Recruiting new spine surgeons can be time consuming and expensive, which places a heavy burden on any private practice. "We're going through physician recruitment right now and there's a couple different models available, such as practices hiring physicians on a partnership track," says Ty Thaiyananthan, MD, founder and medical director of BASIC Spine in Orange, Calif. "There is also a hybrid model where hospitals will do salary support for a specific period of time to keep physicians in the area before they become practice partners."
Here, Dr. Ty discusses physician recruitment and where private practices can have the most success in the future.
Q: What model works best for recruiting physicians into a certain area or practice today?
TT: The best model must come out of a mutual agreement between the practices and the physicians they hire. This agreement should meet the goals of the practice. We've gone out and actually hired physicians through the practice; the advantage is the intimacy between the two groups. This model is also the most customizable to meet the needs of both the practice and the spine surgeon coming on board.
However, it's an extreme cost to support the salary for a physician at fair market value and you have to take over their overhead for a pre-specified period of time, which is usually double the cost of their salary. The practice really has to budget and be willing to absorb those costs. You may not see a return on investment for a year.
Q: When private practices employ surgeons, are those surgeons put on track to eventually become full partners? How does that transition work?
TT: Most private practice employment models involve a partnership track where the individual builds up their practice. They owe a certain amount of their profits to the practice and help the practice recuperate the costs of bringing them onboard. At the end of the negotiated time period, that person can have the opportunity to become a partner. There is an associated buy-in to give them a right to the tangible assets of the practice.
Sometimes physicians who enter into an employment agreement run into difficulties. It's important to really understand what the partnership track means, how long it is and defined perimeters to becoming a partner. They should also know what the potential buy-in will be. When we tried to hire physicians on our own, it was a challenge to set up a system that was fair and maintain responsibility for our practice to recuperate our costs we invested in that person without harming their development.
Q: The second model you mentioned was a hybrid between hospital and private practice employment. Does that alleviate some of the challenges for private practices recruiting physicians?
TT: The hospital recruitment package hires the physicians that will be going into practice and takes on the cost of their salary and overhead. The disadvantage of this model is there are legal ties binding the physician to the hospital. The physician coming onboard has to practice out of the hospital for a certain period of time; it's usually an implied umbilical cord between the hospital and the physician. The hospital becomes the third person involved in a relationship between the practice and the physician being hired.
When the hospital is involved, they also want to recuperate costs and are worried about their return on investments. There is a certain level of commitment the physician faces to make the endeavor worthwhile for the hospital, and sometimes the hospital's needs aren't the same as the practice's needs. When the needs and goals of both are aligned, it may be a better model of hiring an additional provider, but it isn't for everyone.
Q: Are there any models available for surgeons who don't want to sign an employment contract with the practice or hospital?
TT: There is a model where the practices allow physicians to come in and use the facilities if they are able to support their own practice right away. That's not something most physicians can do because they don't have the capital resources. They are working off their overhead costs, but there is a lag in revenues that may take three or four months before the physician gets paid under that model. They have to be able to weather that. It's not a model that would work for a lot of new grads because they have expenses after school and they're looking for ways to support themselves.
Q: During the recruitment process, how can you be sure the new surgeon you're bringing into the practice will be a good cultural fit?
TT: That's the million dollar question. You want someone who can work with different practitioners in the group. It's like a marriage with a very abbreviated dating process. Usually you see someone and interview them, and you have to make that decision based on their short visit and CV information. We try to get a feel of whether their personality will fit the group and look for quantifiable things like fellowship training, scope of practice and experience.
We also ask prospective physicians what their long term goals are and how they want their practice to develop. Make sure their goals align with your practice goals and how you want to treat patients. If there is a reason they want to be in the area where you practice, usually that's also a predictor that they will stay for a long period of time. When you have a partner you are really looking for someone who will be at the practice for their whole career.
Q: Are there any red flags that indicate a physician might not be a good fit for your group?
TT: A red flag is someone who changes jobs very frequently. Fifty percent of people change from their first job today; it's not uncommon, but some practitioners are changing jobs every year or two. Maybe they haven't figured out what they want and they might not be the most stable person to bring on as a partner.
When you come on as a partner, you should have a group mentality. While you want really strong individuals who are good leaders and very good clinically, there needs to be some sort of quality in them that allows them to work with the group and understand the group needs. When they are employed and working toward partnership, you can really figure out if the individual is a good fit.
The individual can also make sure the practice is something they want and believe in.
Q: Where can private practices turn to optimize recruitment efforts?
TT: There are definitely a lot of recruitment agencies that are helpful. The drawback is their charge for placing someone. They might charge a large one-time fee or a percentage of the salary, and depending on the type of provider and location that is anywhere from $10,000 to $50,000.
The other method is to post ads in scientific journals. A lot of recruitment is done through people knowing other physicians. If the practice identifies the need, physicians usually suggest other physicians that might be a good fit. There is an internal process in place and people who are looking for jobs in the area can call them up.
It's difficult to pair physicians with practices and brokers can bridge that gap, but if you have a network of physicians in that area it might be easiest to reach out to them. We've also posted our job offering online and on websites like Craig's List. In the digital age, there are a lot of different ways to post a job. The traditional method is hiring a recruiter, but that's all changing.
Dr. "Ty" Thaiyananthan is the founder of BASIC Spine in Southern California. BASIC specializes in complex and minimally invasive spine surgery and is at the forefront of pioneering new surgical techniques using stem cells and minimally invasive surgery to treat chronic neck pain.
Dr. Ty earned his medical degree from UCSF, did a general surgery internship and neurosurgery residency at Yale and completed a surgery fellowship at Cedars-Sinai Medical Center in Los Angeles. Follow Dr. Ty on Google+.
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