Allergy & Immunology
Dermatology
Gastroenterology
Otolaryngology
Allergy & Immunology- PRACTICE PROFILE QUESTIONNAIRE

Reason for hiring?

If replacing departing physician reason for departure?
How many physicians have left group in past 10 years?
Reasons for departure(s)
What is standard office hours, evenings, and weekends?
How many patients per hour or day does group currently see?
What is primary service area size? ___________ Secondary _______
How many competing specialist are in area? _______ Primary referral source __________
Is there a computer/printer in patient room’s?
Is patient information available on-line?
Does the group have a technology manager on-site?
Do Services Include: PFT _______ Niox FENO ________ in-house nasal endoscopy _______               Skin testing _______Rush immunotherapy ______ cluster immunotherapy _______ patch testing food _________ patch testing chemical _____ Methacholine challenges _______ exercise challenges _______Drug testing and challenges ______ food challenges ______ immune evaluations __________Xolair administration ________ PCN testing __________ Food allergy oral desensitization _________ success rate ____
Does group own its office building? ______Is ownership in office building available? _________
Total square feet of office space PAYER MIX Medicare % _________ Medicaid % ________             Private Ins %________Self Pay % ________ Other % __________________
Overhead Percentage Excluding Physician income:
Number of employee’s _________ # P.A.’s. _______ #RNP’s___________ # M.A.’s_______       Other support personnel ___________________________________________________
Are there any spouses or relatives involved in the practice?
If yes describe relationship capacity, & duties
Describe travel to other locations
Base Salary range _____________________ Bonus structure ______________________
Is partnership available? _____________ When offered _____________
How will Buy-in amount be determined? _______________________________________
How are patients to be assigned? ____________________________________________
Do you have a contract ready to present to a candidate? ______ yes______ no
Tenure of current administrator
What activities will new physician are expected to do in order to build a practice?
Name the top three advantages of joining this practice?
What are the disadvantages that may be perceived by candidates?

DERMATOLOGY PRACTICE PROFILE QUESTIONNAIREReason for hiring?
History of group, year founded, additions and departures
What is average patent volume
Preferred/expected scheduling volume for new physician?
What is primary service area size? ___________ secondary
How many competing specialist are in primary area?
Describe types of lasers, cosmetic procedures, products offered:
Describe P.A./N.P. extenders job duties and volume produced:
Number of FTE’s_________ # P.A.’s. _______ #RNP’s___________ In-house billing _____
Does group have MOHS surgical set up?_______ Number of MOHS procedures ___________
Does group have in-house pathology lab? __________ Slide volume? __________________
Does group do its own dermatopathology? ______ employ pathologist? ________ # days ______
Does group own office its building? __________ Will ownership be available? _____________
Total square feet of office space ________________________________________________
Number and type of exam rooms _______________________________________________
Number and type of procedure room’s ___________________________________________
Does the group have E.M.R? Yes _____ No _____
Describe travel to other locations _______________________________________________
Salary Range ________________________Bonus formula __________________________
Is partnership available? _______ % equity available __________ if yes after how long? _______
Partnership income is/will be distributed by what formula? _____________________________
How are existing versus new patients to be assigned? _________________________________
Is there an employment agreement prepared? Yes ______No ______
Does group have an operating agreement? Yes _____ No ______
Cell phone numbers for key contacts in group. _____________________________________
Tenure of current administrator ______________________________________________
What activities will new physician are expected to do in order to build a practice?
Name the top three advantages of joining this practice?
What will be the perceived disadvantages?

Gastroenterology Practice Profile Questionnaire

Reason for hiring?
History of group, year founded, mergers, additions, departures?
Average number or range of clinic patients scheduled per physician per week?
Back door and/or cell numbers:
Is the employment contract ready to present to candidate? Yes: ________ No: _________
How many competing specialist are in primary area? ______________________________
ANCILLARY REVENUE: Does group own endoscopy center? _____ yes _____ no
OFFICE REAL ESTATE
Describe Hospital rounding and call coverage:
PAYER MIX Medicare % _________ Medicaid % ________ Private Ins %________
Overhead Percentage Excluding Physician income? _______________________________
COMPENSATION: Base Salary minimum ________________ maximum ______________
Describe travel to other locations:
Number and type of employees:
Top 3 advantages to joining the practice?
What will be the perceived disadvantage?
Current number of procedures performed by physician(s) per week?
Is ERCP required or preferred? _____________________________ is EUS required? ___
Would you like sample employment contracts to review? Yes: ________ No: _________
Is ownership in endo facility available for candidate hired? _____ yes _____ no.
Does group have in-house pathology lab? _____ yes _____ no
Does group employ in-house pathologist? _____ yes _____no
Does group employ in-house anesthesia? _____ yes _____no
Does group own its office building? _______ Total square feet of space: ________________
Is ownership in office building available for new hires? ____ yes ____ no.
Number and type of exam/procedure room’s
Current EMR type and stage?
Primary Hospital Other Hospitals
How are extenders utilized in office or in hospital?
Payer-Mix
Is partnership available? Time to partnership?
What is buy-in based on?
Is partnership revenue distributed equally or based on production?
Are there any spouses or relatives involved in the practice?
If yes describe relationship capacity & duties.

OTOLARYNGOLOGY PRACTICE PROFILE QUESTIONNAIRE
Reason for hiring?
History of group: year founded additions and departures.
Daily Office Visits ________ Daily Inpatient _________ Weekly Procedures ________
What is the primary service area size? ____________________ secondary _________
How many competing specialist are in the area? ______________________________
Does the group own a sleep lab? ___________ # beds? _______
Clinical Space square feet ________#general exam rooms _____# treatment rooms _____
Is EMR installed? _______ What type & stage? _______________________________
Does group own office its building? Yes _____ No ______
Is ownership in ASC available? Yes _____ No_______
Call arrangements weekdays ___________________ Weekends __________________
Medicare % _________ Medicaid % ________ BC/BS %________
Overhead percentage exclusive of physician income? ___________
Number of FTE’s_______ #P.A.’s ______ #RNP’s ______ In-house billers ______ Others:
Are there spouses/relatives working in the practice?
Is Yes, duties and responsibilities?
Administrator / office manager tenure?
Describe what activities a new physician is expected to perform to build practice?
Describe travel to other offices/hospitals?
What are top 3 advantages to joining the practice?
What sub-specialty training is desired? __________________________________
What sub-specialty training is NOT desired? ______________________________
How are patients to be assigned? ______________________________________
Is there an employment agreement ready to present to a candidate?
Minimum salary ____________________ Maximum salary __________________
Main Procedures or Surgeries Required
Balance Lab? _______CT scanner? ____________ Type __________________                   Audiology? ______ Hearing aids? ______ Skin testing and immunotherapy? _____
Does group perform/have Facial plastics?
Type of laser/equipment __Videostroboscopy ________ other equipment
Other services offered?
Is ownership in ancillary revenues available for candidate hired? Yes _____ no _____
Is ownership in office building available for new hires? Yes _____ No ______
Term to partnership? What is buy-in based on?
Benefits provided