Hiring a new ophthalmologist has no guarantees

New Orleans-Hiring a new physician is one of the most important and difficult steps an ophthalmic practice can undertake. Good planning can make the process smoother and help ensure a satisfactory outcome for both the practice and the new hire, according to Bruce Maller, who spoke to physicians and practice administrators at the American Academy of Ophthalmology's annual meeting.

"There are no guarantees when it comes to bringing new folks into a practice," said Maller, founder and president of BSM Consulting, a health-care consulting firm. "But there are certain things you can do to make sure your process for recruiting and integrating is a bit more organized and systematic."

Practices have many reasons for wanting to bring a new person on board, ranging from general growth in the practice to increasing demand for a particular specialty to current partners wanting more free time, Maller said.

Even if the practice is struggling to keep up with its current patient load, hiring a new physician may not be the most cost-effective solution. Between salary, fringe benefits, and payroll taxes, the cost of bringing on a new person could reach as high as $400,000. Could the new person see enough patients to cover those costs?

To answer that question, Maller recommended determining the practice's revenue rate per visit, which is the practice's total annual revenues divided by the number of visits. At that rate, how many patients per day or week would the new physician have to see to cover costs? If the number is not realistic, don't hire a new person. Instead, said Maller, consider hiring additional paraprofessionals, or find ways to work more efficiently with existing staff.

If the practice decides to proceed with recruiting a new physician, it is essential to present an image of competence and professionalism. "Remember, when you're looking, they are looking," Maller said. "You have to demonstrate by what and how you communicate that you are on your game." He advised designating one person-usually the office manager or administrator-to work with the practice's lead physician in the recruitment process.

Establish a process

Practices should establish a process for evaluating candidates, including checking references and confirming degrees and licensing.

"You may want someone really bad, but you've got to take your time and thoroughly reference those candidates," Maller said. "The last thing you need is to hire someone and then find out they are not credentialed."

Also important is understanding what needs to be in the new physician's contract. Most contracts are for a fixed period of time, usually a year, and are renewable unless the parties agree otherwise. They include a compensation package-salary plus benefits-with provisions for an increase in future years. The size of the package generally is determined by factors such as the physician's level of experience and subspecialty training and the practice's location. Common benefits include health insurance, disability insurance, and paid time off. Contracts usually include termination provisions, which can be with or without cause.

Although it is important to clearly spell out the immediate opportunities in pay and benefits, Maller said, practices also must communicate prospects for the future. "When someone joins the practice, he or she usually has an expectation of becoming a partner or staying with you for a long time. You need to at least give the person an idea of what those tracks look like."

In recent years, Maller said, the market has grown more favorable for job seekers, driven by an increase in demand for services as the population ages and little change in the number of new people entering the profession each year. As a result, "You have a buyer's market out there with price points for starting compensation packages getting bid up somewhat."

At the same time, Maller cautioned, practices must guard against over-compensating new doctors. If starting pay is too high, no opportunity will exist to earn more as a partner.