One day, if it hasn't happened already, a hospital negotiator may knock on your door with an offer you can't refuse: Sell your practice, and you'll get generous cash up front, a multi-year contract at a strong salary, and an end to administrative hassles, which the hospital will assume. "You just keep right on practicing in the same office," you may be told. "Nothing will change."
But no marriage is perfect. With some hospitals, for example, you may still be responsible for overhead after you sell. That can create a slew of problems. Your supplies, which must be ordered through the hospital's purchasing plan, could end up costing twice as much as before. If there's a longtime employee whom you altruistically overpay, a salary cut could be in his/her future. And once a hospital is your boss, your staff is eligible for its full range of benefits-including retirement-plan contributions. Depending on your contract, you may have to bear a sizable portion of that cost yourself. If you weren't offering benefits previously, brace yourself.
Unless, that is, you have clout with the right people. With clout, an often inflexible hospital policy can become wondrously elastic. Or that $20,000 cost overrun in supplies can disappear with the stroke of an accounting pen. Or a cherished employee facing a salary cut can be reimbursed through a productivity bonus. Or an accounting adjustment can make the cost of benefits, which may equal 20 percent of employee salaries, vanish for a year or two.
While the best time to raise such issues is during pre-sale negotiations, when your leverage is highest, some details are bound to be overlooked, and others you'd have to be a mind reader to know about. Because your power to make demands shrinks after you sign on the dotted line, you need to understand how to work the system to get what you want from then on.
As a hospital employee, the best way to gain influence is to keep your market share high. Rather than dialing back effort once you go on salary, as some doctors do, maintain your reputation as a productive physician after the sale.
It's also wise to join committees. Hospitals increasingly understand that to be effective in the marketplace, they must involve physicians. Try for openings on important committees, but expect to work your way up the food chain. Even if the first couple of committees you join aren't prestigious, use the opportunities to understand and become part of the organization's political fabric.
Don't be afraid to sit on committees that other doctors shun, such as marketing, cost control, and purchasing. These areas are crying out for physician involvement. Attend meetings, make deadlines, and do real work; your reputation will spread like wildfire. So will your clout.
Unfortunately, all this takes time. You can't rush out, join a committee, and-voila-your $20,000 purchasing problem disappears. In the interim, what can you do for more-immediate results?
Aim high. Approach the highest-level hospital administrator who helped negotiate the sale of your practice. Don't go to the chief financial officer, however; that person seldom sees your side of things. The medical director is your best bet, a key administrator next.
Find allies. Are other hospital-employed physicians having the same problem. Seek strength in numbers; try to present a united front.
Stay cool. When thrown their first curve balls by a hospital, doctors often respond by losing their tempers-the worst thing they can do. That there's a basis for your outrage is politically irrelevant. Vent in private. In public, speak in a moderate voice.
Be creative. Don't just fling your problem like a gauntlet at the medical director's feet. Come with possible answers. The more potential solutions you can offer, the higher the probability of getting the solution you want.