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Finding a Job Step 5: Settling in | |||||
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Being a new physician in a hospital or a group practice is a lot like being the new kid on the block: It's never easy, no matter how talented and self-assured you are. You need to acclimate yourself to another place and different ways of doing things, learn the rules, and build trust. Chances are your ideas about how things might be improved won't be welcome—at least, not at first. So keep them to yourself for a while. This is a time for listening, gathering information, developing a patient base, and, perhaps, settling into a new community. In this fifth installment of our six-part series on finding a job, we'll tell you how to increase your prospects of succeeding in a new job—and what to do if things aren't working out. You'll need to fit in "As a new associate, it's up to you to adapt to a practice's culture, not the other way around," says Jack Valancy, a practice management consultant in Cleveland Heights, OH. Find out how the physicians and staff communicate with each other. What are the practice's daily routines? Weekly ones? If you're fortunate, a manager or other veteran will help you settle in. Even if that doesn't happen, you can learn the drill on your own. As you're introduced to the practice's clerical staff, ask about the basics, including coding, billing, and encounter forms. Be sure to take notes for future reference. If you're not sure how to fill out a form or craft a document, ask for an example you can keep in your files. Find out how the practice handles referrals and consults, and if you haven't already met the physicians to whom you'll be referring patients, arrange to do that. Your contract will probably address practice building and call schedules in a general way. Once you're on the job, you'll need to learn the specifics. Practice building. "It's common for the new physician to be assigned patients who call for an appointment and don't request a specific physician," says Valancy. "Dr. New is also first in line to handle patient overflow—that is, treat patients who want to be seen immediately but whose regular physician is unavailable." "Ask the patient's regular physician if he wants you to treat the patient only for that particular episode, or if you should also see the patient for follow-up," says Judy Bee, a practice management consultant in La Jolla, CA. Tread carefully; you don't want to be accused of stealing patients. If another physician's patient asks you to take over his care, Bee recommends the following response: "I'll be happy to be your doctor, but you're Dr. Smith's patient. Anything you work out with him is fine with me." If the patient is uncomfortable doing that, you can discuss the matter with Dr. Smith directly. Regardless of whether the other physicians will cede patients to you, you'll probably be expected to draw new patients to the practice. When internist Geralyn M. Ponzio joined her father's practice in Bloomfield, NJ, several established patients gravitated to her, especially those who wanted a female physician to do their Pap tests and pelvic exams. To attract other patients, Ponzio made house calls, distributed business cards at assisted living facilities, gave talks at schools and senior centers, and handed out cards to friends, family, and specialists. "Practice building can be as simple as telling patients, 'Thank you for coming. I'm new in the community. Please tell your friends that I'll be happy to see them,' " says Jack Valancy. To be more accessible to new patients, you may want to work nontraditional hours, such as Monday and Friday evenings, says Bee. She also recommends working when the established physicians take the day off. Internist Mike Honan of Pekin, IL, urges new physicians to arrive at work 15 to 20 minutes earlier than expected for the first few months. "You'll get a reputation for being earnest, enthusiastic, and a hard worker," he says, "and this reputation will go a long way toward helping you build your practice." For additional information on reaching out to patients, see "Starting a Practice: The final steps ," Sept. 3, 2004 and "Lead patients to your door," July 26, 2002. Call. Find out as much as you can about the logistics of call scheduling, says Valancy. How often will you be expected to take call? How should you identify yourself to another physician's patient? How do you get the patient's history? Are you free to modify therapy, or do you need to check with the regular physician? Under what circumstances does the physician want to be notified? Does the practice pay physicians who take extra call? How are call encounters documented? Putting your stamp on the practice In her first job since graduating from med school, Geralyn Ponzio has re-engineered the office to a new standard. "I've set up EMR templates so that the system produces more useful, succinct notes and reduces our transcription costs," she says. "At my urging, we've added CLIA-waived lab tests, nutritional supplements and alternative medications, in-house ultrasound and echocardiograms, and brought in a physical therapist and a dietitian." But Ponzio's experience is atypical; her ideas were welcome because the head physician is her father. Most new recruits need to wait a bit before pressing for change. "If a practice has been doing something a certain way for a while, there's probably a reason," Valancy points out. "Don't try to change things until you understand how they currently work, as well as how and why they got to that state."
If you can afford to hire your own consultants, they can help you organize your part of the practice and present ideas to your associates. After GP Liza Shiff joined a San Jose, CA, practice, she hired an ethics attorney to advise her on charting, documentation, difficult patient encounters, and other issues where she felt she was on shaky ground. "I also hired my own accountant so that I could explain my profits and overhead to the head physician without sounding silly or confrontational," she says. What if it's not working out? No amount of research and forethought can ensure that a job will meet your expectations. If you suspect that you've made a mistake, don't act hastily, says consultant Jack Valancy. First, identify what's bothering you. Do you or your spouse dislike the community? Are you personally or clinically incompatible with your colleagues? Do you feel overworked? Underworked? Is it the wrong kind of work? Are you getting more than a reasonable share of call or otherwise being treated unfairly? Has the practice failed to assign enough support staff to you? Are you having difficulty getting feedback from the other physicians? "We're all praise junkies," Valancy says. "We like to hear that we're doing a good job." Talk with your mentor or the head of the practice about why you're unhappy, Valancy advises. He might be willing to make changes to accommodate you. Or perhaps he'll ask a consultant or attorney to act as mediator to resolve the situation. If not, at least you'll know that leaving is your best option. If the situation is tolerable, stick it out until the end of your employment term, Valancy notes. And no matter how unhappy you are, do your best. This will smooth the way toward an amicable departure and reduce the possibility that potential employers will get an earful when they call for an employment reference. Another reason to stay put until the employment contract expires is that, although one quick turnover probably won't be held against you, you don't want your CV to be dotted with transitory jobs and hard-to-explain gaps. Cutting your losses might be especially difficult if your contract contains a restrictive covenant. However, some contracts include language specifying that if you and the practice part company within the first 120 or 180 days of employment, the restrictive covenant won't be enforced, says Geoffrey T. Anders, an attorney and consultant with The Health Care Group in Plymouth Meeting, PA. "A physician who leaves a practice after a short time and sets up shop nearby probably isn't going to have an unfair competitive advantage," Anders notes. Even if your contract doesn't contain such language, the practice is unlikely to enforce a restrictive covenant if you leave before the ink on the contract is dry, Anders adds. If you move on after a year or so, the practice may let you buy your way out of the covenant. The buyout fee will probably be based on expenses related to your recruitment and integration into the practice. Most contracts contain a no-cause termination provision that you can exercise by giving the requisite notice—usually 60 or 90 days, says Anders. If you leave without giving notice, you're in breach of your contract and the practice can sue you for damages. To stave off legal action, and to find out what your rights are under the employment agreement, consult with a healthcare attorney. In most cases, a practice is unlikely to put roadblocks in your way if you want to extricate yourself from a regrettable employment situation. "If you're unhappy with the practice, they're probably unhappy with you," Valancy notes. Even if you're delighted with your new job, it's important to maintain a good network of contacts. After all, jobs can be unpredictable. Thank everyone who helped you land this position, be sure to maintain old contacts while you add new ones, and keep your CV up to date. That way, if your current job sours, or if an even better opportunity comes along, you'll be ready.
Part 6 of this series, in our March 4 issue, will look at how to return to practice after a hiatus. |
