Hi all,
I'm an early career pain doc that is transitioning from my first job after training. It's a long story that I will make a separate post for, as I believe it is beneficial to new grads about some of the challenges that can occur, particularly private practice. There is no non-compete associated with my previous job, so I am able to stay in the same region. My initial plan was to transition into a hospital-based practice for greater stability, but I was somewhat shocked at how expansive the noncompetes were and how poor the compensation was for PM&R based pain docs at the systems in my area. I found that each hospital system I spoke to felt that they could compensate PM&R-based pain docs less than anesthesia-based pain docs, despite no difference in work requirements (i.e.: the anesthesia folks weren't covering the OR). As such, I have effectively narrowed it down to two options, and I would greatly appreciate any insight, feedback, or experiences that you all have had with similar practice settings.
General information:
- Mid-sized city in flyover country
Option 1:
- Joining a solo PM&R/pain doc with 1 NP
- Two offices, approximately 25 minutes apart
- Has PT, in-office lab, and DME, which are profitable, but could be challenging to maintain the profitability, as some of the staff that are currently covering the in-office lab and PT are part-time, have worked at the practice for a number of years, and are nearing retirement.
- Comp: 400K with 40% of collections after $800K, and 45% of collections after $2M. After partnership buy-in, eat what you kill.
- Eligible for a buy-in to the practice in year 3 after a third-party evaluation of the practice value. Separate landholding company that could be bought into at the same time, which owns the two buildings.
- Pros: Established practice and referral network. The doc is looking to retire in the next 5-7 years and states that they would be willing to sell the entirety of the practice. No PE involvement. Approximately 40% overhead.
- Concerns: the current physician does very limited interventions (no SCS, kypho, cervical epidurals, or RFA) and the office would require a build-out and additional equipment, though the practice said they would fund it. There would also need to be a change in staffing, as the current staff does not include nursing or trained fluoro techs. One person does their current in-house billing/auth and is nearing retirement. The physician's spouse is the practice manager, so if there are concerns with the other physician, that could become messy. No ASC affiliation. Never had a partner in the past. I also find that solo docs tend to over-value their practice given the amount of time and effort they spend in setting up and growing the business.
Option 2:
- Joining a mid-sized ortho group (<15 ortho docs and 1 sports trained PM&R doc)
- Two offices, approximately 20-25 minutes apart, with an ASC set to open early winter 2024
- Has in-office imaging, DME, and cash-based sport-specific biomechanics simulator which are profitable
- Comp: $400K. No bonus until my P&L is in the black, then I would transition to eat what I kill as a partner.
- No partnership buy-in required ("sweat equity") once my P&L is in the black. Separate landholding company for the two buildings that would be eligible for buy-in, as well as ASC shares, once I make partner.
- Pros: Established group and referral sources. ASC ownership option. Facilities would not require further changes. Practice prefers limited to no opioids, so hopefully that would decrease the chance of post-op opioid dumps from other partners. No PE involvement. Established auth team/billing team. Familiar EMR.
- Cons: I would be the first true pain doc in the practice, so there would need to be some new staff hires/training. Possible need for additional equipment, though they do have a C arm and RF machine. Being a non-surgeon in a primarily surgical practice. Higher overhead during their current expansion/ASC build out (50-55%, typically 40-45%) that could delay my time to partnership. Higher risk/potentially longer timeline to partnership in a sweat equity set-up compared to an actual third party evaluation/buy-in. Profitability of the practice would need to be shared 15 ways, which could dilute the benefit when compared to the other practice.
Thanks in advance for your insight!
I'm an early career pain doc that is transitioning from my first job after training. It's a long story that I will make a separate post for, as I believe it is beneficial to new grads about some of the challenges that can occur, particularly private practice. There is no non-compete associated with my previous job, so I am able to stay in the same region. My initial plan was to transition into a hospital-based practice for greater stability, but I was somewhat shocked at how expansive the noncompetes were and how poor the compensation was for PM&R based pain docs at the systems in my area. I found that each hospital system I spoke to felt that they could compensate PM&R-based pain docs less than anesthesia-based pain docs, despite no difference in work requirements (i.e.: the anesthesia folks weren't covering the OR). As such, I have effectively narrowed it down to two options, and I would greatly appreciate any insight, feedback, or experiences that you all have had with similar practice settings.
General information:
- Mid-sized city in flyover country
Option 1:
- Joining a solo PM&R/pain doc with 1 NP
- Two offices, approximately 25 minutes apart
- Has PT, in-office lab, and DME, which are profitable, but could be challenging to maintain the profitability, as some of the staff that are currently covering the in-office lab and PT are part-time, have worked at the practice for a number of years, and are nearing retirement.
- Comp: 400K with 40% of collections after $800K, and 45% of collections after $2M. After partnership buy-in, eat what you kill.
- Eligible for a buy-in to the practice in year 3 after a third-party evaluation of the practice value. Separate landholding company that could be bought into at the same time, which owns the two buildings.
- Pros: Established practice and referral network. The doc is looking to retire in the next 5-7 years and states that they would be willing to sell the entirety of the practice. No PE involvement. Approximately 40% overhead.
- Concerns: the current physician does very limited interventions (no SCS, kypho, cervical epidurals, or RFA) and the office would require a build-out and additional equipment, though the practice said they would fund it. There would also need to be a change in staffing, as the current staff does not include nursing or trained fluoro techs. One person does their current in-house billing/auth and is nearing retirement. The physician's spouse is the practice manager, so if there are concerns with the other physician, that could become messy. No ASC affiliation. Never had a partner in the past. I also find that solo docs tend to over-value their practice given the amount of time and effort they spend in setting up and growing the business.
Option 2:
- Joining a mid-sized ortho group (<15 ortho docs and 1 sports trained PM&R doc)
- Two offices, approximately 20-25 minutes apart, with an ASC set to open early winter 2024
- Has in-office imaging, DME, and cash-based sport-specific biomechanics simulator which are profitable
- Comp: $400K. No bonus until my P&L is in the black, then I would transition to eat what I kill as a partner.
- No partnership buy-in required ("sweat equity") once my P&L is in the black. Separate landholding company for the two buildings that would be eligible for buy-in, as well as ASC shares, once I make partner.
- Pros: Established group and referral sources. ASC ownership option. Facilities would not require further changes. Practice prefers limited to no opioids, so hopefully that would decrease the chance of post-op opioid dumps from other partners. No PE involvement. Established auth team/billing team. Familiar EMR.
- Cons: I would be the first true pain doc in the practice, so there would need to be some new staff hires/training. Possible need for additional equipment, though they do have a C arm and RF machine. Being a non-surgeon in a primarily surgical practice. Higher overhead during their current expansion/ASC build out (50-55%, typically 40-45%) that could delay my time to partnership. Higher risk/potentially longer timeline to partnership in a sweat equity set-up compared to an actual third party evaluation/buy-in. Profitability of the practice would need to be shared 15 ways, which could dilute the benefit when compared to the other practice.
Thanks in advance for your insight!
