So you are an employee and your compensation will be determined by collections which your bosses will solely have control of.
As an employee, you will most likely not have any access to the "books"/ financial records.
You are at risk of unscrupulous business owners taking advantage of you and cheating you out of your pay and you will have no way to prove it.
What is the payor mix? PPOs will typically pay more than some of the medicare/medicaid rates and some of the HMOs. Who is determining who gets what patients.
As the new person, are you getting stuck with the crappy insurance patients?
Private groups try to do this shady stuff.
Also, are you a W2 or 1099? If they want an employee, they need to pay up and give you a guaranteed salary. This adjusting stuff is garbage if they want you to be employed. You get all of the negatives of being a partner (volatile income) without the benefit.
Importantly, who is paying your malpractice?
If you leave, who pays your tail? That can be tens of thousands depending on your situation.
This is obviously spoken by a person who has direct experience with the situation. This is the life I lived for WAAAAAAAY too long.
I was SEVERLY underpaid for the work I was doing and could never claw enough. Now you work your ass off even more and your numbers improve yet again, and you tell yourself ok, this next year will be the year that I finally break through, only to have a modest, but discouraging improvement over the last. Wash, rinse, repeat.
After the attractive (maybe) guarantee expires, your base goes down substantially. The income you are generating gets held in hostage for no less than 5 months at a time while they "close out the quarter" and you are entitled to a percentage of what you have earned. Your base will probably barely cover your monthly expenses if you have a family, mortgage and big loan payments to make. You will probably use your hostage money to catch up, especially if you made any significant outlays (few thousand on home improvements or a vacation with family) up to that point. As a result, you have a hard time gaining ground.
You will have to have completely trust the accounting (in any system, really). You will never see the upper tiers of the salary they are broadcasting. That carrot will always be out of reach.
This system is the worst of the worst. even if my production was consistent, no 2 month's financials would ever make any sense. It's seriously demoralizing. With your new base, it never feels like you're making a physician's salary.
I went an embarrassing amount of time like this, always working harder, always thinking this next year is it, but it never was. It's depressing really. I should be a lot farther ahead than I am. What you make is one thing, when you get it and how it's doled out is another. You can keep someone pretty broke (not poor) this way.
My hospital system was recently bought and I'm now under an RVU system. My new salary is based off my last year's overall production numbers. My monthly income has doubled and I finally feel like I can breathe. I'm on track to make 20% more than last year and my salary is doled out in a much more equitable fashion.
The non-compete and loyalty to my patients were the biggest influencing factor as to why I never left. I honestly love every one of them and it hurt me to think about dissolving the relationship. I do a metric ton of responsible mental health, many of my patients are kind of hard to handle. I'm in a small town. If I leave, they go elsewhere, and likely end up on a daily benzo or worse. That's a lot of guilt to try and fade.
I get 15-20 new patient requests a week. I take everybody. I no longer sweat payor source, but my practice is currently very favorable in this regard. I'm still pushed to produce but I finally feel like I can gain some ground.
It seems good for now but the relationship is still in the honeymoon phase so we'll see.
