Keith Borglum, CHBC

Q:I am finishing residency in June and have a few job offers to consider. What should I look for besides a competitive salary?

 Most new physicians join a practice without first giving it a thorough "history and physical exam." Asking pertinent questions will help you avoid joining the wrong practice, and knowing your rights in the practice ahead of time will help you and your employer avoid dragging each other to court in the future. 

The most important issue is deciding where to practice and live. You can earn a living anywhere, and it's better to start where you want to end up rather than relocating to another community or state later. Many physicians spend years building a practice in one location, then waste the fruits of the effort when moving closer to family later. 

 Visit a practice for at least a full day so you can give people a chance to show their true selves rather than their "interview personalities."  

 Call the medical director or chief of staff of the hospital where the employer has privileges, and say that you're considering joining the practice. Listen "between the lines" to their answers. To avoid "revolving door" practices, ask around to find out whether other associates came and left before you. 

 Have an accountant or independent medical practice management consultant (find both at 

) perform a practice survey and tell you whether the offer is a good opportunity or whether the practice is going broke. Check the schedule, computer, labs system, hospital and IIPA relationships, medical records, accounting, and everything else to see whether the practice is organized and up-to-date. 

. Are the productivity incentives reasonable, or are they so unrealistic that no newcomer could expect to reach them? Are other associates achieving incentives? 

 Don't just assume that you will be accepted into the managed care plan. See it in writing from the plan itself, particularly in specialty practices. 

What income and other benefits will ownership provide, and at what cost? Get it in writing in advance, including the buy-in price or formula. You don't want to find out later that the owner wants $1 million for the buy-in. 

 What kind of plan is there for you if things don't work out? If you decide after a few months or years that the practice is not for you, can you walk away without major obligations? Is there a non-competition clause that would force you out of town? 

 Who is in charge of the practice, doctors or the owner's spouse? Will you have a voice in how the practice is run? What if you want to bring in electronic medical records, for example? Remember, many times, staff members really run the practice and often know more than the doctors about what is going on, especially in larger groups. 

 Consultant Keith Borglum, CHBC, of Professional Management and Marketing, has been a licensed practice broker, appraiser, author, and management consultant to physicians for more than 25 years, is based in Santa Rosa, California, and practices nationally. Send your practice management questions to 

Articles

Get your questions answered on coding and billing skills, as well as what to consider before taking the job.

Things to consider before accepting a job offer

 I am the new office manager in my husband's practice, but I have no experience in coding. Do you know where I can take a coding class that is only 8 to 10 hours in duration?

Coding versus billing skills

 I feel like I don't have a good grip on the management of my staff. How do I improve that ability?

 You likely will find that two very simple processes common with highly successful practices will significantly improve staff (and practice) management-and your confidence:1) Have a daily 1- to 5-minute "huddle" with your immediate staff every morning before seeing patients. The later you are arriving, the more important the huddle. Immediate staff members include your receptionist, medical assistant, and maybe the biller. Gather around the day's schedule and ask the following questions: 

2) Have a weekly 1-hour meeting with all staff. 

HOW TO REDUCE TRAINING TIME FOR NEW EMPLOYEES

 Whenever we lose a staff person, we have to start all over training them. Is there an easier way?

 A few techniques can significantly reduce training time for new staff, keep the practice from losing intellectual property when existing staff leave, and foster a culture of cross-training and continuous improvement. 

From the two meetings mentioned in the answer to the above question, you can create an operations manual describing how various tasks are performed in your practice. This information transcends any one person's job description and memorializes procedures for training. This manual need not be an exhaustive list of all situations or circumstances that will be encountered in your practice, but it should provide a good sampling of how employees should proceed in the following areas: 

 Consultant Keith Borglum, CHBC (left), of Professional Management and Marketing, has been a licensed practice broker, appraiser, author, and management consultant to physicians for more than 25 years, is based in Santa Rosa, California, and practices nationally. Send your practice management questions to 

Get your questions answered on how to become a better manager, and how to cut down on training time for new employees.

How to be a better manager, how to reduce training time for new employees

Q: What are some tips to save money on supplies?

Q: How do I keep track of supplies? We often run out of what I need, and at the most inconvenient times.

 Many offices have no inventory control system and, therefore, experience supply shortages that necessitate last-minute ordering at premium prices. Most practices can't afford, or don't have the volume to support, digital-scanner control systems. The cost of physician inefficiency due to missing items often is higher than the cost of the supplies. 

The following manual system is a simple, easy-to-use one that puts control of inventory in the hands of one person while still allowing anyone in the office to use supplies when needed without first having to check with someone else. Sub-systems for stocking each examination room or work station also can be created if desired. 

You can change suppliers, buying cycles, order amounts, and bundle size anytime as needed. Just alter the tags to reflect the changes. 

Supplies in your practice can cost more than you think.

Author | Keith Borglum, CHBC

Articles

Things to consider before accepting a job offer

Coding versus billing skills

How to be a better manager, how to reduce training time for new employees

Q&A: Tips to save money on supplies and control inventory