Medical school provides robust training in the science of medicine, although its curriculum is notably short on instruction about the differences between practice settings and employers, which can leave some physicians transitioning to practice—as well as doctors making a change mid-career or later—in the dark. Knowing how to assess a practice opportunity is vital to physicians’ professional satisfaction. It’s also crucial to patients’ health and safety.
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 three cover accepting the process for what it is, understanding the vision of the organization and making sure there is a defined need for your specialty in the service area.
Step four in the process is just as important: making sure there are adequate resources for you to establish a practice.
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.
Ensure it’s right for everyday use
“If the groundwork for your recruitment has been laid properly, resources should be in place or pending that will allow you to establish your practice,” the guide notes. It then recommends evaluating each opportunity on the following points.
Find out where your office will be located, whether it’s clean and attractive, and if it has adequate space, competent staff and the equipment you need.
“One common question is: Will you have a dedicated office space or will it be shared?” said Leah Grant, president of the AMN Healthcare Physician Solutions division. “But it doesn’t end there. You also have to ask: When was the last time it was renovated? And are there dedicated wait areas for your specialty, or is there a shared wait area?”
Anne Michael Langguth, MD, a pediatric and adult ophthalmologist, has had to evaluate two practice opportunities since she completed her fellowship, in 2019. Before joining an academic health system in Chicago, she had worked in a private practice in Cedar Rapids, Iowa.
“The employer might say, for example, that they want to bring in pediatric ophthalmology, but they haven't really thought through what that might mean,” Dr. Langguth said. “What if there are crayon marks on the walls? They might also have overlooked logistical details, including how tall the chair is that you're doing your examination with. Those sorts of things all need to be worked out.”
In addition to evaluating the physical space and staffing, the guide advises to determine what plans the practice has to include telemedicine as a service offering.
If there is limited access to the technology you need, ask if funding is set aside for purchasing what you need.
“Say you’re a dermatologist and you need certain equipment to grow your practice,” Grant advised, “you’ll want to ask: What equipment do you currently have? How up-to-date is it? And if the practice doesn’t have what you need: How do we go about obtaining that?”
If the position is not with a major teaching program or a tertiary care center, understand the state of the practice’s equipment.
The guide notes that it might not be crucial in such a practice for all the equipment to be state of the art, but “that’s a really interesting thing to ask about because it will let you know how much is being reinvested back into the practice that you're considering,” Grant said.
What’s more important, the guide advises, is “to know how your patients can be referred to subspecialists and the most contemporary diagnostics when necessary.”
Emphasize empathy
As far as dealing with the discomfort that might come with inquiring along all these lines, Dr. Langguth recommends keeping in mind that the job is one you’ll have to live with for years.
“This is where the in-person visit to the locations is so important,” she said. “It might seem like you're just walking through another OR. Well, it's much more than that, because when you're walking through the OR, you're meeting the OR coordinator, you're meeting the surgical technicians, you're getting a sense of if they're familiar with the procedures you perform.
“Similarly, when you’re in an interview, it's about more than just meeting your physician partners. The moment you walk into a new practice, you're greeted by someone. Well, is that someone you enjoy being greeted by? Is that someone you feel you could establish a trusting relationship with? How we practice medicine is about much more than the four walls. It really comes down to the human element.”
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, the Annotated Model Physician-Group Practice Employment Agreement (PDF).
Learn more with the AMA about understanding physician employment contracts.
