PookieMD's Blog: Where Physicians Learn About the Business of Medicine

FP/IM Physician wanted for local Locums (Denver)

Family Practice and Internal Medicine physicians wanted to join ExtraMD, Denver’s local locums.  ExtraMD, in practice for 7 years, specializes in placing FP/IM physicians in short and long term assignments in the Denver/Boulder area.  ExtraMD covers family medicine and internal medicine clinics, urgent care and hospital medicine groups.  Benefits include flexible schedule, ability to have extended time off, and the ability to work in the situation of your choice.  Please do not apply if you are not boarded, and don’t have malpractice coverage.   Physicians who value interesting clinical work, balanced with home and family life should apply.  Slackers need not bother!

Who qualifies?

Must be board certified family medicine or internal medicine physician.

Must have Colorado License, DEA and proof of malpractice.

Must be committed to the flexible schedule and mind candy that go along with fill in work, and who honor their commitment to work and family.

Must have ACLS if doing urgent care or hospital medicine.

Signing bonus: to applicants that commit to working 10 shifts with ExtraMD.

Reply to info at extramd dot com.

It’s hiring season at my compnay, ExtraMD, a “local locums.”  My group of doctors has too much work to cover, so it’s time to add to the stable.  I finally realize that I need to have more doctors that I think I need.

But how to find good, caring doctors that want to enjoy medicine, life, and a balance in between? How to find physicians that put integity as a core value?  How to find physicians that do what they say they are going to do?

Here’s what I have tried so far, and accompanying results:

Craigslist.org: best response from this.  Two physicians interested, will be interviewing one on Friday.

Linkedin: no response

Sermo: no response

Bounty offered for referral: two responses, no interviews.

Mass emails to my friends and acquaintences: no responses.

On the docket for more recruiting: a post card mailing, advertisement on the Colorado Medical Society site, placing ad on medical job websites.  My best results have come from referrals from my friends, but that well seems to be dry.  Any thoughts on how you have successfully recruited the right doctor for your practice?

As I pull myself out of my post holiday over fed stupor, I have a bunch of random items floating in my head.  Most of them have to do with my business, ExtraMD, but quite a few have to do with the process of practicing medicine.

Okay, that’s clear as mud.  I’m such a ruminator it’s amazing I don’t have a cud.  What I’m trying to say, is that I frequently review events and try to figure out what I can do in the future.  It’s a more constructive form of worrying, which I have down pat.  Here are some questions I am pondering, along with questions that have been asked of me:

• How can an EMR mimic work flow?  More specifically, why do most of us still think better on paper, and what can be done about it?  (Quite a few docs have asked said, “You know, I do a note on the EMR, and then can’t even remember what I wrote.”)  I don’t know if this is because we all trained on paper–leave out the puppy training/paper analogy! Perhaps the physicians currently in training that grow up with an EMR won’t have this problem.  Thoughts?
• How can I build more loyalty from the physicians that work for my company?  The last two months have been filled with prima donna behavior from them that has left me cringing and apologizing to our clients.  All from some of my best doctors that usually give me no problems at all!
• How can I recruit more physicians into my company that will help my company grow?  Entrepereneur magazine suggests I ask the potential candidate for his/her vision of their role in my company.  I really like that, as I think most candidates would not have a vision beyond the paycheck.  I’m not cynical, I just know that I have  not been rigorous enough in shaping and sharing a vision.
• Why do some consulting physicians intimidate me? And how can I muster up?   
• How can I find the time to do the things I want to do both professionally and personally?

I’ll be thinking about answers to these questions and post on them.  I’d appreciate your insights as well!

Christmas is a great time.  For me it represents a possibility of what ifs.  What if Santa could bring me everything I wanted?  Here’s what I would wish for, for my company, ExtraMD,  and for myself professionally (and a few personal items thrown in!):

• A second office.  Now that Dear Hubby is entrenched in the upstairs office doing his job search I have moved to the basement, which is cold and dark.
• Another desk top computer.  I have an Acer Aspire which I love, but I still miss the big screen that’s in the upstairs office.
• A cell phone plan that doesn’t drop calls every 10 feet. I have AT&T, and it’s making me nuts.  I don’t have an iPhone,  so I’m not wedded to the plan.  Do I want an iPhone?
• A teenager to come load my mp3 player.  I still can’t remember (did I ever learn?)  how to use the dang thing!
• An assistant like Miss Moneypenny.  No, I don’t want the fawning adoration, just the efficiency and dedication.
• Time.  I want to time to spend with patients, thinking about patients, talking about patients and helping patients.  I also want time to work ON my business, not just in it.  I want time to read, read, read, and think, think, think, and then plan, plan, plan.  I want time to enjoy the journey, not just rushing to the next destination.
• A waterproof watch that is actually water proof.  Simple hand washing has dusted my last 3 Timex ironman watches! Seriously!
• A guarantee that my knees will be okay if I keep running.  Someday, I would like to do a marathon, but received a stern lecture from my local orthopod–”People like you keep people like me in business!”
• A chance to be an expedition doctor. 
• A belief that what I do truly matters.  Isn’t this really what we all are striving for?

What’s on your list?

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Forgive me if this adds to H1N1 hype. For those of you who feel that forewarned is forearmed, here is a simple check list to help your practice in what could be a busy influenza season, both with seasonal influenza and “swine flu.”

• Lay in a supply of alcohol based hand sanitizer and surgical masks.  Have signs on your office door along with a supply of both, advising patients with flu symptoms to use them.
• Remove non-essential items such as toys and magazines from the waiting areas and exam rooms.  These can serve as a mechanism to transmit the viruses.
• Have a place were symptomatic patients are separated from other patients.  Some practices triage over the phone and have symptomatic patients enter through a different door and go directly to an exam room.
• Encourage staff AND their families to get influenza vaccines.
• Have a plan so employees can work from home if possible.
• Cross train employees to cover for each other.
• Have a defined sick policy.  The federal government is recommending those with suspected or confirmed H1N1 stay at home for seven days or until they are well, whichever is longer.  (See flu.gov.)
• Physicians should develop a plan of what to do if they are sick.  (My group, ExtraMD, has already been called in to fill in for one doc out with the flu.)
• Have a plan of how your practice will handle extra patients.  Consider finding an extra practitioner temporarily, or sending patients to another office.
• Current recommendation on treatment: (verify this for yourself, please) tamiflu for those hospitalized with suspected or confirmed influenza, those with high risk from complications, e.g. children younger than 5, adults 65 and older, pregnant women, those with chronic medical/immunosuppresive conditions. Start monotherapy with tamiflu within 48 hours of onset of symptoms.

Hope that helps.  Take good care of yourselves–doctors are people too!

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It’s time to make the next 6 month marketing plan for my company, ExtraMD.  ExtraMD, based in Denver, is  a group of doctors that do fill in work for family practice and internal medicine practices through out the Denver Metro area.  I am the president, and run the group.  My biggest job is finding work for the 6 doctors that comprise the group.  We call ourselves a “local locums”, and our goal is to provide reasonably priced fill in doctors, build long term relationships with clients, and help their practices grow.  We have had a lot of our clients for 4+ years, as they use our group over and over. It takes about 3 months to build a relationship such that a client books shifts with us, so I have to plan accordingly.

As you may recall, I made a marketing plan back in January to combat the recession. It was made to go through June, but actually went through July.  Following is the plan for the next 6 months. 

The Goal: 60 shifts per month.  (Last January my goal was 50 shifts per month, and we didn’t make it.  However, we did get up to 40/month, double our slowest month ever, in which there was only 20 shifts.)  By the way–this goal is a “stretch goal” –it will really push the limits for me as chief (and only!) marketer.

August: postcard to potential/current clients reminding them that we provide fill in physicians when the practice is extra busy or if  a physician is on vacation.  I already did this, and did something I haven’t done previously–I reused a post card that I had sent out in June.  It was the most successful postcard mailing I have ever done, so I used it again.  Mistake:  didn’t check post card stamp rates.  They went up since June, and I mailed a whole bunch with a $0.26 stamp rather than $0.28 stamp.  Arggh! Moral: always check stamp rates as they seem to be going up rapidly!

September: email to clients on collecting co-pays.  I will do this as a blog post and recycle it in to a mailing.  My client list doesn’t seem to coincide with my blog readers, so it’s okay to reuse that content.

October: press release.  I haven’t picked a topic for the release, so will have to be looking and open for ideas.  (ExtraMD can help your practice cover increased volume of flu patients?)  I will also ask the other doctors in the group to leave business cards with the practice managers they are working with and with other people who are interested in our company.

November: Thanksgiving cards.  My company and our doctors have a lot to be thankful for! We survived our slowest 1st quarter ever, and I would like to send a gift card with the Thanksgiving card to our clients.  I have traditionally sent coffee cards, but would like to do something more healthy and fun, like coupons for stuff from Gaiam.  (I love this company, and one of my good friends is an accountant there….Hmmm…can I use that connection?)

December: email to clients on preparing for the January doldrums–the time when patients aren’t coming in because of deductibles etc.

January: a free webinar on medical practice management?  (My good friend and controller of our company, Suzanne, would have to help out with this one.)

For more on stretch goals and celebrating failure, visit Celebrating Failure.  For more on marketing, check out the Duct Tape Marketing blog and book.

I’ll keep you posted!

I am taking a hospitalist to lunch today.  This particular doctor is interested in joining the ExtraMD fold.  As I prepare for the lunch, which is a getting to know you affair, I thought it would be helpful to define what I am looking for in the physicians that join our little group–and hopefully it will help you too if you are hiring!  So what am I looking for?

The most important quality is integrity.

Yes, I go through and google the candidate, check the national practitioner data base (which in my book can be misleading), verify license, dea, malpractice, work history etc.  But this doesn’t tell me about the character of a future ExtraMDite. 

I am taken back three years when I interviewed a physician who was interested in joining us.  He was overly chatty, and actually, a bit negative.  He had a chip on his shoulder as if the world owed him.  I felt a bit uneasy, but couldn’t pin point why.  Now that I think of it, he was down right whiney!  I verified work history, called references, blah, blah, blah…And ended up hiring him.

Wrong move.  He was a competent physician, but  his personality cost me endlessly.  Turns out, he had other schemes as to making a living which sometimes interfered with his duties as an ExtraMDite.  In addition, he had a list of clinics he would and wouldn’t go to.  And, he would whine to me on the phone about this or that clinic, or about this or that person, or how hard he was working, or his schedule.  He got angry easily, and verbally mixed it up one day with one of our colleagues at the hospital.  He would call me at home at night and complain.

Ugh.  He was, to be blunt, a pain in the behind.  When he chose to take a full time job with a near by clinic, I was relieved.  Fortuneately, the new place didn’t ask me for a reference.

So what’s the take home?  I should have listened to my gut.  My company has three values I hold dear: integrity, family and service.  His whiney attitude and conviction that the world owed him was not in line with my company’s values of integrity and service.  Yes, he made ExtraMD some money, but he cost us integrity.

So, today, as I sail off to lunch, I will listen to my gut.  If there’s a bit a tummy ache, I will know that it’s a bad fit.

No more pepto!

Intuit thinks that medical practices are high risk for non-payment of credit card debt.  Following is my encounter with Intuit, in which I try to set up a merchant account so my company can accept credit cards from our clients–medical practices.

My company, ExtraMD, is a “local” locums–there are several physicians in our group, we live in the Denver area, and we fill in at medical practices through out the area.  Our business model is simple, but effective: we act as subcontractors to the practices that use us to fill in.  Practices email or call our trusty assistant with shift requests, we fill the shifts, and the practice gets invoiced, and ExtraMD gets paid.

Pretty simple, huh?  Well, not according to Intuit.  We are in the process of converting to a credit card model to make invoicing and payment easier.  We are asking our clients to let us invoice their credit cards.  They have all agreed, and I, as the president, was in charge of finding a merchant account that would be affordable.

I looked at several, and settled on Intuit, partly because it would mesh with QuickBooks, our accounting software.  I filled out the application, and waited.  And then waited some more.  They sent an email requesting more information.  I complied instantly, and waited.  And waited.  They emailed me again, saying they needed more information (which was actually included in the FIRST email I sent.)  This time I called, and reviewed the account with the nice Intuit customer service agent.  They would process my request, they promised.

Two weeks went by. Nothing, not a peep, no email, no phone call, zippo! 

I called back. “I’m sorry,” said Intuit lady, “but medical practices and medical practice staffing are just too high risk.  We are worried we won’t get paid, due to the risk.”

“What?!”  I asked.  “I’ve been in business for 5 years, and our time in AR is probably one of the shortest in the business world!”

“Well, you are a service industry, and medical staffing is too risky.”

I asked to speak to a supervisor, which she wouldn’t let me do.  I sputtered along for a few more sentences and then finally hung up.

The take home: Intuit considers medical practices high risk for non-payment, or late payment.  That’s you,  my friend–hard working physician and practice owner.  This is the cold reality–and so much for loosening up credit with bank bail outs! 

Needless to say, we won’t be using Intuit.  If you have a vendor for a merchant account that you recommend, please feel free to comment.  I’m still looking!

Things have been in disarray at the PookieMD household–Hubby got laid off two days ago, and we are picking up the pieces.  As a wife of an engineer that loves working in small companies, you would think I would be used to this.  But I’m not.  I am trying to get better at it, looking at it constructively, asking what I can learn from it.

But it is still a really scary place to be.

I go through the seven stages of grief every time.  Warning–rest of post may be a bit whiney for those hard-core-stiff-upper-lip people!

Shock: yesterday I was shocked, but I think this wore off quickly as I have been worried that Hubby would be the next under the axe as 3 of the 15 people company had already received their walking papers.

Denial: Hubby is at this stage–”well what if I get a job next week?”, he asked.  What if, indeed!

Anger: for me, it is the turning upside down of my carefully crafted world, the helplessness I feel at not being able to control everything that is enraging.  It is tempting to blame someone, but I know there is no one to blame.  I spent a lot of time sitting on my front step the last two days so I wouldn’t yell at Hubby.  Helplessness makes me furious!

Bargaining: nah, I don’t bother with this stage.  What’s there to bargain about and who to bargain with?

Depression: not there yet.  I think this will depend on the length of the lay off.  We are bracing for at least 6 months, if not longer, given the economy.

Testing: I have already taken more shifts at the hospital, and Hubby has already found a some jobs to apply for.   I have always worked 2/3rds time as a hospitalist so I can spend more time with my daughter, but I will have to give up that for a while.  I know I am lucky I have this option, but I am also sad, because spending time with my daughter when she is out of school is one of the greatest joys of my life.  In addition, we went through our budget via an excel spread sheet, and know we can go a year on my salary as a physician and president of ExtraMD.

Acceptance: does any one ever accept bad news?  I don’t know if I will ever get to this stage–maybe more study of Eastern Religions would help.

All right, enough whining and tissue wringing!  If anyone needs an electrical engineer let me know, and if you want me to cover some shifts, I’m here for you!

Yes, it’s here, your bags are packed, the reservations made, the dog walker notified…Ah, summer vacation! But wait, who will cover your practice when you are gone???!!! Following are tips on how to most effectively prepare for and use a fill in physician. (If you are in Colorado, check out my company, ExtraMD, a “local locums.”)
• Plan ahead. Book locums coverage 2-3 months ahead if you can.
• Read the contract carefully, paying attention to cancellation policies.
• Let your patients know that there will be a physician available to care for them in your absence. Give them the fill in physician’s name, if possible.
• When scheduling patients, make sure they know that your replacement, Dr. Fabulous, will be seeing them.
• Considering cutting down the number of days that your office is open. Many patients will NOT want to see Dr. Fabulous and will delay their appointments. Going from being open 5 days/week to 3 days seems to work the best. You will need to weigh the cost of overhead on closed days vs. the cost of paying a locums physician.
• Make sure you have your nights and weekends covered, and that the fill in physician has the names and phone number of night/weekend coverage.
• Make sure your replacement has names and phone numbers for specialists you refer to.
• Have emergency department phone numbers on hand. (Can’t tell you how many times I have filled in at local practices and have had to hunt for local hospitals’ emergency department phone numbers.)
• Make sure you leave clear directions on coding policies.
• FILL THE SCHEDULE! This can’t be over emphasized. Your receptionist or nurse should call and schedule visits for over due physical exams, pap smears, diabetic checks, hypertension checks, and cholesterol screens. My company’s physicians prefer to be busy when they fill in, and you don’t want to lose money-so keep ‘em busy!
• Have a written check sheet for the fill in physician: do they call patients with follow up labs or does the nurse? What is the policy for follow up on abnormal exam/lab findings? What is the prescription refill policy? (Good policy-nurse can call and tell the patient that labs are okay, if labs/studies are not okay, the nurse can tell the patient to schedule a visit-and good news!-there are openings in the schedule!)
• Make sure your fill in doc reviews labs, studies, consults and initials them and is clear on follow up protocol.
• Have a way for the fill in physician to leave follow up information for you on interesting/concerning patients. (My company has a standard form we leave for you to follow up on.)
• If your practice uses an EMR, consider bringing the fill in physician in early to learn the system, or consider paper charting and scanning the paper in. When you request a locums physician, ask if they have EMR experience, and if so, which EMR?

Have a good time, and rest assured that if you utilize a locums physician effectively, your practice and your patients will thrive. Don’t forget the sunscreen!