How To Hire An Associate

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By Robert Smith, Contributing Editor

Hiring an associate can be a time-consuming, involved process—if it is done properly. As with any major professional decision, you must take great care and consideration in order to make the right move at the right time with the right person. Making a rushed or uninformed decision can result in excess costs and wasted time, not to mention the potential damage done to relationships with patients. Do you really need an associate? There are a number of key considerations in determining whether to bring an associate on board. • Do you need more time off? Bringing an associate on board enables you to take that time off without inconveniencing patients by closing the office or referring those patients to other DPMs in your absence. • Are you too busy? Having an abundance of patients is a nice problem to have until you attract such an overflow that you are unable to serve your practice efficiently. • Are you handling too many repetitive or administrative tasks? Too many doctors bring aboard associates for this reason, resulting in frustration for all involved parties. If you hire an associate simply to take all your night calls or handle paperwork, you’re missing the point and denying your practice the kind of potential long-term assistance it needs to grow and meet more of your patients’ needs. Residents know this. The best residents perform as much due diligence on potential employers as those employers do on them when considering them for an associate position. “One of the things a prospective associate asks himself or herself is, ‘Why does this doctor need an associate?’” notes Jasen Langley, DPM, an associate at a New Jersey podiatry practice. “If there are only three patients in the office, an alarm might go off that the doctor is just looking for someone to do his ‘scut work.’ If the office is busy to the point where you can recognize a need for help, there’s a greater probability that an associate will be able to really work at the practice.” Finding The Right Person If you decide to pursue the hiring of an associate, set the groundwork before you begin your search. Consider the costs associated with hiring an associate—salary, benefits, perks and the like—and whether your current and projected patient base and billings enable you to handle the additional costs of an associate. Determine the specific needs of the practice and figure out what areas you would like a new associate to take on (new procedures, specific scheduling requirements and so forth). Prepare your staff for the search and enlist their assistance in readying your practice for the arrival of a new doctor. When setting out to find the right associate for your practice, it is imperative that you give yourself plenty of time in order to make the right decision. “When people want an associate, they typically don’t make the decision to find one until the 11th hour,” explains John McCord, DPM, whose practice is based in Centralia, Wash. “Then they look through the want ads or something like that. They don’t give themselves enough time to meet people.” “You need to begin your homework very early,” concurs Hal Ornstein, DPM, of Ocean, N.J. “I wouldn’t just throw an ad in the paper. You should do that as well but also put something out in your state newsletter; put something out on the Internet; send letters to colleges and their residency programs. Do all of that in order to get the most responses that you can. However, you should start early because you need to make the best assessment you can of a person. “It’s almost like dating,” muses Dr. Ornstein. “Say someone is a two-year resident. If you can start learning about them in their first year, you’re starting to ‘date.’ If you hire him or her, that’s your engagement. If you become partners, that’s your marriage.” “It is almost like going out and finding someone to marry,” concurs Dr. McCord. “Once they’re there, it’s not easy to get rid of them if it’s not a good fit. It could be very costly, not to mention very sad.” Fire Up Your Network One way to find qualified talent to fill your needs is to talk with other DPMs, or make connections with any residency directors or colleagues with strong ties to hospital programs. These connections within your professional network can help you get to know residents in a much deeper, more thorough manner than you might be able to through simply interviewing them. “That’s the best way to go about it because they get to know the shining stars, the people who are hard workers, who are dependable and mature, who also go above and beyond,” explains Dr. Ornstein. “Those are the residents you want to talk to—the people who come in on their off hours to learn the business of medicine. The medicine of medicine is the easier part of what we do.” As Dr. Ornstein points out, there are reasons for being so selective and for being focused on business as much as medicine. “When I have young associates come in here, as much as they have been taught coding over the last however many years, they still need help coding,” he notes. “I want to bring in somebody who comes out and is not a liability. Many of them are liabilities when they come into a practice. If they bill incorrectly, it’s my business that is on the line if I get audited. I am the responsible doctor—he is my associate, not my partner. It’s the same with my staff. I am responsible, ultimately, for whatever they do.” Venture Onto The Prospective Associate’s Turf In performing due diligence on a prospective associate, you should, of course, carefully examine the candidate’s podiatry school transcripts, as well as all available residency evaluations. Also do not hesitate to pay a visit to the candidate’s residency to see him or her in action. “It’s important to get out to the residency and just wander around,” suggests Dr. McCord. “You get a pretty good idea how a young doctor is dealing with people. I wouldn’t have done it any other way.” If you like what you see on site at the candidate’s residency, Dr. Ornstein says you should encourage the prospect to reciprocate. “I would have that person spend at least a week in my practice,” he notes. “You’ll learn a lot about him or her and that person will learn a lot about you.” What Is The Relationship With Your Staff? While the candidate is on-site at your practice, you should also take note of how he or she interacts with your staff. “A lot of new associates come out and think they’re hot stuff and they had this great residency and they’re so well educated,” notes Dr. Ornstein. “You know what? My staff has been here eight or 10 years and they don’t care how educated you are. They want to see your smile, they want to hear ‘thank you,’ they want to be appreciated and they don’t want turf wars. I personally haven’t had those problems, because I’m so careful in checking out the personalities of my associates before I do anything. Those personalities—the staff’s and the associate’s—had better be at least reasonably compatible though or you could run into trouble.” Indeed, the quality of the relationship between a DPM, the practice staff, the associate, and his or her dependents, is key to the prospect of a healthy, potentially long-term connection and affiliation between all parties. However, your work is not done once you’ve narrowed the field down to your candidate of choice. Address Expectations Very Clearly If you have not explicitly communicated your expectations or addressed those that the prospect might have, take the time to do so, airing all concerns and addressing any questions you might have. Remember, though, your own expectations must be as realistic as those you encourage in your prospective associate. “One of the kisses of death is when you tell an associate, ‘I’m going to hire you and you’ll be a partner in three years,’” offers Dr. Ornstein. “You can’t say that. You don’t know each other that well. You might want to put that in the contract as an option to discuss, but not as a hard-core commitment. That first year, you’re looking for them to understand more what the practice and business of medicine are about.” That understanding, according to Dr. Ornstein, is hard-won. “I’ve been in practice 13 years,” he notes. “I used to work 70 or 75 hours a week. I did anything and everything to get my practice busy. The young associate comes in and sees all these checks come in and all these patients come in, and he does not know how we built this beautiful house and how we keep it painted so beautifully. They just see the money coming in. I call it sweat equity. They don’t see the work, the sweat that has gone into it and that continues to go into it. That’s a key understanding for them to have right up front.” How Should You Handle Compensation? One of the primary expectations you must address early on is compensation. According to Dr. Langley, what an associate gets paid is fodder for much hearsay in residencies. “I remember being a resident and hearing stories about so-and-so making $200,000 a year, and I tried to figure out how he was doing that,” recalls Dr. Langley. “The reality is, you could be making $90,000, but does that cover all your benefits? I don’t think a lot of young guys and young women come out understanding that concept. They think everything is being paid for with their high salaries, but that’s not the case. If you’re making $90,000 and have to pay for your health plan, that could run $5,000 to $7,000 if you have a family. Traveling, gas, car, rent, mortgage—you could be looking at $40,000 right off the top of that salary. So now you’re back down to $50,000—considerably less than what you started with.” “The first question that’s asked whenever I talk to young practitioners is, ‘What’s the standard we should be getting paid?’” explains Dr. Ornstein. “I tell them the truth—there is no standard—there are many variables. A fluffy estimate would probably be $60,000 or $70,000. There are people getting paid $30,000 and there are people getting $100,000, but $60,000 or $70,000 is a pretty good guess at an average. It’s not a lot of money.” Dr. Ornstein notes there are three basic models of compensation for associates. These include straight pay, straight incentive and a hybrid of straight and incentive pay. “The most logical model I’ve seen out there is if you base their salary and incentives on what they collect, usually one-third of that amount,” adds Dr. Ornstein. “For example, if I pay the associate $40,000, they must collect $120,000. If they collect anything above that, they get a percentage of the take—probably 20 to 30 percent.” Dr. Ornstein is quick to note there are many variables where compensation is concerned, based in part on how much the associate is driven by incentives. “In a way, you’re testing their motives,” he explains. “If you pay them with straight incentives, perhaps they’re working their tails off just to make more money and they don’t really care about the individual patients. If you pay them straight salary, they might not work at all. With the hybrid, you’re testing both sides of the coin. Will they meet their minimums? If they do, do they become something different?” How To Address Lifestyle Issues With a new associate on board, you can share your practice’s patient load, as well as such exigencies as night calls, weekend hours, outreach programs and the like. These “lifestyle” issues should be addressed with the associate up front, so everyone is clear on your needs and expectations. “Get it all out in the open right from the start,” counsels Dr. Ornstein. “All that should be worked out ahead of time. Do they have to do hospital calls or hospital consults? Do they go to nursing homes or retirement homes? Do they do house calls? Do they have to come into the practice all the time? What are their administrative responsibilities? Part of the onus for that discussion is on the associate as part of their due diligence in order to know exactly what they’re getting into.” Divvying Up The Patient Load It is also a good idea to agree up front how you and your new associate will divide the patient load. You might want to keep established patients and give new patients to the associate, or you might simply maintain a set schedule and let the appointments fall where they may. Remember to keep your existing patients in mind when determining this division of labor. Your relationship with them can be affected significantly. You should also be open to letting the associate see new conditions or handling new or different procedures, if he or she has a specialty that you do not. Adding new expertise deepens the value of your practice and can help bring in even more patients. “You have to evaluate what you want this person to do,” explains Dr. Ornstein. “In my group, we just took a person in who has three years of training in rearfoot, does excellent work in rearfoot and she taught at the New York School of Podiatry in the surgery department. She is a great person to have on staff. We used to send second opinions out because we didn’t do that kind of work. She’s been a great asset for us.” “Now, she’s not doing a lot of rearfoot surgery,” he continues. “She does more. She’s good at the bread-and-butter podiatry, which is the majority of what we do. The more well-rounded your associate, though, the better off you’ll be.” Put Everything In Writing Work with a lawyer to draft an all-inclusive employment contract, covering the following topics: • employment duties and performance; • terms of employment; • issues regarding maintenance of working facilities; • death, disability and worker’s compensation; • malpractice insurance; • compensation, including salary, health insurance, malpractice insurance, disability insurance, dues, vacations, auto and gas allowances, and fees for licenses, boards and managed care applications; • a non-compete covenant; • issues pertaining to ownership of medical records; and • termination clauses. Final Words Finally, don’t forget that your associate is not a summer intern. He or she is a peer, albeit one with less experience in a practice than you. While you want to take an active role in the associate’s development, it is not necessary to keep looking over your shoulder if you made the right choice in associate. “Associates are professionals with ten years of education,” explains Mike Dujela, DPM, an associate at Dr. McCord’s Washington practice. “We’ve seen a lot, although we don’t have the experience the ‘big guy’ has. Doctors should know that it is possible to treat an associate as a professional and as an equal, and still maintain one’s leadership and ownership in the practice.” Mr. Smith is a freelance writer who lives in Cleona, Pa.

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