Going to a private practice interview is always a little overwhelming, as you’re assessing many things simultaneously - the practice itself, the location, future colleagues, compensation, job description, and overall fit. As expected, practices will put their best foot forward, so it can be hard to sense if there’s anything more going on behind the scenes that you may want to dig deeper into before accepting a job. While we all want to trust our physician colleagues and believe the best about them, there are some things that many physicians routinely point out that in retrospect were signs that a job wouldn’t be a good fit but that they chose to waive off because they liked the other aspects of the job. Navigating the fine line between acknowledging that no job will be 100% perfect while also paying attention to those spidey senses that something is off is hard, particularly if it’s your first job. Below, we’ll cover some red flags that members of our physician communities have pointed out that they wish they’d have taken into consideration more seriously prior to signing on the dotted line.
Disclosure/Disclaimer: Our content is for generalized educational purposes. While we try to ensure it is accurate and updated, we cannot guarantee it. We are not formal financial, legal, or tax professionals and do not provide individualized advice specific to your situation. You should consult these as appropriate and/or do your own due diligence before making decisions based on this page. To learn more, visit our disclaimers and disclosures.
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Keeping Things in Perspective During Your Private Practice Job Search
Before we dig into red flags, we want to remind you that private practice is fundamentally a small business, and you may view some of these red flags differently when you’re reading this article from the lens of a prospective employee versus the lens of a private practice owner. Remember that your goal if you’re looking at private practice jobs is to hopefully become a partner in the private practice one day, and therefore when evaluating policies and procedures at that practice, you’ll want to make sure you’re not running away from situations that in the short term may not be ideal for you but will be great in the long run. That said, you don’t want to get taken advantage of either, and that’s where really trying to understand both sides of the coin in negotiations is important, such that you can direct your negotiation skills towards dealbreakers rather than sweating the small stuff. With that in mind, let’s dig deeper into things that should raise your antennas and cause you to ask more questions or think carefully about whether it's the right practice environment for you.
Red Flags When Interviewing at a Private Practice
High Physician Turnover
While there are harmless circumstances in which a physician or two may have left their positions after a short period of time (i.e. their spouse obtained a job in a different city or they wanted to be closer to family), if many physicians have left a practice after only a short period of time being there, you’ll want to determine why there has been so much churn.
Frequent physician departures can be indicative of job dissatisfaction, poor workplace leadership, or an unsustainable workload with poor support or compensation structures. If the practice avoids answering or provides conflicting responses to your questions, this is an obvious red flag.
Questions to Ask to Assess Turnover:
Who is your longest-employed (non-partner) physician and how long have they worked for you? Have they been offered partnership, and if so, why haven’t they taken it?
How many physicians have left in the past 5 years? Why did each of them leave?
Did any of the partners leave the practice or were any removed from the practice?
Why is there an opening at your practice?
How long have you been actively trying to fill this role?
For those practices that have a partnership track, why have certain physicians been offered partnership and why have others not been offered partnership?
Remember that there may be confidential reasons or legal reasons why they can’t always provide you details, but if the reasons they are stating don’t make sense to you or something doesn’t add up, you’ll want to investigate further. You may want to ask around to get answers on why a physician left, or even ask to talk to those physicians if they claim it was on amicable terms. If possible, it’s also helpful to speak with other staff such as the medical assistants or supervisors in the office to learn about physicians who left. Another source of useful information is another employed physician who has been there for at least a year. That person can provide a lot of perspective on culture and working environment.
It’s also important to remember that there are always two sides to every story and that a physician who left may also have bad blood towards the practice and say things from a biased viewpoint. As above, the practice may also be limited in what they can say about the situation for legal reasons. All of this is to say, look for trends rather than isolated situations, especially if the person who left offers a very polarized view of the situation. Ultimately, you’ll have to decide who to trust.
Lack of Transparency in Compensation Structure and Contracts
Most employment contracts in private practices will have some sort of base salary with a possible bonus structure based on production or wRVUs in excess of a specific number. You want to be confident in how much you’ll be making to minimize financial surprises down the road. You should ask about and develop an idea of what your productivity will be like in the practice, asking for examples based on the starts of other physicians. If they are reluctant to share ballpark figures or what percentage of employees tend to bonus, you may view this as a red flag.
An employer may choose to entice a recruit with a high base salary and then switch to a pure production model after the initial 1-3 year contract period. In circumstances such as this, you should ensure that you won’t be taking a large pay cut when switching to a production model. Again, try to figure out based on their projections how easy or hard it will be to maintain that salary. If they’re not confident, you may also not want to be confident.
Additionally, as you take the long view at the practice, be sure you know how the practice approaches partnership and evaluates incoming physicians as potential partners. Also make sure you have an idea of what the perks are of being a partner, and how much additional revenue above and beyond your personal salary and bonus structure you can expect to make from ancillary revenue streams in the private practice.
Questions to Ask to Assess Compensation and Contracts:
What is the base salary? Is there a bonus and how is that determined?
Tell me about the trends in the compensation of physicians at your practice over the last five years.
What has been the year 1 vs. year 2 etc compensation for your past employed physicians?
If there is a production component to the bonus structure, what is the production that physicians are generating across their years in the practice? This question helps you to determine whether the unmet need is present in the area to accommodate and grow a new incoming physician.
What is the pathway to partnership in your practice?
Does your practice have any sources of ancillary revenue for its physicians? What is the structure to receiving the benefits from these passive sources?
If you’re not sure what is fair compensation for your role, look into our physician compensation database as a guide. Keep in mind the numbers that a practice presents you with are a starting point, not a final offer. Use our contract negotiation resources to help you navigate your contract, and remember that before signing any contract it’s important to have your contract attorney look it over.
Productivity Imbalances or Inconsistencies
This can be a difficult topic to sleuth out during a job interview, but as productivity is a factor in virtually every physician’s pay, it’s important to have a clear understanding of how the practice’s productivity looks. You may discover that one or two physicians or partners at the practice have much higher productivity than the others. This could be a sign of the maturity of their practice, the hours they work, or the number or complexity of patients they see, or it could be a sign of how referrals are distributed. In extremely rare cases, we’ve even heard of physicians in our communities who discovered the practice they joined was inaccurately (and illegally) billing codes to increase their profit margin, which led to investigations for insurance fraud (yikes!). If you know about this, you could also be roped into legal issues.
Questions to Ask to Assess Productivity:
How is productivity measured? Does the practice use RVUs or collections as their basis?
How many patients does this position average per day and how much time are they allotted for each appointment?
What is the average number of daily patients seen by each physician in the group?
How are referrals dispersed amongst physicians?
What is the method by which referring physicians get to know a new physician in the group? What’s the marketing strategy behind new hires?
Who decides how much time is spent with patients?
If production is tied to RVUs, what is the dollar range per RVU in bonus territory? The practice may not want to answer this question, but it would be both important to demonstrate your savviness and important to attempt to glean what the guidelines are amongst the various physicians in the group for their bonus structure.
Family Members as Employees or Partners
Many members of our communities have mentioned that physicians should stay away from practices where a spouse or other family member is an employee in the practice, particularly if it’s a spouse or child. While this isn’t always a bad thing, our members point out several conflicts of interest. For example, if the physician’s wife is the office manager, this can potentially set up a conflict of interest with referrals and schedules, or in disputes about the practice in general. If a spouse or child is another voting physician in the practice, the two parties may be likely to vote similarly, which could give you an unfair disadvantage in votes where you have an opposing viewpoint. Additionally, when it comes to employment, you don’t want family ties to influence hiring and firing practices.
Of course, the counter argument could be made that there are more people with a vested interest in the success of the practice, so again, we leave this at your discretion.
Partnership in the Practice
Becoming a partner at a practice can be a great opportunity. When at your interview, ensure that your future employer makes it clear to you what the track to partnership looks like. It is unlikely their employment contract will have any of the partnership terms in it, but you should have an understanding by speaking with the other partners what it takes to become one. You should also know how they determine practice valuation for partnership, whether there is a buyin, and how much a buy in is if there is one. There are many different ways to become a partner, so ensure that you are comfortable with the terms the practice sets forth in theirs. One red flag is a practice with many employees but few partners. A sign that the practice model is successful for long term sustainability is one having many partners as well as employees.
Questions to Ask to Assess Partnership in a Practice
What is the pathway to partnership? What are the metrics by which it is determined? When is it determined?
Describe the governance structure of the practice. How often do the partners meet? What are the committees and roles of the administrators, and how are members of the committees determined?
What percentage of the physicians are partners?
Is there, and if so, what is the buy-in process to become a partner?
What does becoming a partner mean in terms of change in duties, responsibilities, voting, and economics?
What is the method by which one leaves the practice as a partner? Can you be removed from partnership and if so, how does that happen?
Tell me about the short and long term goals of the practice.
Tiers of Partnership or Uneven Power Dynamics
In some practices, there are tiers of partnership with some partners having more say than others or getting higher compensation, percentage of profits, or more access to ancillary income streams than others. While this may be okay, you should understand what the process is to get into the higher tier - is it just a certain number of years until you also are in that echelon, or is that that there is a tier of partnership that will always be unavailable to you? Sometimes, the founders of the practice will have different voting rights or compensation structures, or they may have access to ancillary income streams that you don’t.
You will have to decide if you’re okay with this, but the ideal situation for most physicians is one where they are equal partners with equal say and equal opportunities to earn money. This assures that everyone’s incentives are aligned and prevents a situation where a small group of partners or even one individual can make critical decisions for the practice that affect everyone. For example, if the older partners have more voting rights, they may choose to sell to private equity even if most of the junior partners are against it.
It’s important to understand the history of the practice and power dynamics and politics within the practice, as well. Is there a particular physician that seems to run the show? One subtle but problematic example mentioned by one of our physician members was that the same partner hired every physician. For their group, this created a feeling of indebtedness to that one partner amongst all the physicians that was leveraged by the partner in voting situations.
These are admittedly hard politics to ascertain on an interview day, but perhaps something to pay attention to during the contracting process. You could ask the various administrators you meet how they arrived at their positions, which could shed light on their intrinsic biases.
Questions to Ask to Assess Politics or Power Dynamics in a Practice
As above, what is the pathway to partnership? What are the metrics by which it is determined? When is it determined?
How are decisions made within the practice?
Do major votes require a majority or supermajority of the partners to approve them?
Does anybody’s vote have more power or does anybody have veto power?
Are all partners equal in their rights to the practice?
Who handles hiring and firing decisions?
What are the different revenue streams of the practice, and when do I get access to each of them?
How are referrals distributed? Are they evenly distributed or is there a certain formula or procedure that is followed?
Does any partner have a different contract than another partner?
How are disagreements resolved?
Insufficient Support Staff
One of the things that will make or break your experience at a practice is the degree of support and the number of hands you have available to you to do your job. We all know that physicians are being asked to do more and more with less resources. While most of us can deal with minor interruptions or temporary situations, you want to make sure that you’re not chronically understaffed, as that could hurt both your clinical burnout and your productivity (and therefore your compensation).
Questions to ask when assessing whether support staff is adequate:
How many nurses and MAs does each physician have? (or PAs and NPs as applicable)?
What determines how many staff are available?
Who pays for my staff, the practice or myself?
Who handles.. [insert critical things to your workflow, like setting up trays, calling back patients, calling back lab results, etc.]
Insufficient Technology
Tech is becoming increasingly important to provide our patients with the highest quality of care in an efficient way.. A practice should always either own up to date technology or partner with an organization who provides them access to it. They also should have an EMR system that meets the needs of the physicians and practice. If a practice ensures you in an interview that they “plan” on acquiring technology that you consider essentially, do not assume they will follow through on their plan, and see if you can get it in writing.
Questions to Ask to Assess Available Technology
What type of equipment is available to your physicians?
What EMR system does your practice use? What is the practice management software? Are they integrated to optimize for revenue cycle management?
How does patient scheduling work? What is the method by which patients can communicate with their physicians?
Who is responsible when a computer breaks, or the internet goes down, or the EMR is unviable?
Who purchases or provides the equipment for the practice?
Do you have an AI scribe or dictation service, or would you be willing to consider one?
Negativity in or Around the Practice
Do your best to meet the different members of a practice as a way to assess the dynamics of the group. Some practices are better at hiding a negative workplace environment than others, but oftentimes you can start to feel an unsettling vibe during your time there. Pay attention to any signs of poor team dynamics, staff dissatisfaction, or lack of collegiality. Try and analyze if the physicians you meet with seem engaged and valued. If the physician interviewing you says anything negative about their former employees or current physicians, note this.
In a large practice, you may not have a chance to meet everyone just because of the sheer number of physicians. However, in a small practice, If you aren’t meeting a particular physician (and they’re not on vacation or in a procedure), this may be a sign that they don’t want you to talk to that physician because they are unhappy. Ask if you’re able to speak to that physician at some other point via Zoom or phone. If they’re still hesitant, this may raise red flags.
If possible, ask around in the community to see how the practice is perceived. If it’s a large practice or hospital setting you may want to consider asking in different forums to see if anyone has experience with them. Look over their online reviews (with a large grain of salt) to see if their reviews are overwhelmingly negative or citing consistent complaints.
Questions to Ask to Assess Negativity or Collegiality at the Practice:
How would you describe the organizational culture of your practice?
What are the biggest challenges your organization is currently facing?
How would you describe your work life balance in the practice?
How do physicians support each other when emergencies or other demands come up?
How would you describe the pressure on productivity at your practice?
How would you describe your level of autonomy?
What’s your biggest complaint about the practice?
What’s the biggest stressor to you personally at the practice?
Do you ever hang out with your partners outside of the practice? If not, why not?
Does the practice host any regular events or activities for physicians and employees?
Unclear Terms or Vague Answers
As mentioned with compensation, anytime a physician provides you with vague responses to your questions (on anything related to your job), there should be cause for concern. If your questions are consistently passed over or met with uncertainty, it may be time to pursue other opportunities that you know for certain align with your goals. If the terms of a contract are unclear in a way that does not benefit you, chances are you don’t want to sign it. Be especially wary with gray areas around on-call coverage, non-compete clauses, vacation schedules and how vacation is requested, and partner buy-in terms. You don’t want to be in a situation where you’re “stuck” due to a non-compete or aren’t able to pursue your side gig and you definitely don’t want to find out after you’ve signed a contract that you’re going to be responsible for the majority of call.
Bottom line, if you’re not getting straight answers in an interview, it may be because they know you won’t like the straight answers. Trust your gut.
Pressuring You for a Quick Decision on Whether You Want to Join
This is a big decision, and most physicians should know this. If they give you a very tight timeframe for a decision like less than a week, you should be curious as to why they are pushing so hard. It could be because they have another candidate, which is reasonable, but don’t allow FOMO to push you into a bad decision. Take time to do your due diligence and let them know if you need more time. If they can’t accommodate, don’t be afraid to gently ask why they need the response in such a short time frame. If you get the sense that there’s more to the story with how aggressively they’re asking for a commitment, don’t be afraid to take your chances that the position is gone in favor of making the decision more confidently.
Conclusion
When it comes to interviewing with a practice, remember you are assessing them just as much as they are assessing you. Don’t be afraid to ask questions and ask for clarification around vague or confusing answers/information. We love to focus on the facts as physicians, but don’t be afraid to trust your intuition about a position even if you don’t have the evidence to back it up. Never sign a contract without consultation with your contract attorney and never let a practice pressure you into giving them an answer too quickly. You deserve to perform your due diligence and take some time to make your decision about a job before you agree to it.
Additional Interviewing Resources for Physicians
Physician Contract Negotiations: Red Flags to Look for and Avoid in an Employment Agreement
Transition to Practice series for graduating residents.