In the transition to practice, many young physicians might be unsure what questions to ask prospective employers to ensure their expectations of a job will line up with the reality they face on day one. In fact, not knowing where to start may lead some to avoid asking the tough questions altogether. But one of the most common reasons why physicians don’t stay with a job long term is that their expectations of time commitments were not properly established during the interview process.
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.
Step five in the process covers this very topic. It outlines how to go about ensuring the employer has a clearly written work schedule with patient volume and on-call expectations.
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.
Time may be the most valuable thing
“Physicians seeking a new practice opportunity typically begin the process by asking two questions: Where is the practice located? What is the financial offer?” the guide notes. “These are important questions, but physicians interested in determining if a practice opportunity is right for them and for their families should go much deeper.”
Get tips on your transition to practice
Make your transition from resident to attending physician seamless with expert advice.
The guide recommends focusing on these following points.
Ask what the standard work hours are, as well as how many patients you will be expected to see per day to cover your salary, benefits and overhead.
“There are still a lot of practices that pay based on based on volume, i.e., how many patients you see per hour,” said Leah Grant, president of the AMN Healthcare Physician Solutions division. “However, we're seeing a shift in the market to value-based care, where practices are paying a flat rate for seeing a specific number of patients. You need to understand which situation you’re walking into.”
In addition, Grant encourages interviewees to inquire about the split between administrative work and clinical work.
“If administrative duties are not built in, that's when a 40-hour work week can become a 50- or 60-hour work week,” she said.
Determine what the rotation and ordinary number of encounters per month are in these three on-call categories: outpatient-only practice calls, the practice’s inpatient census and unassigned emergency department calls.
“This piece is probably the most overlooked,” Grant said. “On-call responsibilities, especially for specialties like ob-gyn, can become very strenuous. If you’re on call frequently, that almost becomes a second job. So understanding that on the front end—including if the employer is partnering with any secondary groups, hospitals or private practices to help with that on-call responsibility—is helpful.”
While you might prefer opportunities with little or no on-call responsibilities, understanding frequency versus volume is essential to determining your potential quality of life.
“One in three, for example, can refer to week over week. So you’d be on call one out of every three weeks. However, some groups still very much go day to day,” Grant said. “So make sure: Is it days? Is it weeks? You'll also want to ask: What time does my call start? Is it 7:00 a.m.? Is it 7:00 p.m.? And what time does it end?”
These questions are typically more difficult for newer practices to answer because they often do not have historical data on call rotation.
“But if you can get an understanding of what their patient ratio is or how many patients you will potentially see, that usually will tell you how many calls you'll be taking,” she added. “Many times when you're on call, you’re not just covering your own patients; you’re covering the entire practice’s patients. So that's something that you will also want to dig into.”
Be clear on vacation schedules, and ask whether physicians in the practice typically take their allotted vacation time.
“One thing to ask is: How far in advance does the employer schedule vacations? Also, is it something they do on a quarterly basis, or is it month to month?” Grant said. “Beyond that, be sure to ask: How would you accrue vacation time? Is it automatic? Is CME time accrued in addition to vacation time? Some employers split it up into sick days, paid time off and CME. Having a really clear understanding of this can help you head off burnout.”
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.
