San Francisco, Calif.—For residents embarking on their professional careers or physicians changing a career, navigating the many issues involved in making a decision that will significantly affect both their professional and personal lives can be daunting and challenging. To provide some guidance, practicing physicians with many years of experience in their respective careers discussed these issues during a session held here Sept. 13 at the 2011 American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) Annual Meeting.
The first step to consider is whether a physician is looking for a career in private practice or in academia. The opportunities in each vary, so a clear understanding of their distinct milieu is integral to a career choice, speakers said during the session, which was co-organized by the AAO-HNS Section for Residents and Fellows and the AAO-HNS Women in Otolaryngology section.
A Career in Private Practice
Robert Glazer, chief executive officer of ENT and Allergy Associates, LLP, in Tarrytown, N.Y., said that when hiring employees, it is important to consider the many issues that will determine if a physician is a good fit with a given group.
“We are looking for people who are aggressive and want to grow a practice,” he said, adding that he is looking for people who want to be with the practice either as a general otolaryngologist or subspecialist for a long time. Included in the discussion with a new recruit are issues that will affect their personal and family lives, such as location.
Along with knowing where and what type of otolaryngologic care a person wants to practice, Glazer emphasized the need for those seeking employment with a private practice group to be aggressive in questioning the practice on operational issues, financial stability, technology development, compensation and staffing and leadership.
“I encourage you to ask serious questions,” he said.
For operational issues, he advised asking questions about the length of the business operation, the overall productivity, the level of turnover and retention and educational opportunities.
It’s also a good idea to ask for a practice’s financial statement for a thorough exam of balance sheets as well as current debt-to-assets ratio to evaluate the financial stability of the practice, he said.
Determine whether the practice has a team of people who can support technology systems and what types of systems are in place for things such as billing and appointments.
Glazer also advised asking questions to determine how solid the compensation model of the practice is; for example, ask whether there is an established revenue stream for ancillary staff, what the billing procedures are for such services as CT scans and sleep studies and whether these revenues are included in compensation.
Asking questions about staffing and leadership is important, he said, in order to find out how the administrative team is structured, the role of physicians in that structure, what the requirements are for partnership and how maternity/paternity or disability leaves are handled.
Angela Sturm-O’Brien, MD, a facial plastic surgery fellow at the University of Houston Health Science Center at Houston, reiterated the need to ask specific questions. “Ask to see the first three months productivity of the last person hired and the specifics about the earnings of the group as a whole and individually,” she said.
An Academic Career
Marvin P. Fried, MD, professor and chairman of otorhinolaryngology-head and neck surgery at Montefiore Medical Center at Albert Einstein College of Medicine in the Bronx, N.Y., spoke about what to seek in an academic position. Although many people are drawn to an academic career because they want to teach, he said, in reality, teaching alone is not what is looked for in a prospective faculty member. Rather, it is the desire to work closely with other specialists in a setting that is often hospital based.
Other factors that draw people to academia are the opportunities it affords to work with interesting patients, to do research and to have time to think. He emphasized that, unlike in private practice, compensation packages are usually fixed, and salary is not the most important issue to discuss. More important to ask are questions that will reveal what the department needs, what role a new physician will have, how responsibility and work are distributed and whether there is equality among faculty.
To find which academic setting may be the best fit, he recommended talking to faculty and, in particular, the departmental chair to get a feel for and understanding of the focus and tenor of the department. The chairman sets the tone of the department, he said. “If the chairman likes research, the department will be research driven,” he said. “If the chairman has more of a clinical focus, the department will focus on things like building satellite offices.” He also emphasized getting a feel for the chairman in terms of personal attributes, such as feelings on values and family, fairness, honesty, reliability and sense of humor. All of these things will contribute to whether he or she can be a mentor, he said.
Overall, Dr. Fried emphasized that physicians interested in academic medicine need to have clearly defined goals and expectations. These include clinical responsibilities (such as patient office volume, operating room volume and on-call schedule), teaching responsibilities (such as lectures) and research (such as publications, grants). ENT Today