How to Find Your First and Hopefully Last Orthopedic Job

So we're gonna talk about how to find your orthopedic job. Changing jobs for a young orthopedic surgeon is very costly. It's gonna cost you $20,000 to $300,000 easy of lost revenue, lost time to change jobs, so it's incredibly important that you get it right at the very beginning.

Um, so we, uh, want to, um, as a, as, as my group uses this, we are completely transparent in the interview process because the very last thing I want is an orthopedic surgeon to take a job with us and then not be happy and then end up leaving in 2 or 3 years cause it costs us as a, as an orthopedic group time and effort to recruit another orthopedic surgeon.

Um, so you wanna know how your orthopedic group is governed. This is probably the single most, uh, important thing. Um, it's easy if you're in an academic job, the chair of the orthopedic department is gonna make the decision, and they are the king in high, on high, and you basically serve their wishes. If you're at a hospital, it's gonna be the hospital CEO that's probably gonna ultimately decide any

Major disputes. If you're in Private practice though, most of them will have an elected board, uh, and you need to know how that board is comprised, and you need to know that that board has some term limits so that the same 4 or 5 people aren't on that board forever.

You need to know who is the person who's gonna make it, and you need to ask, is that person the same person who's making the decisions 5 years ago, 10 years ago. If that position doesn't change over, then you basically have a dictator in that group, and that's a tough place to settle a, a resolute, uh, a dispute.

Uh, the larger the orthopedic group, the more governance there'll be and the less likely that you'll ever be taken advantage of. Um, so, um, the size does tend to have a correlation with, uh, with, uh, how, how well you, how you could be treated.

The Other important thing is transparency. You want to make sure that as a physician, you have access to the complete financial data of the group, the collections, the revenue, the salaries. You should be able to see everyone's salary. There shouldn't be any hidden expenses or hidden salaries. Uh, you should know how overhead is shared and how individual, uh, expenses are handled, and you need to know a little bit about the hiring and firing of key personnel, um, so that you have at least some knowledge about how that could all happen.

Um, you know, if you are, uh, if you are in your practice all by yourself, then you have complete transparency because you were the one and only decision-maker. If you're in bigger and bigger groups, you tend to start losing some of that transparency. So if you're a PGY 5, I put out a little timeline on what you should expect for the next year to get you, uh, your job. So this is mostly for PGY 5s, but anybody else can, can extrapolate as they want to.

If you're finishing up your fellow, your residency, about to start your fellowship in August of this year, um, you wanna limit your search to where you're gonna be working, uh, to 2 or 3 cities and find 2 or 3 groups in each city and start to reach out to them by September. When you start your fellowship, the, I find that the fellowship directors and the attendees and the fellowship programs are phenomenal at helping place you in a job, so

Most of them really want you to land a great job because they want to have a great reputation of being a great fellowship that, that lands great jobs, so they're gonna help you find a job, so definitely use your fellowship director as a great resource. Um, by October, you should have contacted, uh, 3 to 5 groups and basically have, um, uh, interviews lined up. By November or December, you should have gone on 3 or 4 interviews, um.

And then by January of your fellowship year, you need to sign a contract with an orthopedic group.

And the reason is, is because it takes a long time to get credential. You need to have a state license in the in the state that you're gonna be practicing in, and if you're practicing in any adjacent states, you need to have licenses in those states, and then you need to start getting on all the insurance plans no later than March. It takes 6 months to get on insurance plans, and I would tell you that probably about 1/3 of startingy physicians aren't credentialed on.

All the insurance plans and uh the best thing you can do as a resident is to stay on top of the group that you're joining and just pester them with, have I signed up for every insurance plan? Am I all taken care of on every insurance plan? You have to stay on top of that stuff because it costs you a ton of money if you're not credentialed when you start. So usually you'll finish up your residence, your fellowship, maybe take a vacation and then start building your practice.

Uh, when it comes to signing a contract, um, it's hard to sign your first orthopedic contract. It's a it's a daunting process. I hired an attorney to review my contract. They didn't really make any changes, but it's probably good for your peace of mind just to hire an attorney. It'll cost you 200 or 3000. It shouldn't be too much.

A lot of contracts will have a guarantee for the first year or two. do realize some of those contracts you will have to pay back that guarantee if it's a hospital-based guarantee if you leave the, uh, institution. Most orthopedic surgeons are making $300,000 if you practice in a moderate-size orthopedic or moderate-sized town in the United States. If you're a Spine surgeon and going to New York City, you'll learn a lot more and so forth.

Most groups should not have a buy-in. Uh, the only thing you should ever be expected to buy in any orthopedic group are tangible assets. So if they have real estate or ASC ownership, then yes, you're gonna have to buy into that, but there shouldn't be any good faith buy-ins anymore. I don't think of any, many orthopedic groups that try to do that. Uh, non-competete exists, but they really shouldn't, and they shouldn't be an important factor with that orthopedic group. If they make a big deal about their non-compete.

I would ask them if they've ever enforced the non-compete and if they're, if they're prosecuting their non-compete uh against young orthopedic surgeons who are just trying to start their job, then that's uh, a group that you might want to think twice about joining.

Um, when you're signing a contract, I think it's very important that you have a clear path to, to shareholdership. You wanna know how you're gonna be put on equal footing with everybody else in the group. For most, uh, groups, it's gonna be, you have to pass your boards and meet a certain, uh, threshold in terms of your collections, but it should be something tangible. It shouldn't be, oh well, we'll make you a shareholder when we feel like it. Those

Uh, those young doctors will oftentimes get taken advantage of and will, uh, end up leaving, uh, when they don't get made shareholder and the rest of their peers who joined different groups are making, are making shareholder. Um.

So when you're starting your orthopedic practice, uh, you really need to be a team player. Uh, I would recommend taking call. I know it's not always fun to take call, but it's a great way to get your name out there with Primary care doctors. It's a great way to get your name out there as a team player who's willing to do what it takes, uh, and, and just say that, hey, I'm not a prima donna, I'm an orthopedic surgeon. I'll do what I can.

Uh, I would say yes to everything, uh, even the stuff that you don't wanna do, um, but at first, you just say yes. If it's an infected joint, you just say yes and just do it.

When you say yes to cases, there's so many people that are around you that will learn that you are a nice person who is willing to do the extra to, to take care of patients, but everyone in the hospital will learn that. Everybody in your office will learn that, and that's how you get referrals moving forward is when people like you and they say he's a, he's a nice person who will help out Other patients.

Um, I would be careful if, uh, the busy surgeons in a group have a bunch of PAs. It's great for that busy surgeon, but if you're a young surgeon trying to start out and your mentor who's in the same service line as you are has got 3 or 4 PAs, it basically means all of that overflow or exhaust or patients who are just calling up to say, hey, I want to come in to see somebody for my Knee Arthritis. That busy surgeon is capturing a lot.

A lot of those through his PAs or her PAs and so you just got to be careful about how uh the people that are doing the same thing that you do use PAs because it can make it hard to start your practice. I would very much recommend going to a coding class when you start off. Um, billing and coding is challenging and if you get good habits from the very beginning, you will make a lot more money doing the same amount of work throughout your career.

Um, and to quote, uh, Paul Graham, who runs the YC Commary, I think at the beginning, you do things that don't scale, which means you do things that you're not gonna be able to do once you're a busy surgeon, but you wanna maybe call your patients the day before the Surgery and say, hey, I just wanna check in and see how things are going. You might wanna create video or blogs or do things that go the extra mile, knowing full well you won't be able to do them once you get really busy.

Um, that's, uh, it in terms of the talk. Just remember when you do, when you sign a contract, the intention should be that you're gonna be there for 30 years of your life.

That is equivalent to a marriage. You should take it as, as, as important of a decision in your life as marriage. Um, be patient with, uh, building your practice. It is a marathon, it's not a sprint. It'll take you 2 or 3 years to get your name out there and to get known in the community as a good provider. That's it for the talk. We'll answer some questions and everybody can raise their hand and, uh, Rachel will take you off mute and um.

And we'll, and let you answer, ask your questions.