Since physicians are the revenue producers of a busy medical practice, there can be a temptation to add doctors to ease patient loads and increase the bottom line. But while bringing on more practitioners can reduce workloads and create economies of scale, it shouldn't be a snap decision. Many factors come into play when adding personnel -- especially those who might ultimately have an ownership stake in the practice.


Marketing a New Addition

One way to market physicians is by sending them to medical conferences in hopes of building up referral networks.

Other ideas: Have new doctors donate time at local clinics or give lectures at hospitals, schools, civic groups and nursing homes. Hold an open house at your practice after hours.

Trips to local primary care offices to meet other physicians can also help. Don't forget to focus on the office staff too. While the physicians of nearby practices may authorize referrals to a specialist, it is often clerks and nurses who actually make the referrals. Showing them some recognition by bringing lunch or snacks may put a new doctor's name at the top of the referral list.

Once members of the practice agree on the need to add more colleagues, evaluate your numbers on patient volume and time-to-next-appoint status. Compare the results to the Medical Group Management Association's benchmarks for practices of your size. This gives practice members some objective data to use evaluating the benefits and drawbacks of adding a practitioner.

While an additional physician can cut down the daily number of patients that existing doctors must see and reduce their on-call responsibilities, it also may mean a drop in income until the newcomer builds a patient base.

This can be a source of contention. With physician compensation and practice revenues based on patient volume and payer mix, there will be pressure on a new doctor to build a base quickly without poaching the patient lists of other doctors. On the other hand, if a new practitioner is added to replace a departed colleague or to help manage a burgeoning patient load, existing physicians are more likely to be grateful for the help rather than irritated by the competition.

Add up the costs of hiring. Factor in all anticipated expenses, including marketing costs, salary, payroll taxes, liability insurance, health insurance, retirement plan costs, other fringe benefits, new equipment, supplies and furnishings. Will you need additional office space or need to hire additional staff as a result of the new physician?

The Recruiting Process

Of course, there are headhunters who specialize in physician placement. Or you can recruit by simply placing ads in medical journals. But your best recruiters are already working for you -- that is, the existing members of the practice. They may know available doctors -- their reputations, philosophies and practice interests. In addition, they have an incentive to find a quality individual whose style matches your practice. Some practices add to that motivation by paying a "finder's fee" or bonus to practitioners who help recruit new doctors.

Hiring a physician is like marriage. So proceed with caution since untying the knot can be painful, lengthy and expensive. Here are some points to consider:

  • Does the practitioner return calls or provide requested information promptly and in the required format?
  • Is the doctor courteous to the office staff? Responsiveness and courtesy are key in good patient service.
  • Are there any irregularities on the applicant's resume? Verify that the doctor holds a current medical license, U.S. Drug Enforcement Administration number and any board certifications listed on the resume. These days, imposters can use the Internet to fabricate impressive credentials.

You Find a Match ... Now What?

Once you settle on a particular candidate, it's time to negotiate. Every practice should have a standard agreement laying out members' responsibilities and compensation. It's a good idea to have a lawyer who specializes in handling such contracts draft the agreement. Besides compensation and bonuses, medical practices might cover items such as moving expenses, realtors' commissions on home sales and purchases and car allowances.

Your work is not done once the new practitioner accepts the practice's offer, however. To avoid internal squabbling over patient loads and falling compensation rates, make sure the new physician gets the majority of overflow and new patients. That way, he or she stays busy while trying to build a reputation in the community. It also allows patients to see a doctor more quickly.

In this age of increasing productivity and decreasing reimbursements, new physicians can't live on the practice's overflow forever. Doctors must fill their patient books quickly and one way the practice can help is by marketing practitioners. (See right-hand box above for some ideas.)

Help Facilitate the Transition. Don't forget to help ease your colleague's transition into a new community when he or she is arriving from out of town. Some practices have set up welcome/relocation assistance programs that provide referrals and information on realtors, neighborhoods, schools and other important factors. You can also set up a mentoring program to provide feedback and support for the new practitioner in the early days with the practice.

These are just some of the issues and pitfalls involved in adding new physicians to a practice. Done properly, it can enhance both the personal satisfaction and the financial situation of all members of the practice.