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wHAT IF YOU'RE DOWNSIZED?
Doctors rarely worry about being "downsized" out of a job. But while a layoff isn't an everyday event for physicians, it does happen. And it can befall any doctor-specialist or primary-care practitioner.
Only last September, a health plan in South Carolina that has hired 42 doctors since 1995, dismissed two physicians-an internist and an FP. It wasn't because of any problem with their clinical skills, but because they failed to meet productivity standards.
Other doctor-shedding scenarios aren't hard to envision. A staff-model HMO, for example, could lose a large state-employee contract. Poof: 20,000 patients vanish overnight, and the institution has 25 more primary-care physicians than it needs. Or a growth-hungry hospital buys too many primary-care practices and finds itself with a $20 million budget shortfall. The options: Cut everyone's pay, or cut a few doctors out of the organization. Many administrators would cut the doctors. Or a primary-care group mismanages the specialists it sets out to subcapitate and finds itself in the red for a significant sum.
Which doctors lose their jobs is usually based on two factors: productivity and effectiveness, as measured by cost of care, patient-satisfaction scores, and quality ratings. If you have high costs in a capitated environment, or low revenues in a fee-for-service environment, you're vulnerable.
If the ax falls, here's how to respond:
Don't panic; wait and negotiate. When you get the news, you may go into emotional shock. So don't try to discuss the details of your departure right away.
Postpone that discussion for a couple of days or a week. Then request a meeting with the appropriate person-probably the medical director or the director of human resources. In the interim, gather your wits and consult your family, attorney, and accountant in preparation for negotiating your termination package.
In some situations, you may be able to negotiate up to a year's salary as severance pay. But the norm is less than a week's salary for each year you were employed. Ask that health insurance be continued for you and your family at the organization's expense until you land your next job-a request that's often granted. Even if you're refused, the law requires a former employer to make health insurance available to you for 18 months at the group rate plus 2 percent.
If you were receiving disability insurance as a benefit, however, it's unlikely that your former employer will agree to continue paying the premiums. Forget malpractice insurance, too; you must be on staff to be included in an employer's policy.
Tail coverage is another story. If you're truly being downsized rather than being let go for cause, the employer should pay the premium without too much objection. Doing so can prevent a legal mess if you're sued after leaving the job.
If you need help, ask for it. Picking yourself up after losing your job can be traumatic. You may feel that you no longer trust anyone or anything. And the last thing you may want to do is start going out on interviews. But the sooner you get yourself back into circulation, the better.
That's where out placement can be a boon. An out placement firm doesn't find you a new job. Rather, it helps you put the pieces of your professional life back together so that you can find a new job for yourself. The more lost you feel, the more it can help.
Out placement isn't common in the health-care field-partly because doctors have yet to be laid off en masse, and partly because employers have been slow to recognize its value. Still, you should ask for the benefit. You may get raised eyebrows and befuddled looks. Or you may get a green light.
You'll improve your odds by contacting several out placement firms beforehand, obtaining their literature and rates, and presenting them to the medical director or administrator when you meet to negotiate the details of your departure. If you're refused, and you feel you need direction, consider paying for such services on your own.
Be realistic about your situation. Minimize the shock by recognizing that being fired doesn't mean you're a second-rate physician. Prospective employers, as a rule, won't regard you with suspicion or contempt.
That's the good news. The bad news is that you may have to relocate. You simply may not be able to find work if you're in a highly competitive market like San Diego.
One large medical group in the Southwest lost a major health-plan contract. With it went the group's entire patient base at a key site. A dozen doctors suddenly found themselves unemployed. We couldn't find any of them jobs because they refused to move out of the area.
If you're strongly attached to your present location but having problems finding work there, level with yourself about your priorities. Which is more important: remaining in a place you love and taking whatever work you can get, or finding the right situation as a physician in another locale? Which matters more to your family: staying put and living on a reduced income, or moving somewhere else and enjoying a more comfortable lifestyle than you could if you stayed put?
When launching your job search, consider your values, the type of practice you'd like to join, and locales that need doctors in your specialty. And don't hold out for an unrealistic compensation package. If you're a cardiologist who was pulling down $350,000 a year, and you're looking in an area where cardiologists are making considerably less, expect your pay to drop to local market rates.
If you've been downsized before-or if your CV jumps around with, say, three full-time jobs in five years-you'll have a problem finding work. Nothing is impossible, but you'd do well to hone your networking skills without delay.
This article was published by Cejka Search and originally appeared in Medical Economics Magazine. Copyright by Medical Economics Company Inc. at Montvale, NJ 07645. All rights reserved.