Planning the Transition to a New Practice Opportunity
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The keys are allowing plenty of time and being prepared for possible delays
For physicians contemplating a transition to a new opportunity, the most important considerations, understandably, are deciding what they’re seeking in terms of the practice type, size, and setting; and where, geographically, they would like to practice. Physicians who’ve been in practice five years or longer are likely to have a pretty good idea about both of those factors, especially if what they’re looking for is markedly different than what they’re currently doing.
Some physicians who practice with a large organization might, for example, want to move to a smaller practice setting. Conversely, those who have practiced in small to mid-sized groups that struggle with the economics of operating in a challenging marketplace might simply want an employed opportunity — a regular paycheck and a degree of distance from financial matters. Others might be eyeing a return to the academic setting that they remember fondly from their training years.
Regardless of where they hope to land, physicians seeking a new opportunity should keep another key consideration front of mind: when they plan to make a move. Recruiters report that many physicians who have been out of job-search mode for several years — especially those who’ve never looked for a second opportunity — don’t have a sense of the optimal timeline for a successful transition.
Physicians might think that because demand for their skills is high, and it is, and that opportunities are plentiful, which they are, they can accomplish the transition in a few months. That’s certainly possible, but it’s not realistic, said Aisha DeBerry, MBA, FASPR, Atlantic Group director of physician and provider recruitment for Bon Secours Mercy Health in Virginia. “Physicians should really be looking at nine months to a year, at a minimum, because of all the factors involved,” said Ms. DeBerry, who serves on the board of directors for the Association for Advancing Physician and Provider Recruitment (AAPPR).
Physicians who are working on H1 visas should extend the overall timeframe for their job search to 12 to 18 months at a minimum. These candidates should also be very clear about the kinds of opportunities they’re permitted to pursue before they start talking to recruiters.
Licensing and credentialing — expect delays
Why is the timeline so long? It’s because there are many moving parts in making a practice transition, and two of the key ones – licensing and credentialing – are completely outside the physician’s control. “Credentialing can take 90 to 120 days, and many physicians don’t expect that. It might be on the shorter end if the physician has only practiced in one place, but physicians shouldn’t count on that,” Ms. DeBerry said, “because it can vary a lot from one organization to another.” If the physician plans to move to a different state, it’s important to keep in mind that the credentialing process doesn’t start until the physician has applied for a license, which could further extend the potential start date.
Emerson Moses, MBA, FASPR, director of clinical talent acquisition for Optum’s Northeast region, advises job candidates to prepare for an extended credentialing period. “I’ve seen wide variations — from one month after the state license is issued, to upwards of six to eight months, depending on the organization and the complexities of the vetting and approval process,” said Ms. Moses, president elect of the AAPPR. “The sooner physicians can start planning their job search and timeline, the better.” As a general guideline, she recommends allowing at least two to three months for the application and interview process and an average of 60 to 90 days for licensing and credentialing, after the physician has accepted a position.
Licensing timelines, like those for credentialing, are widely variable. Although many states process a physician-license application in two to three months, it can take up to eight months in some states. In Hawaii or Georgia, it might take only a month to obtain a license, for example; in Texas, it might be six months or longer.
Michelle Seifert, FASPR, director of the office of physician recruitment at the Cleveland Clinic Foundation, notes that candidates are sometimes surprised to learn that it can take five months to obtain an Ohio license. “Credentialing is usually fairly quick here, but physicians really should plan on it taking several months to get through licensing and credentialing – and back up their timeline accordingly,” Ms. Seifert said. A malpractice claim, for example, regardless of its outcome, can extend the usual credentialing timeline by a few months.
On the positive side, physicians can expect and will receive considerable help from recruiters in managing the logistics of credentialing, once they’ve received an employment offer. However, in an era when mega health systems are proliferating, credentialing logistics can be complex indeed, Ms. DeBerry noted. “If the physician will be working with a large health system, the credentialing will be done at both the system and per-hospital level, and that takes time,” she said.
To be proactive, physicians who plan to practice in another state should research the licensing and credentialing environment in any area under consideration. Preparing for a potentially lengthy licensing or credentialing period, Ms. Seifert said, can help prevent situations in which the physician moves to a new area, saddled with a new mortgage payment, but is unable to receive any income for a few months.
First things first: Check your contract
Even before they start evaluating job opportunities, physicians should get a good understanding of what will be involved in leaving the practice they’re in. That means looking at all the fine print in the contract that governs their current employment. Physicians should be clear about the notice requirement, first and foremost, and any noncompete clauses that might prevent them from practicing with presumed competitors in certain locations or within a certain distance of their current employer.
“Noncompete clauses are actually one of the first things we discuss in our initial conversations with physician applicants,” said Ms. Moses. “Because the last thing anyone wants is to hire a physician only to discover that there’s a noncompete that affects the physician’s ability to take the job.” Even though noncompete enforceability varies from state to state and even regionally, it’s prudent to proceed from the premise that if the clause exists, it might be enforceable, sources agreed. “Recruiters need to be aware of any noncompetes, as they might be able to help you offset any of the financial penalties of departure when negotiating an offer,” Ms. Moses said.
Ms. DeBerry recommends that physicians not only read their contract carefully but also have an attorney review the document, ideally before they begin exploring opportunities. “It’s best to have an attorney review the contract obligations, and to have this review occur at the very start of the process,” she said. “With noncompetes, for example, it might take an attorney to decipher the language and determine what it actually means in terms of where the physician can or cannot practice.”
Another contract area where substantial variability exists is the termination-notification clause. Although 60 days’ notice is typical, some organizations might require as much as six months to a year. Based on her experience, Ms. Moses said, the typical range is 30 days to six months. However, some organizations might require six months, and academic organizations might request a full year’s notice.
It’s also important to check when the current employment contract is up for renewal, because that date might affect other matters, according to Patrice Streicher, associate director of Vista Physician Search and Consulting, a national recruiting firm. “It’s best not to rely on memory for any contract requirements, as many physicians tend to pay little attention to the document after they start the job,” she said.
Finally, physicians should be aware of any requirements regarding patient notification when they plan to leave the practice. In most cases, organizations will have set policies and procedures regarding how and when such notifications are made, but there might also be requirements regarding how much information can be disclosed to patients. And in most cases, it’s assumed that the practice owns the patient records, so physicians who plan a local job change should be aware of the implications if patients choose to follow them.
Following are a few financial contract considerations that might affect the timeline for a transition:
- Retirement plan vesting schedule and annual bonuses. This is an often-overlooked issue that several sources mentioned. If the physician is, for example, 10 months away from full vesting, he or she might adjust the planned departure date accordingly, to avoid missing out on funds they might be entitled to. The same goes for performance bonuses. If they’re paid out a certain date, such as Dec. 31, and aren’t prorated for partial-year payments, physicians might choose to stay long enough to receive those funds.
- Tail insurance coverage. Physicians should check their contractual requirements regarding malpractice tail insurance coverage, to determine who will cover it and what portion of premiums, if any, they’ll be responsible for financially. “This is a potentially huge issue that physicians don’t pay enough attention to early on,” Ms. Seifert said.
- Potential bonus repayment. Physicians who received a sign-on bonus or loan repayment at their current job should check if any portion of those funds — often structured as a retention strategy and predicated on the physician staying in the job a specified period of time — might have to be repaid. “Often, you’ll see a ‘clawback’ requirement for sign-on and or loan- repayment programs,” Ms. Moses explained. “Your employment document should outline this, but if you have questions, work with your human resources manager to fully understand the implications.”
On the basics front, physicians starting their job search should also address two key matters: ensuring that they’re fairly clear on what they want to do and where they want to practice, and making sure that their CV is polished and current. “The latter might seem obvious, but physicians sometimes fail to do that before they send it out. The CV should be current up to the date they start looking,” Ms. Streicher said. She added that physicians should also be prepared to explain, in a cover note or letter, any time gaps in the CV. It’s also helpful to let recruiters know of any personal reasons the physician wants to relocate, if applicable, such as family considerations.
Navigating the logistics — and politics — of a transition
One reason why recruiters urge physicians to plan on a long and, ideally, flexible job-transition timeframe is because certain discrete phases of the process, from interviews and site visits to the practical logistics of moving a family, are fraught with contingencies.
Hiring organizations do their best to arrange site visits for candidates as quickly as possible, but it might take several weeks to get all the parties involved lined up for the interviews. Even after the interviews, if an offer is extended it might take another few weeks before the paperwork is ready. “I recommend planning on two to three months for the application and interview process,” Ms. Moses said.
This fluctuating timeframe can make it challenging for physicians to decide exactly when it’s appropriate to notify their employer and their colleagues about their planned move. In an ideal scenario, physicians should inform all affected parties of their decision to leave as soon they as possible, to enable the organization to plan for their departure without putting undue stress on the practice.
“It’s best to be up front with your current practice about your plans,” Ms. Seifert said. Small organizations or rural practices might have to plan an extended search to identify a replacement, for example, or set up locum tenens coverage. Even large organizations might have to reorganize, at least temporarily, to accommodate the departing physician’s absence. As such, providing ample notice is a matter of professional courtesy and a way to avoid burning bridges, all sources agreed.
Physicians who plan to relocate and haven’t moved houses in a while might not remember — or know — just how time consuming and stressful it is to transport a family and personal belongings. After ensuring that the family is on board for the change, and that a spouse or significant other’s possible career adjustment has been addressed, physicians should still plan for a few months of upheaval for all involved. They should also make sure that there will be health coverage continuity, ideally without having to access expensive COBRA coverage.
Once they’ve accepted a new position, physicians should tap any relocation resources available to them through their new employer. Beyond providing monetary assistance with the move, many practices and health care organizations also have local connections that can be very helpful, such as a realtor with whom they’ve worked in the past and a community “expert” who can advise on schools and other important considerations.
“The family dynamics are really critical, so if physicians can minimize disruption by planning a suitable start date for the new job around the school schedule, for example, that can really help with the transition,” Ms. DeBerry said.
Ms. Darves, a longtime contributor to NEJM CareerCenter, is a Seattle-area freelance writer and editor.