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Everything You Should Know About Hiring An Associate

When hiring another DPM as an associate in your practice, it is important to find a capable practitioner who will enhance patient care and fit in well with you and your staff. This author speaks to practice management experts who offer a guide of what to look for and what to avoid when searching for an associate.

   As your podiatry practice begins to flourish, you may find yourself in need of an associate DPM who can take on some of your patient load and draw more patients to your practice. Although you may have numerous candidates for the job, it is vital to choose a new associate whose goals are in line with yours and who can integrate into your existing practice and day-to-day operations.

   When starting your search, it is important to hire the candidate with the best possible traits for your practice. John Guiliana, DPM, stresses that a new associate should meet the practice’s needs. The practice’s needs might include expanded procedural capabilities or merely more time off for the senior doctor, says Dr. Guiliana, a Trustee and Fellow of the American Academy of Podiatric Practice Management, who practices in Hackettstown, N.J.

   Motivation and initiative are important traits in a new associate, according to Molly Judge, DPM. She says the potential associate should have “a distinct desire to bring something to the table.” Patrick DeHeer, DPM, stresses the importance of the new doctor being a team player as well as someone who interacts well with patients and other physicians.

   Since the new associate will not yet have a patient base, Dr. Judge says he or she should have a clear plan on how to get out into the community and encourage new patient inflow. She says it is also important for the associate to have a desire to lecture in community settings such as diabetes education classes, senior centers and nursing homes. The associate’s ability to reach out to the community for new patients can potentially offset the costs of a new doctor, according to Dr. Judge, a Fellow of the American College of Foot and Ankle Surgeons.

   Kevin McDonald, DPM, cites a potential associate’s intelligence as a primary selling point. When interviewing a potential hire, he will ask questions about a difficult patient case on which he is working.

    “The way the potential associate answers the questions can reveal both the academic knowledge and common sense of the applicant,” says Dr. McDonald, a Fellow of the American Academy of Podiatric Practice Management, who is in private practice in North Carolina.

   For busy surgeons, it is also vital to have an associate who can demonstrate some technical prowess and training. When prospective associates visit with Dr. McDonald, he will frequently ask them to perform injections and/or other minor surgical procedures while they are seeing patients.

    “A smooth delivery of the common services is a good sign,” he notes.

Emphasizing Communication And Philosophical Agreement

   Interpersonal communications with nurses and other staff are also important, notes Dr. McDonald. When seeking references for an associate, he will check with the operating room supervisor at the applicant’s hospital.

    “I find that nurses tend to relish the opportunity to provide feedback about doctors,” he says, adding that a surgeon who is difficult in the OR will likely be difficult in the office.

   Similarly, Dr. DeHeer emphasizes the importance of checking several references.

   It is also important to be able to see eye-to-eye with your potential associate. Dr. Guiliana says attitude is the most important aspect. He says the new associate must be willing to learn and adapt readily to the “corporate culture” of the office, which includes the relationship with the staff.

   Dr. McDonald notes that an associate’s philosophy toward practice is a factor. “I feel that an overall agreement on how to run a business and how to treat patients is important for the long-term success of the relationship,” explains Dr. McDonald. He discusses these philosophical matters with the candidate before agreeing to the associate’s employment.

   While he feels it is improbable that one will become best friends with a podiatry associate, Dr. McDonald says it is a plus if the two can get along and enjoy one another’s company. He tries to arrange a social gathering with his associate candidates.

   Eric Polansky, DPM, says it is important for one to understand the new associate’s goals. Do the new doctor’s goals match yours? If you are not on the same page as the new associate, he says the relationship will be short term at best and one should just keep looking.

Recognizing Red Flags In Potential Associates

   Just as important as knowing who to hire is knowing who not to hire as an associate. The experts point out several red flags one should be alert for when interviewing.

   One big red flag to look out for is a potential associate who expects a large salary before demonstrating that he or she actually has anything to bring to the practice, according to Dr. Judge, who has offices in Port Clinton, Ohio and Lambertville, Mich. In reality, she says one should be able to offer 50 percent of what a person brings in net and then negotiate upward if the net increases significantly over time. She says this guarantees coverage of overhead and leaves an incentive for the associate to increase both patient load and revenue.

   If potential associates are genuinely looking to be part of the team, Dr. Judge says they will offer to help with the existing patient workload in any way they can. One way to help with the workload, she suggests, is by accepting the overflow of new patients or allowing the senior doctor to shorten his or her workday.

   On the contrary, if the candidate’s only plan is to report to the office and wait to see if any new patients come in, then you probably have a weak link, says Dr. Judge. She also says if the candidate is a big talker and boasts of highly technical or complex procedures from residency, there should be logs describing those in detail.

    “If not, you can predict that the candidate will have an honesty problem and potentially an ego problem that will be hard to deal with,” says Dr. Judge. She recommends speaking directly to the candidate’s residency director, other attendings from his or her training and previous employers.

   It can be a bad sign when the associate lacks an important desired attribute, according to Dr. McDonald. He recalls one associate who was smart, well trained and professional in appearance. However, the job entailed independently building a practice and this doctor “couldn’t sell coats in Alaska.”

   If an associate is unwilling to follow standardized protocols established in the group, that is a red flag against hiring, notes Dr. Polansky, who practices in Ohio. Dr. Guiliana recommends that the senior doctor be extremely clear on the goals for hiring an associate and write down those goals. Also make these goals clear to the potential hire.

    “A disconnect in any of these issues or unrealistic expectations on the part of the associate should raise suspicion,” says Dr. Guiliana.

   On a more personal level, there can sometimes be incompatible personalities. Dr. McDonald notes that some people believe the world revolves around them and do not like to compromise. He says these candidates would be better off in a solo practice and not a group environment.

   Look out for “drama magnets” or people who seem to attract problems, warns Dr. McDonald.

    “Conversations with prospective associates that indicate regularly occurring financial woes, bizarre legal disputes, difficulties with family and spousal relations, automobile misadventures and an overall preponderance of bad luck raise a red flag,” notes Dr. McDonald.

   It is a good idea to spend time with the candidate both inside and out of the office, where one can observe the interviewee’s interaction with the patients and the staff, says Dr. Guiliana. He suggests meeting the associate’s spouse and observing the associate’s interaction with people outside of the practice.

    “For example, how do they treat the server at a restaurant? These behaviors speak volumes about people and can either raise a red flag or provide confirmation of a good choice,” says Dr. Guiliana.

   Dr. Polansky also suggests including the prospective hire’s spouse in the process. If he or she wants to be somewhere else in a few years, then the doctor and the spouse may likely move on from your practice quickly.

   In addition, some potential associates want a practice setting that is incompatible with yours. Dr. McDonald recalls a prospective hire who was motivated and talented, but wanted to live in a big city. Given that Dr. McDonald works in a small town, he realized it was not a good long-term fit and the potential new associate moved on to another opportunity.

Key Tips On Integrating A New DPM Into Practice

   With any new face in a practice, it is important to have a process for smoothly assimilating him or her into a practice. What are the best methods of integrating a new podiatrist into an existing practice as far as day-to-day operations go?

   Drs. McDonald and Polansky recommend having the new podiatrist shadow the managing podiatrist for a few days before he or she begins to operate independently. Dr. Polansky suggests having the associate shadow the busiest podiatrist in the group.

    “This demonstrates to the candidate the organization and team work necessary to perform his or her duties, and what the candidate can excel to if he or she so desires,” he says.

   Dr. Polansky also notes the importance of having the new doctor treat a number of patients in a day within his or her comfort zone. Likewise, Dr. DeHeer says having an associate follow you for a month can permit the new doctor to see how your practice flows.

    “By setting a good example yourself, if you interact with and respect the staff, he or she will pick up on this quickly,” says Dr. DeHeer, a Fellow of the American College of Foot and Ankle Surgeons, who practices in Indianapolis.

   After the associate has been practicing for a few weeks, Dr. McDonald takes a vacation. “The senior doctor will get some well deserved rest and the associate will learn a lot in this ‘sink or swim’ situation,” he says.

   When integrating a new practitioner, Dr. Judge suggests bringing in the associate and introducing him or her to the scheduled patients for the first week. If the practice is behind schedule or there are no openings, she says one can then offer the associate as an option for these patients. She says this gives the patients and the associate time to acquaint themselves gradually without total commitment since the patient can always opt to see the more senior member for the next appointment.

   Dr. Judge says it can be a problem not having the additional patient volume to support a full-time associate. If that is the case, she says the associate should have a distinct plan on how to use the extra time to drum up business either by community service, “meet and greet” visits with other local physicians, lecturing or contributing to local newspapers or submitting articles to professional journals.

   To integrate a new doctor into a practice, Dr. Guiliana says a good start is to provide a clear and concise job description. He adds that it is the senior doctor’s job to set a tone for assimilating the associate. He says everyone in the practice should view the associate as an empowered entity within the practice with a few limitations that are at senior management’s discretion. Furthermore, he suggests introducing the doctor to patients in ways that avoid any negative connotations, such as “the new doctor” or “Doctor X’s new associate.”

   Dr. Guiliana says the senior doctor should set written mutual goals together with the associate, both financial and personal for each month, quarter and year. As he notes, these goals are frequently part of the compensation package. One should also schedule a weekly meeting with the senior podiatrist(s), suggests Dr. McDonald. He says it is helpful at the meeting to review the past and set goals for the future, as well as use practice statistics to measure progress.

   In addition to meshing well with the established DPM, it is also a good idea for the associate DPM to interact well with the rest of the staff. Before starting the search for a new doctor, Dr. McDonald says one should meet with staff and outline the reasons for the new associate and how it will affect the staff members. He recommends involving staff in the interviews and getting their feedback on the candidates.

   Dr. McDonald also suggests establishing clear guidelines and boundaries for both the staff and the new DPM. When hiring a new staff person to work with the new associate, Dr. McDonald says one should involve the new doctor in the hiring process.

How Do You Address Compensation?

   A new associate will change more than the group dynamics of your practice. It will also change the financial dynamics. How can you provide a fair salary for a new doctor while ensuring the compensation is fair to your practice’s fiduciary health?

   Dr. McDonald utilizes a three-year contract. With these contracts, the practice may lose money on the associate the first year, break even the second year and make money the third year of the deal. As he notes, it is the practice that typically loses on the deal the first year. He pays the associate a percentage of gross collections and the new DPM will have a guaranteed monthly and yearly salary only for the first year.

   Dr. DeHeer also feels an incentive bonus is important. Dr. Guiliana says it is prudent to provide performance bonuses based on meeting collection targets. He suggests setting the performance target at approximately three times the base salary. After meeting the target, he says the associate is entitled to a percentage (usually 10 to 20 percent) of each dollar above the target.

   Dr. McDonald also supports having a flexible spending account in which the associate can choose his or her benefits in addition to the mandated malpractice insurance and state and national association dues.

   Down the road, an associate may want to buy into the practice. In such situations, Dr. McDonald advocates outlining the method and parameters for doing so in the initial contract.

In Conclusion

   When searching for an associate DPM, it can be a daunting task to sift through the pool of applicants and find the best person for your practice. However, if you know what to look for and what not to look for, you can find someone who fits the goals of your practice and enhances your patient care.

Brian McCurdy, Senior Editor
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