March 27th, 2012

Transitioning from Trainee to Attending? The Business Details

Several Cardiology Fellows who are attending ACC.12 this week are blogging together on CardioExchange.  The Fellows include Tariq AhmadBill CornwellMegan CoylewrightJeremiah Depta, and John Ryan (moderator). Read the previous post here. Read the next one here.

As trainees, we are so preoccupied with learning the fundamentals of cardiology that we have hardly any time to learn, or even think about, the business of medicine. Fortunately, Dr. Justin Matthew Bachmann, chair of the ACC Fellow in Training Center, organized on Monday a great  session on career development to help us gain a better understanding of some critical issues, which we need to be familiar with as soon as we enter the workforce. For example, regarding interviewing and contract negotiations, there are many general things to mull over, like group strengths and interests, key affiliations, electronic medical records and liability claims. Specific considerations include meeting the practice manager and determining whether you agree with how he/she runs the group.

What about the contract length? Terms and termination? Assistance with relocating? Loan repayment assistance? CME allowance? These are important for both the applicant and the employer. According to Susan Childs, founder of Evolution Healthcare Consulting, groups can spend excessive amounts of money on recruiting and relocating new partners, sometimes in excess of $100,000. In light of these numbers, it is critical that the “t”s are crossed, the “i”‘s dotted, and no stone left unturned when determining whether a group is the right fit for you and you are the right fit for the group. Childs explained that job dissatisfaction usually stems from a failure to clearly define terms during contract negotiations; so this issue is critically important when transitioning from fellow to attending physician.

Financial planners were also present and offered counseling for those of us who have accrued exorbitant amounts of debt. According to Michael Merrill, of Finity Group, the average graduate has $180,000 of debt upon entering the workforce. His goal for trainees is  “Become worthless!” — meaning reach the point where you are finally out of the red with a net worth of zero. Some goal! He offered tips to achieve this goal, including meeting with financial planners to establish good money management strategies early, before we “get those contracts” with the big bucks. Merrill explained that all too often he meets with cardiologists who only worsened their debt by making poor decisions with regard to their finances. Early financial planning clearly is another critical piece in the transition from trainee to attending.

Fellows simply don’t have time during their training to consider these issues to any appreciable extent. This was a great opportunity for experts to reinforce important principles, from identifying the right group to negotiating a contract, starting financial planning, and establishing healthy financial habits.

2 Responses to “Transitioning from Trainee to Attending? The Business Details”

  1. David Brogno, Md says:

    I’d like to pose a question to the forum. What makes otherwise smart doctors accept lousy practice positions after finishing fellowship?

    For the seventh time in as many years I have witnessed another young cardiologist having to pick up sticks and move to another state because he made the mistake of signing on to an abusive practice with an egregious restrictive covenant. I’ve been in this community for over 20 years and EVERY other cardiologist around here knows about the history of this particular practice chewing up and spitting out young cardiologists after 2-3 years of abuse. And yet there never seems to be a shortage of eager applicants to fill the vacancies. If these doctors were of marginal quality with limited options I could understand it, but most of them are well-trained, bright, caring individuals. Many of them signed contracts without even consulting an attorney. I often ask them, as they frantically search for new positions, why they signed on in the first place. The usual excuse is that they had no idea of what sort of practice they were getting into.

    So, I don’t get how this happens. Is it that finishing fellows are not taught how to do due diligence before interviewing with a practice? Does the subservience of residency and fellowship make them too timid to inquire as to doctor retention rates or to ask for the names of former associates of the practice? Are they getting bad information from program directors? Do they even call around to ask other cardiologists about the practices they are considering? Are they dazzled by the short-term gain of a nice salary enough to ignore the fact that they have no future in the practice? Are they unable to discern outright, obvious lies?

    I’m a partner in the same practice I joined 20 years ago straight out of fellowship. I was lucky enough to have a program director who steered me away from other, unfair or abusive practices (including the one I mentioned above). My advice:

    1. Before you interview, ask everyone you know if they have heard anything about the practice. You’d be surprised at how small a community cardiology really is.

    2. When you interview, don’t be afraid to ask how many associates have left the practice. If it’s more than a couple in the last 2-3 years, call them up and ask them about the practice.

    3. Unless you are only looking for a short-term position, don’t be dazzled by a high starting salary. Ask yourself what you are going to be getting in 5 years, or if you’re even going to be there in 5 years.

    4. Rather than asking specific questions about the workload (i.e. call schedule, office hours, vacation, etc.) try to find out if the workload is distributed equitably. (You are more likely to get this information from the office manager than one of the doctors.)

    5. If you know nurses in the community ask them about the practice.

    6. Beware of any practice that has one physician with overwhelming dominance over management. Especially beware of any practice where the senior partner’s spouse is involved in management.

    7. Don’t give too much credence to hospital administrators singing the praises of a particular practice. Hospitals and doctors are signing deals left and right. They’re often scratching each other’s backs.

    8. Don’t be afraid to cold-call other cardiologists in the community. If two or more independent sources have nothing nice to say, walk away from the deal. Plus they might turn you onto other better alternatives.

    9. Beware of contracts with overly-convoluted or confusing paths to partnership.

    10. Never, ever, ever, sign a contract before you have shown it to an attorney, preferably one who specializes in health care contracts. No matter what you pay the lawyer it will be more than worth it.

    We’ve been fortunate to hire excellent cardiologists over the years, most of whom are now my partners. At their initial interview I tell them all the same thing: “Ask around about our practice. Ask doctors and nurses and anyone else. If we are good, we don’t mind. And if we are bad, you need to know.” The same can be said of any practice. If you are worried that they won’t “like” you because you are asking these questions, that alone should be a red flag.

    Good luck on your search!

  2. This maybe the most important post I have read in the last few years!