First job - small vs large outpt practice?

[fleshwound]

Practice A - located in the greater metro area of an east coast city, I'd be joining 1 neurologist with >10 years in practice; there was a 2nd neurologist who recently retired and I would be able to pick up a lot of her pts quickly. Very light practice call alternate weeks. 1st year guaranteed 220k; 2nd year will be collections minus overhead. Waiting to get more data on expected income for year 2 and beyond. They are part of a larger national multispecialty physician organization that helps with setting up insurance contracts.

Practice B - located in the greater metro area of an east coast city, I'd be joining a group of 10+ neurologists with a wide range of experience from 5-20 years in practice; 1st year guaranteed 200k floor with ability to earn "more" if collections cover salary (however the bulk of the bonus would go back to the practice); partner after 3 years with minimal buy-in; they were vague about expected income for partners but it sounded like at least 300k. Call for practice pts for the entire group.

The idea of grinding 3 years as basically an employee making the lesser of the two incomes listed above does not sound particularly appealing considering I was hoping to pay off my student loans aggressively within a few years. However, the idea of being surrounded by lots of experience is something that's difficult to quantify and factor in. I think I could work fairly independently and I could ask questions to my extended network of colleagues from training, however it's probably not the same as being in close proximity to a "braintrust" on a daily basis. Does anyone have any wisdom and insight on this? Thanks

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[Postictal Raiden]

These are low offers for a fellowship (EMG) trained neurologist.

 

[fleshwound]

I agree! The numbers look better in the Midwest than the east coast

 

[deathmerchant]

Practice A - located in the greater metro area of an east coast city, I'd be joining 1 neurologist with >10 years in practice; there was a 2nd neurologist who recently retired and I would be able to pick up a lot of her pts quickly. Very light practice call alternate weeks. 1st year guaranteed 220k; 2nd year will be collections minus overhead. Waiting to get more data on expected income for year 2 and beyond. They are part of a larger national multispecialty physician organization that helps with setting up insurance contracts.

Practice B - located in the greater metro area of an east coast city, I'd be joining a group of 10+ neurologists with a wide range of experience from 5-20 years in practice; 1st year guaranteed 200k floor with ability to earn "more" if collections cover salary (however the bulk of the bonus would go back to the practice); partner after 3 years with minimal buy-in; they were vague about expected income for partners but it sounded like at least 300k. Call for practice pts for the entire group.

The idea of grinding 3 years as basically an employee making the lesser of the two incomes listed above does not sound particularly appealing considering I was hoping to pay off my student loans aggressively within a few years. However, the idea of being surrounded by lots of experience is something that's difficult to quantify and factor in. I think I could work fairly independently and I could ask questions to my extended network of colleagues from training, however it's probably not the same as being in close proximity to a "braintrust" on a daily basis. Does anyone have any wisdom and insight on this? Thanks

Like everything, depends on many factors. I personally would chose Practice A, just because there might be higher potential for short term and long term compensation and less bureaucracy. You also might have more flexibility and decision making ability.

Plus the call in Practice B will be awful- covering outpatients of 10 neurologists!! and with just 200k. Only reason to chose B would be if you want to see niche patients and I'm guessing everyone there has a little bit of subspecialty preference. But being so down in the hierarchy, you might just get Nonsults for the first 2-3 years.

 

[Telamir]

Doesn't help your decision at all but: I would take neither for what you're being offered. Those offers are too low ball. Hell, some academic centers start you out at 240, let alone 200-220 for private practice.

To add more: If you're looking at private practice you should be looking at 280-300 IMO, but at LEAST >250, especially if you're outpatient and you do a procedure. While EMG has been cut it still generates some money. Call schedules/hospital coverage can be negotiated but I really think you're being lowballed. Harvard/John's Hopkins start people out at 200 ish, and that's ivory tower academia!

 

[Postictal Raiden]

Doesn't help your decision at all but: I would take neither for what you're being offered. Those offers are too low ball. Hell, some academic centers start you out at 240, let alone 200-220 for private practice.

To add more: If you're looking at private practice you should be looking at 280-300 IMO, but at LEAST >250, especially if you're outpatient and you do a procedure. While EMG has been cut it still generates some money. Call schedules/hospital coverage can be negotiated but I really think you're being lowballed. Harvard/John's Hopkins start people out at 200 ish, and that's ivory tower academia!

At my residency program, all attendings make 250k+. I can’t imagine one would leave this “prestige” and having residents do most of the work for you and go to the dog-eat-dog world of private practice for anything less than 350.

 

[fleshwound]

you should be looking at 280-300 IMO, but at LEAST >250

even for year 1? I would expect no less than 280-300 once I've built my patient panel by year 2 and have a full schedule. I've actually cold called a lot of metro areas and year 1 salaries were between 200-240 for nearly all independent PPs. For some employed practices, I've been quoted year 1 numbers that are higher but this comes with them taking a bigger chunk later on.

 

[Telamir]

I've been at mid 300's since my 1st year out, that being said I'm doing inpatient neuro not outpatient. The folks at my hospital group who do outpatient are all at 300. That being said I am not at your geographical location. I'm at a medium sized ~500k city. It's unfortunate but you sometimes "pay" to work at big metro areas. If you aren't flexible when it comes to location then this may truly be the best out there for you but...I don't know, man. 200k seems low to me.

 

[Splenda88]

So why that low ball offer then? Are they just hoping someone will take it? Even FM docs where I am (a metro area of > 6 mil people) are getting 200k+ for 4 1/2 days/wk.

 

[neglect]

Once you meet the people the answer will become obvious. Who do you like? Who do you trust? What feels better? Both have pros and cons otherwise. A larger practice is stable, more likely to have things like billing/intake/MAs in place and in order. A smaller practice is exactly that, but more room to grow over the next few decades.

For all those who wold take more money to do academics, beware. You are then employed. You will never be a partner, never be an owner. When a 24 year old with a BS MBA degree tells you that your numbers aren't up to snuff (or that you haven't referred people for surgery or EEGs or EMGs), you will have to listen to her nonsense and abide.

 

[GuillainMollaret]

For all those who wold take more money to do academics, beware. You are then employed. You will never be a partner, never be an owner. When a 24 year old with a BS MBA degree tells you that your numbers aren't up to snuff (or that you haven't referred people for surgery or EEGs or EMGs), you will have to listen to her nonsense and abide.

Unfortunately, when I was looking for non-academic jobs, the vast majority were employed positions, typically as part of a community hospital or large medical center. Although these employed positions typically offer stronger base salaries and sign on incentives, the trade off is less physician autonomy and less earning potential down the line.

I would have been very interested in interviewing for partnership track private practice jobs, but nothing really came up on my job search (and no, I was not restricting myself geographically).

Physician groups selling out to hospital corporations and private equity over the last decade or two means that many physicians in my generation have no choice but to go the employed route unless they get lucky.

 

[neglect]

Unfortunately, when I was looking for non-academic jobs, the vast majority were employed positions, typically as part of a community hospital or large medical center. Although these employed positions typically offer stronger base salaries and sign on incentives, the trade off is less physician autonomy and less earning potential down the line.

I would have been very interested in interviewing for partnership track private practice jobs, but nothing really came up on my job search (and no, I was not restricting myself geographically).

Physician groups selling out to hospital corporations and private equity over the last decade or two means that many physicians in my generation have no choice but to go the employed route unless they get lucky.

Totally agree, trade offs and there's no great single fit for all people.

Private practice groups who sold out to hospitals and even private equity are so odd. Gimme a DM if you're not happy.