Family Medicine Vital Signs

By Chad Spain, MD

Let’s face it, we can all say in one way or another we miss David Letterman and his Top 10 List.  I was asked to discuss the most important questions to ask when selecting a job.  So, let’s make a top 10 list.  Smooth transition, check.

Coming out of residency I had a basic understanding of what I wanted in my job, in no particular order:

• No OB
• No inpatient hospital call
• A medical group that shared my visions of quality care
• The ability to have a life outside of my clinical duties.

The thing to remember in Primary Care is: you are hot commodities, don’t be afraid to ask all of your important questions to make sure that the group you decide to sign on with is the best fit for you.

10. Administrative Input 

Having the right medical assistant (MA) can take your life from being miserable to a well-oiled machine.  Important things to know regarding your MA:

• How many MAs will work exclusively with you?
• Can you bring an MA with you, or be involved in their hiring process?
• Who is the manager of your MA; are you involved in determining their workload, salary, hours, disciplining them – or is that another person’s job.

Also inquire about other daily functions of your clinic:

• How many clinic rooms will be yours exclusively?
• Will you get an office to yourself where you can go and curse repeatedly after you’ve filled out your 7th FMLA paperwork for the day?
• Who runs the clinic, administratively and functionally?
• How involved in the administrative functions of the clinic are you expected/able/required to be?

9. Scheduling & Call

Your schedule can make or break your life – think about vacations, days off, sick time; what do you want your home life to look like; what do you want your workday to look like?  Remember the time that I had that surprise Disneyland vacation planned for my wife, had everything perfectly in place until the night before when I realized I forgot to hold my clinic schedule?  No?  Well I certainly do.  Having a great staff with policies in place that can account for change can be amazing.

• How many appointments per day are you expected to see?
• Is there flexibility in your appointment lengths?
• How much vacation and sick time are you allowed?
• How far in advance do you need to request vacation time?
• Phone or Hospital Call?
• How often do you get called in, or called?

8.   EMR

Electronic Medical Record Systems are difficult and different from clinic to clinic and hospital system.

• What program/system do they use?
• What is the training like?
• Who supports you if you have questions/issues?
• Will you be able to access charting from home or on the go?
• How will you be expected to write or dictate notes?

7. Compensation

What is your base salary?  Are you salary or production?  If you are production, what if another clinic opens near by and your numbers slow down?

6. Bonuses

More and more healthcare entities are basing pay on quality measures. What does the bonus structure look like?  Is the bonus clinic based (the entire clinic needs to meet the goal) or personal (each physician gets a bonus based off of their own performance)?

5. Opportunities / Requirements

Will you have opportunities to grow outside of your clinical work?  Ask if you are able to teach medical students, join your local medical association activities, lead projects or anything else that your heart desires.  Or maybe you aren’t interested in teaching and that’s a requirement in your clinic.

4. Non-compete clause

Simple enough to remember, but you don’t want to sign that contract if it means your next job has to be 100 miles away.

3. Controlled Substance Policies 

Does the clinic have a policy on controlled substances?  Can you reserve the right to not take on chronic pain management?  Do you have a provider in the clinic who is always out of town but his candy shop patients are always asking you for their 12,000 pill per month script of oxycodone?

2. Why is the position open?  

This is huge.  Is someone retiring (GREAT! Instant patient population)? Are all the other physicians overwhelmed by volume that they need someone else (all the trouble patients get dumped on the new provider)?  Are some of the current providers and/or administrators so difficult to work with that no one new will stay?

1. Work-Life Relationships 

Are the other providers in the group similar in personality to you – and have the similar goals to you?  Maybe you want to be married to work and you don’t care what time you need to get there and when you get to leave.  I assume that most people want to go home and sleep sometimes – being that you chose Family Practice:

• How do they problem solve clinical issues?  Are there big foundation disagreements?
• Do other physicians resist covering other patients?
• How many hours are you expected to be in clinic each day?
• How often are their administrative meetings that you are required to attend?
• Are you encouraged to take vacation or are you expected to go on vacation on weekends and take as little time off as you can?

 

Hopefully these questions help you find the job of your dreams!

Chad Spain is a graduate from the University of Utah Family Medicine Residency program. He is currently working as a Family Medicine Physician.