Buy-In: A Scam or Typical Hurdle in PP?

[Mman]

What would you do if you were a 3rd year medical student with an application competitive for any specialty, but categorically uninterested in /unwilling to be a surgeon?

You have to pick a specialty where you enjoy the clinical work. That's really about it. All of medicine is going down the same pathway and you can't try to forecast 20 years down the road as to what might be impacted more than another. Medicine is a long, hard road and if you don't enjoy the day to day work you will be miserable no matter how much you are getting paid.

---

Members don't see this ad.

 

[Notorious T.E.E.]

But it's ok when these old hacks profit off our work? I'm not asking for the money they earned, I just want to keep the money that I earn.

How many positions have you contacted and interviewed with in the past 6 months? You aren't going to improve your lot in life without effort. If you are being taken advantage of move on. I can assure you that lobbying for better treatment on SDN isn't going to help.

The majority of anesthesiologists are not partners in PP earning $500k+benefits with 10 weeks off. Having said that, there are many who are, and if you want that job type of job you are going to have to work to find it, and likely pay your dues for a couple of years.

I've been an anesthesiology employee. I worked, collected a check, and went home. It wasn't the ideal job but it was the best I found at the end of training and I was happy to be in a stable place and not doing locums. I used the time to find something better and moved on. In this era, an anesthesiologist may have 5-10 practice locations in a career. It's how every other person in business has moved up the ladder for a generation, and now it's come to medicine.

 

[timgasman]

Group I am talking with has a 1-2 year buy-in that concerns me. It's somewhere around $300K. Is this at all typical and if so, should it involve buying into a surgery center, etc.?

TIA,

ECCA-1

I would not rely on any buy-ins in this economy. The reality is that small groups are getting gobbled up by the big players and the buy-in may just be something to keep them afloat for another year before they cash out. These groups have NO loyalty to the individual physician.

 

[deleted171991]

Gas docs < 40 yo still are in upper echelon of earnings, rank #3 behind Ortho and Derm. How can this be explained in light of AMCs/decline of PP?

Medscape Young Physicians Compensation Report 2016

This does not take into account work hours and stress. In many other specialties, you don't run around like a headless chicken all day long for those salaries.

 

[AdmiralChz]

Let's review threats to other specialties:

Cardiology: Saturated market except in rural areas, interventional/other subspecialties with high 8+ PGY training requirements
Derm: Extender encroachment, declining reimbursements
Radiology: Off-shore reading groups
Primary care (FM/IM/Peds/Psych): extender encroachment
ER: (probably my favorite, check their board out sometime) "Should this specialty exist", large for-profit take-overs, extender encroachment, major burnout factor
CCM: extender encroachment
Pain: Declining encroachment, increasing oversight with narcotic epidemic
Surgery: more production pressure then ever, bundled payments might squeeze out many sick/comorbid patients to academic centers, burnout factor
Interventional rads: encroachment from NSG/Neurology/Renal/Procedural Medicine/everyone else.
Rad Onc: Physicist encroachment

Any requests for random ones I missed?

Every, EVERY specialty has threats. Many have been there for years. People will continue to be sick and require surgery in the future. I'm happy and excited for my future, personally.

 

[deleted162650]

Radiology: Off-shore reading groups

This is oft talked about, but I don't think I've ever been at a hospital where this is actually done. Wouldn't the "off-shore" radiologist still need to be licensed to practice medicine in that state?? How do they get around this?

 

[AdmiralChz]

This is oft talked about, but I don't think I've ever been at a hospital where this is actually done. Wouldn't the "off-shore" radiologist still need to be licensed to practice medicine in that state?? How do they get around this?

The community hospitals as well as the VA I rotated at (and continue to work at) as a resident use them for night/weekends. Becomes a major issue when you need to discuss an imaging finding when they are covering. It was a service out of Australia, I believe.

 

[Carbocation1]

This does not take into account work hours and stress. In many other specialties, you don't run around like a headless chicken all day long for those salaries.

Dermies typically run from room to room every 5 mins to see another high maintenance patient for a total of 80 patients a day. Ortho performs backbreaking labor with radiation exposure to get paid.

Supervising rooms 4:1 with unconscious patients seems less stressful to me, as long as the CRNAs know their place.

 

[GravelRider]

Is that any different than anyone, anywhere, who goes to anybody else, anywhere else looking for a job?

It's no more greedy or fearful than selling your Apple stock because you think the iPhone is a fad. Hardly worthy of the contempt you show.



This is where you confuse cause and effect. The businessmen were coming, regardless. Physicians didn't come up with bundled payments. Physicians didn't cause the cost of healthcare to explode (our salaries are less than 1/10th the cost of healthcare in the US). Physicians didn't conjure the Affordable Care Act. Physicians didn't invent CMS and hire the werewolves and vampires at the Joint Commission. Businessmen did all those things.

The businessmen came because the system was bloated, full of money-extraction opportunities for middlemen. It is increasingly bogged down by regulations and certifying agencies, and physicians were (and are) generally unmotivated and ill-equipped to handle it all.



I share your anger about that. I hate being referred to as a "provider" ...

But the biggest deficiency in your sense of perspective is that it's not just anesthesia, it's all of medicine ... and it's not just medicine, but the entire economy. You're angry that the Anesthesia Dream isn't what you thought it would be? Get in line behind the other 300 million people here who are having more trouble realizing the American Dream than their elders.

There is nothing wrong with greed. It is what it is, but stop equating these anesthesia group sellouts with the glorious cause of capitalism.

You are 100% right in that it is not just anesthesia. The entire previous generation of Doctors let this happen. There was no foresight, no political action, no organization and now our healthcare system is a mess of consolidation, protocols, and midlevel care. I think the current generation of physicians have every right to be angry. Maybe we need a little more anger to actually get something done.

 

[GravelRider]

So what happens when the group you work for collects a far higher $$$ amount than you could on your own for your work. Did you earn that money yourself? Or did their long term negotiated/contracted rate help earn that money? Because in my eyes, the only money you actually earn yourself is what you could collect on your own as an independent contractor which is probably approaching CMS rates. Anything beyond that absolutely requires a group to negotiate collectively.

Sure, seems reasonable....so long as you're not skimming the extra.

 

[skypilot]

Dermies typically run from room to room every 5 mins to see another high maintenance patient for a total of 80 patients a day. Ortho performs backbreaking labor with radiation exposure to get paid.

Supervising rooms 4:1 with unconscious patients seems less stressful to me, as long as the CRNAs know their place.

4:1 is awful. Remember that you have to give lunches and breaks, along with your inductions, IVs, pre-ops, and firefighting. 4:1 means 4 hours of breaks, and lots of running up and down the hallway making sure the cases are served up on a silver platter. If a case goes awry in the postop interval or in the OR you have to be there immediately.

 

[anes121508]

Is that any different than anyone, anywhere, who goes to anybody else, anywhere else looking for a job?







It's no more greedy or fearful than selling your Apple stock because you think the iPhone is a fad. Hardly worthy of the contempt you show.



This is where you confuse cause and effect. The businessmen were coming, regardless. Physicians didn't come up with bundled payments. Physicians didn't cause the cost of healthcare to explode (our salaries are less than 1/10th the cost of healthcare in the US). Physicians didn't conjure the Affordable Care Act. Physicians didn't invent CMS and hire the werewolves and vampires at the Joint Commission. Businessmen did all those things.

The businessmen came because the system was bloated, full of money-extraction opportunities for middlemen. It is increasingly bogged down by regulations and certifying agencies, and physicians were (and are) generally unmotivated and ill-equipped to handle it all.



I share your anger about that. I hate being referred to as a "provider" ...

But the biggest deficiency in your sense of perspective is that it's not just anesthesia, it's all of medicine ... and it's not just medicine, but the entire economy. You're angry that the Anesthesia Dream isn't what you thought it would be? Get in line behind the other 300 million people here who are having more trouble realizing the American Dream than their elders.

They built and/or acquired something of value and sold it prior to retirement to someone who wanted it and had money. The horror.

Unless they lied to any members of the "younger generation" or breached a contract, I can't bring myself to fault them.

When I'm on the edge of retirement, I plan to sell the things of value I have acquired over my lifetime, too.

By now every member of the "younger generation" has been well and truly warned that predatory practices exist and can take steps to minimize their risk of unexpectedly getting hosed by a bad contract and unscrupulous group.

Yes, the days of the mid-90s when the least competent rejects of every med school in the country could get an anesthesia residency and then accidentally stumble into a booming market and then get rich are over. But don't let your disappointment in being born 20 years too late turn you into some kind of bitter anti-capitalist. Be careful where you choose to work, live beneath your means, and be glad you're not soaking wet in Haiti right now.

Beyond the $$ of the buyout what are the motivating factors to sell? What can make your group feel like the selling now is the only option?

What does the AMC offer that joining up with other local practices doesn't?

If the future of anesthesia reimbursement is not looking good, why are these financial guys buyin up practices left and right?

 

[pgg]

Risk of being left with nothing when they are underbid next round of contract renewals.

AMCs can collect more $/unit because of their negotiating power, and may be less needful of a stipend from the hospital.

As for your question about the future ... Wall Street is not known for making universally good decisions. Time will tell if their purchases were good ideas or not.

 

[RadOncDoc21]

Rad Onc: Physicist encroachment

I came to this thread because I was interested in buying into a practice and decided it was not worth the investment and was too risky due to today's environment and the practice's financial situation.

I did want to reply to the comment stated above that most of the encroachment in my field (Radiation Oncology) is not from the physicists (lack of clinical authority) but mainly from other fields (Derm, Urology, IR, etc). Even though they are not trained in the skills and utilization of radiation therapy, some places either hire a Radiation Oncologist to do their bidding or purchase equipment to use it on their patients (most of time this done in an inappropriate manner).

 

[anes121508]

Sure, seems reasonable....so long as you're not skimming the extra.

So what is the answer to all of this? For us young people seems like we should start asking the more sr folks what our options are from here for the future. I realize that understanding the history of how we ended up here and being super critical at this point is important, but we should also come up with solutions or at least ideas for the future. Target the weaker disheveled AMC contracts and win over the hospital? How would this be done? What would it take? What if the solid pp folks just started banning together and not only playing defense but also went on the offense? I mean I really love what I do and don't wanna go back and do another specialty. I don't want to get into business full time, but if I need to learn some hospital legal jargon to start winning back, then I sure as he!! Will. How do we position ourselves to start takin back from the amcs what is being lost? Is that possible?

Im sure there are groups out there that have taken over contracts after the hospital realized that the AMC produced a poor product.

 

[anes121508]

I would not rely on any buy-ins in this economy. The reality is that small groups are getting gobbled up by the big players and the buy-in may just be something to keep them afloat for another year before they cash out. These groups have NO loyalty to the individual physician.

For you pp guys out there in good groups....im sure there have been buyins in place for years and years. Many young grads are aware of the fact that pp groups may sell out on them before they turn partner and they may gravitate towards an AMC that gaurantees a decent salary up front (especially given the fact that most grads have tons of debt at much higher rates than the older generations had). Ultimately this is probably bad for the pp and the new grad, but the uncertainty is driving it. How many pp groups out there have changed their partner track and buyin in recent years to reflect the current state of uncertainty and era where AMCs are flourishing? Are pp groups losing good potential candidates because the AMC lures them in with up front $$?

 

[Mman]

Sure, seems reasonable....so long as you're not skimming the extra.

skimming what extra? We pay our partner track physicians more in salary than they generate using CMS rates. Should we just pay them less?

 

[Mman]

4:1 is awful. Remember that you have to give lunches and breaks, along with your inductions, IVs, pre-ops, and firefighting. 4:1 means 4 hours of breaks, and lots of running up and down the hallway making sure the cases are served up on a silver platter. If a case goes awry in the postop interval or in the OR you have to be there immediately.

I'm sorry, but WTF? While I'll sit in a room for 2 minutes for somebody to go pee, a physician supervising 4 rooms can't give lunches and breaks. I mean legally you can't because you are then unavailable in your other rooms when you are required to be immediately available throughout the case. We never have a doc give breaks.

 

[GravelRider]

skimming what extra? We pay our partner track physicians more in salary than they generate using CMS rates. Should we just pay them less?

So the young people or new grads bring no value beyond a warm body in a stool? You're able to negotiate those higher rates because of the value you provide as a group. If you didn't have those new people, you wouldn't be able to cover all those locations. It's a two-way street here. Your argument is that the new people owe you something because you were able to negotiate higher reimbursement rates. Well you wouldn't be able to get those rates if you were unable to provide the staffing.

 

[Mman]

So the young people or new grads bring no value beyond a warm body in a stool? You're able to negotiate those higher rates because of the value you provide as a group. If you didn't have those new people, you wouldn't be able to cover all those locations. It's a two-way street here. Your argument is that the new people owe you something because you were able to negotiate higher reimbursement rates. Well you wouldn't be able to get those rates if you were unable to provide the staffing.

Your argument seems to be that if we pay them a penny less than what they generate in revenue we are stealing from them. I'm wondering if we pay them more than they could generate if they are stealing from us. I mean they had nothing to do with the contracted rates that are billed/collected.

Or maybe is it a little more subtle than that? Maybe paying someone less than the full $$$ value of the work they generate could not be seen as skimming from them as you so put it in certain situations. You seem to strongly believe that any sort of partner track agreement is almost by definition to be horrible for the doc, but I would disagree. I came out far ahead by taking a partner track position that included a lower salary than I'd have earned in an academic job and a $$$ buy in after the fact.

It's all about the details.

 

[GravelRider]

Your argument seems to be that if we pay them a penny less than what they generate in revenue we are stealing from them. I'm wondering if we pay them more than they could generate if they are stealing from us. I mean they had nothing to do with the contracted rates that are billed/collected.

Or maybe is it a little more subtle than that? Maybe paying someone less than the full $$$ value of the work they generate could not be seen as skimming from them as you so put it in certain situations. You seem to strongly believe that any sort of partner track agreement is almost by definition to be horrible for the doc, but I would disagree. I came out far ahead by taking a partner track position that included a lower salary than I'd have earned in an academic job and a $$$ buy in after the fact.

It's all about the details.

You're not going to collect those rates if you can't provide the staffing. The value is in the group as a whole.

When did I say partnership buy-ins were horrible? I did say exclusive contracts were bad for the field and I've been saying that groups selling out were not some noble capitalist cause, but I never said buy-ins were horrible. I'm not looking for a free ride. I work hard, but I'm also not looking to subsidize some partner's 500k+ salary while he works 2 days a week,takes 12 weeks off, and doesn't take call. That's not an anesthesia group, that's a pyramid scheme.

 

[Stank811]

We have not changed our contract and new grads will do better than any AMC contract that has been talked about on this forum. 2 yr to partner with buy in to AR. Pretty standard stuff for PP partnership track jobs.

 

[Mman]

We have not changed our contract and new grads will do better than any AMC contract that has been talked about on this forum. 2 yr to partner with buy in to AR. Pretty standard stuff for PP partnership track jobs.

pretty much

 

[anes121508]

We have not changed our contract and new grads will do better than any AMC contract that has been talked about on this forum. 2 yr to partner with buy in to AR. Pretty standard stuff for PP partnership track jobs.

When you say with buy in to AR....what does that mean and why does it work like that? (Just don't know enough about the billing aspect)

Also, I've read your posts in the past and you seem to have a more positive outlook on the field and aren't buying into the panic. Seems like you have a very strong group with good leadership...What moves has your group made to build stability in this new environment?

 

[Arch Guillotti]

When you say with buy in to AR....what does that mean and why does it work like that?

The answer is that it depends. Most anesthesia groups don't have too many assets and A/R is probably the biggest and most tangible. You are buying into ownership of the A/R and into profits of the business legally.

 

[anes121508]

The answer is that it depends. Most anesthesia groups don't have too many assets and A/R is probably the biggest and most tangible. You are buying into ownership of the A/R and into profits of the business legally.

The answer is that it depends. Most anesthesia groups don't have too many assets and A/R is probably the biggest and most tangible. You are buying into ownership of the A/R and into profits of the business legally.

Is the price of the buyin a reflection of the accounts receivable? Or is it completely variable based on what the group decides?

Let's say the buyin is 200k over 2 years. How does the group sit down and come up with that number?

 

[Arch Guillotti]

Is the price of the buyin a reflection of the accounts receivable? Or is it completely variable based on what the group decides?

Let's say the buyin is 200k over 2 years. How does the group sit down and come up with that number?

They probably either make it up or there is a formula that has been used for those before you. A formula may include such variables as AR, expenses and number of partners. Buyin may be over the initial 2 years or after the 2 years is complete.

If you are that serious about the group, then the group should be able to tell you what previous buy-ins have been and how long they took to achieve.

 

[Stank811]

When you say with buy in to AR....what does that mean and why does it work like that? (Just don't know enough about the billing aspect)

Also, I've read your posts in the past and you seem to have a more positive outlook on the field and aren't buying into the panic. Seems like you have a very strong group with good leadership...What moves has your group made to build stability in this new environment?

Accounts Recievable is the amount of money that has been billed but has not yet been collected. So if your group has 1 mill in accounts receivable and there are 10 partners your buy in would be 100k. And then when you retire or leave the group your buy out is based on the same idea.

The above example is over simplified but gives you an idea.

 

[deleted162650]

Accounts Recievable is the amount of money that has been billed but has not yet been collected. So if your group has 1 mill in accounts receivable and there are 10 partners your buy in would be 100k. And then when you retire or leave the group your buy out is based on the same idea.

I know a number of groups operate that way, but it seems a little weird to me. The groups I've worked for just pay you out when your share of the AR is actually collected. So you have a lag of a few months when you join the group, and then when you either leave or retire you will continue to receive a paycheck until there's no longer any money coming in on accounts you are a part of. Buy-in is a totally separate entity and takes the form of a certain percentage of your collections (essentially you are working at a higher overhead percentage than the partners, but your income is still tied to production and not a set dollar amount).

 

[Mman]

I know a number of groups operate that way, but it seems a little weird to me. The groups I've worked for just pay you out when your share of the AR is actually collected. So you have a lag of a few months when you join the group, and then when you either leave or retire you will continue to receive a paycheck until there's no longer any money coming in on accounts you are a part of. Buy-in is a totally separate entity and takes the form of a certain percentage of your collections (essentially you are working at a higher overhead percentage than the partners, but your income is still tied to production and not a set dollar amount).

Our buy in is your share of the AR as mentioned above. You start getting paid out immediately from it, so that's what you buy in to. That's what all equal share groups do as far as I know. Then when you leave we give you a buy out as in your share of AR that you will no longer be around to collect.

Groups that are so called eat what you kill tend to operate in the manner you describe where you only get paid for the cases your name is on.

 

[deleted162650]

Groups that are so called eat what you kill tend to operate in the manner you describe where you only get paid for the cases your name is on.

Most groups in my area are "eat-what-you-kill" with a blended unit so yes, that's why things are done the way I describe. My group operates on a points system which is a little more socialistic than a blended unit eat-what-you-kill. Collections for the month are divied up based on how many points you worked that month as opposed to how many units you generated. Each spot in the daily line-up is worth its own number of points.

Eat-what-you-kill groups(or other production based reimbursement schemes) make it a little harder for the old guard to screw the new guys provided of course that they aren't gerrymandering the schedule.

 

[Mman]

Most groups in my area are "eat-what-you-kill" with a blended unit so yes, that's why things are done the way I describe. My group operates on a points system which is a little more socialistic than a blended unit eat-what-you-kill. Collections for the month are divied up based on how many points you worked that month as opposed to how many units you generated. Each spot in the daily line-up is worth its own number of points.

Eat-what-you-kill groups(or other production based reimbursement schemes) make it a little harder for the old guard to screw the new guys provided of course that they aren't gerrymandering the schedule.

I'm happy with our socialist group that splits every penny equally and shares call equally. Then nobody cares what cases they do during the day.

 

[deleted162650]

Then nobody cares what cases they do during the day.

Yup, that's what's nice about our points system as well as opposed to blended unit eat-what-you-kill. It's nice when everyone just wants to get the work done as efficiently as possible and doesn't care what they are doing. So if you wanna take less call, then you just "sell it" to someone else?

 

[Arch Guillotti]

I'm happy with our socialist group that splits every penny equally and shares call equally. Then nobody cares what cases they do during the day.

What about at night?

 

[Mman]

What about at night?

we split call equally. Nobody likes working overnight, but we all gotta pitch in and cover it.

 

[Mman]

Yup, that's what's nice about our points system as well as opposed to blended unit eat-what-you-kill. It's nice when everyone just wants to get the work done as efficiently as possible and doesn't care what they are doing. So if you wanna take less call, then you just "sell it" to someone else?

yes, we essentially have a free market of people buying/selling call, weekends, vacation, etc. amongst themselves. The call is randomly and equally assigned ahead of time and then you just swap with a friend or buy/sell what you want.

 

[deleted162650]

yes, we essentially have a free market of people buying/selling call, weekends, vacation, etc. amongst themselves. The call is randomly and equally assigned ahead of time and then you just swap with a friend or buy/sell what you want.

So let's say you wanted out of one of your calls and you have partner who wants it. Do you literally write him a check to take it? Does each call have a set going rate? What if 2 people are interested in your call up for grabs - can a bidding war ensue?? Just curious how your system works.

 

[Mman]

So let's say you wanted out of one of your calls and you have partner who wants it. Do you literally write him a check to take it? Does each call have a set going rate? What if 2 people are interested in your call up for grabs - can a bidding war ensue?? Just curious how your system works.

We generally just have our business office transfer the funds from my upcoming distribution to their upcoming distribution or vice versa. If 2+ people want it, it is a bidding war. For the most part there is a fairly narrow range of what people buy/sell various shifts or weeks of vacation for but occasionally there are outliers of people that either need/want the money or people that really need to not be working at a particular time.

It's generally one person sending out an email offering to buy or sell for a given $$$ amount and first to respond gets it.

 

[sevoflurane]

We work differently with an extremely fair system. Everyone gets access to ANY calls that are not wanted. No secret deals under the table or biding wars- that system may harbor animosity between partners.

Say I don't want to work this weekend. Then that call goes to our schedulers who then send it out to our group to get picked up. There is an ongoing list of everyone who has taken extra calls. If I happen to be at the top of that list for the weekend in question then I get it and then get moved to the bottom of the list. If I'm at the bottom of the list and nobody wants the call, then I get it. That goes for all calls- trauma, OB, 1st, 2nd, 3rd, etc. It is also divided up by weekday. This is by far the fairest system I have come across.

Regarding "nights": In our model we get a salary from work that is done from 7-3pm. The surplus of funds that are generated during those hours goes to a pool for running the group + year end bonus. After 3pm and on weekends, we keep 85ish% of all of units that are generated thereby incentivizing late calls, overnight calls, etc.
If you like to work 7-3 and not take call, then you aren't going to make nearly as much as the eager beaver who is crushing it every night.
Love this system as it self adjusts for partners who are in different stages of their career. Partners who just want to do day work make way for those who are out of residency and want to crush it for x amount of years.

 

[sevoflurane]

The problem that I've always had with salaried positions is that I have never bought into the "it works out in the end" mentality.

If I have a rough night on OB, I want to get paid for my work... especially if the guy I took over for placed 4 epidurals in a 24 hour period.

 

[Arch Guillotti]

The problem that I've always had with salaried positions is that I have never bought into the "it works out in the end" mentality.

If I have a rough night on OB, I want to get paid for my work... especially if the guy I took over for placed 4 epidurals in a 24 hour period.

Exactly, if you get pounded on call and some other guy works an equivalent time yet manages to skate through I would expect to get some incentive pay.

 

[deleted126335]

Exactly, if you get pounded on call and some other guy works an equivalent time yet manages to skate through I would expect to get some incentive pay.

I don't see why you object. It is about everybody taking the same spin on the same roulette wheel. Quiet nights where I do little I consider a victory and winning the small lottery. Nights that I get crushed make me sad because I get paid the same. But as long as everybody takes their turn in the box equally, (or pays someone to take his turn)I don't see why someone has an issue.

The problem with the salaried, non productivity based call nights is that it incentivizes people to do less and dump. We have two docs who when on call look for reasons not to do blood patches or central lines or cases when consulted and dump for the team coming on.

 

[anes121508]

Accounts Recievable is the amount of money that has been billed but has not yet been collected. So if your group has 1 mill in accounts receivable and there are 10 partners your buy in would be 100k. And then when you retire or leave the group your buy out is based on the same idea.

The above example is over simplified but gives you an idea.

This is really cool that you all are sharing this. I think Im starting to grasp the concept....if I am the new guy, how long does it take for a group to start receiving payment for my work?

Accounts receivable is money that is owed but has not yet come in. Is all the money collected eventually? or is it possible to have people never pay up?

 

[deleted126335]

This is really cool that you all are sharing this. I think Im starting to grasp the concept....if I am the new guy, how long does it take for a group to start receiving payment for my work?

Accounts receivable is money that is owed but has not yet come in. Is all the money collected eventually? or is it possible to have people never pay up?

This is basic info (that many young docs are clueless about). Let's say you start work on July 1. Assuming that you (or your practice manager) has been amazingly diligent about getting credentialed with health insurance plans and done all the paperwork perfectly , Your group probably won't see a dime on your work for about two months. You, however will expect to be paid after 2-4 weeks. You are building up A/Rs that the practice will subsequently collecting. It is perfectly reasonable to buy the A/R's. Conversely a doc who has been there many years retires July 1, reimbursement for work that has been billed in his name will come in for several months. In most reasonable, functional practices probably about 75% will be collected with in 90 days or so most of the time. The amount that comes in after he retires is his A/Rs. The A/Rs are something of a guesstimate and frequently vary and rise or fall based on issues with individual payors, CMS, etc. Cash flow (and take home pay) for unsubsidized private practices can be very uneven. Part of the fun of being a small business owner.

 

[Arch Guillotti]

We have two docs who when on call look for reasons not to do blood patches or central lines or cases when consulted and dump for the team coming on.

A lot of practices probably have guys like this unfortunately. If you are doing procedures or cases that some other guy is avoiding then I think you should get paid more.

 

[deleted126335]

A lot of practices probably have guys like this unfortunately. If you are doing procedures or cases that some other guy is avoiding then I think you should get paid more.

Unfortunately, the flip side is that productivity based private practices often have a few docs who try to game the system so that their hours on the playing field are most productive. E.g., high volume ENT room with good payors vs slow as hell general surgeon with a Medicaid/no pay practice

Whatever the system, there will always be some people who try to game it. Depends what the incentive is: Money, Time, or Workload.

 

[skypilot]

I'm sorry, but WTF? While I'll sit in a room for 2 minutes for somebody to go pee, a physician supervising 4 rooms can't give lunches and breaks. I mean legally you can't because you are then unavailable in your other rooms when you are required to be immediately available throughout the case. We never have a doc give breaks.

Sounds good to me... I plead the fifth.

 

[Arch Guillotti]

We generally just have our business office transfer the funds from my upcoming distribution

Is your distribution a dividend?

 

[Arch Guillotti]

4:1 is awful. Remember that you have to give lunches and breaks, along with your inductions, IVs, pre-ops, and firefighting. 4:1 means 4 hours of breaks, and lots of running up and down the hallway making sure the cases are served up on a silver platter. If a case goes awry in the postop interval or in the OR you have to be there immediately.

Are you serious?

 

[IlDestriero]

Sounds good to me... I plead the fifth.

How can "someone" give more than a bathroom break when covering 4:1. It makes you unavailable. Unavailable to start cases or come for emergencies in the OR or PACU. If that's how you operate, why supervise them at all?
What passes as the standard of care at many groups is fascinating.


--
Il Destriero