Physician Jobs: Private Equity or Industry?

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dwade1109
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Physician Jobs: Private Equity or Industry?

Post by dwade1109 »

At a crossroads and would appreciate input from any MDs (or non-MDs with some insight into private equity and pharma!).

I posted a few months back that I was offered an industry position. People were very helpful in giving guidance and I decided against it, primarily due to location reasons.

Now I am at a big decision tree moment:

Current position: academic surgeon. I am fortunate to be at a great university where I make between 350-400k a year working an average of 4 clinical days and 1 administrative day a week.

Reason for change: My wife (just married!) works in a different state and has an in-person medical job that she cannot relocate from.

Options: There are no universities hiring within a 1.5 hour radius of my wife's job. So my options are the following:

1) A local surgical practice recently bought by private equity investors. They are offering a salary higher than my current one (but in a higher tax state it works out about the same), will require 5 days a week clinical plus more frequent call. It's a reputable practice but I am afraid of what happens when they are sold again (rumor is that they will sell within the next 6-12 months). Maybe my contract gets rewritten etc. and not great other options in area. Big pro is I maintain clinical practice, make good money, and get to operate still. Con is the uncertainty and I have heard horror stories from MDs about PE.

2) Industry job came back to me and said I do not have to move to their headquarters. Instead I could work remotely from anywhere as long as a I am willing to do 25% travel including academic meetings (which I did regularly pre COVID anyway). Salary is lower than my current one with stock options as well. Pro is the flexibility, ability to work from anywhere, can always go back clinical if I dislike it, get to go to meetings etc. Cons are the lower salary and entering the unfamiliar world of industry/medical affairs.

Anyone with experience with PE or pharma physician jobs? In a perfect world I would just keep my current position but love is love :mrgreen:
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dwade1109
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Re: Physician Jobs: Private Equity or Industry?

Post by dwade1109 »

Accidentally posted in Personal Finance, maybe better in Personal Consumer Issues? Will defer to moderator
MedSaver
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Re: Physician Jobs: Private Equity or Industry?

Post by MedSaver »

Each has some downsides. Not all private equity is the same, but in my specialty, it's all pretty bad. I worked a few months for PE during the tail end of my last job, it was ok, but not something I would aspire to do. The money is inherently less than a non-PE private practice job (have to pay the middle man) and you work the same or more hours. You will probably have several layers of hierarchy above you and you might never even see the "real" boss man, which means you're expendable in a time of crisis (e.g. Covid pandemic). Rumors of an impending resale is a red flag IMO, even if only because of the instability and potential staff turnover. Your input about how things should be done is a low priority. In other words, if something works, even if it's not the best, they expect you to keep doing it the way they've always done it because it's "good enough". If you go this route, just go with eyes wide open and don't drink the Kool Aid.

If you go into industry, are you sure it will be easy to return to clinic/OR? Hospital credential committees require a certain number of procedures in the year prior to hire or else require proctoring of core procedures before working unsupervised. This would certainly be true of academic centers. Most surgeons I know would shrivel and die if they couldn't be in the OR.

In the end, the decision should be pretty easy. Don't even think about the salary, travel, stock options, PE risk, etc. Just decide if you would rather be in the OR or in an office.
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dwade1109
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Re: Physician Jobs: Private Equity or Industry?

Post by dwade1109 »

MedSaver wrote: Mon Apr 12, 2021 12:06 am Each has some downsides. Not all private equity is the same, but in my specialty, it's all pretty bad. I worked a few months for PE during the tail end of my last job, it was ok, but not something I would aspire to do. The money is inherently less than a non-PE private practice job (have to pay the middle man) and you work the same or more hours. You will probably have several layers of hierarchy above you and you might never even see the "real" boss man, which means you're expendable in a time of crisis (e.g. Covid pandemic). Rumors of an impending resale is a red flag IMO, even if only because of the instability and potential staff turnover. Your input about how things should be done is a low priority. In other words, if something works, even if it's not the best, they expect you to keep doing it the way they've always done it because it's "good enough". If you go this route, just go with eyes wide open and don't drink the Kool Aid.

If you go into industry, are you sure it will be easy to return to clinic/OR? Hospital credential committees require a certain number of procedures in the year prior to hire or else require proctoring of core procedures before working unsupervised. This would certainly be true of academic centers. Most surgeons I know would shrivel and die if they couldn't be in the OR.

In the end, the decision should be pretty easy. Don't even think about the salary, travel, stock options, PE risk, etc. Just decide if you would rather be in the OR or in an office.
Thanks for the advice! Yes, you are right. OR is tough to give up. The industry job would allow me 2 days a month of clinical so potentially could still operate.
Shalom Aleichem
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Re: Physician Jobs: Private Equity or Industry?

Post by Shalom Aleichem »

I am a private practice specialty surgeon. I love my job. Generally I can’t wait to go into work. I recognize that I am an anomaly. One point is we all have bosses. Although I am the owner of the practice, obviously every single refer and every single patient is in reality my boss. In addition to that later if you work in academics the chairman is also your boss. And I was young I wanted to work in academics. I am so grateful I did not as a chief against authority and when instructed or forced to do things I don’t think are the best. For me personally I think my personality would not fit at all with the private equity group where your job I assume is to make as much money as possible so that they can profit.

I am now old enough that I think it would be difficult for me to start over in a new location and build a practice. If you are young that might be a feasible option. Tough situation to be in. If one of you is going to have to restart his or her career, would she be willing to move to you? As mentioned above it would be hard for me or most surgeons I know functionally to give up surgery. I get that you could have a day or two a week clinical but for me I would not be able to generate the surgical volume sufficient to maintain technical excellence one day seeing patients and relying on that one day to generate surgical cases. I would be concerned that my skills would deteriorate. Over this last year with the decreasing clinical volume I feel like I am not as smooth as I was before. The outcomes seem to be the same but everything takes a little longer. And that was only after a bit of decrease in cases. If I saw a quarter of the patients in clinic and so presumably generated a quarter of the cases permanently I don’t think I would feel comfortable that my skills we’re at their best.

Depending on how old you are and how sub specialized you are I wonder if it would make sense to join a more general group in your field and become the specialist or even opening your own practice and depending on your savings and your wife’s work to maintain your income until you can build a practice. Otherwise I would wonder if depending on your salaries it would make more sense for her to move to you rather than the other way around.
Shalom Aleichem
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Re: Physician Jobs: Private Equity or Industry?

Post by Shalom Aleichem »

Oops – I sought two days a week, not two days a month as your clinical. If you are only seeing patients two days a month I would think that is not enough volume to maintain your technical skills and if you consciously know that your volume is so much smaller than your peers I would think at some point you would give up surgery as your skills become rustier. I don’t know That I would feel comfortable operating with two clinical days a month.
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ram
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Re: Physician Jobs: Private Equity or Industry?

Post by ram »

Other physicians might be reluctant to refer to a surgeon who works 2 clinical days per month. (There are many procedures where outcomes are better for high volumes)
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goodenyou
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Re: Physician Jobs: Private Equity or Industry?

Post by goodenyou »

How long have you been in practice? If you are ready to get out of clinical medicine, then the Pharma job sounds good. Let me know what the Pharma job is, if you aren't interested. I may be interested. :D
"Ignorance more frequently begets confidence than does knowledge" | “At 50, everyone has the face he deserves”
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dwade1109
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Re: Physician Jobs: Private Equity or Industry?

Post by dwade1109 »

Thanks for responses all!

I am five years out of fellowship so still pretty early.

I enjoy operating so I guess it’s more fear about the unknown with private equity and the unique opportunity from industry perspective because usually MDs without experience do not get medical affairs offers at this level so the same opp may not present itself in near future.
cutterinnj
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Re: Physician Jobs: Private Equity or Industry?

Post by cutterinnj »

Specialty surgeon here

I recommend against going to a practice involved with PE.

The advantage of PE (for the surgeons) is when they are bought by the PE firm and they get a big payout (often millions).

They then take a lower salary and decreased autonomy to make up for it.

You will be accepting a lower salary and decreased autonomy without the payout.

Lose/lose.
Rex66
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Re: Physician Jobs: Private Equity or Industry?

Post by Rex66 »

It is rare for non owners to think PE worked out for them. Very rare.
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Re: Physician Jobs: Private Equity or Industry?

Post by Xrayman69 »

P/E is often musical chairs and assuming there will be one more squeeze left to get juice. It’s an awesome business model as long as your not last one holding the paper. Doesn’t sound appealing or stable from the clinical side. Thus the OP may find themselves in the exact same position in the future now with less leverage.

P/E often reference efficiency and “quality” as there value proposition. However, “quality” in healthcare is difficulty to define and thus a low threshold objective measure that nearly everyone meets and thus “advertised” or shared with payors or the general public. I have learned that “quality” in the healthcare industry is like statistics, you can often make it appear how you need or want based upon various gymnastics. Ie this provider orders less test and thus saves money a d therefore meets bonus criteria. Unfortunately a deeper dive showed this providers patients needed more invasive surgeries , longer hospital stays or sent out form more consultants that had to order the tests.

To the OP, 5 years post fellowship likely translates into a golden period of enthusiasm, comfort with skills and clinical knowledge and sense of professional satisfaction. If your family has to bridge 2 cities for a year our two with optimal professional jobs for both this is a short period to clearly identify your future long term needs and status in your respective fields.
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dwade1109
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Re: Physician Jobs: Private Equity or Industry?

Post by dwade1109 »

Yeesh. PE sounds like no picnic. Are there any positive/neutral stories about PE?
MedSaver
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Re: Physician Jobs: Private Equity or Industry?

Post by MedSaver »

The people who will sing PE’s praises either sold out for 7 figures and need fresh blood to vest their buyout or recent grads who think PE jobs are normal (they might pay better than academics, after all).
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Re: Physician Jobs: Private Equity or Industry?

Post by JPM »

Neither of these opportunities seems appropriate for a highly skilled young surgeon with a few years experience beyond training. I agree with the above posts suggesting OP will probably receive few surgical referrals in part-time practice in most situations. Losing the hard-won surgical skills of so young a man to a nonclinical Pharma job, a man who may have 20-25 years of valuable contribution to society and his profession, would be a tragedy for the profession.

I do understand that many surgical practices need to recover financially from the partial or complete shutdowns of 2020 that resulted in sharp unplanned drops in practice revenue without commensurate drops in practice overhead. Opportunities in surgery may be temporarily constrained by practices' need to avoid guarantees to new hires. This may be why OP sees himself as faced with this dismal binary choice.

If OP has to reside near his bride's locale and will have to remain there for the rest of his career, he should avoid a restrictive covenant with the PE group in particular, any group if possible. A no-guarantee contract or a standing start would be better than a restrictive covenant that the PE can exploit if he can rely on his bride's income until successfully established in practice.

Maybe cast a wider net? Network with former residents or former colleagues? Call VPMA at hospitals within reach of his bride's locale or the medical directors of the local larger integrated groups to unearth opportunities that may not be listed with headhunters. VPMAs and medical directors know who is still just thinking about hiring a new colleague but hasn't come to a decision, but may be ready to pull the trigger if an attractive candidate such as OP were to turn up.
Shalom Aleichem
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Re: Physician Jobs: Private Equity or Industry?

Post by Shalom Aleichem »

dwade1109 wrote: Thu Apr 15, 2021 6:51 am Thanks for responses all!

I am five years out of fellowship so still pretty early.

I enjoy operating so I guess it’s more fear about the unknown with private equity and the unique opportunity from industry perspective because usually MDs without experience do not get medical affairs offers at this level so the same opp may not present itself in near future.
Five years out is really young. I was - and I assume you are - still developing as a surgeon. As much as I learned in residency and fellowship, my ability increased a lot over the next five or ten years. At only five years out if I did only 2 clinical days a month I would very quickly lose confidence in my surgical skills and would feel it is inappropriate to operate when other local surgeons will do a better more efficient job than me. I think if you leave clinical medicine for more than a year or two it will be permanent.
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dwade1109
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Re: Physician Jobs: Private Equity or Industry?

Post by dwade1109 »

This has all been super helpful, humbling, and also more confusing 😂

My SO could move but between her job and her parents (who are not in great health) I think she would be unhappy to be so far away. We have already been long distance for some time, it’s just with COVID the market has been pretty bad in terms of positions.

I have reached out to several local hospitals and so far have come up dry. So I guess it’s a question of how bad working for PE is from a risk standpoint (especially since she works for a different medical group owned by the same PE entity) versus the con of giving up clinical practice, which is the whole reason most of us pursue medicine in the first place.
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Re: Physician Jobs: Private Equity or Industry?

Post by Edujo »

I guess the question comes down to do you really want to be a surgeon? If you do, then go with the private practice (despite the PE overlords). You know the work you put in to get into med school, survive residency/fellowship & develop those surgical skills. The private practice will have you still using/developing those further. The pharma job really is for those who may not be that interested in practicing anymore and/or are into business. I’ve seen a few hybrid docs that practice a few days a week and work MA or as MSL, but they’re not surgeons. As an industry guy, I’d suggest going with the private practice while you’re still relatively young in your career. Pharma/biotech will always be there and happily snap up every doc with communication skills and interest in the industry. I’m not saying that your surgical skills would disappear working in pharma. However, if you take X years off to work in pharma, is it easy to go back into practice as a surgeon? I don’t know the answer to that question. I do know it’s relatively easy to go from practicing doc to pharma at almost any time you want.
With regards to opportunity being at a higher level: that’s all negotiation & leverage. Congratulations, you’ve done it once and can do it again if you are motivated. The elevated titles can be negotiated because MDs have huge leverage compared to the average candidate applying for other positions. I’ve seen people get elevated titles simply to come close to matching salary. Give or take a few, literally every pharma/biotech company is looking to fill roles that require an MD and there aren’t enough in the pipeline. Working in industry affords a great lifestyle, compensation (vs the average Joe) and you’re insulated from the inevitable negative outcomes that come with medical practice. You’ll probably be able to do that whenever you want. I’m not sure if it works the same way for surgery, so I can only speak to one side of it. Good luck with your decision!
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dwade1109
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Re: Physician Jobs: Private Equity or Industry?

Post by dwade1109 »

Edujo wrote: Fri Apr 23, 2021 7:53 am I guess the question comes down to do you really want to be a surgeon? If you do, then go with the private practice (despite the PE overlords). You know the work you put in to get into med school, survive residency/fellowship & develop those surgical skills. The private practice will have you still using/developing those further. The pharma job really is for those who may not be that interested in practicing anymore and/or are into business. I’ve seen a few hybrid docs that practice a few days a week and work MA or as MSL, but they’re not surgeons. As an industry guy, I’d suggest going with the private practice while you’re still relatively young in your career. Pharma/biotech will always be there and happily snap up every doc with communication skills and interest in the industry. I’m not saying that your surgical skills would disappear working in pharma. However, if you take X years off to work in pharma, is it easy to go back into practice as a surgeon? I don’t know the answer to that question. I do know it’s relatively easy to go from practicing doc to pharma at almost any time you want.
With regards to opportunity being at a higher level: that’s all negotiation & leverage. Congratulations, you’ve done it once and can do it again if you are motivated. The elevated titles can be negotiated because MDs have huge leverage compared to the average candidate applying for other positions. I’ve seen people get elevated titles simply to come close to matching salary. Give or take a few, literally every pharma/biotech company is looking to fill roles that require an MD and there aren’t enough in the pipeline. Working in industry affords a great lifestyle, compensation (vs the average Joe) and you’re insulated from the inevitable negative outcomes that come with medical practice. You’ll probably be able to do that whenever you want. I’m not sure if it works the same way for surgery, so I can only speak to one side of it. Good luck with your decision!
Thank you!
This is extremely helpful. I think the only 'unique' part of this opportunity is the remote working part of it but maybe more companies will allow remote working long-term post COVID and this is just the first opp of many to come along like this.
Shalom Aleichem
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Re: Physician Jobs: Private Equity or Industry?

Post by Shalom Aleichem »

Edujo wrote: Fri Apr 23, 2021 7:53 am I guess the question comes down to do you really want to be a surgeon? If you do, then go with the private practice (despite the PE overlords). You know the work you put in to get into med school, survive residency/fellowship & develop those surgical skills. The private practice will have you still using/developing those further. The pharma job really is for those who may not be that interested in practicing anymore and/or are into business. I’ve seen a few hybrid docs that practice a few days a week and work MA or as MSL, but they’re not surgeons. As an industry guy, I’d suggest going with the private practice while you’re still relatively young in your career. Pharma/biotech will always be there and happily snap up every doc with communication skills and interest in the industry. I’m not saying that your surgical skills would disappear working in pharma. However, if you take X years off to work in pharma, is it easy to go back into practice as a surgeon? I don’t know the answer to that question. I do know it’s relatively easy to go from practicing doc to pharma at almost any time you want.
With regards to opportunity being at a higher level: that’s all negotiation & leverage. Congratulations, you’ve done it once and can do it again if you are motivated. The elevated titles can be negotiated because MDs have huge leverage compared to the average candidate applying for other positions. I’ve seen people get elevated titles simply to come close to matching salary. Give or take a few, literally every pharma/biotech company is looking to fill roles that require an MD and there aren’t enough in the pipeline. Working in industry affords a great lifestyle, compensation (vs the average Joe) and you’re insulated from the inevitable negative outcomes that come with medical practice. You’ll probably be able to do that whenever you want. I’m not sure if it works the same way for surgery, so I can only speak to one side of it. Good luck with your decision!
When I simply come back from vacation for a week or two I find that I have to think more in the OR and the OR is no place to think. You should have every reasonably possible outcome planned out and simply execute when the issue arises. After only a week or two off I feel like my operating is not as automatic as it was before. I can't imagine only working 2 days a month. The surgical skills may not completely disappear but I think any surgeon would become sufficiently rusty as to feel not comfortable operating as he did in the past. Personally if I knew a surgeon were working only two days a week I would not feel comfortable sending patients to him.

As you suggested, either you want to be a surgeon or you want to be a corporate guy. I don't know any surgeon in my area in Los Angeles that practices say once or twice a week, much less once or twice a month. I don't know that's a feasible option for a surgeon. For a medical doctor, not a surgeon, where it's purely intellectual and technique is immaterial that would be different.
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