Group PP - what to ask

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psychacad

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Looking to start a PP part time. Debating between solo vs group. Interview coming up for group PP run by an MD and has MD, NPs, and SWs. It's cash only in large metro area, looks successful (established now for around 10 years). Full flexibility time wise, 60-90 min intakes, 30-45 min follow-ups, med/therapy combo (like you want). There are staff helping with OON insurance claims. Clinicians are filled. I'm opting no more than 15 hours per week by choice.

What are some of the things you want to hone down?
As a fresh grad, is this setup preferable to solo? What are the downsides?
 
Non-compete sounds very important if you want to setup your own practice in the future. % of collections they take (roughly 70/30 split would be about "average" but this can vary). Are your cash rates set by the practice or do you have say over them. Practice expectations for managing out of hours calls?
 
There's no feeling quite like being your own boss and running your own practice. If you're entrepreneurial and business-minded, go for it.

The pros of joining this group PP? Filling rather quickly, having a cushy arrangement (i.e., 60-90 minutes intakes and 30-45 minute follow-ups), having a say over the types of cases you take on (i.e., medication management, therapy, or both), and enjoying financial security/guaranteed referrals while establishing yourself in a city and private practice milieu.

Be sure to ask about non-competes, exit options (i.e., do you need to buy yourself out of the contract?), and percentage of fees that go towards the practice versus in your pocket. I've heard of truly wild things that make their way into contracts.

The pros of starting a solo practice? Setting your own rate (and of course keeping 100% of that rate), creating your own schedule, developing a niche (if you want), and being your own boss. The downsides are slow growth and unclear earnings for awhile. That said, owning a practice, especially a solo practice, is the most liberating and empowering feeling in medicine.
 
Are jobs like these easy to come by? There’s none in my area. This is what I’m looking for.
 
Are jobs like these easy to come by? There’s none in my area. This is what I’m looking for.
I'm sure there is some regional variation but IMO this is a big draw of psychiatry. There are literally dozens of these opportunities in one of the large metro's I'm familiar with. If someone already has the space/infrastructure, its a net positive to them to have you come onboard and start generating them $$ for very little work, so I would be surprised if any city of a million or more people didn't have several setups like this.
 
Non-compete sounds very important if you want to setup your own practice in the future. % of collections they take (roughly 70/30 split would be about "average" but this can vary). Are your cash rates set by the practice or do you have say over them. Practice expectations for managing out of hours calls?

There's no feeling quite like being your own boss and running your own practice. If you're entrepreneurial and business-minded, go for it.

The pros of joining this group PP? Filling rather quickly, having a cushy arrangement (i.e., 60-90 minutes intakes and 30-45 minute follow-ups), having a say over the types of cases you take on (i.e., medication management, therapy, or both), and enjoying financial security/guaranteed referrals while establishing yourself in a city and private practice milieu.

Be sure to ask about non-competes, exit options (i.e., do you need to buy yourself out of the contract?), and percentage of fees that go towards the practice versus in your pocket. I've heard of truly wild things that make their way into contracts.

The pros of starting a solo practice? Setting your own rate (and of course keeping 100% of that rate), creating your own schedule, developing a niche (if you want), and being your own boss. The downsides are slow growth and unclear earnings for awhile. That said, owning a practice, especially a solo practice, is the most liberating and empowering feeling in medicine.

Thanks guys. Any thoughts about 1099 vs W2? I am def leaning towards 1099, but not sure what is a typical set up.
 
Thanks guys. Any thoughts about 1099 vs W2? I am def leaning towards 1099, but not sure what is a typical set up.

Generally you should get a higher percentage of what you bring in for 1099. My understanding is that with W2 your employer will pay half of your taxes, vs 1099 you are responsible for all of your taxes but also have greater ability for deductions.
 
Generally you should get a higher percentage of what you bring in for 1099. My understanding is that with W2 your employer will pay half of your taxes, vs 1099 you are responsible for all of your taxes but also have greater ability for deductions.
This is a meaningful part of the difference, but keep in mind most places a W2 means you will have a full benefits package of which health care makes up the bulk of the value. You will also be under their 401k, for most docs the match is not great but is "free" money. PTO is standard when employed, as is medical license fees, professional society, CME money, malpractice, small amounts of life insurance, crappy group disability insurance, etc. Most people do not have huge 1099 deductions (mileage if you have multiple sites, home office if working remotely at times, fees covered above including malpractice) so I would not jump to thinking 1099 is always better unless the pay difference is significant.

Additionally many docs are able to be W2 at their main job then moonlight on a 1099 which often gets you the best of both worlds.
 
Thanks. Main motivation for 1099 is that it's easier to transition from group PP to solo since there are less restrictions in the contract, more freedom in regards to setting your rate/time and you already have things set up (need an LLC ).

Did the math on benefits, and for things like health insurance/disability/malpractice, you'd come out paying around 10k more after tax deduction which is pretty good, unless I'm missing something. Biggest difference is perhaps in the 401k match, but usually the higher match rates (7-10) kick in after spending 3-5 years in the company, and you can put in more in self-employed 401K/SEP.
 
Thanks. Main motivation for 1099 is that it's easier to transition from group PP to solo since there are less restrictions in the contract, more freedom in regards to setting your rate/time and you already have things set up (need an LLC ).

Did the math on benefits, and for things like health insurance/disability/malpractice, you'd come out paying around 10k more after tax deduction which is pretty good, unless I'm missing something. Biggest difference is perhaps in the 401k match, but usually the higher match rates (7-10) kick in after spending 3-5 years in the company, and you can put in more in self-employed 401K/SEP.
I've had matches right away for my 401k's at both employers to date, both have only been around 10k/year though and it's definitely nice to be able to fully fund a solo 401k. If that's how the math plays out for you, 1099 makes sense to me. Slightly more accounting costs and hassle but it's perfect training wheels before going out solo. Live the dream!
 
Generally you should get a higher percentage of what you bring in for 1099. My understanding is that with W2 your employer will pay half of your taxes, vs 1099 you are responsible for all of your taxes but also have greater ability for deductions.

You pay an extra 7.65%+1.45% on wages up to 128k and then only an extra 1.45% after that. Run a 1099 tax calculator a few times using a gross income of 250k, 300k and 350k and you’ll see how negligible this is at higher incomes.

If you’re 1099 though you should be getting at least a 10-15% better split to make up for the taxes above, health insurance, 401k match, etc.
 
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