American Society of Hematology

Career-Development Timeline for Private Practice

Published on: October 14, 2011

While every person's career path clearly requires an individualized plan for true success, based on insight from hematology leadership and fellows, the ASH Trainee Council has created a generalized framework to help guide those training for a career in hematology, specifically for those who plan to pursue private practice.

Summary

Second Year

Fall:

  • Explore practice options. Discuss different working environments with mentors, and, if possible, rotate through interested practices as part of a community rotation.
  • Attend the ASH Annual Meeting. Bring your updated CV and meet/speak with recruiters.

Spring:

  • Contact practices and discuss practice opportunities.

Summer:

  • Interview

Third year

  • Review and sign a contract.

Getting Started

Prior to the end of your first year, update your CV. Over the course of training, people will ask for your CV, so having a copy readily available helps you looked organized and prepared. You never know where opportunities exist, so being able to accommodate interested parties is key to success.

One of the more common questions asked during a private practice job interview is, “What are you looking for in a practice?” During your second year, crystallizing your career goals is essential.

There are several options for private practice models, many of which can offer diverse practice experiences and quality of life opportunities.

Practice options:

  1. Hospital owned practice
  2. Multi-specialty group
  3. Large private practice
  4. Small private practice (less common)
  5. Corporate models

Geographic options:

  1. Proximity to family and friends
  2. Urban or rural
  3. Community activities
  4. Schools (for children)

What practice is right for you?
A brief description of the practice options are described below:

  • Hospital owned practices: These come in a variety of different flavors. Some hospitals have incorporated hematology/oncology practices in order to capture a piece of this potentially lucrative market. Other hospitals have developed hematology/oncology practices in order to meet community needs and ensure high quality patient care. Hospitals that have a strong palliative care presence, housing for patients and families with long commutes, funding to support travel and gas allowances, organized support groups, nutritional services, and a coordinated clinical trials department tend to be focused on patient care. Being part of a hospital owned group alleviates a significant amount of regulatory and administrative frustration that private practice physicians experience, but you are now an employee and have lost some independence.
  • Multispecialty Groups: These vary from large groups with dozens of physicians in multiple specialties to small groups with just 1 or 2 oncologists in the mix. In general, these partnerships have arisen due to competitive pressures or in order to obtain economies of scale. These arrangements can be complex with a variety of types or organizational leadership, shared ownership, and missions. In smaller groups, there is the potential to share call with other subspecialists (like pulmonary, GI, etc). Such practice environments allow for a diversity of experiences and intellectual challenges but are not ideal for everyone.
  • Large, Small, and Corporate-supported Practices: In general, small practices (2-5 physicians) provide the most autonomy and offer great integration with their communities. These practices have limited resources but there are numerous co-operative groups that they can participate in for drug purchases, research, and insurance negotiations. Physicians who enjoy independence, community leadership, and entrepreneurial endeavors will thrive in this environment. Large private practices have many of the same benefits but have additional resources. There is often a practice manager who coordinates the business aspects as well as an elected leadership ‘board’ that makes core practice decisions. These groups offer additional security in terms of maneuvering in an ever changing health care environment as well as additional efficiencies that can improve quality of life and reimbursement. Corporate models, like U.S. Oncology, are another option. These groups often have excellent managerial experience and significant purchasing power to maximize profitability. They have also developed integrated and efficient supportive office based information technology that helps to streamline patient care and improve quality of care. These services can come at a premium and understanding the practice’s commitment to these organizations in terms of time (some contracts extend over many years) and cost (what percentage of the profits go to them) is essential. These arrangements alleviate physicians from many of the bureaucratic hassles associated with day-to-day practice, but that has to be weighed against the costs of these arrangements which can vary widely.

Make the Connection

When is the right time to make the connection? It is never too early. Most practices have a sense of their growth and expansion plans over a year in advance. At the latest, I would start this process early in the spring of your second year.

There are many ways to connect with practices. Attending the ASH annual meeting during your second year of training is a great way to learn about various practice opportunities. These conferences usually included dedicated sessions for recruiters. Speak with several recruiters, even if they are practices or hospitals at which you do not necessarily envision working. This will provide some insights into existing opportunities and market demands.

Next, if you are looking in the same region for a job as your fellowship, there are numerous resources that you can utilize. First, many faculty speak at outreach programs throughout the region. Many practices will ask if they know of any fellows interested in working locally. Touch base with your professors and see what they know. Drug representatives also have insights into what many community practices are looking for and are more than happy to connect with fellows. Many fellowship programs have outreach clinic opportunities. Doing a rotation at a practice you may be interested in is a great way to learn about a group and potentially open a door for a practice opportunity.

If you are looking outside your fellowship region, this can be challenging. Many hematology/oncology jobs (particularly the good ones) do not actively advertise. If there is a region where you would like to practice, research the local opportunities. Cold calling these practices requesting to speak with the practice manager or physician recruiter is one way connect. Some practices may not return initial calls, but continued attempts will often prompt a response.

Finally there are the professional recruiters. Many of these recruiters represent select practices or regions and can be helpful if you are interested in relocating outside of your geographical region.

Interviewing

There is no magic regarding when to interview. However, this can be an exhausting process. If you are looking at practices near your fellowship training program, it is fairly easy to coordinate local visits. If you are traveling far, clustering interviews will save time and frustration (particularly if you are traveling with your family). It is hard to gauge a practice’s intent on an initial phone call. However, asking about the itinerary is fair. If your family is invited and they are paying for their travel expenses, it speaks to their interest in you as a candidate.

The Offer

Negotiating an offer is a process that few fellows have much experience with. At some point during the first or second interview, finances are discussed. Sometimes this is a very vague overview and sometimes it is quite specific. Try to find a faculty member who may have been in private practice before and see that they recommend. A member of the business leadership in your cancer center can also be a good resource as they often have intricate knowledge regarding industry expectations, RVUs, MGMA valuation, etc.

Have a clear sense of what you want. Sometimes practices would like to hash this out over the telephone. Other times, they send a sample contract with the stated parameters. If you have specific requests (time off, CME, call, etc.), it will save time if you discuss this with the practice before your contract is drafted.

Many offers are full of dense legal language that fellows are not equipped to decipher. Legal counsel early in the process is helpful. One option is to find a local (with regard to practice opportunity) lawyer familiar with state laws and who has a rapport with the group or institution. If you are joining a hospital based practice, see what lawyers the other physicians in the group utilize. This helps to ensure some consistency between the physician contracts and the hospital and can alert your lawyer if the hospital is making drastic changes in their contracts (from one recruit to the next).

Most offers come with a deadline. Make sure that you know when the offer expires.

The Counter Offer

If you are looking regionally, many of the physicians know one another and you will still have professional interactions with the groups. Maintaining a cordial relationship is important (you never know where you may end up!). Personally call the physicians/administrators that you interacted with to let them know that you accepted another offer. Most groups will wish you luck. Some groups may ask you what it would take for you to change your mind. If this is the case, have a sense of what is important and what WILL change your mind and be prepared to discuss it!

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