Growing Pains
How to add another physician without rocking the boat

By Judy Capko
Judy Capko is a writer for Physicians Practice

Many practices complain about the difficulty of finding new physicians to join their practices. It's true that we face a physician shortage in general, and in some specialties recruiting is particularly challenging. Still, if you're looking for a new doctor, you're likely to find a number of seemingly suitable candidates with impressive credentials. But simply finding someone is easy compared to finding the right physician – that is, a person with whom you can forge a lasting and mutually beneficial relationship that makes sense professionally and economically.

Before you rush to judgment, take cautious steps to ensure that adding another doctor to your crew won't rock the boat.

Examine your motivations
Begin with a careful examination of your motivations for bringing a new physician on board. For many physicians, the reasons include the following:

1. Having a colleague with whom to share interesting or complex cases – providing an "in-house" informal second opinion.
2. Freeing up time. Having someone else in the office who can handle both clinical and business issues allows physicians to get out of their offices for more than one week at a time to take those longed-for, well-earned vacations.
3. Implementing a succession plan. Identifying someone who perceives the value in the opportunity to join your practice may also provide an opportunity for you as the senior physician to develop a succession plan that incorporates younger physicians purchasing equity when the practice has achieved its greatest value.

While these are all valid reasons, there are other considerations that are equally important when evaluating why and how to go about adding another physician to your practice.

Face economic reality
Are there enough existing and potential patients in your practice to keep the new doctor busy? If not, you'll have to factor in the costs of providing the new physician's operating expenses and compensation while he or she beefs up his or her own revenue. Then there are the hidden costs relating to the time it will take senior doctors to mentor a new physician and bring him or her up to speed with everyday activities and long-term goals. These costs can initially create an unexpected downward trend in the senior physician's productivity.

There are also administrative responsibilities entailed with bringing on a new physician that take time from both the practice manager and the senior physicians. These can include getting the new doctor involved in the community, introducing him or her to referring physicians, and implementing new marketing strategies based on his or her capabilities. Of course, there's a cost to all of this – it requires time, resources and financial investment.

Beyond Money
Sometimes adding another physician can be a great complement to an existing practice, providing much-needed relief to busy physicians. The new doc can broaden the services you offer and appeal to different types of patients.

But selecting a new doctor for your practice can also be an experience that brings with it a barrage of issues you never expected. In general, when such a scenario works out, it's very good – and when it doesn't, it can get ugly.

Good, bad, ugly
Lewis Kanter, M.D., the founder of Coastal Allergy in Camarillo, Calif., made several attempts to bring in a physician partner before he succeeded. First he worked with a physician who leaned toward public medicine and preferred to work within a large practice with a great deal of structure. This doctor preferred not getting involved with administrative issues, the details of building a practice or dealing with day-to-day business problems.

"Looking back on it, it may have worked if I had just given him an employment contract, offering salary and benefits for five years," says Kanter. "He would have made less money long-term, but more stability and certainty. He just wasn't suited for a partnership track."

Then there was the physician too good to be true; he was mellow and interviewed well. He talked the talk, but ultimately he didn't understand what it took to build and be a part of a small group practice. Sure enough, it got bad – then ugly.

In less than one year, Kanter discovered that his partner-in-training was making plans to set up his own practice and ultimately become a direct competitor, all without prior discussion or the notice he was contractually obligated to provide. The emotional havoc and the financial repercussions that resulted were difficult to deal with. It's tough to discover that a person on whom you have spent a great deal of time and money is planning to turn around and compete against you. Fortunately, Coastal Allergy Care has an excellent reputation, a great community presence and loyal patients that kept it on firm ground throughout this incident.

The third time Coastal Allergy was much wiser. Not only had Kanter better learned how to evaluate a potential future partner, but he had also put more time into understanding his practice's needs.

"I looked at the demographics – the community, patients, and the competition. Based on this, it made sense to recruit a female Hispanic with training in internal medicine rather than pediatrics. I needed somebody who was well-read, personable, and hard-working – someone with a desire to build a practice, someone with the basic entrepreneurial spirit. I hit the trifecta. I couldn't be more satisfied," says Kanter. "It's a win-win – a perfect fit for physicians, the staff, patients and the community."

Communication advantage
Too often, senior physicians in a practice fail to tell their new doctor their expectations. This includes everything from how to build a patient base to the number of patients he or she should be seeing after a month, after six months and at the end of the first year. Let the new doctor know what kind of support staff he or she will have, what resources are available, how many exam rooms will be given, which tools and supplies are on hand and which will be ordered upon request.

Good communication also includes a new physician integration plan. How will he or she be integrated into the practice and the hospital? What type of orientation will you provide and how will he or she be introduced to your patients and your medical community?

Beyond this, who will take responsibility for guiding the new physician through your office routine, teaching him or her how to do charting, medical record maintenance, handle telephone messages, and code and submit both office and hospital charges? Who will teach the new doctor how to use your practice management system and understand the reports that help assess each physicians productivity and overall performance? Having the answers to these questions will make a big difference in how well you bring your new doctor up to speed.

Once a new doctor comes onboard, meet weekly with him or her, discuss how things are going, address small issues before they evolve into bigger issues, answer questions and provide reassurance. Each month, share your practice's numbers with him or her. The new doctor wants to know how he or she is doing. And it's important for him or her to understand the costs of operating a practice.

Words of wisdom
Learn from those who have gone before you to avoid their mistakes. For example, don't assume a noncompete covenant will stop someone coming in, learning the tricks of the trade and setting up shop across the street. Covenants vary from state-to-state and can often be difficult to enforce. Even if they are enforceable, the legal costs of contesting one may not make it worth pursuing in court.

When recruiting, include all stakeholders in initial interviews. If there is even one issue that is unacceptable to the other physicians, it's fruitless to go forward.

Physicians who have gone through the process agree that adding a physician can be a wonderful experience, but there have to be guidelines and expectations. These things need to be discussed before the new doc's start date.

There are hard lessons, says Kanter: "You cannot assume the person you are dealing with is honorable – on either side. Have multiple discussions (over time) with the physician you are considering. Discuss as much as you can about the practice, your expectations, the community and the patients."

And remember, spouses are also part of the equation, so include them in relevant discussions. It's a family decision.

Open communication is vitally important, both before and after making an offer. "Above all," says Kanter, "don't be in a big hurry – the decision is too important to rush!

Back to top