For physicians who are new to a practice — especially those new to practice, period — scheduling can be a tricky subject. But surgeon Kenneth Johnson had it easy when he joined New Mexico Orthopedics in Albuquerque.

The foot-and-ankle specialist was replacing a physician who had recently left the group, meaning Johnson was practically inheriting an existing practice, diminishing the pressure for him to build a patient base from scratch. He also had previous experience, so he could handle more patients a day than a rookie. And because he was joining a group whose 19 other members were focused on different clinical areas, he didn't have to worry about internal competition.

All that made the transition smoother for him and the practice schedulers. Still, clinic manager Cathy Trujillo took nothing for granted. She planned carefully for Johnson's arrival because she knew he wanted to hit the ground running with a full load of patients.

"That's sometimes difficult" with doctors new to a practice, Trujillo says, "so we marketed it very well. We sent out information about Dr. Johnson, with his picture and his background, to referring physicians and worker's compensation case managers. And we had an open house. ...We wanted our referrers to meet him and to see what we have available here. We did all that in advance, so by the time he arrived, we had patients who'd been calling us ahead of time."

Many physicians who join new groups aren't as fortunate as Johnson. For them — and for group administrators — the first weeks can be challenging and delicate.

For one, new doctors tend to take more time with patients than their more seasoned colleagues; even practice veterans need some ramp-up time when joining a new group. As a result, both experienced and novice doctors sometimes find themselves making less money than they expected just after joining a group.

Meanwhile, acrimony can arise among group members when the number of providers expands too quickly. With physician compensation and practice revenues based on patient volume and payer mix, new doctors are often expected to build their practices quickly without poaching other doctors' rosters.

But the proactive approach that worked for New Mexico Orthopedics can work for you, too. Diligent planning and creative marketing will help your new doctors —  whether they're experienced or straight out of residency —  build their patient base faster and lessen dissension among the group.

Know thy colleagues

In smaller practices especially, it's imperative to know where your colleagues stand on staff additions before expanding. That means doctors need to understand the potential downside —  reduced revenue —  in addition to the potential upside of a lighter workload.

Bruce Johnson, a lawyer with Faegre & Benson in Denver who handles physician compensation issues, says he's seen cases where new doctors were hired just to reduce the number of days on call for the other doctors. A new hire can have that effect, but existing members aren't always happy with the adjustment to their bank accounts. Sometimes doctors are surprised to see the extent to which their patient volumes drop after a new physician's arrival, he adds.

"If a four-member, all-male OB/GYN group adds a 35-year-old female physician, immediately patients will start asking, 'Can I see the woman?'" says Johnson. That may be OK with the existing doctors, or it may rankle them.

Sometimes veterans of a practice will seethe silently as their patient volume dips; others will take matters into their own hands by trying to influence the schedulers, observes Lori Foley, of Gates, Moore & Co., a healthcare consulting and accounting firm based in Atlanta.
"I've actually seen a case where the physician has told a scheduler, 'I'll pay you $100 to direct a certain type of patient to me,'" Foley says.

Blatant bribery is rare, but it's not uncommon for doctors to make it known to the schedulers, even unintentionally, that they prefer to see particular types of patients, or to suggest that certain patients not be scheduled with the new doctor, according to Foley. And there are cases when schedulers, on their own, direct certain patients to certain doctors, for any number of reasons. All this can affect how much group members get paid, and such matters are complicated when the group expands.

"Often, the pie doesn't get any bigger," Johnson says, "it just gets re-sliced. And that's when things get exciting."