TA R G E T E D N E U R O LO GY R E CR U I T I N G

TARGETED NEUROLOGY RECRUITING

How to Evaluate a Neurology Practice Opportunity

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Today’s Topics

• Setting Your Priorities• Common Mistakes in Choosing

a Job• How to Compare Positions• Compensation Structure and

Amounts• Compensation Models• Employment Models• Interviewing• Negotiating a Contract

• Questions?

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What they don’t teach in residency:

• How differences in practice and employment structures impact your control over your work environment and your compensation.

• How to tell whether you can build a successful practice in a particular position.

• How different employers figure out how much they are willing/able to pay a neurologist.

• The risks and benefits of being employed by a hospital vs. joining an independent practice.

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What are your priorities?Location, practice, people and $$

• Being happy with the location is critical. You can’t change the location.

• However, if you can’t develop a sufficient volume within your subspecialty, you will not stay, even if the location is fabulous! Your work-life balance needs to be as important to them as it is to you! You don’t want to get burned out!!

• If you can’t get along with the people, either you will leave or they will leave!

• If you love your practice, your partners, and the place you live, you will likely be satisfied enough with the money to stay!

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Choosing a Job: Common Mistake #1

Focusing on geography so much that you forget how important it is to have a really good job.

I have a job on the beach. I just can’t GET to the beach.

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Choosing a Job: Common Mistake #2

Working with people you don’t trust and thinking your contract will protect you. A contract is only as solid as the parties signing it. A dishonest person won’t care about a contract!

People sometimes do this because they really want to be in a particular location, or because a position seems very lucrative.

Who wants a lousy job and a lawsuit?

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Choosing a Job: Common Mistake #3

Ignoring difficult politics!

• Is there a conflict between the hospital and the neurologists?

• Is there conflict between the doctors in the practice?

• If politics may impact volume, talk to the doctors who will be sending you cases.

• If there has been turnover, call the neurologist who has left the practice, recognizing that there are two sides to every story.

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Choosing a Job: Common Mistake #4

• Accepting a hospital-employed position without understanding how your compensation will be set when the initial term of employment is over. 

• Questions to ask:• How will raises be determined?  • Will they move you to a different compensation model in

the future?  • How will your performance be evaluated?• How will your compensation be set when your contract is

up for renewal?

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Let’s talk about compensation….What will your compensation depend on?

• Your clinical interests and expertise• How busy you are• Where you live• Your employment model

Compensation data is available from many sources, and the MGMA is widely recognized as the “Gold Standard” for benchmarking data.

There is very little subspecialty data available, but in our experience, Neurocritical Care and Stroke neurologists generally make more than others.

MGMA Starting Median Compensation: 2015: $250,000

MGMA Median Compensation: 2013: $265,443

2014: $268,925 – Academic: $189,2262015: $269,936 – Academic: $197,000

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Comparing Jobs—Salary & Bonus Structure and Amount Depends on Type of Employer

Compensation depends on who employs you: an independent group practice or a hospital.

Join us! We’ll teach you how to run your practice!

Join us, and you won’t need to run your practice!

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Independent Practice: Pre-Partnership Comp

Practice-Sponsored: Salary plus bonus

• Salary and bonus are both often negotiable• Understand bonus structure• If you expect a certain compensation based on a

base salary and bonus, is that realistic?• What is the partnership track?• Money they pay you is coming out of their own

pocket! So they’re quite invested in your success!

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Long-Term Compensation Models: Independent Private Practice

• Income-sharing• Incentivizes collegiality• Can be problematic if production

varies widely• Expense-sharing, pure

collections-based• Incentivizes production • Can foster competition between

partners• Part income-sharing, part

production• Allows for development of less-

lucrative specialties• RVU-based division of assets

• Advantageous when practice is committed to serving indigent population/no-pay patients

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Compensation Models: Hospital Employment

• Straight Salary

• Salary plus collections-based bonus

• Salary plus RVU-based bonus

• Collections minus expenses

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Private Practice: What is an “Income Guarantee”?

• Federal law permits the Hospital to provide a forgivable loan to the private practice so they can attract you if there is a proven “community need” for a neurologist. That way the private practice doesn’t have to take money out of their own pocket to pay you.

• If the hospital needs to loan you money for you to make the guarantee amount, the hospital will forgive the loan if you continue practicing in the community for a certain defined period of time.

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How does the “forgivable loan” work?The forgiveness period is usually 2 years for every 1 year you are on the guarantee. The forgiveness period may be negotiable.

Example based on 2 year forgiveness for each guaranteed year of income:

Year 1: Hospital pays you $300,000 for you to earn the guaranteed amount. Then, in practice, you make $150,000, which goes directly to the hospital to off-set your salary and expenses. The hospital forgives one quarter of your loan.

Year 2: Hospital pays your $300,000 for you to earn the guaranteed amount. Then, in practice, you work brings in $200,000, which again, goes directly to the hospital to off-set your salary and expenses. The hospital forgives one quarter of your loan.

So, in essence, you “owe” the hospital two more years of work (two years of guarantee = four years of work).

Year 3: Hospital forgives one quarter of the loanYear 4: Hospital forgives the last quarter of the loan. You are free and clear!

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Compensation Models: Academics

• May be Hospital-Employed or Physician Practice

• Think about impact of compensation structure on:• Your ability to make a

living, especially if you are in a less-lucrative subspecialty

• Your ability to have meaningful protected time for research

• Your relationships with others in your department

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Hospital Employment: Pros and Cons

• Pros• No need to run your own practice• You are likely to earn more $$ right away because hospital earns technical and

facility fees in addition to the professional fees.• RVU or salary based structure makes payor-mix irrelevant• You do not have to decide how to allocate revenues, overhead and expenses

between you and your partners.

• Cons• You are employed and can be fired.• Your agreement may change when your contract term is over.• Changes in hospital administration may mean changes in your practice.• You may have less control over which other neurologists are hired as your

colleagues.• If you have a collections-based bonus, you do not control the collections• You are less likely to have complete control over your mid-levels and other staff

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Independent Practice: Pros and Cons

• Pros• Practice is likely to be well-established and offer mentorship.• Ability to admit to more than one hospital may give you important leverage.• You and your partners will control the vision/direction of your practice.• You will generally have control over when you retire or choose to leave the

practice. • You may be able to develop ancillary sources of revenue to protect you from

downturns in reimbursements.• Cons• Usually make less money to start.• Need to run your own practice.• Insurance status of patients will impact gross revenues to your practice.• Reimbursements may impact the way you practice.• Malpractice risk may impact the way you practice.• Allocation of revenues, overhead and expenses between you and your partners may

cause conflict.• Attempts to develop ancillary income sources may result in bad investments.

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Don’t “Miss the Forest for the Trees”

• Do you like the location?• Can you develop a successful practice? • Do you like the people? • If you are happy with the location, the practice, and the

people, it is unlikely that you will want to leave just because of money.

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Proximity to Family?

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Proximity to Family?

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The recruitment timeline

• Try to start between 12-18 months before the completion of your training – Especially if you have visa considerations (If you require a J1-visa waiver, you need to have signed your contract by August or September of the year before the completion of your training!!)

• Try to have phone conversations with 8-10 practices to get an idea of what you like and don’t like.

• Plan to visit 3-5 different practices to get a real feel for them.

• Ideally, when you decide it is time to make a decision, you will have several contract offers in front of you! Starting early gives you many advantages!

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Questions you can ask during the phone interview.

• Do you mind telling me about your practice and what your needs are?

• What are you looking for in your new hire?

• Can you describe the culture of your practice? Do you mind sharing your vision for the development of the practice?

• What types of patients are your neurologists currently seeing? Are you trying to expand the scope of the practice or do you want someone to fit into what your practice is currently doing?

• How many hospitals do you cover? What can you tell me about them?

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Questions you can ask on a site visit

• Can you tell me about what I will need to do to successfully develop a practice here? Where do your referrals currently come from? How are new patients allocated?

• Is anyone expected to retire?

• Has there been turnover in the practice? Who left? Why?

• Can you tell me about the relationship between the practice and its admitting hospitals?

• Are there any ancillary income sources for the practice?

• Is there MENTORSHIP available?

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When can you ask about money, vacation, and benefits?

Focus the first visit on learning about the practice, the needs of the group, and getting to know the people.

At the second visit, it’s appropriate to ask about money

Vacation and benefits will become clear when you receive your offer. If it isn’t clear, you can clarify it then.

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Ask Questions About Support for the Practice

• Is the practice run efficiently?

• Does the hospital or practice have all the equipment that is needed to develop the practice you want?

• Is call appropriately consultative in nature? Who admits the patient?

• Are they set up to allow you take advantage of advances in medical technology (eg, remote monitoring)

• Are there intensivists and/or hospitalists?

• Are there mid-levels and how are they used?

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Negotiating a Contract: Part of the Interview Process

The contract negotiation is really the last step in the interview process.

This goes both ways: If you are unreasonable, your offer may be revoked. If they are unreasonable, you won’t join them. 

The WHOLE Northern Hemisphere? Really?

“Our non-compete clause prohibits you from practicing in the Northern Hemisphere… …Forever”

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Take-Home Points

• Focus on your ability to practice in a supportive environment in an acceptable location

• Learn about local practices and hospital politics

• Consider your professional goals and values

• Think long term about compensation; a big short-term guarantee is not a good deal if you will have to move.

• Don’t contract with someone you don’t trust!

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Thank you all very much!

Questions?