Part 2: Multi-Specialty Practice Perfect

Jarrod Shapiro, DPM PRESENT Practice Perfect Editor Mountain View Medical & Surgical Associates, Madras, Oregon

I received this letter in response to our last Practice Perfect issue:

I find your recent topic (Podiatry and multi-specialty groups) perfectly timed. I have recently been approached by a large group in my community looking to add a podiatrist. Currently I have a solo practice which I opened following residency in '06. I'm interested to know what you have seen as positives and negatives of the multi-specialty approach and, more importantly, what questions I should be asking before committing (and leaving my solo practice behind). Specifically any suggestions on contract negotiations or structure would be greatly appreciated.

—Anonymous

	Today's Premier Lecture is on Hypermelanotic and Melanocytic Proliferative Lesions of the Leg and Foot, Part 1 presented by Terrence Harrist, MD.

I think our colleague’s questions refer to the most significant issues involved in deciding what type of practice in which to enter.  This question has importance not only for those of us already in practice but also for our resident and student colleagues.  I invite any of our readers to submit their answers to the above questions.  Your leadership is requested!  The more discussion and advice we can provide the better. 

Let's attack this issue in three parts: advantages of multi-specialty practice, disadvantages, and discussion points when negotiating for a multi-specialty practice position. 

Advantages of Multi-Specialty Practice

1. Established large patient base – providers commonly refer to each other within the practice.  This is a marketing benefit.
2. More time to focus on patients and less on “business”.  This may or may or may not be an advantage.  If you enjoy practice management you may consider this a loss of overall control.
3. Organized practice structure with management staff to handle the daily minutia of practice.
4. A larger umbrella organization to absorb expenses such as health and malpractice insurance, rent, equipment, staff, etc.  I. E. deeper pockets.
5. Collegiality – see Practice Perfect 153.
6. Comprehensive benefits package – larger organizations are capable of offering more complex packages.

Disadvantages of multi-specialty practice

1. Loss of control – probably the largest single disadvantage of multi-specialty practice.  You leave the management of the practice up to someone else.
2. Staff reeducation – unless the practice has employed a podiatrist in the past the staff will require training beyond the typical new doctor situation.  This will require a constant effort on the doctor’s part.
3. Potentially lower long term income – this point is debatable.  I was once told the base salary of multi-specialty practices is initially higher than an associateship but maxes out at a lower long term level.  I’m not sure if this is true; it depends on the specific circumstances.  For example, my contract has a “base + productivity bonus.”  When my practice makes money I make a potentially large bonus. 

Negotiating points – much the same for any organization in which you are not the boss. 

1. What is my salary?  They should be able to tell you this without ambiguity.  Be cautious whenever someone says, “Don’t worry, you’re going to make a lot of money here.” 
2. What is the bonus structure? This should also be clear.  Ask if anyone has ever actually received a bonus.  Remember, you’re looking for red flags that would make your employment unsatisfying (whether personally, professionally, or monetarily).
3. How much autonomy do I have?  Will you be able to treat your patients as you feel appropriate?  Will you have some say in the specific products you dispense and treatments you perform?  For example, will the practice purchase skin substitutes like Apligraf and Dermagraft if you need them?
4. What are my benefits?  Here’s an noninclusive list of benefits: 401K/retirement package, mileage reimbursement, company car, cell phone/pager, CME money, paid vacation time, sick leave, personal days, malpractice coverage, tail coverage (protects you if you leave the practice), health insurance (for doctor and family), professional journals, professional society dues, state association dues, state licensing fees.
5. How many patients will I see?  You know (or you’ll learn) how many patients per day you can see and continue to provide high level care.  Will they overwork you or will you be bored?  If there’s another podiatrist or orthopedist you’ll need to establish scope of practice and new patient distribution methods.  It has to be fair to all involved.
6. What marketing plan do you have for me? This is important for all doctors.  How are they going to let the community know you exist and you’re the best at what you do?
7. What is the practice history?  How stable has it been over the years?  Are the financials in order?  Have they had a podiatrist before?  What is the relationship between the doctors?  Is there currently an orthopedist or other podiatrist?  If so you must speak with them. 
8. What is the physician retention rate?  If there has been a high turnover then why?  Can I speak with some of the physicians who have left?  This is about work environment.
9. Can I meet the current physicians?  For the obvious reasons.
10. What is the overall practice/town environment?  Does the practice have a respected and respectful relationship with the town you’ll be practicing in?  Will you be able to live in this new place?

Now its your turn... Join in on any of the eTalk Topics taking place on PRESENT Podiatry, or create one of your own.

Keep writing in with your thoughts and comments or visit eTalk on PRESENT Podiatry and start or get in on the discussion. We'll see you next week. Best wishes!

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

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