Joining a spine practice takes more than finding a salary that's a good fit or managers you like. Physicians should also evaluate operational factors behind a prospective employer.
Here are two green flags and two red flags spine surgeons should be on the lookout for.
Green flags
Community relations
Spine surgeons should consider a practice's relationship with its region.
"[A green flag is] that your entity (hospital, practice, academics, etc.) is positioned well within the community," said Richard Menger MD, of Mobile-based University of South Alabama. "You can be the world's best-trained surgeon, but the acquisition of primary care practices is a thinly veiled mechanism for internal referrals to hospital employed surgeons. In the regional market sphere, is this entity going to win?"
Research engagement
Practices and institutions that support efforts to push research and innovation forward can be more attractive to spine surgeons looking to do the same.
"For those inclined toward academia, a practice that supports or actively engages in research can be a significant green flag," said Joel Beckett, MD, of UCLA and DISC Sports and Spine Center in Marina del Rey, Calif. "This includes funding opportunities, resources for trial design and implementation, support for publishing and a culture that values protected time to accomplish these endeavors."
Red flags
Leadership turnover
The leadership history of a spine group can indicate its ownership future and administrative dynamics.
"There seems to be many changes for ownership in practices and health systems," said Jeffrey Carlson, MD, of Newport News, Va.-based Orthopaedic & Spine Center. "It is important to ask questions about ownership and how it could change in the next five years. New physicians will want to know that the organization they are joining will have the same administrative structure they are expecting for a long career. If the president or CEO of the practice opportunity is expecting to leave the job in three years, the physician will want to do more investigation."
History of federal investigation
Issues with federal investigations are something that spine surgeons should be wary of.
"Albeit most individuals are reluctant or even unwilling to readily disclose such misfortunes, the unreliable poison of any practice or health system would be local or federal inquiries into concerns over noncompliance or fraud with healthcare regulations," Christian Zimmerman, MD, of Boise, Idaho-based St. Alphonsus Medical Group and SAHS Neuroscience Institute, said. "Any governmental agency investigating a practice for such allegations usually signals unsavory circumstances, bodes unwell prospectively, and may signal desperation by the hiring entity. Forbidding behavioral issues such as infighting and tedious negativity should also be analyzed and pursued with caution. Economically, the red flags could be many, like excessive voids, adjustments or modifications to accounts receivable most likely represent issues and should trigger hesitance prior to scrutiny by a reputable accountant."