Health care delivery is undergoing profound changes, and this process presents new challenges to physicians seeking employment—especially those transitioning to practice, who often are inundated by job offers. According to the most recent survey by AMN Healthcare Physician Solutions, a major health care recruiter, 56% of final-year residents said they had received 100 or more job solicitations.
A guide (login required) published by AMN Healthcare Physician Solutions, formerly known as Merritt Hawkins, explores how to assess a medical practice opportunity through eight essential steps.
The first step is simply to accept the process for what it is. But the second is just as important: “Understand the vision of the group, hospital or health system.”
You can learn more with a separate AMA STEPS Forward® toolkit, “What to Look for in Your First or Next Practice: Evaluate the Practice Environment to Match Your Priorities.” It is enduring material and designated by the AMA for a maximum of 0.5 AMA PRA Category 1 Credit™.
The toolkit is part of the AMA Ed Hub™, an online learning platform that brings together high-quality CME, maintenance of certification, and educational content from trusted sources, all in one place—with activities relevant to you, automated credit tracking, and reporting for some states and specialty boards.
Learn more about AMA CME accreditation.
A vision is a test of values
“Understanding the vision of the group, hospital or health system is critical because—as we learned from the COVID-19 experience—the overall plan is what matters most,” said Leah Grant, president of the AMN Healthcare Physician Solutions division. “A resident or fellow needs to understand that leadership stability can speak volumes about the type of situation that they’re walking into.”
The guide suggests evaluating an organization’s overall plan by asking these questions in seven key areas.
Do they intend to designate as an ACO or medical home? If so, what is the plan for physician integration, quality measures, cost containment and payment distribution?
Much of this is based on your specialty, Grant said. “A lot of this you will probably learn as you go through your interview process instead of on the front end,” she said.
Are there key physician leaders within the hospital or health system advocating the physicians’ point of view? If so, who are they and what are their priorities?
“This is critical,” Grant said. “As a physician, you want to be heard. For example, what if there's a new piece of equipment coming in? What if that requires having additional medical assistants or other support staff members?”
What are the plans for integrated EHR?
For starters, you need to know if you've already worked on the system they are using. “Understanding what it is—is it hospital owned or is it practice owned—will tell you if it’s going to be completely new to you. It will also tell you a lot about how smoothly things will go once you join the practice,” Grant said.
Are there ongoing negotiations with major payers within the state?
You want to understand: Who is the organization speaking to and what are the key pieces that might change? Will my contract change if you were to move forward with integration or negotiation with other major payers?
Are there plans for practice mergers or integration with larger entities?
More specifically, Grant noted: How is this going to impact me? Will it add support? Will my contract change? Will there be any adjustments to compensation? “Those answers will let you know if they're in a revamp stage, which will then help you understand the depth and details you need to get into.”
Where does the practice stand in the shifting continuum between traditional, fee-for-service practice and the integrated model with its associated quality and cost effectiveness metrics?
This can constantly shift as organizations look at cost-effectiveness and quality measures, especially when evaluating providers, Grant said. “So what is the priority? Are you seeing 30 patients a day or is it more about quality of service where you might have a lower patient volume? Understanding if a group is looking at shifting into that is critical.”
How is the practice responding to payment changes being implemented by CMS, the ACA and the Medicare Access and CHIP Reauthorization Act (MACRA)?”
“That all goes to what counts as compensation,” Grant said. “It’s not necessarily something that you need to assess on the front end as a potential deal breaker, but it’s good to know.”
The AMA has assembled a variety of resources to help physicians flourish in the employment setting. They include the AMA Physicians’ Guide to Hospital Employment Contracts (PDF), free for AMA members, and the Annotated Model Physician-Group Practice Employment Agreement (PDF).
Learn more with the AMA about understanding physician employment contracts.
