Many new ophthalmologists considering private practice job opportunities spend too much time thinking about their credentials and qualifications to get the job. What they should be concentrating on are the prospective employers' qualifications to hire them. Here are a few easy ways to spot good -- and not so good --places to work.

Can you build a constituency?

Every new physician must build a constituency. In addition to your colleagues and the staff in your practice, your constituency consists of the referring physician community and the patient population you serve. You'll have to help the practice grow, no matter what the setting. Therefore, be sure the practice has the pieces in place that will allow you to build your constituency.

Figuring that out requires you to analyze the types of patients the practice serves, what referring physicians it's associated with and the environment in which you'll be working. For example: Is there enough work for you to do; what are the competitive factors; and are there any problems with the referral base?

All these questions really boil down to a fundamental one: Why am I being recruited? If the answer is, "to help pay the overhead," trouble may lie ahead. Physicians don't pay overhead -- patients pay overhead.

The doctors

Your potential employer is also a potential long-term business associate. How well you fit together is crucial to continued success, especially in a group practice.

Evaluate potential employers the same way you'd evaluate potential employees. Look for people who are smart, educated, experienced, friendly and mature. Big differences between your personality and his don't bode well for long-term success. Substantial differences in age, personality, religious or political beliefs and personal lifestyle could make it hard for you to co-exist as associates.

That's not to say that colleagues should be clones of one another. Complementary differences can strengthen a practice, but if the differences are too great, they can make it difficult to find common ground on practice issues.

The staff

Generally, the best employees work in the best practices. One of the most important indicators of a potential employer's qualifications is the caliber of personnel he has assembled. Employing a crew of sub-par employees may indicate lack of leadership, a naive approach to management or a stranglehold on the checkbook that inhibits success.

Look for a smart, trained and experienced receptionist who is personable, friendly, assertive and reasonable. Poorly managed offices frequently have the youngest, least experienced and lowest paid employees in this crucial position.

Look for an office manager or lead employee who can communicate, solve problems and answer questions with a minimum of hand wringing. Employing a good office manager is the sign of a good doctor and an excellent indicator of a good place to work.

Beware of practices that employ family members or close personal friends of the physicians'. While it sometimes works in solo practices, it almost never works in group practices. You may also wish to explore with the manager and potential employer what influence they would have on the selection and supervision of the staff. While you shouldn't expect to come in and take over, the personnel are so important to your success that you should have some say on the topic.

Management

Other indicators of a good place to work are the practice management systems. How many rings go by before the telephones are answered? What do people say when they answer the telephone? You can easily assess these characteristics by paying attention while you're visiting the practice. They're solid early indicators of the sophistication of the office management and the attention to detail of the physicians.

What about the appointment schedule? How far are patients booked in advance? What's the "on-time" performance of the practice? Is there room to work in emergency patients? Does the practice have a reputation with referring physicians as "hard to get?" All of these are make-or-break issues for you as you build your new practice.

Physical plant and equipment

While it may seem like a petty concern, the office in which you'll work is crucial. Many practices see the new doctor as the solution to the "we're too busy" problem and will expect you to pick up the workload, relieving senior physicians from extended days and rigorous on-call responsibilities. But are there enough exam rooms?

Most medical offices are too small. Determine early in the interview process if there is enough room for you to work. This means a minimum of three exam rooms available for each physician on the premises during scheduled office hours. Watch out for the practice that plans to "fit you in" during slack times in the schedule. And look at the appointment book to see if any slack times exist.

To solve a space problem, some practices take the naive approach of creating a satellite office to accommodate the new doctor. Be aware that operating a satellite office is fraught with practical problems that only the most skilled managers can cope with. So, while a practice may look like a good opportunity in other ways, if you have no place to work, you'll have a hard time building your constituency.

The deal

Finally, if everything else looks promising, move on to considering the offer the practice is extending to you. Where is the risk, and who gets the rewards? The straight salary arrangement places the risk with the employer, who should demand some rewards for it. Count on bringing in more than you actually get. A compensation package based on your production places the risk of building a constituency on you. That may be a fair risk to take if the rewards are also fair.

Try to get the terms of the long-term arrangement spelled out at this point, too. It's reasonable to ask the potential employer that assuming the arrangement works out, what the terms of long-term practice will be. Prolonged employee or junior associate status is generally distasteful and usually not necessary. Most physicians can determine if a professional relationship has potential within a year or so.

You should also determine at this point what the "dues to join the club" will be. This represents the amount that the employer or host medical group expects to realize in good will contribution from you when you transition from employee to a more tenured status. As an associate, partner or shareholder in the practice, you may be asked to pay for the privilege of joining. While reasonable people can differ as to how much that payment should be, it's not reasonable to expect the new doctor to sign a blank check at the beginning of his or her career by failing to negotiate all of these terms in advance.

Hit the ground running

As you can see, your personal success will depend heavily on the practice whose job offer you accept. Better to do your homework first than spend time in a situation that wasn't right for you from the start.

Jeffrey J. Denning is a management consultant with Practice Performance Group. You can reach him at (800) 452-1768 or through www.ppgconsulting.com.