Audrey Barker Vice President, Physician Recruitment and Retention US Urology Partners Columbus, Ohio
LUGPA: A 2020 AUA survey revealed that nearly 68% of all urologists reported the need to hire general urologists. Is this a statistic that makes the role of recruitment integral to the success of the incoming workforce and the medical group? How or Why?
AUDREY BARKER: Absolutely. The role of a recruiter should help an organization secure a candidate who will ultimately root into a community and provide that community with care for the long term. It’s the recruiter’s job to assess fit within a practice culture and within the organization, so the group doesn’t fall into the practice of having high turnover at the physician level. This protects both candidates and groups and affirms the process a recruiter has to assure fit.
LUGPA: Do you find the physician shortage in Urology to be an unfillable void? How are you, or have you worked to reverse some of these stats?
AUDREY BARKER: While the sheer numbers are not in our favor (600 Urologists are retiring per year, with only 300 entering the workforce per year) Avg. age of Urologists is 58 and 1/3 of urologists over 65 are planning to retire in the next 5 years; our approach on how we deliver care is morphing from historic and more rigid concepts to requiring more flexibility. Examples include hiring additional Physician extenders to assist with volume both from a clinical perspective and hospital coverage. Additionally, in rural areas where we have had long standing physicians providing full time urologic care – this may look different in the way we are physically present at those locations. Outreach agreements and rotating schedules allow us to still be present, but not tied to a full time M-F every week schedule that we would have trouble committing to.
LUGPA: I want to offer Residents a peek behind the proverbial HR curtain and give some inside info they could benefit from when making the important choice of where to go next. Is it true that Residents should be looking for a landing place as early as year two? Why or why not?
AUDREY BARKER: Yes, if a resident is comfortable and confident to start interviewing early, I would encourage this. Early signing allows residents to take advantage of potential bonus payments made during residency, lower tax burdens on those said payments, potential to onboard and rotate through the practice during out rotations, etc. There are many benefits to securing a position early and aligns itself with a progressive group that has awareness around their internal physician succession plan and their future needs.
LUGPA: Do you encourage an RVU-based compensation model with all of your recruits? Is there a difference in what work model you promote to them?
AUDREY BARKER: I do not encourage any one compensation model over another. In my career I have seen a multitude of compensation models, and all have positives and negatives. Its great in that I can educate residents on many types of models and as they learn more about each one, they themselves will start to lean towards one that they believe suits them.
Compensation Models
Straight Salary
Salary based on Net Collections
Salary based on RVUs.
Ancillary buy ins and ownerships
Group partnerships
Shared Bonus pool across all partners
LUGPA: When a Resident is looking for a job, location is said to be one of the most important factors. A 2009 AUA study showed that urologists younger than 45 years old were 3 times less likely to be located in nonmetropolitan and rural counties than their older counterparts. Why do you believe that younger urologists want to work in a more urban area? Have you worked to assist in getting younger practitioners to underserved areas?
AUDREY BARKER: We are a much more mobile society now and new physicians in general are seeking a broader fit outside of the urology practice. They are not only reviewing the urologic offerings within a medical community, but what the additional subspecialty support looks like from Interventional Radiology, Anesthesia, robotics, etc. This plays in much larger consideration of where a physician will land than in prior generations. Our training programs have come a long way in terms of diversity as well and many residents desire urban areas where they feel comfortable and safe within their respective culture. Many residents are making a familial decision on where to locate, and reviewing not just the medical community, but other areas such as social, religious, cuisine, grocery, airport access, the list goes on. However, if a resident is seeking to serve a rural or underserved area, there are great resources to get them started. The government has official websites that list the communities that are designated a MUA/ HPSA/ HRSA site (Medically Underserved Area, Health Professional Shortage Area, Health Resource Shortage Area). These are typically federally funded to assist and attract physicians into that community. If you are motivated to provide services for a formal MUA location, start with these sites first.
LUGPA: What do you think is the importance of having a diverse group of urologists to serve a large population?
AUDREY BARKER: I have seen many great examples of how this plays out in a positive manner. We cannot assume who a patient may connect with, and how their own history affects their relationship with a provider. A diverse physician group offers many paths to connect with a community, from languages spoken, to upbringing, training location, familial status, etc. This helps cast a broad net around our ability to market to niche populations within a specific geography and bolster the outreach and relationships we have with that community.
LUGPA: Do you participate in any minority recruitment programs for women or people of color?
AUDREY BARKER: I do provide recruitment education to the Society of Women in Urology and am working to expand my outreach. This includes topics on how to discuss and negotiate contracts for a female physician wishing to understand a practices policy surrounding maternity leave, job share, telemedicine work, and many other topics.
LUGPA: What are some resources a Resident could use to start to decide where he/she should enter private, academic, employed or Private Equity practice?
AUDREY BARKER: Ask your residency program for education sessions on contract negotiations. I myself present on the differences between these types of agreements. Every resident should start with their own internal wish list, and a long list of questions to help them identify what suits them best. And be prepared to interview with a few of these options so you can compare them. Ask your attendings for their perspective but take it with a grain of salt. This is your career and job search, and only you can make this decision. It is a long process, so move at a pace that is comfortable for you.
LUGPA: Are there a set of skills that a person coming out of Residency should have under their belt to give them a leg up when negotiating a new contract?
AUDREY BARKER: Having some basic business acumen will really prepare the resident for the thorough negotiations that lay ahead of them. Understanding basic employment contract language and knowing to ask about things including compensation after an initial guarantee period, malpractice policy type (claims vs. occurrence) what is negotiable, what isn’t, and partnership tract are just some areas that will empower them to negotiate for their best contract. No question is a bad question, so ask them all and be confident!
LUGPA:How often do you think a Resident should be encouraged to renegotiate their employment contract? Is that built into the contract?
AUDREY BARKER: Usually contracts aren’t “renegotiated” per se, but rather have evergreen renewal terms. Often times, sections that may have areas for future changes will state “mutually agreeable” or “with prior agreement from all parties”. This is language that allows for future changes, but prevents the employer from making a change without your say so. This type of wording feels good for all parties and keeps everyone with some skin in the game.
LUGPA: Is a candidate who has had Fellowship training considered more valuable than one who has not? Why/why not?
AUDREY BARKER: Not necessarily. When a resident is first starting out, in general, you never want to say, “I won’t see those types of patients”. The majority of offers come with an initial ramp up period where your goal is to build your practice and develop your clinic and patient base. To limit yourself of a robust trajectory would be professional suicide. Having a fellowship definitely lends itself to opportunities to develop niche clinics with a practice, like a men’s health clinic, fertility clinic, robotics program, etc. and those come with great marketing opportunities. But in general, I would encourage even fellowship trained physicians to be open to general medicine, if at least initially in your first 3 or so years of practice.
LUGPA: Is work-life balance and burnout dealt with in the contract negotiation? How?
AUDREY BARKER: Work life balance is often discussed by way of call burden, outreach obligations, clinic schedule, etc. Burnout however, is something we all continue to try and expand on, and uncover resources. It’s encouraging that I see in the world now, normalizing discussions around therapy, culture, emotional awareness, and the multitude of personal and professional responsibilities that trigger burnout. A proactive discussion with a potential employer surrounding burnout would be great, and let’s a group know that it’s an important factor in your decision making. How open they are to discussing this may tell you a lot about the culture of the practice and if it fits your personal and professional needs.
LUGPA: Let’s say there is a first-year Resident who is asked what they were thinking about doing after residency, whether subspecialty, solo practice, large urology group, etc., and they say, “I don’t care whichever makes me the most money.” What would you say to that first-year resident?
AUDREY BARKER: I would say “that’s great! You know what you want!” All residents have different professional goals, whether it’s becoming employed with a highly noteworthy system or practice, or being an academic, or eliminating their financial debts as soon as possible, the offers are endless, literally. Knowing their goals may change over the course of their training is to be expected, like any decision in life. They are in a season of learning and in their first year of training, the financial burden they will come out of training with can be debilitating. Understanding the path to find a great practice that will make you the most money, and what potential ramifications that has (rural location, call, subspecialty support, etc.) is absolutely fine, just knowing what you’re signing up for.
LUGPA:Do you think a new hire should always plan to stick with that same employer a set number of years, or receive a certain amount of on-the-job education before moving to another practice?
AUDREY BARKER: Many contracts have bonus money tied to it. I call this gravy money, and this can confuse residents, as our industry has about a dozen different names for this bonus money. They include: residency stipend, fellowship stipend, sign on bonus, transition payment, relocation bonus, retention bonus, the list goes on.) Residents should understand the forgiveness schedule for this extra money, as its often longer than your initial employment term. For example, you may have an initial two-year employment term, but your bonus money is substantial and it comes with a four-year forgiveness term. Understanding as well, that if you are truly unhappy and want to leave, you always have negotiating power with your next employer, if you owe anything back to your organization. This is where your knowledge and confidence in understanding your contract will help you! Asking the employer about continuing education, outside of just the CME package is important. What ongoing professional development do they offer, do you have leadership aspirations that could allow for a director role within the organization, or chairing a certain area of the practice. These are great interview questions to show a practice you are engaged and seeking a long-term relationship.
LUGPA:When considering candidacy, should a young urologist be thinking about how to have an ideal retirement plan? Does this affect contract negotiations?
AUDDREY BARKER: I liken this to the housing market. We want to buy a house, but our realtor is helping us identify a home with the best potential resale value, and you haven’t even moved into the home yet. Initially this might not make sense, but you’ve worked so hard thus far, keep the momentum going in assuring yourself a happy and fruitful retirement. Ask about vesting, match, contribution buy-ups, who their broker is, etc. If you have to, pay the money to have a CPA assist you in how much to save and contribute. Your future self will thank you!
LUGPA: Another surprising statistic the AUA 2020 survey revealed is that only 23% of current practices anticipate hiring at least 1 urologist. With such a staggering shortage of urologists predicted for the next 10 years skewed by a higher number of urologists who will retire, why aren’t more practices looking to hire?
AUDREY BARKER: It’s my opinion that many practices are solo or small groups where they will essentially dissolve after the last one leaves or retires. I see that now in hospitals who are losing their one Urologist. It just isn’t attractive to a new physician coming out, so they reach out to larger groups within their respective region to determine if there are mutually beneficial arrangements that can be created to continue to provide urology care, but not employ them directly.
LUGPA: Is their money – revenue and budget ultimately the most important factor they consider?
AUDREY BARKER: It shouldn’t be. Now some LUGPA practices just simply will not have the deep pockets you see in offers coming from large systems and institutions, however, they may be able to offer you tangibles that others cannot. It may be heading up a new division or subspecialty clinic within the practice or taking over a legacy practice of a retiring physician whose been there 35 years. And I want to acknowledge that the budget in the first two years of a physician starting in practice is always in the red. Your salary and expenses are far outweighing the revenue you are bringing in initially, but it’s a steady course to breaking even, that’s why you see that typical two-year guarantee. We see you as an integral investment into the practice and understand fully it comes with a large financial lift. This is why we build resources to support you in all aspects of medicine, so we have mutual risk. No practice should hire without a proforma or needs assessment. And every practice should be willing and able to introduce you to those staff that will ultimately make your practice a successful one; the nurses, financial team, operations, revenue cycle, referral dept, marketing and outreach liaison, etc. It takes a village and the cost to replace a physician if it doesn’t go well is staggering. Everyone wants to see you succeed.
LUGPA: What about your role at US Urology Partners do you find the most rewarding?
AUDDREY BARKER: I love my outreach with residents. I have been a physician recruiter for 16 years, and while the process really hasn’t changed, each resident is their own person with their own career goals. It concerns me the lack of business exposure our residents get in training, and we require so much of them once they start interviewing. There are horror stories and pitfalls that I try to share with them, to produce strong, confident negotiators of their own futures. This is what fills my cup. Regardless of whether residents sign with me, if I’ve helped them identify their best opportunity and negotiate their best deal, I feel I’ve won.
