April 23rd, 2012

How to Avoid a Lousy Practice Position After Fellowship

The following post by a CardioExchange member who did not wish to be identified was originally submitted as a comment to another post. Because the topic is likely to be of significant interest to many in our audience, the editors have decided to publish it as an independent blog post.

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 two to three 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 so dazzled by the short-term gain of a nice salary that they 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 two to three 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 others’ 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 on to 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!

3 Responses to “How to Avoid a Lousy Practice Position After Fellowship”

  1. What a great post! I’m going to make this must reading for our fellows.

    I think some of the blame here falls on the fellowship programs. A recurring theme from our fellows is that while they feel well prepared to pursue an academic job, they do not feel that we prepare them well enough to navigate the practice landscape. We’ve been trying different approaches, including putting the fellows together with cardiologists from the community, some who were formerly our trainees and others with no relationship to us. We’ve done this in both formal and social environments and found the social mixing works better. We’ve made some progress, but are limited by our own gaps in knowledge. Since so few of us have ever negotiated (or even looked for) a practice job, we are ill prepared to mentor in this area. What have other programs done to help fellows find good jobs….and avoid bad ones?

  2. Unbelievable true! …”Especially beware of any practice where the senior partner’s spouse is involved in management.”

  3. Fahim H Jafary, MD, FACC, FSCAI says:

    I suppose an even bigger question is whether fellows should even join a practice given the current environment in the United States, wherein most practices get bought out? Is it not better for them to just seek a hospital employed position ?