joining private group practice

[scentofpapaya]

---

Members don't see this ad.

In my neck of the woods without any benefits (1099 situation), below $150/hr is low, $150-160/hr is borderline low, $160-$175 is average, $175-$190 is good, and above $190/hr is great. This is a generalization by me though. If I’m offered $120/hr for 12 hours to take call in-house at a place that averages 1 encounter/12 hours, I may do it because I could be paid to read a good book. If I’m offered $200/hr to see 5 follow-ups/hr at a high-acuity outpatient center, I’ll pass that job right on by. The better the quality of life, the less I’m willing to accept.

I'm not sure why the owner prefers W2 model as opposed to 1099 model... the practice itself appeared very reasonable: 2 follow-ups/hr outpatient practice. Maybe I can ask for a base salary with incentive like the other PP owner offered me.... But at the same time, I'm not familiar with this "incentive" model so I don't even know if this is just a bait. If I calculate $175/hr x 34hr/week x 48wks/yr, then it would come to $285,600/year guaranteed. This is really not bad compared to hospital based jobs, because I don't need health insurance which I've heard can cost ~20k/year. I just don't know if that is a fair compensation.

 

[finalpsychyear]

Hi guys, so I'm back with after another PP interview...
This other PP wanted me to join, 9-5 Monday-Friday place (no weekends and no evenings, yay!) they accept some insurance.
I asked for 4 week vacation, potential maternity leave, coverage, office space, support from staff etc.
The owner was asking me first for what I have in mind for salary with W2.
I'm not sure what to ask.... I'm thinking... hmm do I ask for W2 with incentive?? but incentive would not be a "guarantee." I did mention that I don't need any health insurance.
She did mention that I may switch to 1099 later on.
What do you guys think? (btw I'm also talking to people about opening my own PP trying to obtain more information about this...)

 

[michaelrack]

Yea exactly, I thought 1099 was simpler because it would be a "split" from what I understand. I do live in NE with a hospital outpatient job usually offering around anywhere between 190-220K for a starting salary, but those would come with benefits and a full support of hospital staff. I've heard that VA offers 210-250K range. All those jobs come with full benefits and staff support. The other PP that I interviewed at offered W2 with guaranteed base salary of 200-240K plus "incentive" based on the total amount I would generate for the practice: if I generate 200K/year then I take 50%, if 400K+/year then 60%, and if 600K+/year then 70%. The deal breaker was weekends and evenings... I'm just feeling very unsure about what I should ask because I can't come up with a single number for a W2 salary....

No need to be simple. Ask for a base salary plus productivity bonus. both components can be w2- quite a common arrangement

 

[scentofpapaya]

Do you have plans to start a PP of your own at some point or have you gone away from the idea altogether ?
If so get a telepsych job, VA, CMHC, even part time or 3-4 day max and start 1 day a week private insurance/medicare only practice.

Do not waste your time building up someone else's practice and having them take 40% of your pay in the process. It is not that tough in psych to just learn all the business info. You can run on your own and hire a billing company or even learn that on your own through EMR integrated billing options. It can truly be that lean with a timeshare 1 day a week running 200-300 bucks a month.

I just got off the phone with a younger resident in my class who I had given the same exact advice (above) to almost a year ago but he didn't listen. He joined a PP group and he quickly realized he was a fool to do that as there were tons of pts in the area and they were eating a chunk of his pay and he had some issues with one of the staff to boot. He has since left that group but due to non-compete he is restricted 15-20 miles from where he wanted. He highly regretted not starting the PP in the same area he joined the other PP and has to wait several more months to do so once the clause expires.

Yea I'm trying to learn about opening my own too. Limited resources because only 2 people I know actually opened PP and both ended up closing down the practice 🙁 Not because they weren't getting patients, but because they had difficulty managing it... One had a full time job and then opened it up on the weekends and evenings, and said it was too much for him so he just decided to keep the full time job because it came with benefits. The other one had it for 3 years and then decided to close it down and just get a regular hospital job because he also said it was difficult to manage without a partner because he had nobody to cover for him. I'm going to talk to more people and ask around....

 

[finalpsychyear]

Yea I'm trying to learn about opening my own too. Limited resources because only 2 people I know actually opened PP and both ended up closing down the practice 🙁 Not because they weren't getting patients, but because they had difficulty managing it... One had a full time job and then opened it up on the weekends and evenings, and said it was too much for him so he just decided to keep the full time job because it came with benefits. The other one had it for 3 years and then decided to close it down and just get a regular hospital job because he also said it was difficult to manage without a partner because he had nobody to cover for him. I'm going to talk to more people and ask around....

I guess the issue of "coverage" always comes up. I do my own coverage and prefer it. If my staff has a patient who needs refills or a minor issue I take care of it even if i am on vaca because it is very easy for me when your EMR is integrated so you can even order a refill through your phone. My patient severity is limited as i don't take patients who are too high risk so I have yet to have a single patient go to the hospital for SI. If you screen and establish your patient base in a set way you can limit the burnout and high risk nature of your business.

Good luck in whatever you decide.

 

[TexasPhysician]

Yea I'm trying to learn about opening my own too. Limited resources because only 2 people I know actually opened PP and both ended up closing down the practice 🙁 Not because they weren't getting patients, but because they had difficulty managing it... One had a full time job and then opened it up on the weekends and evenings, and said it was too much for him so he just decided to keep the full time job because it came with benefits. The other one had it for 3 years and then decided to close it down and just get a regular hospital job because he also said it was difficult to manage without a partner because he had nobody to cover for him. I'm going to talk to more people and ask around....

Some weeks I love my practice and others I’d gladly trade some income for 0 admin hassles. It’s a very personal decision. No right answer

 

[finalpsychyear]

Some weeks I love my practice and others I’d gladly trade some income for 0 admin hassles. It’s a very personal decision. No right answer

Working and building something yourself to me has more value than something i can quantify. Being my own boss, setting my own schedule, taking vacation and days off when i want to... for me that goes beyond dollars and cents. Also, if your ever "let go" from your employed job you ALWAYS have a job which is an awesome feeling that i wish every doctor has the chance to experience.

 

[TexasPhysician]

Working and building something yourself to me has more value than something i can quantify. Being my own boss, setting my own schedule, taking vacation and days off when i want to... for me that goes beyond dollars and cents. Also, if your ever "let go" from your employed job you ALWAYS have a job which is an awesome feeling that i wish every doctor has the chance to experience.

There are plenty of group practices that allow a non-owner to take vacation whenever and work any hours/days of their choosing.

 

[Marasmus1]

What are the options for brand new psychiatrists if he likes academia and research field but not willing to work for ****ty salary? I have been thinking this for a long time. Universities and academic institutions pay pretty bad. I even saw a contract from Presbyterian hospital offering 170k annually. I can make more than this by not leaving my bed with telepsych. On the other hand, there are private practices out there in big cities that offer 300k base with productivity bonus but no academia and research. I need an advice. I am definitely not working for less than 250k but also I need to be somewhere intellectually challenging. Any advice?

 

[romanticscience]

TMS has been mentioned as a way to supplement income. What are other's thoughts about the benefit of investing in this device? I currently own a solo practice without employees. I'm considering adding another office room to my lease so that I could provide the treatment. However, I'm afraid of adding more logistical stress to my practice because, as of now, I do everything myself and I have very low overhead (<5%) and my rate is $225/hr +/- $20.

My doubt is that increased revenue would not largely offset the cost of the device (the potential need for another staff person, more expensive lease, larger patient volume, more calls, etc).

 

[scentofpapaya]

There are plenty of group practices that allow a non-owner to take vacation whenever and work any hours/days of their choosing.

I guess regardless of PP setting or hospital setting, I will be working "for" somebody. The question is, unless I build my own PP from the scratch, I would fall into two different scenarios: do I generate money for the hospital so that they can pay their administrators who tell me what to do, in return for the benefits and "security" (although I've seen plenty of psychiatrists who left a big institution in less than 2 years because they were burnt out or not generating enough RVU and were pushed out) or do I generate money for PP owner?

I'm going to talk to someone in the community who has solo PP and see how she does it, has coverage, billing stuff, etc...

 

[TexasPhysician]

TMS has been mentioned as a way to supplement income. What are other's thoughts about the benefit of investing in this device? I currently own a solo practice without employees. I'm considering adding another office room to my lease so that I could provide the treatment. However, I'm afraid of adding more logistical stress to my practice because, as of now, I do everything myself and I have very low overhead (<5%) and my rate is $225/hr +/- $20.

My doubt is that increased revenue would not largely offset the cost of the device (the potential need for another staff person, more expensive lease, larger patient volume, more calls, etc).

TMS can work well for high volume insurance practices. I’ve seen 2 high volume places market it substantially, and they are doing well. I’ve met 2 average volume solo pp that lost their shirt on it.

 

[finalpsychyear]

TMS has been mentioned as a way to supplement income. What are other's thoughts about the benefit of investing in this device? I currently own a solo practice without employees. I'm considering adding another office room to my lease so that I could provide the treatment. However, I'm afraid of adding more logistical stress to my practice because, as of now, I do everything myself and I have very low overhead (<5%) and my rate is $225/hr +/- $20.

My doubt is that increased revenue would not largely offset the cost of the device (the potential need for another staff person, more expensive lease, larger patient volume, more calls, etc).

Also keep in mind that payments for TMS peaked about 3-4 years ago and from my colleagues who are doing it they have been cut almost in half since and likely will further go down as with any type of treatment. I know a handful of people who said that it was a huge loss for both of them.

 

[Sushirolls]

Some places will shy away from 1099, because when you dig into state laws the nature of employment does not meet the threshold of a true independent contractor and are now potentially liable for all the benefits they didn't pay previously. Realistically these can be big law suits. I know of at least one physician case and it was a big bill for the employer. I have had 1099 pay in the past and the nature of the contract my lawyer laughed and stated it didn't pass the employment test. I was okay with that. But that's not a good way to do business as an employer hoping and crossing fingers that the contractor is okay with it.

Thus, some places know their laws and W2 is the only real answer.

 

[scentofpapaya]

Some places will shy away from 1099, because when you dig into state laws the nature of employment does not meet the threshold of a true independent contractor and are now potentially liable for all the benefits they didn't pay previously. Realistically these can be big law suits. I know of at least one physician case and it was a big bill for the employer. I have had 1099 pay in the past and the nature of the contract my lawyer laughed and stated it didn't pass the employment test. I was okay with that. But that's not a good way to do business as an employer hoping and crossing fingers that the contractor is okay with it.

Thus, some places know their laws and W2 is the only real answer.

thanks, I guess then W2 vs 1099 really comes down to accounting.... I live in NY, I just know that with W2, you need to give your employee a "guaranteed" salary, "maternity leave" and "family medical leave act." I don't know if you have to give employee health benefits, retirement benefits, liability insurance.
I guess if I end up "working for someone else," then it really just ends up being a W2 model just by the nature of it, regardless of hospital setting or already established PP setting.

Also, I find it a bit odd that the PP owner wanted me first to come up with salary.... This is very difficult because I don't even know how much that practice is charging for each patient.

 

[michaelrack]

Also, I find it a bit odd that the PP owner wanted me first to come up with salary.... This is very difficult because I don't even know how much that practice is charging for each patient.

you could always come up with salary +/- productivity bonus based on expected number of RVU's. If you are a non-partner employee, what the practice is charging shouldn't matter

 

[Sushirolls]

Also keep in mind that payments for TMS peaked about 3-4 years ago and from my colleagues who are doing it they have been cut almost in half since and likely will further go down as with any type of treatment. I know a handful of people who said that it was a huge loss for both of them.

I believe the future of TMS may be in tandem with ECT. In other words a group practice that focuses on Neurostimulation and offers the treatment spectrum for patients of either TMS or ECT, and if one non-remits they have the other as an alternative.