Comparing two contracts

[22yis]

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Really torn about these two options. Input would be greatly appreciated.

1. Private ortho group, I am first and only pain guy. 200k base year 1, year 2 150k draw and 40% on collections 0-600k, 45% on collections 600k-1.2m, 50% on collections above 1.2m. in 2 years will consider for partnership which will allow for NP collections, DME, PT referral, etc alternative revenue streams. "Promise" ASC buy in at floor, land purchased, but not built yet.- no reason to question this but also none of this a guarantee. I like the people there, 2 main guys (sports) who are partners by handshake, have hired young guys (sports and joints) to grow with and not yet offered partnership because their collections are not substantial yet. They have great insurance contracts. Non compete 3 miles. No malpractice offered. Benefits are health and 401k match. My thinking is if my collections are high i just renegotiate my collections.
2. "Privademics". 350k base, 50k sign on (3 years retention), 25k year quality bonus. Year 1 and 2 cap is 550k, make 65/wrvu above 5400 wrvu. After year 2 its 65 w/rvu, cap will increase if you surpass the base and will constantly be reevaluated and raised appropriately. Top earners seem to cap around 900 or so. Caveat that they expect you to cover APS of the hospital that your clinic is associated with. Mine is a 285 hospital beds. Benefit of covering APS is when you get busy they help you with a nurse and you get their wrvu signing off on dilaudid pca orders, but until then sucks to have to see APS. Non compete is tremendous 10-20 miles - would really screw me out of the area I want to be in permanently (house, family, etc).

In the private gig, Year 1 has a bonus structure identical to year 2, but the collections start from 600k-1.2m at 45%. Per 1.2m collections yields 410k take home pre tax. Struggling to extrapolate how this compares to MGMA data for collections, also how the privademics compares to MGMA data.

If Private offers partnereship, renegotiate collections, or ASC buy in at floor cost, then its worthwhile but otherwise privademics rly the way here?

 

[RoloTomassi]

#1

 

[22yis]

#1

What makes you say 1?

 

[RoloTomassi]

#1. ASC buy in at floor is rare situation. Multiple ortho to 1 pain should keep you busy, no med mx. Good contracts are underemphasized. Have to make sure ASC contracts will be good though. Very small non-compete. Good in a big picture way, if you trust in the growth of the company and your ability to become partner.

#2. Lot of big negatives. Caps, APS, non-compete.

 

[22yis]

#1. ASC buy in at floor is rare situation. Multiple ortho to 1 pain should keep you busy, no med mx. Good contracts are underemphasized. Have to make sure ASC contracts will be good though. Very small non-compete. Good in a big picture way, if you trust in the growth of the company and your ability to become partner.

#2. Lot of big negatives. Caps, APS, non-compete.

Even if the privademic cap inc. I think 3 tiers. ~550, 750 and 950ish. Really appreciate the input!

 

[RoloTomassi]

I personally just hate the idea of a cap

 

[Ronin1]

In option one where do you do the bulk of the procedures? If ASC you will have a hard time making any money.
Van I assume this is a pmr based offer. It seems so low

 

[22yis]

In option one where do you do the bulk of the procedures? If ASC you will have a hard time making any money.
Van I assume this is a pmr based offer. It seems so low

Office for all procedures. I’m anesthesia. Offer is low bc they are expanding and hiring more ortho, maybe in anticipation of opening the asc? The partners don’t have pain and are conservative guys. Claim they don’t know what pain brings in, but the partner I spoke primarily with said he would renegotiate the collections and base if appropriate. When I negotiated the base up it took a hit on my collections and if I’m starting a practice im willing to bite the bullet and take a lower base to keep long term collections up

 

[Ronin1]

If you trust these guys maybe #1 but you will be making nothing after malpractice. If you are able to take the hit and maybe willing to do some anesthesia on weekends to beef up the cash flow. Go for it. Although I wouldn’t count on any future ASC money as it doesn’t even exist yet. Maybe years away from turning a profit.

The other job is a major no mainly to the noncompete. If you can negotiate that away maybe but the inpatient side would be a hard no for me

 

[Ducttape]

Both have some risks.

The first seems like a start up. It might work out in which the rewards are tremendous. But it may also falter.

The second is a known entity. You walk in and plug and play. Non competes seem to be becoming dependent on location. And most are for just one year so if you joined another system, they'd prob send you offsite for a year only. But you have to deal with admin.


I think it depends on your aversion - or desire - for risk. Job 1 higher risk but higher likelihood for unrivaled success.

Also... If you are a youngling, job 1 would prob be better choice. If an old guy like me, then job 2.

 

[au bon pain]

#1 is totally dependent on a) how decent the orthos are at running a business and b) how trustworthy they are.

For #2, in what way is it academic? Industry research? Fellows? These things can be benefits or a ball&chain. For doing APS, these guys better be giving you a legit stipend--not just the wRVUs--as it will be both a soul killer and likely a paycheck killer. Also, is this a hospital employed position, a small private group, or one of those "physician-enablement company" schemes. If it's the latter...beware.

 

[Dr. Ice]

#1 is totally dependent on a) how decent the orthos are at running a business and b) how trustworthy they are.

For #2, in what way is it academic? Industry research? Fellows? These things can be benefits or a ball&chain. For doing APS, these guys better be giving you a legit stipend--not just the wRVUs--as it will be both a soul killer and likely a paycheck killer. Also, is this a hospital employed position, a small private group, or one of those "physician-enablement company" schemes. If it's the latter...beware.

What is a physician enablement company?

 

[22yis]

#1 is totally dependent on a) how decent the orthos are at running a business and b) how trustworthy they are.

For #2, in what way is it academic? Industry research? Fellows? These things can be benefits or a ball&chain. For doing APS, these guys better be giving you a legit stipend--not just the wRVUs--as it will be both a soul killer and likely a paycheck killer. Also, is this a hospital employed position, a small private group, or one of those "physician-enablement company" schemes. If it's the latter...beware.

It’s a major hospital system, but private hospital. Most physicians are signing off on np notes who manage the aps service

 

[au bon pain]

What is a physician enablement company?

It’s the latest sleaze term I’ve heard to describe a physician services organization aka management services organization. They sell themselves as handling all aspects of practice management and all you have to do is show up and “be a doctor who gets to own his practice.” And while you’re doing that, they’re fleecing you. Many are private equity owned.

 

[au bon pain]

It’s a major hospital system, but private hospital. Most physicians are signing off on np notes who manage the aps service

So to clarify, you’d be a direct employee of the hospital?

 

[22yis]

So to clarify, you’d be a direct employee of the hospital?

Correct

 

[Dr. Ice]

It’s the latest sleaze term I’ve heard to describe a physician services organization aka management services organization. They sell themselves as handling all aspects of practice management and all you have to do is show up and “be a doctor who gets to own his practice.” And while you’re doing that, they’re fleecing you. Many are private equity owned.

That sounds exactly like what is happening up and down my state with a particular “MSO” company gobbling up small to medium sized practices and providing billing and better in network contracts. They have grown exponentially in the last 18 months. Doesn’t pass my sniff test and I started to get concerned when I heard they were using AI to bill patients on follow up communication known as “remote therapeutic monitoring” without the consent of the patient. Needless to say..I’m getting out of here in 3 months..

 

[drusso]

Do #1 and never look back.

 

[GlowInTheDark]

#1) never discount the ability of partners to screw you.
#2) never discount the ability of admin to screw you

Good luck.

 

[lobelsteve]

drusso 2.0