Medical practice (Neurology) buy-in

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gujm
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Medical practice (Neurology) buy-in

Post by gujm »

Hi,

I am a current fellow and have already signed a contract with a private practice. At time of signing the contract there was no mention of exact amount for buy-in, but it has to be atleast same amount as the current partners. It is a 3 physician practice, and I got information from the senior physician that the practice is evaluated at 10 million and each one of them have put more than 1 million. That is a crazy, scary number and I am freaking about joining them.

I have not yet started working there, it is in different part of the country so it will be a big relocation and I don't want to leave it at later date. I am wondering if I should look for another position or if I do join them, stay without partnership. Any thoughts???

I am reimbursed 70% of billing collections from day 1 and as per senior partner, I may not get any monetary benefit from buy-in anyways. But the idea of not having any say in how the practice is run in the future makes me nervous.

Any thoughts or help greatly appreciated.
Thanks
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LAlearning
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Re: Medical practice (Neurology) buy-in

Post by LAlearning »

to be fair you dont know anything about how their contracts are structured. so for now since you already signed, go work. if it doesn't work out, you'll leave.
most docs change jobs the first 5 years anyways.
I know nothing!
mac808
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Re: Medical practice (Neurology) buy-in

Post by mac808 »

How do they arrive at the $10 million dollar figure? What hard assets do they own (office building, equipment, ASC, etc)? What's the average profit per partner?

If the $10 million is ''good will'' (local reputation and referral networks and similar) then you're getting swindled.
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gujm
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Re: Medical practice (Neurology) buy-in

Post by gujm »

They lease the office space but owns their equipment including EEG and EMG machines. As per the senior partner, they invested money for getting on insurance panels, hospital credentialing, EMR, employee salaries etc.

My biggest reason for seeking opinion is to understand if other people stay in a practice but not become partners-what will be disadvantages of that?

This is the only big city in the state, and I have kids and am not willing to relocate to move again. I have't started yet and can still refuse to go and work for them.
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Artsdoctor
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Re: Medical practice (Neurology) buy-in

Post by Artsdoctor »

Some practices place an inordinate value on "goodwill" which could drive up the value substantially. There are many ways to buy in to a practice; the most humane would be to have a certain amount of buy in deducted from your paycheck (for example, you make less the first year, a little more the second, more the third, and equal pay the fourth). If they ultimately want you to buy in with cash, I would avoid that scenario.

It's easy to inflate the value of a practice so I would be weary of numbers like that, but you will ultimately be entitled to see the books. I always advocate having a contract lawyer take a look at what they're proposing, preferably one that specializes in doctors' practices.

I don't think you'd "never have a say" in the financials. Once you're a partner, you should have equal say.

Be aware that many private practices will ultimately fold and doctors will be employed by a hospital or other healthcare entity. If you're buying in, you won't get any of that money back so keep that in mind.

Finally, make sure that the senior partners don't get a "buy out" if they retire. It's not fair for you to buy in only to have to buy out the senior partners. I've seen this done and it has always struck me as very unfair.
mac808
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Re: Medical practice (Neurology) buy-in

Post by mac808 »

gujm wrote:They lease the office space but owns their equipment including EEG and EMG machines. As per the senior partner, they invested money for getting on insurance panels, hospital credentialing, EMR, employee salaries etc.

My biggest reason for seeking opinion is to understand if other people stay in a practice but not become partners-what will be disadvantages of that?

This is the only big city in the state, and I have kids and am not willing to relocate to move again. I have't started yet and can still refuse to go and work for them.
I don't know how much the equipment is worth (used) but investments to get on insurance panels, credentialing, EMR, and salaries - that's all a rip off. Are there any neurologists in private practice who you trust who you could have an honest conversation with? Maybe one or two your program director could refer you to? Or former residents you were friendly with who have graduated and gone out into the world? Don't be shy about asking people for practical business advice. I'm very familiar with other specialties but not as much with neurology so I can't help there.

@ 70% of billings (with no deduction for overhead?) I can't imagine your upside as a full partner would be much, since overhead usually runs at least 20%. What would your estimated income be first year? (Working how much?) Insurance mix in this city might be even more important than partnership. The trend is clear that small independent private practices are an endangered species. Even if you start your career here I would expect to end it working at a hospital or as part of a hospital network, so keep that in mind. Also keep in mind that the trend in medical reimbursement is to the downside so the next ten years of practice for you might count ''extra'' than the rest of your career.
Last edited by mac808 on Sun Oct 23, 2016 11:56 am, edited 1 time in total.
Topic Author
gujm
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Re: Medical practice (Neurology) buy-in

Post by gujm »

They want me to buy-in using cash, I don't think that's reasonable.

But if I do buy-in and become a partner, when they eventually sell to hospital/corporation, I will get some money back, right. Otherwise, why would you want to buy-in to a practice.

Any other big problems if I continue to work without becoming a partner.

Thanks
mac808
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Re: Medical practice (Neurology) buy-in

Post by mac808 »

gujm wrote:They want me to buy-in using cash, I don't think that's reasonable.

But if I do buy-in and become a partner, when they eventually sell to hospital/corporation, I will get some money back, right. Otherwise, why would you want to buy-in to a practice.

Any other big problems if I continue to work without becoming a partner.

Thanks
How much do they want you to pay in cash? Some % of $10 million? That seems ridiculous to me. How's that even possible for most MDs coming out of residency (in student loan debt)? Most buy-ins occur through salary reduction for the first X years.

As far as practice buyout - they happen but are not guaranteed. I've seen cases where the hospital CEO doesn't like a small group and just invests $ to recruit new specialists into the area and puts the small group out of business. No matter what, I doubt a 4 MD neurology group would be valued anywhere near $10 million, unless you live in some kind of commercial insurance nirvana and have bulletproof referral networks.

Being a non partner will make your job a little less stable (although toxic partnerships can be unstable also), but it doesn't sound like the amount they are asking you to pay is worth the extra bump in stability.
Dottie57
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Re: Medical practice (Neurology) buy-in

Post by Dottie57 »

gujm wrote:Hi,

I am a current fellow and have already signed a contract with a private practice. At time of signing the contract there was no mention of exact amount for buy-in, but it has to be atleast same amount as the current partners. It is a 3 physician practice, and I got information from the senior physician that the practice is evaluated at 10 million and each one of them have put more than 1 million. That is a crazy, scary number and I am freaking about joining them.

I have not yet started working there, it is in different part of the country so it will be a big relocation and I don't want to leave it at later date. I am wondering if I should look for another position or if I do join them, stay without partnership. Any thoughts???

I am reimbursed 70% of billing collections from day 1 and as per senior partner, I may not get any monetary benefit from buy-in anyways. But the idea of not having any say in how the practice is run in the future makes me nervous.

Any thoughts or help greatly appreciated.
Thanks
Can I assume you signed an employment contract?

Before you would become a partner, I assume you would get much more information about the group and practice. You need to learn a lot more about how the business is run. You would need a lawyer.

I really think you are putting the horse before the cart. You haven't even started working for this group yet.
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Artsdoctor
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Re: Medical practice (Neurology) buy-in

Post by Artsdoctor »

gujm wrote:They want me to buy-in using cash, I don't think that's reasonable.

But if I do buy-in and become a partner, when they eventually sell to hospital/corporation, I will get some money back, right. Otherwise, why would you want to buy-in to a practice.

Any other big problems if I continue to work without becoming a partner.

Thanks
No, you most likely would not get any money back. All things are regional, but most healthcare centers learned from their mistakes in the 1990's. Anything is possible, but the most likely scenario is that the healthcare plan which would employ you will not pay you for the practice. If you're fortunate, they may pay you a hefty salary for 3 years because your practice is perceived as lucrative, although the days of payouts have become limited.

I have to say that I am skeptical of your offer. I am in private practice and I am a senior partner. There really should be no private physicians at this point who are unaware of the potential threat to private practice. Even if your practice is incredibly stable (ours is), you have to appreciate that it can change quickly.

If I wanted to be cynical, and I would do it just to give you another perspective, I'd argue this: Your senior partners are probably getting fed up with the way private practice is going and by having a young associate buy in with a lump sum right away, the injection of cash would enrich them. Perhaps they might consider joining a healthcare system in the future, but for now, your injection of cash would provide quite a bit of capital to the practice--which would be divided up in their favor.

That's not say your current agreement wouldn't work. But in this environment, you should be very skeptical and I would definitely not make that type of investment without a contract lawyer helping me.

You should also know that it's very unusual to buy in to a practice from Day One. There's usually a period when you're an employee while you all get to know each other. After that period (1-2 years), then you sit down and discuss partnership. But again, things may vary tremendously by region. Nonetheless, I would consider your current offer high-risk for you.
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gujm
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Re: Medical practice (Neurology) buy-in

Post by gujm »

Thank you for such a detailed reply.

I have option to buy-in after 2 yrs of working with the group. Based on the feedback, seems like don't stress about buy-in (who knows this practice may not survive for long), but considering I can start making decent money at start -70% all the collections generated by me (hopefully, will be busy from start-they have long wait time) there is no harm in getting the money till it lasts.
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Artsdoctor
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Re: Medical practice (Neurology) buy-in

Post by Artsdoctor »

Sounds good. Remember to put it in the back of your head that you might benefit from a contract lawyer in your new area so keep your ears open; I have seen many contracts in my career and am a firm believer in having a good one. And ultimately, there's no shame in remaining an employee; you may not make exactly the same amount of money as you would as a partner, but your risk will probably be much less as well.

Good luck.
mmcmonster
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Re: Medical practice (Neurology) buy-in

Post by mmcmonster »

I was just becoming a partner in a 12-partner Cardiology practice when the practice was being sold to the local hospital.

According to the hospital, the value of the practice was minuscule. The hospital stated that patient charts are worth almost nothing. The building and nuclear camera were leased (you don't want to sink a lot of money into those sorts of things). And everything else in the offices depreciated quite severely. In addition, the software license were scrapped to go to the hospital's site licenses.

Eventually the partners sold and all worked for the hospital. I didn't buy into the practice and didn't get anything from the sale.


On the flip side, I got 'bought' by a competing hospital in the area. They didn't care about buying charts. They knew the patients would follow me. Good will follows the physician (within limits). They gave me a near-$100,000 sign-on bonus and jacked up my base pay by almost 50% compared to being in private practice. (Even the smaller hospitals have economies of scale that even large private practices cannot match.)


My take away: A buy-in to a practice should be to cover hard assets that would get liquidized if the practice goes under. Those hard assets depreciate like crazy. Therefore, unless the practice owns their own buildings, the buy-in should be quite small (low six-figure) at most.
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gujm
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Re: Medical practice (Neurology) buy-in

Post by gujm »

Thank you.

I really appreciate words of wisdom from all of you.
coalcracker
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Re: Medical practice (Neurology) buy-in

Post by coalcracker »

I think it's a crap shoot.

My wife is primary care and belongs to a large multispecialty group. She bought in for $30k, and about a year after she became partner the group was sold to a large hospital/insurance corporation. Because of some unusual local healthcare politics and great negotiators on her side, there was, if not a true bidding war, a sense that her group was one of the last good independent ones in the area. They had a lot of patients, which the corporation hoped to steer into its hospital system.

As a result of this, each partner received a windfall of just over 7 figures with the sale of the group. We were gobsmacked. I don't imagine this type of sale is anywhere near the norm, however.
malabargold
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Re: Medical practice (Neurology) buy-in

Post by malabargold »

Hmm. If it's a 3-person practice the last partner bought 1/3
of the practice and you'll be buying 1/4 of the practice.
Ergo,
Your buy-in should be smaller unless the practice is growing
faster in accounts receivable and assets than it is staff.
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gujm
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Re: Medical practice (Neurology) buy-in

Post by gujm »

This is a new practice-about 5-6 yrs old. It was started by new resident after finishing residency and 2 yr later 2 more residents joined him. When I interviewed there, I was told they don't have buy-in amount calculated. But recently they were approached by someone willing to buy them and got themselves appraised and got the 10 million number.

Now they want me to make same contribution as them (roughly between 1-3 million) after working for 2 yrs. I understand they had worked hard to set up things but lets be honest, things depreciate the moment you buy them.

After I got the latest information, I was worried about future buy-in but my wife was adamant that it will work out. So I decided to get expert advice, to make sure I am not unreasonable.
staythecourse
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Re: Medical practice (Neurology) buy-in

Post by staythecourse »

10 million worth for a 3 member neurology group that only owns EMG and EEG equipment? That is laughable.

If you are getting 70% of your collections I would just start work and see how it goes from there. If buy in is discussed just tell them your lawyer is requesting an independent evaluation on your dime of the value of the company. If they say great then figure it out. If they say no then just work as an employee and collect your 70%.

If you join and bought in it would be a 4 member group, BUT 3 of those folks have been together for several years and "built" the practice and right or wrong they will view themselves as the founders and will not likely side with you vs. themselves on voting issues anyways. You will find, what I and many other folks find out over time, is that there is ageism in private practice, but working in the reverse. Older docs feel entitlement over younger docs just because they have been there before. They feel their views are worth more then younger docs.

Good luck.

p.s. The ultimate trump card lies in your states presidence on restrictive covenant enforcement. If they don't enforce it then you can ALWAYS threaten equity owner or not that you will just leave and start a competing practice down the street and take your patient load with you.
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Five
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Re: Medical practice (Neurology) buy-i

Post by Five »

Hello. I am a physician and have been in practice since the late 1990's. A few pearls...
1. Be very careful with buy-ins.... A physician can buy in with time, money or both. From what I have seen, the senior partners usually always inflate the value of their practice. Furthermore, some of them have been through a divorce and have kids in private schools, pay a mortgage on a big house in which they live with their current girlfriend or second wife, and have a second house in a nice sunny climate on which they pay a mortgage. Also they drive expensive luxury cars because of ego.
Such a senior partner needs your infusion of cash because they have lost a lot in their divorce and don't have enough to retire.
Thus, he will tell you of the huge worth of the practice! Bottom line--you MUST see "the books" and how they value the practice. You NEED a very good contract lawyer to help you and I am not talking about the small townie lawyer who "does it all". He should be a specialist in this area, especially medical practice contracts. Also you have to be careful that if you are in a small town, there may only be 1-3 such lawyers in town who have worked on most all the medical practice contracts in that town. One or all of these lawyers might actually "know" your partners and "give them a call behind closed doors" to inform them of the proceedings and be influenced by a "payoff" from one of your senior partners to help structure the contract in favor of the practice.....help the medical practice and not you. This happened to me when I needed legal advice. A small townie lawyer told me that my contract was "not worth the paper it was written on" so I had no case. When my contract was reviewed by a large city, health care specialist, a different story emerged. My group listened to the latter lawyer because of the enforcement that was possible....the group did not want to give me a pension-profit plan written into the contract. The crooked townie lawyer told me I had no case but the health care specialist told me it would be a federal offense with possible jail time if the pension plan was withheld. Guess who won! I later found out that my chairman and the crooked lawyer were friends and played golf together regularly at one of the only two private golf courses in the area. I left the group soon after.
2. Do not feel it is just easy to pick up and move. It is a huge expense as well as an inconvenience to you and your family.
Make sure that if you and your family want to stay in the area that the contract and its structure is correct from day1. Otherwise you and your family will suffer....possible moving and if you need a lawyer in the future to help "clarify" the things in the contract which should have done earlier. It will be much more of an expense. Also, if the other senior partners are older, they will want to retire one day. They will hire another new graduate out of residency at that time and you will no longer be the new young grad. They may structure his contract differently and "play one against the other".....play him against you if you become a "problem" to the seniors because you actually want fair treatment and a fair contract. This will create bad blood between you and the new grad and you may eventually leave if the senior partners take his side against you.
3. I am a specialist and in the top five for physicians. I am in a small private practice group. There is no way our practice is worth 10 million!! I seriously doubt if a group of 3 Neurologists' practice is worth 10 million!! If it was, why didn't they just sell off the practice, split the money and be on a fast track to retirement?! I know of a 6 man very busy Orthopedic practice that covers 4 hospitals. Their practice is valued at 12 million. Does this sound like your practice?
4. Be careful with malpractice insurance. You want an occurrence policy, not a claims made policy.
5. Be careful of the do not compete clause. It should not push you out of the state or where you have to drive 2 hours to get to your next job. I have seen that happen as well.
6. Make sure you have a clause that allows you to remediate any complaints and gives you an opportunity to cure any allegations they make against you. Physicians are businessmen. Some can be ruthless!! Protect yourself and your reputation!!
You are a valuable asset and a trained, educated physician. You do not have to accept a bad situation or a bad contract. There are other places where you can work! Better to find out now than when you have to explain your situation to another group 2 years from now!
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gasman
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Re: Medical practice (Neurology) buy-in

Post by gasman »

Agree with stay the course and others who feel that this is likely a ripoff. If you do consider buying in, do it as a salary reduction over five years or so.
staythecourse
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Re: Medical practice (Neurology) buy-i

Post by staythecourse »

Five wrote:There are other places where you can work! Better to find out now than when you have to explain your situation to another group 2 years from now!
Well said. One issue I see over and over and over and... is the feeling from docs of all levels of experience that you the worker are "so lucky" to be chosen to work with group x. It should be the other way. There are PLENTY of jobs out there and one should feel that it is the employer who should be courting the new grad. If the contract is not exactly what you want just keep looking. A physician by supply/ demand is still a commodity if one is willing to look for the best job/ position and not be confined to a specific metro. area.

As for leaving a job I agree it is hard, just like for anyone who works in any field in life, but learning a mistake earlier is better then just staying in a job that you don't feel valued. As I say about almost everything in life, "Vote with your feet".

Good luck.
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gujm
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Re: Medical practice (Neurology) buy-in

Post by gujm »

@Five.
That is a scary scenario. It is sad we treat other physician in such a way, but I guess there is no end to greed.

I don't think I would plan to buy-in but I am worried about this opportunity and coming out of fellowship, trying to pay off loans and set up life with all this uncertainty is not exciting. Now, I understand why so many new physicians join employed/hospital practice (all my co-residents and fellows).

This practice has almost 50% medicare and medicaid and I doubt reimbursement is good overall. Also, they see way too many patients-18-20 in outpatient clinic-half day and 20-25 inpatient-rest of the half day. Seems too high for my specialty.

I am also supposed to get them certified as center of excellence and I am skeptical that once everything is set in place, I won't be required.

Lastly, it is so hard to believe that it is hard to trust our peer out of training
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Artsdoctor
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Re: Medical practice (Neurology) buy-in

Post by Artsdoctor »

gujm wrote:@Five.
That is a scary scenario. It is sad we treat other physician in such a way, but I guess there is no end to greed.

I don't think I would plan to buy-in but I am worried about this opportunity and coming out of fellowship, trying to pay off loans and set up life with all this uncertainty is not exciting. Now, I understand why so many new physicians join employed/hospital practice (all my co-residents and fellows).

This practice has almost 50% medicare and medicaid and I doubt reimbursement is good overall. Also, they see way too many patients-18-20 in outpatient clinic-half day and 20-25 inpatient-rest of the half day. Seems too high for my specialty.

I am also supposed to get them certified as center of excellence and I am skeptical that once everything is set in place, I won't be required.

Lastly, it is so hard to believe that it is hard to trust our peer out of training
Running a private practice is running a small business. For our practice, I'd like to think we have always been doctors first and businessmen second. There are things we don't do: we don't let patients make us do something that's unwarranted (and in Southern California, that's a bold statement), and we don't take advantage of junior associates/partners (what goes around comes around). But we are businessmen: you are looking at the bottom line, you have salaries to pay, and you have to pay your rent. There is a conscious priority on how you want to play it.

Greed is a strong word. But there's no doubt that many practices have a different set of priorities. In our area, medicine is extraordinarily competitive and there are plenty of doctors who will bow to patient demand seemingly without end, the lines are blurred between professional and personal lives, and income may well trump medical care. I'm sorry to see it, but it's there.

Just starting out, you will ultimately need to decide at some point which direction you want to go in, and that's great. It'll be what makes you you. But you will always have to balance income with your own ethical code.

Medicare and Medicaid will not pay the bills unless you're seeing a very high quantity of patients. Your description of 25 patients in a half-day is hopefully not accurate. That pace would be pretty brutal unless you had a tremendous number of support staff, which would drive up overhead. I bet that's not the case if you're keeping 70% of your Accounts Receivable, so I suspect you're going to working very, very hard.

They won't fire you after you've attained a Center of Excellence designation.

And finally, it occurred to me that if they own the building, the worth of the practice could very well be quite high. But that's something that should be obvious from the beginning.
staythecourse
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Re: Medical practice (Neurology) buy-in

Post by staythecourse »

Artsdoctor wrote: Running a private practice is running a small business.
100% true. The biggest issue I see is that nearly everyone is medicine is incompetent running the "business" of medicine. Most doctors are idiots and admin. in hospitals even with MBA are nearly as clueless as the doctors they oversee.

This is the reason I think most of the folks who are now partners basically because they have been in the practice for x years when medicine was making a lot of money are starting to realize that they ONLY way they ever make a profit as a partner is by hiring young grads and using them. They don't seem to understand how to make money on their business model, but have figured if doc x is payed y and they make z then I can take that delta home as a profit.

Good luck.
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Artsdoctor
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Re: Medical practice (Neurology) buy-in

Post by Artsdoctor »

staythecourse wrote:
Artsdoctor wrote: Running a private practice is running a small business.
100% true. The biggest issue I see is that nearly everyone is medicine is incompetent running the "business" of medicine. Most doctors are idiots and admin. in hospitals even with MBA are nearly as clueless as the doctors they oversee.

This is the reason I think most of the folks who are now partners basically because they have been in the practice for x years when medicine was making a lot of money are starting to realize that they ONLY way they ever make a profit as a partner is by hiring young grads and using them. They don't seem to understand how to make money on their business model, but have figured if doc x is payed y and they make z then I can take that delta home as a profit.

Good luck.
LOL! Got a good laugh there!!

No, we do just fine and when a new associate comes on, we all take hair cuts. You learn pretty early in your career, hopefully, that if you chew through younger associates and abuse them, you develop a less-than-stellar reputation very quickly.

In fact, as we move forward in this very volatile climate, our practice is currently transitioning so that the YOUNGER partners benefit the most. The OLDER partners are putting the younger partners' interests at the heart of the negotiations because, at the end of the day, by treating the younger partners fairly, they in turn will do the same in future for their younger associates. You have to sometimes teach ethics; it doesn't always come naturally.
staythecourse
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Re: Medical practice (Neurology) buy-in

Post by staythecourse »

Artsdoctor wrote: You have to sometimes teach ethics; it doesn't always come naturally.
Kudos to you. It is good to hear not all folks are eat their young. When I look back I think this attitude of many to "eat their young" is why you don't see huge groups. They start to get big then the senior partners start screwing younger guys and they leave. In turn those groups end up with a bad rep. and no one joins of quality so they stop growing. New guys move into the area to practice and instead of joining group X which has a bad rep. they just start on their own.

I truly believe if equitable treatment was given there would be much larger and succesful groups out there and you would see the advantages of economy of scale. For a new grad why would they ever want to do everything on their own if a well run and fairly treated group was around to join. On the other side of the coin why wouldn't a large group want to hire out all the competition and take on a larger market share of the location by just hiring new grads instead of competing against them and just continue to expand?

Makes me think what could have been.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle
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Artsdoctor
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Re: Medical practice (Neurology) buy-in

Post by Artsdoctor »

^ I will admit something though.

The senior partners are in good health and have never been divorced. There has never been significant illness, and we all have lived well within our means (or lower). Consequently, we have never been tested.

We had a parallel group which had a similar business model and were pretty nice competitors. Then bad things started to happen: a death, a serious illness, a divorce--and everything fell apart. They ultimately became employed by the hospital.

I've come to believe that three, or four max, is the magic number for a private group. The more people, the more variability (and room for illness, death, kid problems, etc.). And when there's 3 or 4, you're more nimble to confront issues and adapt quickly. For bigger groups, it's harder to get things done.

Back to the OP, there are people who will take advantage of younger associates, to be sure. But those groups generally get a reputation that reflects that. Unfortunately, it's hard to get a feel for a reputation when you're in another part of the country looking for a job. Hence, the suggestion of a good contract lawyer. And no reputable group would take offense at a contract lawyer getting involved.
mmcmonster
Posts: 615
Joined: Sun Jan 12, 2014 12:18 pm

Re: Medical practice (Neurology) buy-in

Post by mmcmonster »

Another thing to consider:

When I joined my previous practice, I didn't worry about the restrictive covenant because I figured 'if I leave the group, I might as well leave town'. It's much harder to leave town after being settled in a few years.

Really reconsider if the restrictive covenant is something you can't live with. They can be a bitch to fight in court and the group has both time and money on their side.
LiveLoveLaugh
Posts: 3
Joined: Sun Oct 23, 2016 10:15 pm

Re: Medical practice (Neurology) buy-in

Post by LiveLoveLaugh »

Artsdoctor wrote: You have to sometimes teach ethics; it doesn't always come naturally.
Ahhhh Doctors. It's good to be amongst my own. Thanks to all the older physicians for the solid advice in this thread. After being a long-time Bogleheads reader I had to sign up after seeing this post because it's sounds like your Neurology contract may not be what it seems. Keep in mind, you're a very precious commodity, more than you think. Your worth only increases as you work with a new group. I would be VERY cautious of this offer or any other offer. I've heard too many stories of new docs getting screwed. Who's to say you'll even like the practice even if the practice is worth 10 mill?

I finally finished fellowship 1.5 years ago and left a cushy hospital job for a private practice group with a stellar reputation but neither of the two docs has ever brought anyone new on. I got offered a straight salary with the option to buy in to a piece of the practice in 1-2 years but who's to say your Neurology practice or mine will be a good fit. Test the waters first and get a feel for the character of the individual's you will be associated with in your new practice.
staythecourse wrote: When I look back I think this attitude of many to "eat their young" is why you don't see huge groups. They start to get big then the senior partners start screwing younger guys and they leave. In turn those groups end up with a bad rep. and no one joins of quality so they stop growing...

I truly believe if equitable treatment was given there would be much larger and succesful groups out there and you would see the advantages of economy of scale.
Solid analysis. I hope my new situation is that of me joining a new group who want to grow things the right and moral way.


Sad to say but my generation of doctor's has such an extreme join a hospital system mentality that private practice will decrease not because it can't compete, but rather because no new physician is willing to take on additional risk (especially when you owe 300k at 7%).
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