Before You Sign That Physiatry Contract – Consider the Repayment of Bonuses

Before you sign a contract, it is necessary for physicians to minimize the amount they may be required to repay for bonuses.

In the case of exiting a contract, be aware of the requirements to repay sign-on bonuses, residency stipends, relocation reimbursements, or student loan assistance. There are often constraints built into the contract in order to incentivize the physician to remain at the same practice for a number of months or years.

Additionally, know when you typically receive salary and RVU or productivity bonuses so that you don’t miss out on receiving this compensation which you have earned before you exit.

This article was contributed by PhysicianThrive, https://physiciansthrive.com

RVU’s for Physiatry – Should We or Shouldn’t We!

The following advice was provided to the question of whether a practice should use RVU’s as a basis for payment to a new doctor:

RVUs correlate to CPT Codes, which correlate to income.

RVUs are good for physiatry employees whose PM&R practice has low-reimbursing insurance carriers, like Medicaid. In this case, the lack of reimbursement will not unfairly penalize the physical medicine and rehabilitation employee who is working hard, but does not receive correspondingly high reimbursement. In other words, their RVUs will be high, but their reimbursement will not be as high.

But, all things being equal, RVUs translate to reimbursement.

RVUs only confuse the physiary employee. Using them is awkward, not well-understood, and confusing.

Better to stick to dollar incentives, which is understood by all.

This information was contributed by Bruno Stillo, CPA, MBA, Physiatry Billing Specialists, 800-835-4482,
www.physiatrymedicalbilling.com
[email protected]

Partnership Terms for Physiatry

A doctor recently asked me about how to set up partnership terms. I don’t have much experience with this subject but here’s some research I did.

First, you need to determine your practice’s financial value of your practice. Your accountant can help. Once a price has been set, the new partner either pays the full amount up front or pays it over a few years, with or without interest. While the new partner receives no tax deduction for the investment, the selling owners must report any gain on the sale of the stock (the portion that they are selling to the new partner) as a capital gain.

The value of the practice is a major element of the buy-in agreement. Three main
factors – tangible assets, accounts receivable, and goodwill – are used to determine the value
of the practice and therefore the physician’s share or buy-in amount. The tangible assets are
the easiest to determine because they include cash, furniture, equipment, and other items with
measurable cash value. The accounts receivable are monies owed to the practice for services
already rendered. Goodwill is the value of the practice’s expected future earning power.
Theoretically, determining the amount that should actually be paid for the buy-in involves
multiplying the sum of these three values by the proportion of ownership interest that the new
doctor will receive in the practice. However, the absence of any single, reliable methodology for
calculating goodwill complicates the matter considerably.
There are several ways to go about determining buy-in value. Some practices pay for a
full-blown practice valuation by an outside consultant each time a partner buys into the group.
Even such “professional” valuations are imprecise, however, since there is no single generally
accepted methodology for calculating practice value. Thus most valuators use several
methodologies to construct a range of value. Other practices use crude rules of thumb or
comparable practice sales data to calculate goodwill. Some practices use a pre-determined
amount and phase in the buy-in over several years through salary reductions (“sweat equity”).
Some practices choose to ignore goodwill and tangible assets and instead base the value solely
on accounts receivable. Some include all tangible assets and accounts receivable and leave only
goodwill out of the formula.

Taken from https://www.acponline.org/system/files/documents/running_practice/practice_management/human_resources/income_dist.pdf

Physiatrists, Don’t Forget the Receptionist!

One way to find out more about a practice is from the receptionist or any staff member. They will often provide honest information invaluable to assessing the true nature of the practice culture on a day-to-day basis. Just a basic question like how long have you worked here can tell you alot. If the front desk person hasn’t been there awhile, it could be a key to a bigger picture about the rest of the staff and their turnover. And, it could be an indication that the practice doesn’t have good patient-office relations which could lead to less patients than other practices attract. Other basic questions are: What do you like best about working here? What are your hours? (If the answer is longer than the posted hours, it can indicate the hours you might work.) What do you think of the patient charting system?

How do I Know if a Physiatry Practice is Busy Enough to Add a New Doctor?

A physiatry resident recently asked me this question. It reminds me that on occasion I’ve been told by PM&R doctors that the reason they’re calling me to find a new position is because the practice they’re at isn’t busy enough to support them. Here are some ways to possibly identify beforehand whether a physical medicine and rehabilitation practice you’re considering joining is busy enough to support you:

Ask why they’re adding a new physiatrist.
Make sure there’s a salary as opposed to an incentive based compensation. Also, that the salary is the major chunk of your compensation as compared to the incentive portion.
Ask who the referral sources will be. Are they already servicing these referral sources? How do they expect extra work from them for you?
Find out the reputation of the PM&R practice. Again, if you’re not familiar with the area, then this might be difficult to do.
Ask about the physiatry turnover at the practice. When was the last time they added a PM&R doctor? If it was recently, then maybe they can’t support another doctor.
Ask about the practice’s financial situation.
Ask for the books. This is a simple, yet often times, difficult request to make.
Survey the waiting room. Is it busy?
What marketing are they doing or plan to do?
Ask how long the waiting list is for an appointment?
Ask the practice what are their growth plans and vision for the future.

What’s New In Physiatry?

Physiatry has seen trends in the favored services. For example, EMG’s were a favorite 20 years ago, then interventional, then subacute. New graduates are now gradually returning to an interest in inpatient, TBI, and SCI .

A newer trend in physiatry is the interest of private equity firms in physiatry. Some private equity firms favor physiatry by the service provided. For example, some firms affiliate with physiatrists who do subacute work while some favor those who do general outpatient or interventional work. If you have an interest in affiliation/acquisition, please contact me at [email protected], 888-362-7200, 717-232-7211 cell phone.

2020 New Year’s Resolutions for Physiatrists

Everyone is talking about New Year’s Resolutions! What is your physical medicine and rehabilitation business resolution for 2020? You might consider these PM&R resolutions:

Find a new physiatry job. Farr Healthcare, Inc. can help you with this!
Increase your bottom line
Pursue avenues towards physical medicine and rehab practice acquisition as many practices are being acquired these days. Farr Healthcare, Inc. has information about some possibilities.
Change the practice’s incentive arrangement
Add new information technology to the practice
Do more marketing

You have to ask yourself what is your true desire for the future. Whatever it is, the experts say it’s important to set goals and priorities to accomplish the resolution. In these days where many doctors feel like they’re losing control, making a New Year’s Resolution and accomplishing it will make you gain control.

Why Physiatry Recruitment Firms are Useful and Cost-effective

High demand and low supply increases the competition to find a doctor which creates the usefulness of a physiatry recruitment firm. Recruitment firms provide many useful services to include sourcing, screening, qualifying, appointment-setting, closing, interview prepping, debriefing, offer negotiation and counteroffer-defense. Many of these services often go unnoticed by either the physician candidate or the hiring entity. The networking capabilities of a physician recruitment firm that has been doing solely physical medicine and rehabilitation recruitment for 20+ years like Farr Healthcare, Inc. provides an employer with a unique resource and great capability and some might even say priceless advantage.

Through the various efforts of a PM&R recruitment firm, a doctor who is in the mid-career stage and happy with their work may be convinced to take a new position. This result would not be possible through the simple placement of an ad or job board posting. Experienced recruiters such as Farr Healthcare, Inc. are able to identify the features of the practice opportunity and match it with candidates seeking those benefits.

Recruiters can help a resident who is not experienced in the practice search process navigate it efficiently and effectively. I often talk with residents who don’t know the difference between an independent contractor and an employee so a recruiter can explain the terms. This behind-the-scenes discussion can help steer a physiatrist to a practice opportunity the physician might never consider otherwise.

Due to their years of experience a physiatry recruiter can often identify if a candidate is truly interested or not and save the employer otherwise wasted time with the candidate. Sometimes doctor candidates are testing the waters but not ready to make a move. Sometimes a doctor will tell a recruiter information that they wouldn’t say directly to the hiring entity.

The overall cost of physician turnover is a huge financial cost. The recruitment fee pales in comparison to the revenues lost without a physician on staff. Yet another reason to hire well to retain physiatrists for years.

Don’t Use Farr Healthcare Physiatry Recruiters! Yes, You Should!

Recently, a physiatrist commented to me that physician recruiters are too expensive and not necessary. Needless to say, it struck a nerve. I’ve heard the comment before on occasion. I’d like to address it here.

There is a need for physician recruitment companies in that hiring entities reach out to them to help with recruitment. Entities use physician recruitment services because they find it difficult to find physicians and/or that it is more cost-effective to outsource the process. There is a doctor shortage so entities often need help.

Conversely, as was the case with this doctor, one might think that if there’s a doctor shortage then doctors can easily find jobs. On the surface, this logic prevails however there are many considerations when looking for a practice opportunity, many concerns and cases when a practice opportunity is only available through a particular physician recruiter, that a physician recruiter is a vital component of finding a job.

To be continued . . .

The Steps to Getting a Physiatry Job

There are several steps to take for getting a Physiatry Job. Below are ten steps to take to land that dream job!

Determine Your Interest
Find Physiatry Practice Opportunities
Narrow Down the Practice Opportunities
Contact Practice Opportunities
Look for Items That Match Your Interests and Any Red Flags
Be Selective
Check out the Corporate Culture
Provide References
Review the Contract With a Lawyer
Sign on the Dotted Line and Best Wishes!

Physiatrists assess and treat individuals with short-or long-term cognitive and/or physical impairments and disabilities resulting from:

Musculoskeletal conditions, such as work or sports injuries, or back or neck pain
Neurological conditions, including brain injury, stroke or spinal cord injury
Other medical conditions

A new clinical physiatry pathway that offers rewarding work for doctors is cancer rehabilitation medicine.

As doctors, physiatrists are trained for leading a multidisciplinary rehabilitation team, including healthcare professionals like:

Physical, occupational and speech therapists
Nurses and prosthetists
Dietitians

When trying to figure out how to get a physiatry job, your first step is to first become a doctor. Then you’ll complete special physiatry training.

10 Steps to Getting a Physiatry Job

Below are the steps to take when learning how to obtain a physiatry job.

1. Determine Your Interest

First, you’ll need to figure out what appeals to you for your physiatry position. Perhaps you want to provide general inpatient and/or outpatient services. Or maybe you want to subspecialize. Some subspecialties are:

Sports medicine
Spinal cord injury
Pain medicine
Neuromuscular medicine
Hospice and palliative medicine
Pediatric rehabilitation
Cancer rehabilitation

What about compensation? The average physiatry salary in the U.S. as of September 26, 2019, is $232,230. However, the range often falls between a little over $210,000 and $259,000. Salary ranges can widely vary depending on many essential factors, including:

Certifications
Education
The number of years spent in your profession
Additional skills

Also, what is your location preference? Do you want to work in the city or in the suburbs?

2. Find Physiatry Practice Opportunities

Research online to identify physiatry practice opportunities. For example, Farr Healthcare offers a huge list of the latest in physiatry practice openings, inpatient and outpatient job opportunities and pain management jobs.

Farr Healthcare visits physiatry residency programs to offer information regarding the practice search process and attends national and regional physiatry meetings every year. In fact, Farr Healthcare has often been the only recruitment firm to speak at many American Academy of Physical Medicine and Rehabilitation (AAPMR) meetings.

Farr Healthcare is your easy, one-stop for physiatrist practice opportunities with a large list of nationwide physiatry practice opportunities.

3. Narrow Down the Practice Opportunities

Depending on your interests, you may need to narrow down the practice opportunities to about six that seem most promising. While you should consider your preferred clinical settings during residency, you should begin your serious considerations by your fourth year.

Some practice options to think about are:

Census or patient load
Inpatient or outpatient
Opportunities for procedures, such as EMG, ultrasound and intrathecal baclofen pump program
Opportunities to teach residents vs. medical students vs. fellows
Full time vs. part-time
Availability of support staff
Flexibility to mold your practice
An acute hospital vs. free-standing rehabilitation hospital
Government hospital setting
Multispecialty centers vs. single-specialty centers
Small vs. large practices
Need for fellowship training

Also, physiatrists might pursue various career paths. Some physiatrists work as part of a bigger treatment team in private practices, but most others work in outpatient specialty clinics, sports medicine facilities, inpatient hospitals and surgical settings.

4. Contact Practice Opportunities

Contact the identified practice opportunities for more information. If you don’t have a connection to the practice, you can email or cold call them. There’s no harm in trying to connect with individuals.

Clinics and institutions might not publicly recruit or advertise for a position because this also expends resources, so it’s worth contacting a recruitment firm like Farr Healthcare or those practices you’re interested in even if you don’t see a position being advertised. The contact person is typically a practice manager, HR representative, PM&R department administrator or physician recruiter.

5. Look for Items That Match Your Interests and Any Red Flags

After identifying potential practice opportunities and learning more about their practice, review the information to see if the opportunity matches your interest. If they meet most of your criteria, you may want to pursue them. However, if you saw any red flags, it may be a good idea to rule their practice out and move on.

6. Be Selective

Visit the practices or hospitals that are of mutual interest. You can essentially interview each practice to find a mutual fit. Consider which organizations would be the best fit for your personality, work ethic, schedule, lifestyle and any other factors important to you.

7. Check out the Corporate Culture

While visiting, look for practices that match the corporate culture you’re looking for. Ask for a sample contract before leaving. Besides the scope of practice, some different areas to consider to look into are:

Signing bonus
Moving expenses
Licensing reimbursement
CME reimbursement or time-off
Student loan repayment
A non-compete clause regarding location, duration and the scope of practice
Productivity vs. salary-based pay
Vacation and sick days
Advancement track

During an interview, it’s wise and appropriate to ask the interviewer about the corporate culture. By doing this, you’ll deepen your understanding of the work environment and how individuals relate to one another at the company. You’ll likely meet with many individuals in the department during the day, which might include the doctors in the practice, nurses, basic science researchers and administrators. This is the best way of obtaining a good sense of corporate culture and personality of the environment and practice you’ll be working in.

8. Provide References

Be prepared to provide references. Ask your references before giving their names out. Typically, practices will request two or three references, either formal or personal recommendations.

9. Review the Contract With a Lawyer

It’s fairly standard today to have a lawyer look over your contract. They can help identify pitfalls and translate legalese. They should be familiar with health law or contract law. Remember, your contract should be properly written out since you’ll be living with it. Your lawyer can negotiate with your employer, but this will cost more and take longer.

Beyond stating the actual term of the rehabilitation and physical medicine contract, what are the terms for termination and continuation? Typically, the time of the term is outlined at the start of the contract and for more information, you’ll have to look usually towards the end of the contract.

If your contract is renewed, will it include the same terms or will it be open for discussion? Check for certain requirements like:

You need to live inside a specific radius of the practice.
You have to abide by past and current policies.
You have to carry a certain type of malpractice insurance.

Ensure the terms aren’t one-sided.

A letter of intent isn’t a substitute for a contract. Whether you use your lawyer as your negotiator will ultimately depend on your comfort level with the contract negotiation and the contract itself and if your employer has their own lawyer.

10. Sign on the Dotted Line and Best Wishes!

Once you’re happy with the contract, now it’s time to sign it. Congratulations, you just landed a job! Make sure you send out a thank you note to all individuals involved in the journey.

Check out All the Open Positions Today

If you’re wondering how to become a PM&R doctor, you might want to check out Farr Healthcare. We have over 30 years of physician recruiting experience and provide an extensive list of physiatry opportunities, including interventional and pain management subspecialties. To fulfill practices’ needs, we’re committed to quality with a great record of recruiting top-notch, results-oriented physiatrists with outstanding interpersonal skills. We provide top-of-the-line physiatry jobs and rehabilitation and physical medicine opportunities.