Small independent medical practices face a challenge recruiting talent from big healthcare systems, which can offer better pay and fewer administrative headaches. But they have a certain feature in their favor: flexibility. They can offer autonomy and mentorship, among other benefits.

“Even among younger doctors, some still have the belief that medicine is an art and they should be able to practice how they want,” said Mike Belkin, Divisional Vice President of Recruiting for Merritt Hawkins, a physician recruitment company that is part of AMN Healthcare, based in San Diego. Small practices have to consider how they can even the playing field with large healthcare systems.

Jason Farr, Senior Vice President of The Medicus Firm, a Dallas-based physician staffing firm, recommends his clients focus on the mentorship opportunities at smaller groups. He encourages practices to allow candidates to spend time with a physician during a day in the clinic. “Allowing them to shadow as part of the interview lets them see and feel that kind of mentorship,” Farr said. 

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Partnership considerations

Small independent groups understand they have to be competitive with national compensation rates. Practices in less desirable areas or seeking high-demand specialties may even have to pay above-market salaries. But there are also a handful of ways small independent groups can compete beyond the base income.

The most obvious is partnership, but gone are the days when reputable practices charged incoming doctors just for the privilege of joining the group or when doctors came up with 6-figure payments to buy into a practice. Anything more than 2 years before being eligible for partnership might not be sufficient to attract a doctor to the practice. Belkin said. Some practices offer buy-ins of just a few thousand dollars or even no cash at all, just sweat equity. “That’s a good way to bring in younger physicians who have an entrepreneurial spirit,” Farr said.

Practices used to allow everyone a voice and a cut of the pie when they became partners. And doctors would work at the same office until they retired. But young graduates do not necessarily want to be an owner of a practice. Rather, they probably seek a share of the revenue quickly because they may not be there in 10 years. Belkin advises offering a revenue-based partnership and a separate one for doctors wanting to buy into the real estate, equipment and organizational structure.

Doctors thinking about joining a small independent practice “want some kind of income stream not tied to production,” Belkin said. “If they are employed with a hospital, they are never going to gain [that kind of] income. That’s the primary advantage of independent practices, outside of autonomy.”

Financial incentives

Bonuses are pretty much mandatory in today’s market. A recent survey by Medicus found that 80% of healthcare organizations offer salary plus incentive to new hires. But a small practice may not have $50,000 sitting around for new hires that have not yet generated revenue. A retention bonus may be an answer to that problem. Offering $10,000 a year for the first few years ties them to the practice.

Another option is repayment of student loans. Most graduates leave medical school looking for a way to pay off the significant amount of debt they have accumulated. Employers can sign an agreement to cut a check to the loan company for each year a new doctor works.

Small independent groups also can try to identify and accommodate a candidate’s most pressing needs. Instead of offering a sign-on bonus, loan repayment, and relocation assistance, they could say, “We have $100,000. How would you like to use that?”

“Hospitals tend to be highly structured and have to have rigid benefits because they have so many employees,” Belkin said. “Small groups and nontraditional providers can be more innovative because they don’t have to worry about that.”

Additional benefits

A good benefits package is an important draw for healthcare providers. In the past, some benefits like retirement, continuing medical education, and health and dental coverage were taken out of a doctor’s check. Today, this package must be in addition to a doctor’s guaranteed salary.

Small practices also can offer extras that large healthcare systems cannot, such as state licensing assistance, payment for daycare expenses, a car allowance, concierge services, and assistance with mortgage loans, Farr noted. Another option is spousal perks, like using community connections to help a spouse find a job.

Finally, organizations can focus on work-life balance. Hospitals typically offer a 40-hour week with a base salary. An independent group may be able to offer extra time off or a flexible work schedule. “Doctors 20 years ago never thought about burnout or stress, they just dealt with it,” Belkin said. “The younger generations are wired into it. They are much more interested in a better quality of life.”

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