment or otherwise) that is worth a significant amount of money should be analyzed by a professional. Attorneys specialize in practice areas just like physicians. You would not go to an orthopedic surgeon for a colonoscopy, and you should not go to your cousin (or brother, aunt, etc.) who practices family law to review your employment contract.

Find a health care attorney with experience reviewing physician employment agreements. As Benjamin Franklin stated, “an ounce of prevention is worth a pound of cure.”

It”s absolutely critical that you find out what the practice expects of you in terms of minimum productivity levels. What do you have to do to earn the base salary? At what level does the productivity bonus kick in?



What’s it worth to you?

How physician compensation trends and realities affect your income potential.

By Timothy W. Boden | Fall 2012 | Feature Articles


Earning a lot of money won’t make you happy, but not earning enough can sure make you miserable! But how do you know how much is “enough”? Finding the answer that’s right for you begins with understanding your own financial needs, goals and dreams.

Only you can determine how much money you’ll need to take care of your financial obligations, provide a comfortable lifestyle and achieve your family’s longer-range financial goals. Figure out how much you need to pay bills (like student loans) and establish your home. At first you’ll likely be more concerned with what kind of house and car you can afford than with how to build an investment portfolio or retirement account.

But even a rough budget will prove helpful as you head out into today’s physician job market. You will find a very broad range of compensation packages out there. Different medical specialties provide different levels of earning potential, of course, but compensation also varies widely within the same specialty.

What are you worth?
As you search for your dream job, what can you reasonably expect in terms of compensation? What constitutes a fair offer? Your ability to answer that question depends on your willingness to do some research.

Start your quest by simply asking around. Talk to your friends and fellow residents. Ask them what they’ve found out there in the market. But recognize the limitations of anecdotal data. Job offers are a little like
snowflakes: No two are alike. Dozens of factors affect job requirements, salaries and benefits packages. You have to go deeper to gain a more realistic picture.

Marcella Gravalese, director of practice development at Vohra Wound Physicians, says, “Graduating residents have to do their own due diligence”‹carefully studying each opportunity for themselves.

Over the last two decades, a number of organizations have developed reliable benchmarking data that prove useful in determining the “going rates” for physicians serving in a variety of practice settings spread across the country’s diverse geographical regions. The Medical Group Management Association’s annual Physician Compensation and Production Survey has become the virtual “industry standard” for benchmarking doctors’ incomes and outputs. A complex and somewhat expensive report, it breaks the data down by the major factors that differentiate income opportunities (geography, gender, practice size and ownership, single- or multi-specialty and more).

Cleveland’s Case Western Reserve University School of Medicine, for example, uses the MGMA surveys extensively. According to Family Medicine & Community Health Department Chairman George Kikano, M.D., the school and health system use the data to set productivity expectations and to make sure physicians’ salaries remain competitive.

All over the map
Your research will quickly reveal great differences in compensation between different regions of the United States.

This year’s Medscape survey showed average annual salaries (for allspecialties) ranging from $204,000 in the Northeast to $234,000 in the upper Midwest.

Figure out where you want to live and work before setting your compensation expectations, suggests Aaron Lear, M.D., a family and sports medicine specialist at Akron General Sports Medicine in Ohio.

Aaron Lear, M.D., a family and sports medicine specialist at Akron General Sports Medicine in Ohio, recommends that graduates figure out where they’d like to work and live first. Then they can adjust their expectations according to location. “Busy urban and suburban markets generally have a good supply of candidates–so their pay rates will usually be lower,” he says.

Package components
Many surveys only provide data on direct compensation: salary and bonuses. Indirect or deferred compensation varies considerably, and typically includes insurance (health, malpractice, disability) and retirement plan contributions.

Study how each recruiting practice plans to pay you. Ask fundamental questions like: “How will my salary and bonuses be calculated?” and “How much can I reasonably expect to earn?”

Typical compensation today includes a base salary plus some kind of performance bonus. The base salary portion is especially important in the early years, because it provides your income floor while you build your practice.

Determine if the base meets your own minimal requirements, and get answers to the following questions:

• How did the organization set the amount? Did it use acceptable survey data? Is the number based on median figures, or did the practice set the base low in order to incentivize your production?

• Does your base salary rise or fall over time? Practices emphasizing fixed salaries usually increase the base as you gain seniority. But these days, more practices‹including hospitals and health systems employing physicians‹actually taper the base salary over time. This makes the physician more and more reliant on productivity pay. Many groups eliminate the base in year two or three, resulting in a pure productivity compensation plan.

• How will the practice fund your salary until your production grows enough to cover it? Is it relying on a hospital guarantee? Physician career coach Jack Valancy says, “I’m not a big fan of hospital guarantees for physicians recruited to private practices.”

Compliance with federal laws require hospitals to treat income guarantees as loans to doctors they don’t directly employ.

A first- or second-year guarantee “loan” may be forgiven over time (three to five years) as long as the physician remains on staff at the hospital. In other words, if it turns out that you can’t produce enough revenue to cover your personal income, you might personally owe the hospital some big bucks (Valancy says $300,000 is not unusual). And if you decide you want to leave the area before the forgiveness period is complete, you’ll have to pay it back.

“Despite these risks, should the physician feel strongly about the opportunity, he or she should perform due diligence to assess how his or her practice might develop, estimate the loan balance at the end of the guarantee period, and anticipate whether he or she can maintain, if not increase, compensation,” Valancy says. “This requires a degree of financial disclosure that is typically absent from such arrangements.”

When is enough…enough?
It’s absolutely critical that you find out what the practice expects of you in terms of minimum productivity levels. What do you have to do to earn the base salary? At what level does the productivity bonus kick in?
Valancy advises job candidates to make sure that the expected productivity and the base salary are in sync.

For example, if the base salary is based on the 25th percentile level reported in the MGMA survey, make sure the minimum required productivity is also at the 25th percentile. If your productivity bonus doesn’t start until you rise above, say, the median level, you will in effect get nothing for your output between the 25th percentile and the median.

Understanding how a recruiting practice calculates physician bonuses can be far more confusing than its base-salary standards. While you¹ll see a lot of different ways to do the math, productivity bonuses are designed to award physicians a share of the revenue they generated by treating patients. To find out what your share will be and how you can earn it, ask:

• How does the practice measure productivity? Few practices today use gross charges as the measure, because there is hardly any connection between what you charge for a service and what you can collect for it. The emerging standard is total work RVUs. RVUs are more objective than net collected fees, because different sources pay different amounts for the same service.

• How does the practice convert physicians’ work output into compensation?
If, for example, your new employer awards a quarterly bonus based on your RVU production, how much money will you receive per RVU? If the practice doesn’t have a set dollar/RVU rate, ask to see historical data–what was the average for the past year?

• What percentage of your total direct compensation depends on productivity, and how will that change after your initial term of employment?
Related: How can you calculate your worth as a physician? ow.ly/dge7o

Getting paid for other things
Find out if any of the salary is based on hours worked. Ask whether you get paid for night and weekend call duty, or whether the group simply participates equally. A departure from years past, an increasing number of practices offer opportunities to take pay reductions for more time off, or increased pay for more clinic or on-call time.

Ask whether the practice offers financial incentives for other measures besides productivity. Most physician employers have started incorporating quality measures in their compensation plans. An increasing number of practices conduct patient-satisfaction surveys and award cash bonuses to physicians for good ratings. Doctors in some practices receive additional compensation for so-called “good citizenship”: participation in administrative duties, marketing and public relations, and other time-consuming activities.

Fringe benefits
You can expect some fairly standard fringe benefits, too. Health insurance may include family coverage‹but you may be responsible for the additional premiums to cover dependent family members. Most practices offer participation in a retirement plan–usually optimized for physicians to defer the maximum allowed in pre-tax contributions.

Practices sometimes offer better-than-average disability benefits, but doctors typically supplement the company-offered plan with a personal policy to protect their high earning potential. You can expect a professional development allowance, too. Practices usually allow time off for CME events along with a financial allowance to pay for associated costs (like tuition, travel, subscriptions and membership dues).

Time off can vary considerably between practices. In a pure (non-production-based) salary position, you can expect a set limit for paid time off (vacation, sick days and personal days). But groups that pay on a purely production basis may allow more generous time off–after all, you will pay for it with reduced productivity pay.

Case Western’s Kikano says, “I hardly track time off anymore–if our physicians are meeting productivity goals and service standards, what difference does it make if they take a few more days off for vacation or CME?”

Upfront money
Depending on the competition for your chosen specialty, you might see some generous upfront incentives from practices hoping to attract you to their opportunities.

Signing bonuses have become a fairly standard recruitment strategy Payment schedules can vary, too. They might write one big check when you sign on the dotted line, or pay part of the bonus at signature and the rest after you start working.

Still others agree to monthly stipends for second- and third-year residents who have an employment agreement well before graduation.

New graduates entering the job market today feel oppressed by the sizeable student-loan debt they have accumulated while in school. Recruiting organizations sometimes offer to repay the loans as incentives to accept a position.

Most practices provide some kind of moving allowance‹about $10,000 on average.

Watch for…
Medical practice brings its own unique set of issues to be cautious about. New recruits should pay attention to issues such as:

• Malpractice tail. Make sure you understand how your malpractice premiums will be paid. It’s especially important to understand what will happen if you leave the practice. Even if you quit medicine altogether or leave the state, a patient can bring a claim against you later. Most states have a three-year statute of limitations with even longer periods in pediatric cases. Typical “claims-made” policies don’t cover you after you leave the practice and cancel the policy, so insurers offer an optional extended reporting endorsement, commonly called “tail coverage.” Tail coverage for the three years can cost up to two-and-a-half or three times your last annual premium. If you leave the practice, who is going to pick up that hefty tab? Some doctors feel trapped in their situations because they would be personally responsible for their own tail premium–and that could easily top $200,000 in some situations!

• Signing incentives. When you look at those tantalizing incentives like signing bonuses and generous upfront offers, always consider the downside.

Sometimes you have to think like a lawyer and ask, “What’s the worst that could happen?” Make sure you know what happens if you accept upfront money but things don’t work out as planned. There’s a reason they refer to such generosity as “golden handcuffs.” Valancy suggests taking a look at the upfront money being offered and asking the practice to reduce some of those amounts and add it to your base salary. If you don’t need thousands of dollars to get started, you’ll find more value in the long run by setting your salary’s starting point at a higher level.

• Ownership track. If you’re joining a physician-owned practice, spend extra time understanding how you can become a partner or shareholder in the group. Some practices still offer a reduced income for the first few years in exchange for a lower buy-in down the road.

But what happens if you don’t end up as a partner? You might be better off to take more salary now and start saving for the larger buy-in price down the road. At least that way you’ll still have those funds if you decide not to stay and join the shareholders.

Sage advice
Lear tells about a graduating fellow who had big plans to work in a busy, urban practice somewhere. During his search, however, the fellow became aware of an opportunity in a more rural setting. When they showed considerable interest in recruiting him, he proposed an “outrageous” salary–at least 50 percent higher than other places he had visited.

During the compensation negotiations, he decided to keep pushing‹almost daring the recruiting practice to bail out. But they kept saying “yes,” and he ended up modifying his definition of the “ideal” practice in exchange for a four-day workweek and a very generous income. Clearly, the trade-off was worth it to him.
Lear still cautions job-seeking residents to keep lifestyle preferences and professional satisfaction at the top of your priorities.

And Kikano, who has participated in countless recruiting efforts through the years, advises new doctors not to make money the centerpiece of negotiations.

Finding a candidate who fits well with the culture is much more important. “Who cares how much money you make,” he asks, “if you don’t like what you do?”

Timothy W. Boden (TBoden@aol.com), CMPE is an experienced author and editor, a certified member of the American College of Medical Practice Executives and more. Read more about our contributors on page 12.

Job offers are a little like snowflakes: No two are alike. Dozens of factors affect job requirements, salaries and benefits packages. You have to go deeper to gain a more realistic picture.

It’s absolutely critical that you find out what the practice expects of you in terms of minimum productivity levels. What do you have to do to earn the base salary? At what level does the productivity bonus kick in?

Major Physician Compensation Methods

For all the technical language, physician compensation schemes are usually built with the following components. While some plans use a single component (flat salary, for instance), most employers use a combination of two or more. Here are the major methods:

€ Salary based: A set amount paid per work period (weeks, months, years).

€ Productivity based: A variable amount paid based on the physician’s work output (measured in RVUs, collected revenues, patient visits, charges).
€ Profit based: A variable amount paid based on the physician’s share of net profits (revenue minus expenses).
€ Performance based: A variable amount paid for the physician meeting predefined goals (quality measures, patient satisfaction scores, quotas, hours).



Comparing reform plans

By Jeff Atkinson | Fall 2012 | Reform Recap


One of the biggest differences between Mitt Romney’s and Barack Obama’s health policies is who is responsible for making available health insurance coverage. Mitt Romney would place primary reliance on state governments and the private sector. Barack Obama would rely more on the federal government.

Romney’s plan, according to his website, “will begin by returning states to their proper place in charge of regulating local insurance markets and caring for the poor, uninsured and chronically ill.” He says on his first day in office, he will issue an executive order issuing waivers to all 50 states allowing them to develop their own health plans (including Medicaid) without most of the regulations that are currently set by the Obama administration. Romney also would ask Congress to repeal the Patient Protection and Affordable Care Act.

Fewer regulations under Romney

Under the Romney approach, there would be fewer federal regulations regarding how state Medicaid programs and private health insurance plans would operate. States would receive block grants with reduced restrictions on how money is spent. For covering persons who are difficult to insure, Romney favors high-risk pools and reinsurance. In addition, small businesses and individuals would be encouraged to form purchasing pools.

Medicare also would change under Romney as he seeks to have seniors obtain more of their health insurance coverage from the private market rather than from government-run Medicare. Under his plan, seniors would receive a “defined contribution or premium support” from which they could buy health care coverage from Medicare or from the private sector. Although Romney favors less regulation of insurance, he would require private insurance plans that offer alternatives to Medicare to provide coverage comparable to Medicare.

The amount of the contribution or support for health coverage for seniors has not been announced. According to the Romney campaign, “Lower income seniors will receive more generous support to ensure that they can afford coverage; wealthier seniors will receive less support.”

Perhaps to avoid scaring current Medicare beneficiaries or those soon to be eligible for Medicare, the campaign says: “This plan has no effect on current seniors or those nearing retirement. It will go into effect for younger Americans when they reach retirement in the future.”

Romney maintains that “a competitive, market-oriented system” is the best way to deliver health care and that private insurers competing with each other will promote quality and hold down costs. To that end, Romney would allow insurance plans to be purchased across state lines.

Obama standing on his record

President Obama is quite willing to stand on his record. The “health care” portion of the Obama-Biden website leads off with a statement that the Affordable Care Act will “restore health care as a basic cornerstone of middle-class security in America.”

The Obama campaign cites the changes that are taking place, including: providing coverage for 34 million Americans without insurance; ending discrimination based on preexisting conditions; allowing young adults to stay on their parents’ insurance policies until they turn age 26; providing more preventive services to Medicare beneficiaries and persons covered by private insurance; closing the Medicare “doughnut hole” on payments for prescription drugs; and ending lifetime limits on insurance coverage.

Obama says the Affordable Care Act will reduce the federal deficit by $127 billion between 2012 and 2021. He also noted that the Affordable Care Act requires insurance companies to spend 80 percent of premiums on health care (instead of overhead, marketing and profits). Insurance companies that do not meet that criteria will have to pay rebates to consumers.

When President Obama seeks to provide more uniform health care rights for Americans, the vehicle for that is federal law and regulation.

Areas of agreement

Although Mitt Romney and President Obama differ significantly on their methods of achieving health care reform, they do share some approaches.

Prevention of discrimination on the basis of preexisting conditions
Both candidates favor laws that would prevent insurance companies from discriminating against individuals seeking health insurance on the basis of preexisting conditions. Romney emphasizes that the protection should apply to persons who have maintained continuous coverage.


If a person changes jobs, they should be able to maintain their insurance.

Quality measures

To help promote quality and informed choice, both Romney and Obama favor obtaining and disseminating information about the quality of service by health care providers and insurance companies.

Information technology

Both candidates also support increased use of information technology to promote efficiency in the health care system.

Alternatives to fee-for-service

Both candidates recognize the need to control costs and promote quality by developing alternatives to fee-for-service. Such options would include bundling payments to a group of providers for a single episode of care and higher payments to providers for better
quality care.

Medical malpractice reform

Obama and Romney favor medical malpractice reform, including using non-litigation alternatives to dispute resolution. In addition, Romney emphasizes placing caps on non-economic damages. Obama places more emphasis on providing immunity to providers if they follow recognized guidelines.

The presidential election will set the path for future health care reforms—with the alternative paths being continuation and expansion of the federal government’s involvement in health care versus curtailment of the federal government’s involvement and more reliance on states and private insurance. In either case, the makeup of Congress also will affect the pace of future reforms.

For more information about the health care policies of the candidates from their websites, see:
• Barack Obama
• Mitt Romney
mittromney.com/issues/health-care (Health care)
mittromney.com/issues/medicare (Medicare)

Jeff Atkinson (JAtkin747@aol.com) teaches health care law at DePaul University College of Law in Chicago.



PracticeLink Magazine Crossword—Fall 2012

Fall 2012


Take a break from job searching with this crossword, appearing in the Fall 2012 issue of PracticeLink Magazine.

Stuck on a clue? Many of the answers can be found in the content of PracticeLink Magazine’s Spring issue, accessible through our free app or digital edition.



    1  It’s been streamlined under new CMS and DHHS revised regulations

    8  Atomic number 38

    9  Abbreviation for one delivery method for electronic health systems

  12  Metallic element used in lasers

  13  _____ levels: factors to check in due diligence on an IT vendor

  14  Main idea

  16  From head __ toe

  17  Audi-visual, for short

  18  Make sense

  19  Acronym for the Act relating to health information technology

  22  ____ item on a spreadsheet

  23  Polite form of address to the boss

  25  Act which laid down rules for pension plans

  27  Common item in patient waiting rooms

  28  Makes money (3 words)

  31  Harden in place, as of a bone

  32  Small ball, medically

  35  Many physicians and practices are moving to implement these electronic systems, abbr.

  37  Musical note

  40  So far

  42  52, in Roman numbers

  43  Check alma mater connections here for leads in areas you want to work (2 words)

  45  DHSS plans to establish ____ health plan identifiers of a standard length and format for each health plan

  46  Brain enclosures

  48  Ear part

  49  Practice of sterilizing



    1  Career summaries

    2  Web based communications, useful in job searches

    3  Room that was the basis for a TV show

    4  Word processing feature

    5  Another category of staff memberships for non-physicians, _____ memberships, proposed by CMS

    6  Innovative

    7  _____ative medicine

    8  CAT, for one

  10  Datum on a patient’s form

  11  ___ card, for short

  15  By way of, informally

  16  To the point

  18  Slang for intestines

  20  Not relaxed

  21  Bluetooth profile enabling headphones and headsets to be used with bluetooth devices

  24  Tech related

  26  Accounts receivable

  29  Reminders that may be a vital part of a job search (2 words)

  30  It often clinches a job offer even when a practice is not actively recruiting

  32  Health club facility

  33  French the

  34  Out of the ordinary

  36  Evaluations often offered by websites on physicians and their practices

  38  Ventilate

  39  Raises, rates for example

  41  Unit of radioactive activity

  44  Surgeon’s assistant

  45  Prestigious California University

  47  Language of 43 across


>>Click here for the answer key.