Finding a Job in 5 Steps: Practice Setting Matters

This post is the second of a 6-part series where I explain the method I used to find a job after my interventional cardiology fellowship. To read the first post, please click here. As a refresher, here are the 5 steps:

1) Decide on your preferred practice setting

2) Prioritize the core factors which are important to you

3) Familiarize yourself with the different practice models

4) Understand the physician contract

5) Commit

The two general practice pathways for physicians today are academia and private practice, and although the line separating them has become less distinct, large differences still exist. In this post I will focus more on the private practice setting, since the path to academia starts early in our training career and thus is more familiar to us.

Most interventional cardiologists in private practice will spend 70%-80% of their time practicing general cardiology with few hours left to practice interventional cardiology. It is important to have realistic expectations and to identify a practice that is in line with these expectations. Additionally, the amount of time spent in clinic will not only establish continuity with your patients, but it will also help build your practice by establishing a good reputation in the community and financially boosting the bottom line. Procedures take time and the reimbursements for them have declined; as a result, most practices today rely heavily on clinic-generated business for success.

Furthermore, when you first join a practice you are given a guaranteed salary for a set amount of time (usually 1-2 years). After that, most groups switch new physicians to some type of a productivity or shared-practice model. Therefore, it is important to build your practice during the beginning of your career when you are “protected” by your guaranteed salary. Taking call is a fundamental component of this process—you will increase your patient volume by exposure and also establish a rapport with physicians who will serve as a referral base for you in the future.

When evaluating a practice, other variables to consider include:

• Payer mix
• Advancement opportunity
• Administrative duties
• Partnership track opportunity
• Benefits/health insurance
• Malpractice coverage
• Coverage radius
• Noncompete policy
• Vacation time
• Relationship with other service lines
• PPO/HMO contract
• Competing practices

Moreover, there are several financial variables that are important to consider when choosing a practice. Obviously, salary and a signing bonus or a loan repayment program are fairly self-explanatory. However, there are certain pros and cons to joining a practice with a partner buy-in option.

There are many positive aspects to becoming a partner, but it is worth considering the costs and other implications associated with taking this step. There is a lot of variability among practices in regards to the partnership track—some may guarantee this opportunity after a set period of time, while others may offer it on a case-by-case basis. The one consistent thing is that it does not come free. Most practices will charge a partnership buy-in that is based on the overall value of the practice. During my interviews, I was told of buy-in values as low as $200,000 to as high as $650,000. Once you become a partner, you not only share the profits of the practice (facility fees, asset returns, etc) but also its overhead. A very efficient practice can run with an overhead as low as 40%, but most have an overhead that ranges from 50%-60%. This is particularly important for a physician who is early in his or her career who may have not yet established the patient volume needed to cover the cost associated withadvancement.

I hope that this information will serve as a foundation for you to build upon and tailor to your own needs when navigating through the job-search process. As always, please feel free to leave a comment below with any tips you learn along the way.