How to pay partners for working your call

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White Coat Investor
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Re: How to pay partners for working your call

Post by White Coat Investor » Fri Feb 23, 2018 11:02 am

jacoavlu wrote:
Fri Feb 23, 2018 10:30 am
gasdoc

I'm curious how the national company comes in? Do they come to your group and make a friendly offer? Or go to the hospital for the contract, and then come to you?
Sometimes the offers are friendly, but often they are not. These groups own the vast majority of the EM market and soon radiology, anesthesia, hospitalists, intensivists.
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course

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gasman
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Re: How to pay partners for working your call

Post by gasman » Fri Feb 23, 2018 11:06 am

jacoavlu wrote:
Fri Feb 23, 2018 10:30 am
gasdoc

I'm curious how the national company comes in? Do they come to your group and make a friendly offer? Or go to the hospital for the contract, and then come to you?
You will be assimilated. Resistance is futile.

jacoavlu
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Re: How to pay partners for working your call

Post by jacoavlu » Fri Feb 23, 2018 11:11 am

White Coat Investor wrote:
Fri Feb 23, 2018 11:02 am
Sometimes the offers are friendly, but often they are not. These groups own the vast majority of the EM market and soon radiology, anesthesia, hospitalists, intensivists.
I can imagine. Are these guys run by VC's? Please tell me it's not docs at the top of these firms turning our work into a commodity.

Sometimes I realize it's good to live in a place that most people don't want to.

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dm200
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Re: How to pay partners for working your call

Post by dm200 » Fri Feb 23, 2018 11:23 am

The difficulty is only with the payroll system for employed physicians being inflexible
.

Amazing - in 2018 -

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Re: How to pay partners for working your call

Post by White Coat Investor » Fri Feb 23, 2018 12:23 pm

jacoavlu wrote:
Fri Feb 23, 2018 11:11 am
White Coat Investor wrote:
Fri Feb 23, 2018 11:02 am
Sometimes the offers are friendly, but often they are not. These groups own the vast majority of the EM market and soon radiology, anesthesia, hospitalists, intensivists.
I can imagine. Are these guys run by VC's? Please tell me it's not docs at the top of these firms turning our work into a commodity.

Sometimes I realize it's good to live in a place that most people don't want to.
Both. Often docs partnered with VCs. Typical overhead in a "democratic group" might be 8%. But one of these contract management groups might skim 1/3 of the physician fees.
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course

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goodenyou
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Re: How to pay partners for working your call

Post by goodenyou » Fri Feb 23, 2018 1:05 pm

gasdoc wrote:
Thu Feb 22, 2018 7:40 pm
goodenyou wrote:
Thu Feb 22, 2018 7:32 pm
Just cut a check on Monday morning. The one taking the call takes more income (call cost) and pays the extra taxes as income. The one paying expenses it and deducts it. More W-2 for the call-taker. Less W-2 for the call-avoider. We own our own practice, so it's easy.
Goodenyou, please elaborate. It seems that you are writing a personal check to the call taker, and it is pretax money (needs to be claimed by one and deducted by the other. Do you also send out 1099's? How does it end up on the W2 if you are writing the check yourself? Or is "the group" the entity that is actually writing the check?

gasdoc
The corporation writes a check out of the corporate checking account to the the call-taker and he takes it as W-2 wages. The corresponding entry is a pre-tax deduction for the call-giver as an expense.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

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gasdoc
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Re: How to pay partners for working your call

Post by gasdoc » Fri Feb 23, 2018 2:27 pm

goodenyou wrote:
Fri Feb 23, 2018 1:05 pm
gasdoc wrote:
Thu Feb 22, 2018 7:40 pm
goodenyou wrote:
Thu Feb 22, 2018 7:32 pm
Just cut a check on Monday morning. The one taking the call takes more income (call cost) and pays the extra taxes as income. The one paying expenses it and deducts it. More W-2 for the call-taker. Less W-2 for the call-avoider. We own our own practice, so it's easy.
Goodenyou, please elaborate. It seems that you are writing a personal check to the call taker, and it is pretax money (needs to be claimed by one and deducted by the other. Do you also send out 1099's? How does it end up on the W2 if you are writing the check yourself? Or is "the group" the entity that is actually writing the check?

gasdoc
The corporation writes a check out of the corporate checking account to the the call-taker and he takes it as W-2 wages. The corresponding entry is a pre-tax deduction for the call-giver as an expense.
If the corporation writes the check, then the money never shows up on the other's W2, so why is it even necessary "to expense.?"

gasdoc

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gasdoc
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Re: How to pay partners for working your call

Post by gasdoc » Fri Feb 23, 2018 2:31 pm

White Coat Investor wrote:
Fri Feb 23, 2018 11:02 am
jacoavlu wrote:
Fri Feb 23, 2018 10:30 am
gasdoc

I'm curious how the national company comes in? Do they come to your group and make a friendly offer? Or go to the hospital for the contract, and then come to you?
Sometimes the offers are friendly, but often they are not. These groups own the vast majority of the EM market and soon radiology, anesthesia, hospitalists, intensivists.
In our case, we were having what we thought were friendly contract negotiations with the hospital. We were essentially becoming hospital employees. One of the billing companies the hospital spoke to told them, "we can manage the whole thing without a stipend!" Then they came in and told us our salaries would not be touched. Twelve months later, they were asking for a stipend from the hospital and cutting our salaries and those of the CRNA's. We have had between 45 and 50 MD's on our payroll in the last 9 Years- in a group of 6 docs. It's been a series of lies and broken promises ever since.

gasdoc

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goodenyou
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Re: How to pay partners for working your call

Post by goodenyou » Sat Feb 24, 2018 6:53 pm

gasdoc wrote:
Fri Feb 23, 2018 2:27 pm
goodenyou wrote:
Fri Feb 23, 2018 1:05 pm
gasdoc wrote:
Thu Feb 22, 2018 7:40 pm
goodenyou wrote:
Thu Feb 22, 2018 7:32 pm
Just cut a check on Monday morning. The one taking the call takes more income (call cost) and pays the extra taxes as income. The one paying expenses it and deducts it. More W-2 for the call-taker. Less W-2 for the call-avoider. We own our own practice, so it's easy.
Goodenyou, please elaborate. It seems that you are writing a personal check to the call taker, and it is pretax money (needs to be claimed by one and deducted by the other. Do you also send out 1099's? How does it end up on the W2 if you are writing the check yourself? Or is "the group" the entity that is actually writing the check?

gasdoc
The corporation writes a check out of the corporate checking account to the the call-taker and he takes it as W-2 wages. The corresponding entry is a pre-tax deduction for the call-giver as an expense.
If the corporation writes the check, then the money never shows up on the other's W2, so why is it even necessary "to expense.?"

gasdoc
The answer lies in our compensation model. The corporation is not an entity, per se. It is a combination of 9 doctors each with separate collections and different (personal) expenses and common expenses. The overhead is paid out of the collective effort of all as an equal percentage of individual collections. The leftovers are the salary, which is widely disparate on an order of several multiples. Personal and collective expenses are taken out individually against individual collections. If one personally expenses a call weekend it is deducted from the call-givers net collections (less W-2) and added to the call takers income (more W-2). Does that clarify things? Physician compensation models are all over the place, therefore the way you characterize this transaction will differ based on your compensation model, corporate structure and employment status.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

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goodenyou
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Re: How to pay partners for working your call

Post by goodenyou » Sat Feb 24, 2018 7:26 pm

gasdoc wrote:
Fri Feb 23, 2018 2:31 pm
White Coat Investor wrote:
Fri Feb 23, 2018 11:02 am
jacoavlu wrote:
Fri Feb 23, 2018 10:30 am
gasdoc

I'm curious how the national company comes in? Do they come to your group and make a friendly offer? Or go to the hospital for the contract, and then come to you?
Sometimes the offers are friendly, but often they are not. These groups own the vast majority of the EM market and soon radiology, anesthesia, hospitalists, intensivists.
In our case, we were having what we thought were friendly contract negotiations with the hospital. We were essentially becoming hospital employees. One of the billing companies the hospital spoke to told them, "we can manage the whole thing without a stipend!" Then they came in and told us our salaries would not be touched. Twelve months later, they were asking for a stipend from the hospital and cutting our salaries and those of the CRNA's. We have had between 45 and 50 MD's on our payroll in the last 9 Years- in a group of 6 docs. It's been a series of lies and broken promises ever since.

gasdoc
You are ahead of the trend since your specialty is hospital-based. This will be the fate of all doctors as the employment model heats up. Thankfully, I am almost finished with my career. Financial independence is the best remedy. Many young debt-ridden doctors are going into this profession with eyes closed and clueless.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

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