1. How to Avoid the Pitfalls of Choosing a Practice Sigsbee W. Duck, M.D.

2. Location, Location, Location… Political trends specific to distinct geographical locations Population Subset: What types of patients do you want to see? Average age of population at desired location? What percent Medicare, Medicaid, uninsured, and third party payors? Numbers, numbers, numbers… Number of patients Have to see more to maintain income

3. Defining Different “Types” of Practices Practice Types Solo Multispecialty Established Group practice Hospital employee Academics Military

4. Practice Politics Who is running the practice? What is the hierarchy? Who is your boss? Office manager CEO Clinic Director Etc. Who is getting the higher income…and why? Who does the coding? Are you involved?

5. Benefits and Expectations What are the benefits and/or expectations of each scenario? Salary and payment schedule? What equipment do they have? Go look and know What equipment will they purchase for you? When? Who chooses said equipment? Does it matter to you if they own equipment? It should not come out of your overhead If in a group practice: what is the buy in and how is it structured? Guaranteed salary with or without payback? Overhead: How much and why in both primary and secondary clinics? Buy-ins and buy-outs What does your buy-in encompass?, i.e. surgery center, CT Scanner, Lab? Is the buy out capitalized?

6. Benefits and Expectations Continued… Benefits: Time off CME Reimbursement for meetings and expenses Tail coverage Disability Type Policy owner Beneficiary Separate policy for stop-gap coverage Paid with pre-tax versus post-tax dollars

7. Requirements Days worked Know your hours and days Week-hours required Practice mandated meeting requirements Satellite clinics Call Requirements Pass the Boards… The patient always comes first What are my responsibilities? Productivity requirements? Who reviews your work?

8. Contract Specifics Contract length What happens after contract expires? Automatic contract renewal Can I become an employee and not a partner? Get an attorney! Preferably a local attorney so he or she knows the particular state law ramifications GET IT IN WRITING! Non-Compete Slow down plan or are you just put out to pasture…

9. The Fear of the Unknown Healthcare reform… How will new changes affect you? Your practice?