Wanted to share my perspective. I'm a CAP PGY-5 and will start work in summer/fall 2022. I'm wrestling with a few choices I'll have to make over the next year or so between going into private practice and being employed.
I would love nothing more than to go into private practice by myself or with a small, physician-owned group. I've talked to several private practices, as well as a few of these more corporate, PE-backed entities, about jobs. There are definitely pros and cons to both. I would obviously give up autonomy and $$$ by working for LifeStance, Community Psychiatry, Vertava/CWG, etc. But the comforts of working for someone like that are nontrivial: 401k with a match, health/dental/vision insurance, disability / life policy reimbursement, outsourcing all of the scheduling, advertising, clerical, support staff burden, etc. Most of them are willing to include clauses in their contract that I require: NO obligation to supervise midlevels, protected time weekly, reimbursement for required corporate training time, etc. Most of the docs employed by these practices that I've spoken with (formally and informally) seem to appreciate the return they get for sacrificing some of their autonomy.
I have a dependent that gets very, very expensive treatments for an autoimmune illness several times per year. The comfort of being insured under a large policy (instead of fending for ourselves on the exchange every year) is worth a lot to us. If there was a way to have my cake (working fully autonomously in private practice) and eat it too (have access to excellent healthcare), I would jump on it. But I haven't found that solution yet. Curious to hear others' thoughts.
So, here's the thing, I'd have a very clear exit plan if I were to start with one of these PE groups. For instance, the fact that Lifestance just went public means it has a very clear agenda...it has to act in the best interest of its shareholders. Period. Not you, not patients, it is legally obligated to act in the best interest of its shareholders. If the corporation determines financially that means they hire 10 NPs for every 1 psychiatrist and hires every bottom of the barrel new grad LPCC to do "therapy" for minimum pay, that's what they'll do. None of those doctors have been there since they've been a publicly traded company, since it just happened this year.
I would also look very closely and actually calculate out the specific financial benefit of what you're getting vs other private practices or buying market (or even academic centers which tend to not have great pay but can have very good benefits...which might add up in your situation where you could have access to a tertiary care center for a relatively low cost if you work for them).
Lifestance would absolutely not include anything like "protected time weekly" when I was talking to them (and a couple other people I knew who talked to them, some of whom ultimately joined up). They went to a straight percentage of collections model after year 1, so I guess protected in the context of you don't really have to work when you don't want to work but you're not gonna get paid for it. Remember that they say it's "like a private practice" but you're a W2 employee with them...which means if they want you to start following all the rules in the employee handbook, going to 10 "quality assurance" meetings a week, adhering to new "quality metrics" and wearing the lifestance polo with their logo on it, you have to do it.
I'm literally looking at their benefits booklet right now. Their 401k match is max 4% a year (if you contribute at least 5%), which is 10K if you're making 250K. That's literally worse than most employed jobs out there in general. If you're a contractor or own your own private practice, you can contribute to a SEP IRA or Solo 401k which would end up being significantly more (since you'd also likely make much more than 10K a year in those positions).
Their ****tiest health insurance plan was $1100 a month for a family (employee/spouse/children) with an $11K deductible and $14k OOP max and highest PPO buy up was $2400 A MONTH still with a $3K deductible and $6K OOP max. So if you have someone with a really expensive medical condition who will bump you up to at least that deductible and probably the OOP max (and you don't want to stay in their crappy lowest tier bronze network), you'll pay almost $35K a year. If you stayed in their lowest tier plan, you'd still pay $27K if you hit their OOP max. With a group insurance plan. No thanks.
For reference, I literally just bought a HSA eligible gold plan on my health insurance exchange for my family. $900 bucks a month for the broadest PPO network with a $5800 deductible and $8000 OOP max. Also has an out of network OOP max as well so you can avoid getting totally boned and balance billed for a million bucks. So most I'd pay if I stay in network is $18,800 and I can contribute to an HSA to offset some of that. Oh yeah and I only pay 10% after I hit the deductible (Lifestance plans were 20-30% depending on the plan).
As you can see (and I mentioned above), Lifestance's health insurance plans were actually WORSE than what I could buy on my own on an exchange. To the tune of tens of thousands of dollars a year potentially. Keep in mind that health insurance exchanges CANNOT ask you about existing conditions now. They can only base insurance rates on age, number of people under the plan and smoking status. So it doesn't matter if you have a family member who has an expensive medical condition.
www.fiercehealthcare.com
