Tale of 2 doctor job opportunities

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Forsberg21
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Joined: Wed Mar 29, 2017 1:47 pm

Tale of 2 doctor job opportunities

Post by Forsberg21 » Sat Nov 09, 2019 11:42 am

Hey Bogleheads! I am completing my fellowship training and am coming to the end of my job hunt. I have narrowed it down to two jobs and was hoping for people's opinions (obviously acknowledging that I am the only one who can truly get a "feel" for what will be right for me).

Background:
- I am a graduating fellow in a IM subspecialty. HCOL east coast city suburbs (the same where I was raised and am very familiar with the area, with both parents and in-laws within 40 minutes). I am married with a new child.
- Location is not a competing factor, as these jobs are about 20 minutes from each other.

Job 1:
- Pure private practice
- I would be the 3rd doctor. I really liked the other 2 docs
- 1 office, 1 hospital
- Work every 8th weekend (share call with another PP group at a 2nd hospital nearby)
- Seeing 20 patients/day
- Vacation: 8 weeks/yr
- Structure: 2 year employment ($300K/year for full time, or option for $240K/year if I wanted 4 days/week) followed by partnership starting in year 3 (years 3 and 4 are a salary ramp up - 65% in year 3, then 85% in year 4), and year 5 I am making even money (partners split everything equally). Of note, other than the money, I am full partner in all other ways (voting power?). They make approximately $700K/year. At this point I would be 4 days/week like the partners.
- Pros: More money (assuming nothing changes, which is not a given in this climate), ability for part time immediately, more vacation, less weekends
- Cons: uncertainty regarding PP in this era of medicine, especially in this location where 2 hospital systems are buying up everything; less mentorship coming out of fellowship, hit harder by reimbursement changes?; competition with a hospital based group

Job 2:
- Community practice, owned by major hospital system
- I would be the 10th doctor, met about 5-6 of the other doctors, and liked them a lot as well
- 3 offices, 1 hospital. I would spend time at all 3 offices (but not more than 1/day, about 15 min from each other)
- Work every 6-7 weekends
- Seeing 20 patients/day
- Vacation: 4 weeks/year + 1 week for CME
- Structure: Employed. First year is guaranteed $255K. Then after than it is productivity based (last year, a 1.0 FTE made about $550K)
- Pros: stability (this hospital system is not going anywhere; and the community hospital is expanding); no competition (only subspecialty group at this hospital); a lot of mentorship with many docs in group; easy access to top people in the field at the mothership academic affiliate
- Cons: way less autonomy compared to PP, less money, time split between 3 offices which is not the end of the world but makes commute more annoying, no ability for part time until year 3 (at a proportional salary reduction).

Interested in hearing people’s thoughts! Thanks!

lernd
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Re: Tale of 2 doctor job opportunities

Post by lernd » Sat Nov 09, 2019 12:02 pm

MD here. Hospital-based field. I've worked as IC (briefly), hospital employee model and private group model. Without a doubt, the private group model (with partnership) is the best - both for compensation and autonomy. With the private group model (as a partner) you have a more direct say in the day-to-day operations that directly affects your practice. As a hospital employee, trying to change something (even something minor like the call schedule timing) requires 3 meetings with a bunch of admins without a decision. As a private group, you and your partners determine what is best for you and your patients. In the hospital employee model it is an administration that often has other competing interests.

A private group is always at risk of losing its contract with the hospital or to fluctuations in reimbursements etc. But medicine is largely a field where jobs are plentiful and even if the private group folded, you'd find another position easily (even if it wasn't ideal). The private model = equity. You are building something and you own something. That comes with its own set of risks, but in my opinion, the rewards are far superior.

chessknt
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Re: Tale of 2 doctor job opportunities

Post by chessknt » Sat Nov 09, 2019 12:05 pm

Once wci forums are back up ask there since this forum isn't well suited for physician employment assessment.

You don't have enough i for to make a fully informed decision since any productivity based model can vary wildly depending on overhead and how likely it is you will be able to run a full census.

Have you seen 20 pts in a day to get an idea of what the workload is like for you?

HEDGEFUNDIE
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Re: Tale of 2 doctor job opportunities

Post by HEDGEFUNDIE » Sat Nov 09, 2019 12:08 pm

20 patients a day is asking for burnout.

Wyodoc
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Re: Tale of 2 doctor job opportunities

Post by Wyodoc » Sat Nov 09, 2019 12:12 pm

Was in a similar situation a few yrs ago.
I personally chose private practice route and am very happy. I am now a partner, have say about decisions in the group, better income than hospital system comps but I suspect I work harder (but don't mind as it increases my income). Certainly working for a hospital system may give you less stress about "job security" it may end up giving you more stress about job pay. I have 2 friends who are in the same IM sub specialty and when their initial contract was over after 2 yrs the hospital system changed their tune about pay/RVUs required and now they are both looking for new jobs (very common unfortunately).

Downside I see to the practice you would be joining is size. 3 person group is very small. Mine is now 22. As time goes on with overhead increasing, medical compliance becoming more expensive, and hospital systems competing, it may be hard for your group to stay afloat in upcoming yrs. Many smaller private groups are merging/getting bought out for these reasons. I would take a good look at the location and consider other larger hospital systems in the area and if there is a possibility of them "moving in" on the location. I honestly do not think small private groups will survive in 5-10yrs in the vicinity of larger hospital systems/large private groups.

I would certainly discuss this with the private group and determine their concern. There may be none for x,y,z reasons but I would see if they have a game plan for this situation. For all you know they have been in contact with PE firms, hospital systems, other groups about mergers/buyouts...

Wyodoc
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Re: Tale of 2 doctor job opportunities

Post by Wyodoc » Sat Nov 09, 2019 12:25 pm

HEDGEFUNDIE wrote:
Sat Nov 09, 2019 12:08 pm
20 patients a day is asking for burnout.
This is probably about a patient every 25-35 minutes depending on daily hrs and honestly not that much for a full day for many docs.... wish things were different.

arsenalfan
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Re: Tale of 2 doctor job opportunities

Post by arsenalfan » Sat Nov 09, 2019 12:30 pm

Job 1.
Hands down.
You will have a much longer career longevity with autonomy and 8wks vac.
It’s a marathon not a sprint.
PS see if you can buy into any alt revenue streams - ASC, equipment, your office building, etc
Last edited by arsenalfan on Sat Nov 09, 2019 12:31 pm, edited 1 time in total.

minimalistmarc
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Re: Tale of 2 doctor job opportunities

Post by minimalistmarc » Sat Nov 09, 2019 12:31 pm

HEDGEFUNDIE wrote:
Sat Nov 09, 2019 12:08 pm
20 patients a day is asking for burnout.
Yep. In the U.K. most doctors see far more than this and burnout rates are very high.
Last edited by minimalistmarc on Sat Nov 09, 2019 12:32 pm, edited 1 time in total.

arsenalfan
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Re: Tale of 2 doctor job opportunities

Post by arsenalfan » Sat Nov 09, 2019 12:32 pm

Get a scribe

fru-gal
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Re: Tale of 2 doctor job opportunities

Post by fru-gal » Sat Nov 09, 2019 12:40 pm

arsenalfan wrote:
Sat Nov 09, 2019 12:32 pm
Get a scribe
I'm not a doctor, so I know nothing, but I was in an ophthalmologist's office a few days ago and the scribe caught a mistake he was making in that he was saying I needed cataract surgery or I couldn't legally drive - but he had misread the eye test results, I actually was okay. Also, I hear my internist lamenting how much time she spends on paperwork.

Caboose
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Re: Tale of 2 doctor job opportunities

Post by Caboose » Sat Nov 09, 2019 12:54 pm

Option 1 - no question; I was in private practice then nearing retirement sold to a hospital system - would never do it again; PP gives you autonomy and control whereas system-owned guarantees you will have none of that; I am surrounded by PP groups all of whom are doing fine financially; and if down the road PP is not working for you, some system will be happy to hire you, on their terms of course.

darkhorse
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Re: Tale of 2 doctor job opportunities

Post by darkhorse » Sat Nov 09, 2019 1:09 pm

I would lean towards option 2 given stability

3 doc pp is just too small. If one of the doc can't or decides not to work; if weekend arrangement between 2 pp group doesn't work in future or hospital decides to go with on house/employed physician model. Too many variables beyond your control.

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Re: Tale of 2 doctor job opportunities

Post by ChinchillaWhiplash » Sat Nov 09, 2019 1:20 pm

One other bonus of being in PP is you can probably set up a solo401k and maximize your tax advantaged space. If you are set up as a business that is a partner of the group, you hire yourself and own the business 100%. You file your own W2 through the business. This allows you to do payroll deductions for 401k to the max ($19k year) and have employer contributions. If you make enough, you can fully fund up to $56k year (this includes the $19k). Also reduces your taxable income by doing this quite a bit. It's a great way to build up retirement.

BionicBillWalsh
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Re: Tale of 2 doctor job opportunities

Post by BionicBillWalsh » Sat Nov 09, 2019 2:01 pm

Physician here, though not your specialty. The first option sounds great. As long as you feel the practice is well run, it will by far give you greater autonomy and eventually I feel a better quality of life. Understandably you’ll work hard your first few years. That’s ok, you’ll have the stamina and as you already know, not being a resident/fellow any longer will make your work-load seem easy.

The argument for stability with the hospital group is a non-starter. Even if for some reason that economic forces make private practice not possible, you still have stability by virtue of profession. You’d be hired in a minute. Especially in your densely populated region.

Good luck!
Saltwater has an amazing ability to wash away many of life’s troubles

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ram
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Re: Tale of 2 doctor job opportunities

Post by ram » Sat Nov 09, 2019 3:00 pm

Private practice.

Even if the job is not sustainable long term you will still be far ahead by year 8 or 10. There are always jobs available, the worst thing might be that you have to get away from the coasts. Here in midwest we are always recruiting IM subspecialties. And if you are talking cardio or GI the numbers that you are talking can be made.
Ram

doctorfaust
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Re: Tale of 2 doctor job opportunities

Post by doctorfaust » Sat Nov 09, 2019 3:52 pm

I will echo some of the concerns about job 1 being too small. You said weekend call is shared with a different PP group - what about M-F nights? q3 is a lot and if one of your partners goes on leave, quits suddenly, etc. q2 is a recipe for immediate burnout.

Also figure out (and get in writing) what happens if say, the group gets bought out before year 5. Plenty of stories over on WCI about young docs joining practices and then the practices getting bought out, the partners leaving with millions while the young docs who haven't made full partnership yet get squat. Obviously not saying that you deserve an equal slice straight out the gate from fellowship, but you should figure out what your potential would be so that you can factor in the risk that the group gets bought out. (And of course, just because you have equal voting rights, you could definitely be outvoted 2-1 on any issues.)

None of this means that job 1 is wrong for you - it just means there may be some risk that you need to weigh while making your decision. What's the approximate age of the two other docs? This could factor in to how likely they are to take leave, take a sabbatical, sell the group etc.

Basis
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Re: Tale of 2 doctor job opportunities

Post by Basis » Sat Nov 09, 2019 10:25 pm

M.D. speaking.

I’ve had both types of jobs you describe.

It’s #1.

And it’s not that close.
You see what you know.

a_movable_life
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Re: Tale of 2 doctor job opportunities

Post by a_movable_life » Sat Nov 09, 2019 11:10 pm

I'd lean for the PP also I'm an NP not an MD but most other people here have covered the major points. I left my job that I thought I would retire from when the Hospital changed the entire department's structure significantly.

8 weeks will help with your quality of life. Do the other two partners actually take the whole PTO that they earn?

Do the other two partners believe there is a point where the practice stops accepting new patients? So far I have worked for two hospital systems where "We never turn away patients." When your most expensive part of that equation is on salary there is an incentive to get as many billable visits as possible per clinician-year.

Is the partnership an S-Corp? What 401K/Defined Benefit/Deferred Comp do they have in place for themselves? I'm thinking ahead to when you get to the 700K range that you are going to be close to 50% Fed+State.

toofache32
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Re: Tale of 2 doctor job opportunities

Post by toofache32 » Sun Nov 10, 2019 12:33 am

arsenalfan wrote:
Sat Nov 09, 2019 12:32 pm
Get a scribe
Paid for by who?

kinaokole
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Re: Tale of 2 doctor job opportunities

Post by kinaokole » Sun Nov 10, 2019 7:54 am

Employed physician here. I like my job, but choice one seems better by a long-shot. The extra hassle of helping run the business is more than offset by increased autonomy and earning potential. On top of that, job one has less weekend call, more vacation, better commute and a 20% reduction in work days year 5.

I wouldn't worry one iota about job security as a physician. If you're remotely competent, there will always be options. But the $255K-$700K range is huge - the low end is barely more than the average general internist, while the partner salary is on par with high-end proceduralists. I'm curious, what is your specialty?

Also, for clarification, who covers after hour weekday call in both scenarios?

Topic Author
Forsberg21
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Re: Tale of 2 doctor job opportunities

Post by Forsberg21 » Sun Nov 10, 2019 8:17 am

Wow thanks for the replies everyone - I’m actually kind of shocked by the overwhelming responses that favor the PP. Maybe my hesitancy was that I view this as the high risk/high reward option, but in reality you are all right - if it doesn’t work out then the hospital affiliated jobs will always be there.

To answer some of the questions -
- Its a heme/onc practice: so more of the benefits from the hospital system affiliated job do include ancillary staff and access to the experts. But maybe that’s overstated
- Call schedule is a bit odd: the PP group each doc is on call every night for only their own patients. Honestly, onc call is not bad and almost never need to come into the hospital. The Hospital based group is 3 nights/month
- the PP is very busy, and that’s why I’m being hired. One of the docs is older and will retire in 5-10 years but they will want to bring on another doc at that time.
- I don’t know how the PP is organized

Thanks everyone, bring on more comments!

kinaokole
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Re: Tale of 2 doctor job opportunities

Post by kinaokole » Sun Nov 10, 2019 8:36 am

Forsberg21 wrote:
Sun Nov 10, 2019 8:17 am
Wow thanks for the replies everyone - I’m actually kind of shocked by the overwhelming responses that favor the PP. Maybe my hesitancy was that I view this as the high risk/high reward option, but in reality you are all right - if it doesn’t work out then the hospital affiliated jobs will always be there.

To answer some of the questions -
- Its a heme/onc practice: so more of the benefits from the hospital system affiliated job do include ancillary staff and access to the experts. But maybe that’s overstated
- Call schedule is a bit odd: the PP group each doc is on call every night for only their own patients. Honestly, onc call is not bad and almost never need to come into the hospital. The Hospital based group is 3 nights/month
- the PP is very busy, and that’s why I’m being hired. One of the docs is older and will retire in 5-10 years but they will want to bring on another doc at that time.
- I don’t know how the PP is organized

Thanks everyone, bring on more comments!
You should ask how many calls the two partners get each night, on average. While there aren't many onc emergencies, getting woken up because the local hospital culture includes calling sub specialists at all hours for non emergent matters can get old quickly.

And while $700K isn't out of the question for a seasoned oncologist, be a little wary of the PP's infusion practices. Some business savvy, but arguably unethical prescribing patterns have historically contributed to high revenue oncology practices.

Xrayman69
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Re: Tale of 2 doctor job opportunities

Post by Xrayman69 » Sun Nov 10, 2019 8:52 am

Question about job 1 for some clarity and risk assessment as well as valuation

You would be the 3rd member. Other current partners make around 700k year while you do the same work and make about 300K. I get this in that they have invested in all the infrastructure and relationship equity for the practice. Will your addition add increased income for the current partners or is 700K what they are making without your addition. Because when your salary goes up it must come from somewhere and that is directly from profits that would be otherwise distributed to partners.

Are you “guaranteed” partnership or is this based upon “review and metrics”. Are there clauses that would deny your “partnership” and thus leave you as an employee and profits remain with partners?

The other private group has 5 people and your group would have 3 with you and the large center has many more. Why is it that such a great job would go understaffed compared to the others? Are the current partners looking to add volume with your immediate arrival and build up of volume for the next 2-4 years and then the numbers look real attractive for a different group to purchase the practice ? Ie the two private groups merge to be competitive with the larger system and thus your “partnership” structure goes away. Given the fact that both groups are comfortable sharing call they may be comfortable sharing administrative costs which would come with a merger as a result of consolidation trends. Smaller groups get “swallowed” up and this would not be a merger of equals.

Would you be ok with call every third instead of eighth if the other group decided to pull away from shared call as a mechanism of leverage for merger/buy out of partners?

Is there a clause that would prevent you from working within a certain mileage radius if you were not satisfied for fear by the group of you taking patients with you?

Is the partner pay considered total compensation from which they pay their own “retirement” and benefits such as health and malpractice?

Compensation as an “employee “ as in option 2 the pay is likely take home pay and benefits adds typically 20-30% value.

In my experience, NO FREE lunch. You get paid more for effort and risk. Option 1 will carry both. Option 2 as employee minimizes burdens but comes with a cost from a money standpoint and an autonomy standpoint.

Good luck and it must be very exciting to be able to have choices and be near family after such a long journey.

mega317
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Re: Tale of 2 doctor job opportunities

Post by mega317 » Sun Nov 10, 2019 9:19 am

I'm a physician who has only ever been hospital based, employed by a university. I'm curious for those recommending pp for the autonomy and say in day to day operations: how are these decisions made? Partner meetings? After hours? One of the things I like about my job is that I only have to be involved in the decision making that interests me, and the meetings are during normal hours so I can get home. I only miss dinner for unusual clinical situations which can happen in any job, not for scheduled meetings.

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Re: Tale of 2 doctor job opportunities

Post by goodenyou » Sun Nov 10, 2019 9:27 am

If you join private practice, be sure to do a complete audit of the practice. That includes fiscal health, lines of credit, leases on equipment and real estate and billing history for current providers. Young doctors make big mistakes thinking that they are joining a “great” practice only to find out later that the practice is in financial shambles and the doctors are fraudsters.
"Ignorance more frequently begets confidence than does knowledge" | Do you know how to make a rain dance work? Dance until it rains.

Big Worm
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Re: Tale of 2 doctor job opportunities

Post by Big Worm » Sun Nov 10, 2019 9:30 am

Private practice. Avoid being an employee as long as you can.

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Re: Tale of 2 doctor job opportunities

Post by goodenyou » Sun Nov 10, 2019 9:55 am

mega317 wrote:
Sun Nov 10, 2019 9:19 am
I'm a physician who has only ever been hospital based, employed by a university. I'm curious for those recommending pp for the autonomy and say in day to day operations: how are these decisions made? Partner meetings? After hours? One of the things I like about my job is that I only have to be involved in the decision making that interests me, and the meetings are during normal hours so I can get home. I only miss dinner for unusual clinical situations which can happen in any job, not for scheduled meetings.
I am a managing partner of a large subspecialty surgery practice with 9 MDs and 2PAs, 100 employees and 5 offices that span 100 miles. We have had large real estate projects, partnerships in surgery centers, new hospitals and imaging centers. At one time we had an in-house JD and a CPA. The managing MD would spend a lot of time coordinating with the administration. It has been an extraordinary education in business development. Time consuming but financially rewarding. The time put in always felt like an investment in our business, not for the benefit of an employer. It's not for everyone.
"Ignorance more frequently begets confidence than does knowledge" | Do you know how to make a rain dance work? Dance until it rains.

zlandar
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Re: Tale of 2 doctor job opportunities

Post by zlandar » Sun Nov 10, 2019 9:56 am

goodenyou wrote:
Sun Nov 10, 2019 9:27 am
If you join private practice, be sure to do a complete audit of the practice. That includes fiscal health, lines of credit, leases on equipment and real estate and billing history for current providers. Young doctors make big mistakes thinking that they are joining a “great” practice only to find out later that the practice is in financial shambles and the doctors are fraudsters.
That sounds good in theory. In reality the practice has to give you access to their financial records and most will say no. Would you give full-access to your practice's financial records to a prospective MD if he/she asked?

It's a bigger concern if the practice owns a lot of physical assets- buildings, expensive medical devices, etc where a practice may have to obtain mortgages/large loans. If a practice just rents medical offices then the buy-in will mainly be based off accounts receivable.

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White Coat Investor
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Re: Tale of 2 doctor job opportunities

Post by White Coat Investor » Sun Nov 10, 2019 10:02 am

chessknt wrote:
Sat Nov 09, 2019 12:05 pm
Once wci forums are back up ask there since this forum isn't well suited for physician employment assessment.
Hopefully not too much longer but I'll tell you what makes you appreciate folks running a forum a lot--running one yourself. It all seems so easy when it is done well, but there's a lot behind the scenes.
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: Tale of 2 doctor job opportunities

Post by goodenyou » Sun Nov 10, 2019 10:03 am

zlandar wrote:
Sun Nov 10, 2019 9:56 am
goodenyou wrote:
Sun Nov 10, 2019 9:27 am
If you join private practice, be sure to do a complete audit of the practice. That includes fiscal health, lines of credit, leases on equipment and real estate and billing history for current providers. Young doctors make big mistakes thinking that they are joining a “great” practice only to find out later that the practice is in financial shambles and the doctors are fraudsters.
That sounds good in theory. In reality the practice has to give you access to their financial records and most will say no. Would you give full-access to your practice's financial records to a prospective MD if he/she asked?

It's a bigger concern if the practice owns a lot of physical assets- buildings, expensive medical devices, etc where a practice may have to obtain mortgages/large loans. If a practice just rents medical offices then the buy-in will mainly be based off accounts receivable.
I have given full access to all financials. I have even offered to show our corporate tax returns. I have nothing to hide and want to build the full trust of a person joining our practice. The candidate is usually shocked by our full transparency.
"Ignorance more frequently begets confidence than does knowledge" | Do you know how to make a rain dance work? Dance until it rains.

zlandar
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Re: Tale of 2 doctor job opportunities

Post by zlandar » Sun Nov 10, 2019 10:29 am

goodenyou wrote:
Sun Nov 10, 2019 10:03 am
zlandar wrote:
Sun Nov 10, 2019 9:56 am
goodenyou wrote:
Sun Nov 10, 2019 9:27 am
If you join private practice, be sure to do a complete audit of the practice. That includes fiscal health, lines of credit, leases on equipment and real estate and billing history for current providers. Young doctors make big mistakes thinking that they are joining a “great” practice only to find out later that the practice is in financial shambles and the doctors are fraudsters.
That sounds good in theory. In reality the practice has to give you access to their financial records and most will say no. Would you give full-access to your practice's financial records to a prospective MD if he/she asked?

It's a bigger concern if the practice owns a lot of physical assets- buildings, expensive medical devices, etc where a practice may have to obtain mortgages/large loans. If a practice just rents medical offices then the buy-in will mainly be based off accounts receivable.
I have given full access to all financials. I have even offered to show our corporate tax returns. I have nothing to hide and want to build the full trust of a person joining our practice. The candidate is usually shocked by our full transparency.
Yep that's shocking. Your warning is valid as the current group I work at had a poor financial situation when I first joined. It took firing the old president and several years of belt-tightening to clean up the mess.

anil686
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Re: Tale of 2 doctor job opportunities

Post by anil686 » Sun Nov 10, 2019 10:30 am

Another physician - job 1. More autonomy and choices going forward. Job 2 is at the whim of administrators. The hospital system will always choose what is best for itself - and why should it not? Job 1 is more aligned with your interests and you have more of a real say. That counts for a ton in medicine. I am a member of a 2 physician practice for the past 10 years - would never think about joining a hospital system. have seen too many of my colleagues burned over time by either reduction in pay, more workload, less autonomy, changing hospital leadership, changing hospital directions/goals and often all of the above. Due to that, I would pick job 1. JMO though....

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Re: Tale of 2 doctor job opportunities

Post by goodenyou » Sun Nov 10, 2019 10:44 am

zlandar wrote:
Sun Nov 10, 2019 10:29 am
goodenyou wrote:
Sun Nov 10, 2019 10:03 am
zlandar wrote:
Sun Nov 10, 2019 9:56 am
goodenyou wrote:
Sun Nov 10, 2019 9:27 am
If you join private practice, be sure to do a complete audit of the practice. That includes fiscal health, lines of credit, leases on equipment and real estate and billing history for current providers. Young doctors make big mistakes thinking that they are joining a “great” practice only to find out later that the practice is in financial shambles and the doctors are fraudsters.
That sounds good in theory. In reality the practice has to give you access to their financial records and most will say no. Would you give full-access to your practice's financial records to a prospective MD if he/she asked?

It's a bigger concern if the practice owns a lot of physical assets- buildings, expensive medical devices, etc where a practice may have to obtain mortgages/large loans. If a practice just rents medical offices then the buy-in will mainly be based off accounts receivable.
I have given full access to all financials. I have even offered to show our corporate tax returns. I have nothing to hide and want to build the full trust of a person joining our practice. The candidate is usually shocked by our full transparency.
Yep that's shocking. Your warning is valid as the current group I work at had a poor financial situation when I first joined. It took firing the old president and several years of belt-tightening to clean up the mess.
Count yourself fortunate that you were able to wrestle control of the practice and right the ship. I would add succession planning as a potential pitfall to private practice. Young doctors are often ill- prepared, naive and too trusting when they come out of training. I was. I learned a hard lesson over 25 years. I am thankful that it all worked out very well. I have had several friends that have had situations that ended in disaster.
"Ignorance more frequently begets confidence than does knowledge" | Do you know how to make a rain dance work? Dance until it rains.

zlandar
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Re: Tale of 2 doctor job opportunities

Post by zlandar » Sun Nov 10, 2019 10:52 am

Forsberg21 wrote:
Sun Nov 10, 2019 8:17 am
if it doesn’t work out then the hospital affiliated jobs will always be there.
Pretty much. Looking at the two job offers the first 2-3 years of salary are very similar however the PP has twice the vacation. You will appreciate that extra 4 weeks off with a young child. There is the potential for a higher partner salary with the PP however that will have to come from growth of the practice. If the PP is earning ~$1.4 million/year the partner salary is ~$500k with three partners unless the practice grows. That's what the hospital group is making after year 1 with half the vacation.

Let's say you join the PP and it is sold in years 3-4. Do you get 65%/85% of the proceeds of the sale, 100%, or 0%? That's a legit concern if one of the two partners is thinking of retiring in 5-10 years as that's when many PP are sold- partners near retirement age and the extra cash from the buyout allows them to do it earlier than planned.

Also look at any non-compete clauses. You could be in a situation where the PP is sold before you become partner and prevented from working at other jobs in the area if you choose to leave because of a non-compete.

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Re: Tale of 2 doctor job opportunities

Post by mighty72 » Sun Nov 10, 2019 11:21 am

A lot of great advice. One thing I will add is that you discuss if you get any thing from sale of the PP if it is sold before you become a partner. The revenue you bring in will increase the sale price of the practice. The reason I bring this up is because you mentioned that big hospital are buying private practice.

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Re: Tale of 2 doctor job opportunities

Post by JPM » Sun Nov 10, 2019 11:25 am

Small PP groups usually break up over spousal interference or differences over the appropriate balance between professional and commercial values in the operation of the practice. Some break up over the income split if the senior members want to make money off the junior members' work. To grow and prosper the money and work split has to be fair to everyone. Some groups cycle through a series of junior docs over the years due to this approach.

When we sold our clinic to large group, the young nonpartner was included in the deal to a more limited degree than the five partners. One retired at the sale and two others wanted to try solo having never done that before. One worked out and one didn't.

If you choose PP, be confident that your idea of the appropriate balance between commercial and professional values is concordant with that of your partners. As a young doc, I would prefer PP as long as the work and money splits are fair and the values balance is congenial.

In regard to employed positions, some groups are doc friendly and most are not. If your employed opportunity is with a doc unfriendly group, do you want to put up with that or keep looking for a more doc friendly group? A doc friendly group is probably the highest lifetime income option. The large doctor friendly integrated groups subsidize the medical group from their profitable lines of business like lab, imaging, hospital, etc.

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Re: Tale of 2 doctor job opportunities

Post by fasteddie911 » Sun Nov 10, 2019 12:08 pm

I'd go with option 1 and make hay. More pay, more vacation, more potential. If the people, business and numbers seem ok, then it's worth a shot. Either choice will be somewhat a leap of faith. You can always switch jobs. I have seen the pros/cons to PP vs employed. Heard horror stories from both sides on all aspects, including autonomy. Really varies between different hospitals or groups and no definitive conclusion can be made one way or the other on employed vs PP.

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Re: Tale of 2 doctor job opportunities

Post by Spooky » Sun Nov 10, 2019 12:31 pm

Private practice can seem great, and everyone cites autonomy. But sometimes when you joint a group, all the office staff have had years of training to make senior partners happy, and have no interest in making any changes. Also with regards to "splitting everything." I have had the experience where, as soon as I became a partner, the oldest partner decided to cut back on his hours and not take call, and my actual income dropped about $200k from the projected income, even though the revenue I generated was the same. I would recommend reading contracts very carefully and figure out worst case scenarios.

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Re: Tale of 2 doctor job opportunities

Post by goodenyou » Sun Nov 10, 2019 1:00 pm

mighty72 wrote:
Sun Nov 10, 2019 11:21 am
A lot of great advice. One thing I will add is that you discuss if you get any thing from sale of the PP if it is sold before you become a partner. The revenue you bring in will increase the sale price of the practice. The reason I bring this up is because you mentioned that big hospital are buying private practice.
Big hospitals don’t buy private practices. There are rules against kickbacks. They only employ doctors at going rates and may purchase hard assets at fair market value. Private equity, yes. There are strings either way.
"Ignorance more frequently begets confidence than does knowledge" | Do you know how to make a rain dance work? Dance until it rains.

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Re: Tale of 2 doctor job opportunities

Post by Traveler » Sun Nov 10, 2019 2:01 pm

Disclaimer: I am not a physician and don't work in the healthcare industry - I am a businessperson working for a megacorp.

I would think the business skills you will learn in option #1 could be very beneficial in the future. I've always envied those who had the guts to start a business and not be a cog in the wheel of a large company.

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Re: Tale of 2 doctor job opportunities

Post by mega317 » Mon Nov 11, 2019 12:30 am

Spooky wrote:
Sun Nov 10, 2019 12:31 pm
I would recommend reading contracts very carefully
And hire a lawyer to do the same.

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Re: Tale of 2 doctor job opportunities

Post by obgraham » Mon Nov 11, 2019 1:21 am

Couple of issues I learned, sometimes the hard way, about group practices. You want to be clear up front about the issues:
Who pays the tail policy if you leave the group before becoming partner?
If pay is determined in part or all by production, is it "billed" or "Collected" production?
What happens to your accounts receivable if you leave?
Is there a non-compete clause, and if so, can you live with it?
Are spouses allowed to work in the office business?

Etc, etc! I opt for Choice 1 here, but there are caveats!

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