Personality as important as skills in new associates

"Some of the younger guys who are fellowship-trained are looking for the ability to have subspecialization within the group so we can offer top-level care to patients," he told Urology Times. "The feeling among some of the other docs, sometimes the older docs, is more along the lines that since urologists come out with at least 6 years of training, they should be able to do absolutely everything and that, first and foremost, we want someone willing to take anything that comes along."

From a practical standpoint, Dr. Ruff suggests that both perspectives need to be respected.

"We want someone who has an interest in something where we may not offer the newest techniques, whether that's female urology, or infertility, or whatever," he explained. "Conversely, we need someone willing to buckle down and do whatever the team needs. In other words, we don't want any prima donnas.

"Both the medical ability and fitting into the team are important. We have no interest in taking on a second-rate handoff, and being in Austin, which is a highly rated place to live, we can be a little picky.

"One problem we sometimes run into with a subspecialist is that they waltz into town and figure everybody will start sending them their patients, and that is not the case," Dr. Ruff added. "You need someone willing to get out and shake hands, or, as we say down here, 'someone who will sit down and have a glass of iced tea in the dining room' with primary care doctors."

The importance of fitting in

The importance of geography can't be minimized. However, Harold J. Hoppmann, MD, suggests that while the attractiveness of a cosmopolitan environment may attract rising medical stars, a candidate's clinical and human relations skills will determine who will become part of the community in the end.

Dr. Hoppmann, whose group practice is in Edina, MN, acknowledges the reputation of Minneapolis-St. Paul and its suburbs as a desirable location, with great medicine, business, and arts. But he notes that the most likely candidate for a urology position in his group practice is someone who has family in the area.

"If the Twin Cities weren't such a great place, we would have many fewer candidates from which to pick. I'm sure there are some smaller cities in Minnesota, Wisconsin, and South Dakota that have difficulty just getting people to come interview," he said.

"It is probably because we do have a great city that families have chosen to live here, but we're not likely to get applicants coming from Texas or Florida who want to relocate here. More [urologists] are retiring now than are coming out to practice, so what really is happening is that residents are deciding where they want to live," Dr. Hoppmann explained.

"That being said, what is very important for our group is that new associates are team players first. We don't want the guy who wants to be a star. We are looking for somebody who really fits the personality of the group. We've had great success with that. We've been in existence for 50 years and have a nice smattering of people."

Cooperation is a critical quality in those who want to join the practice of William F. Santis, MD, in Concord, NH. In fact, he might even take that expectation a bit farther.

"We're looking for someone who's bright and hard-working, but who can work as part of a team. The people we work with are like family members," he said.

"We are in a growth curve of our practice, so we're looking to support specific programs, whether it's our cancer program, pelvic medicine, or our stone program. It depends on which program needs help.

"More important, we are looking for someone who philosophically parallels the people in the group: how we practice, what our values are, and how we value patient care. Those are the most important [traits]," said Dr. Santis.

"We start off every day together as a group over breakfast, then we divide up the work. Whoever's in the operating room goes to the OR, and whoever is in the office will do rounds.

"We started that when we were group of four. Now we are up to eight people in different locations, but we still think it's important to try to take care of patients as a team.

"New associates have to be well-trained, but they also have to value practicing in a collegial team environment," Dr. Santis explained.

Urologists who relish participating in the team practice model are the lifeblood of the 20-member group in which Perry M. Sutaria, MD, practices. Its unique operational structure extends the team concept to its role in the Morristown, NJ, community.

"We are now a mega-group, encompassing the entire county. I was part of a six-man group that merged into this. We don't accept insurance and we are an out-of-network practice," Dr. Sutaria explained.

"We don't add associates at a rapid clip because we're a low-volume, high-quality practice where we spend time with our patients. We run a more traditional-style practice where we maintain the same types of salaries without having to see 60 people in an afternoon to make a living."

Further, "we are in a position where everyone in our crew happens to be fellowship–trained and is practicing at a fairly high level. So we look for someone coming out of a highly respected residency program, preferably with fellowship training.

"A lot of what we look at is very personal. We're a small specialty and almost everyone knows someone in a program who can give us feedback about the residents: their sense of ethics, their personality, how they treat patients, how they treat their colleagues, how they treat their inferiors and superiors. We can get a sense of their personality and style," Dr. Sutaria added.

"Beyond skill and specialty training-that's probably the most important-it has a lot to do with their ability to interact with people we're concerned about in our community. We need someone who is exceptionally caring for the patients, personable to referring physicians, and shows a friendly face in the hospital."

In addition to clinical and personal skills, Harvey Samowitz, MD, who practices in Aventura, FL, notes that business acumen is a valuable quality in physicians seeking to join a group practice. Dr. Samowitz suggests that business relationships with professionals outside one's specialty are important to a practice when, and if, a partner retires.

"Assuming the applicant is well-trained in current surgeries and treatments, I don't think that will be as important as the personal side and the ability to generate new business, new revenue, and their overall attitudes about medicine," he said.

"Our group practices state-of-the-art urology, so the challenge for the future is going to be on the business side: how to practice cost-effectively and be able to build a strong practice. Someone who is perhaps not as interested in the business side of medicine probably would not do as well."

Medical students contemplating their career path, urology residents considering their next step, and urologists seeking professional change have their work cut out for them. Lone wolves need not apply.

Karen Nash is a medical reporter and media consultant based in Sioux Falls, SD.