Need advice.. Leaving private practice with debt in column

[moonwake]

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Hey guys. Long time since Ive been on SDN but I'm really contemplating leaving a group private practice that I feel screwed me over and severely ruined my chances of being successful. I'm 1.5 years out of residency and started working for a private practice in the southeast which seemed very promising. All the physicians in this practice (10 MDs and 12 NPs) are making 500k+ a year. The practice has been around for 40 years and is the biggest practice by far in a town of 50k people. None of the 10 other physicians accept new patients so all the new patient requests went to me to help me build my patient pool.

So... the reason why I chose this job was the potential to also make 500k+. Who wouldnt want that right? They have no debt as a practice and are a well oiled machine which I can still say after working with them for 1.5 years. My contract guaranteed me a 175k salary for the first 2 years while I built up my patient pool because that was generally how long it took for someone to start generating 175k in profit/revenue and then as my patient pool grows, my revenue would also keep growing past 175k...

My problem: my patient pool was growing abnormally slow and on top of that, they hired another physician 1 year after I started who is now competing with me for new patients and is completely screwing my growth even more. this unfortunately was not something I was expecting them to do. With this new physician, I am projecting to take 3 or 4 years to generate 175k in revenue due to me seeing so little patients. Right now I have generated a lot of debt for the practice due to me not seeing enough patients (my salary, practice overhead, and my 2 nurses' salaries) for the last 1.5 years and I want to just walk away. I know I cant but I am talking to my lawyer to see what can be done because I feel like they set me up to fail and are only looking out for themselves and I am trapped making 175k for probably 4 years.. I have job offers for a guaranteed salary of 340k in a hospital run family practice in a small town nearby where I could be worry free and not responsible for the revenue generated by the practice.

Any thoughts? Is my only way out having my lawyer try and work a settlement for the debt Ive accumulated?

I feel trapped and I dont know what to do...

Thanks for reading.

 

[DocWinter]

Have you had a conversation with them? What were the expectations you had from each other when signing the contract?
And why was the new guy brought in?
Contracts can be broken, for the right reason and right price. Hire a contract lawyer to explore.

Making 175k a year for several years is NOT an option for you. Pull the bandaid off quickly.

 

[moonwake]

I am in the interview process with this job and want to have a contract in hand before I tell them I'm leaving (I plan on it because I feel extremely unhappy here for multiple reasons, the biggest being they dont care at all about me struggling).

At the time of signing they said I was going to have accumulated and paid off my debt/deficit completely and make more than 175k. Its looking like its going to take 4-5 years before I'll start making more than 175k. The new guy was brought in because they want more docs on board so they can lower their overhead and save money... no thought about the financial disadvantage that puts on the new docs. this is obvious when theyre in their meetings and talk about ways to save money/make more money.

I wish I had done it sooner but I approached them 4 months ago and told them Im concerned about my growth and they keep saying just wait a couple of months and you'll start making bank! Well 4th quarter numbers are back and I went in the hole the exact same amount as in Q3. No progression whatsoever

 

[moonwake]

I also examined the payroll and I generated 850k in charges, 450k in payments in 2024. My salary, health insurance, malpractice, etc and nurses salary cost them 350k ... yet I went 250k in debt (in my column) due to how big their overhead is... meaning their overhead minus my costs to them is about 400k/year....

 

[smq123]

First of all, I'm sorry that this happened to you. It is stressful to not have a job work out, and even more stressful when there may be a financial penalty associated.

A few questions:
- Are they providing you with feedback every quarter? It sounds like they're not.
- Are they analyzing your productivity only in how much you've generated in payments? Most practices analyze based on RVUs. How many RVUs a quarter are you generating?
- Have they reviewed your charting and billing to make sure that you're billing correctly? You could be leaving RVUs behind; many new grads do.
- Is the other new physician struggling as much as you are?
- How many patients a day are you seeing?
- Do you need 2 nurses if your panel hasn't grown that much? Could you go down to 1?

Yes, $175K is low - for context, that is about what I was offered as a new grad for a community health center in Florida in 2012. So, yeah, pretty low.
I am a little concerned that you haven't built up to full speed after 18 months, when the norm for the practice is that most people are running at around capacity by then. To be honest, that has also been my experience - at a practice with the community volume to support it, most people should be hitting their stride by 18 months. So either they don't actually have the community volume to support it (and the other new physician is struggling too), or you're not doing enough to bring patients in to get to capacity. Are you providing too much free care to patients? - i.e. reviewing lab results over the phone, answering long questions or starting patients on new medications over the patient portal, etc. How often are you seeing patients with a lot of chronic conditions? Are you referring patients out too fast? Are there community events that you could volunteer at, in order to get your name out there?

Even if you do manage to leave this job, these are important things to examine for future jobs. Because if you're not able to hit reasonable productivity targets within 18 months, it is helpful to figure out why that is.

ETA: I'm not suggesting that you need to stay at this job. You're right - they should not have let you struggle so long without an intervention and it sounds like the mentorship that you need isn't there.

 

[moonwake]

Not sure how to see how many RVUs. I'll ask. They've met with me once and it was very brief... didnt give much feedback on billing. mentorship is definitely not there IMO. I'd say my average is around 10 patients a day and has been for the last year just about. very little increase. One is a MA and the other is a LPN. Unfortunately I'm at the cuff of needing both or my LPN would be overwhelmed with the amount of PAs, phone calls, injections, and new patient requests. I'm going to ask for a settlement quote once contract is in hand. I was thinking of paying 200k of the 400k "debt" I've accumulated, I figure I should ask them what the cost would be to walk away first. It'll be ugly though. They're nice people but I've complained since 6 months in and they just keep saying be patient and I think I see the projection more clearly now.

Keep in mind, I would have probably progressed if the new doc didnt start 4 months ago. She is seeing 5-8 a day.

 

[cabinbuilder]

Your LPN is overwhelmed with 10 patients a day? You should be seeing 30/day minimum. Sounds like you have a bad contract and bad staffing. 50K town base is not that large. Agree that $175K is super low. I would cut my losses and get out. Wouldn't be the first time. I have never known a contract that you couldn't get out of. There is always some clause that will be in your favor. Be wary of tail coverage, how close you can practice, how much notice you have to give, etc.

 

[moonwake]

Thanks for all the input everyone. I will keep you posted on if I get the contract and what the partners say when I tell them I'm leaving.

 

[VA Hopeful Dr]

Your LPN is overwhelmed with 10 patients a day? You should be seeing 30/day minimum. Sounds like you have a bad contract and bad staffing. 50K town base is not that large. Agree that $175K is super low. I would cut my losses and get out. Wouldn't be the first time. I have never known a contract that you couldn't get out of. There is always some clause that will be in your favor. Be wary of tail coverage, how close you can practice, how much notice you have to give, etc.

Depends on the county. The town I live in is around 38,000 people, but the county is around 350k.

 

[DocWinter]

Same as above
Town 50k, service about 300k
In clinic I see 30/d with 2 staff.
FWIW I'm OBGYN not family but I know you're getting the short end.

 

[moonwake]

40-50k town~ services 150k I'd say.

it's 1 hr from two cities both 500k+. sadly alot of new patients are healthy 20-40 year olds who only need annual physicals. takes a long time to stock up on patient base. Ive been seeing about 10 new patients a week over the last year... I'd say range of patients a day is 8-16 ending up being about 10-11 average over the last 6-12 months. half of my patients are referrals from patients who like me. the new doc is getting 10 new patients a week as well. I'd assume at least half would have ended up being my patients if she wasnt practicing here.

 

[sloh]

Not sure how to see how many RVUs. I'll ask. They've met with me once and it was very brief... didnt give much feedback on billing. mentorship is definitely not there IMO. I'd say my average is around 10 patients a day and has been for the last year just about. very little increase. One is a MA and the other is a LPN. Unfortunately I'm at the cuff of needing both or my LPN would be overwhelmed with the amount of PAs, phone calls, injections, and new patient requests. I'm going to ask for a settlement quote once contract is in hand. I was thinking of paying 200k of the 400k "debt" I've accumulated, I figure I should ask them what the cost would be to walk away first. It'll be ugly though. They're nice people but I've complained since 6 months in and they just keep saying be patient and I think I see the projection more clearly now.

Keep in mind, I would have probably progressed if the new doc didnt start 4 months ago. She is seeing 5-8 a day.

10 clinic paints per day is financially untenable for outpatient clinic unless it’s psych. Doesn’t matter if it’s pay by productivity/RVU or W2.

 

[smq123]

10 clinic paints per day is financially untenable for outpatient clinic unless it’s psych. Doesn’t matter if it’s pay by productivity/RVU or W2.

Agreed.

I also think that OP needs a new LPN. Can't manage 10 patients a day, many of whom are routine physicals? How many PAs and phone calls could 10 patients a day generate?

 

[Keona]

When I started I was only given one nurse until I was up to close to 20 patients a day and was close to off the guarantee. I was off my guarantee within 3 months of starting. I took over a retiring physician’s panel and then another one died shortly after I started. I have said since I started that I have entirely too much job security. I saw 10 patients a day from day 1 and my schedule was booked out for months before I started or they’d advertised me coming. I did a rotation there in residency and word of mouth spread and when the other dr retired he talked me up. I also go around in the community with my kids and try to be seen out and about as often as possible. Having 2 staff right now is more than you need if they’re all mostly routine healthy patients.

 

[moonwake]

Update: Ironically they offered me partnership unexpectedly last week (which the only perk of that being is that I would make about 6k/month passive income from our in house lab) which was the right time for me to bring up my grievances and reluctance to accept. They had a projection all planned out on spreadsheets saying that I should have my column paid off by 2027 when they came to offer partnership and explained that I would be making alot of money after my column was paid off (implying I'd be making 175k until 2027). I told them that isnt realistic for me with the MGMA for FP being 250k and that I felt like I was set up to fail from the start and that they werent ready and still arent ready to take on new physicians given the lack of interest/concern in helping me obtain new patients and hiring a second physician after seeing my struggle during my first year. They were surprised and apologized. They said they want to make things right. I told them I wanted a guaranteed salary of 225k until my column is paid off and that they would have to agree to aggressive marketing including google search hits, purchasing a large billboard on the main road in town saying "Dr (me) accepting new patients," and other things at THEIR expense. I also did an audit of my overhead and realized I had been charged about 50k more in my overhead than I should have due to accounting errors. They basically agreed to the salary and all my other requirements. We're coming up with a contract stating clearly what theyre agreeing to do for me. Sure... I'll be making 225k for 3 years (which isnt amazing) but all of them are making 500-600k working 4 days a week and theyre wanting to get me there. Its been a very amicable conversation trying to get things straightened out this last week. In short, I'm going to stay. I think things will grow alot faster with the marketing that hadnt been done until now- due to the office manager deflecting my recommendations and concerns which the partners were not happy about. I am really appreciative of all the feedback and recommendations. The jobs I applied to said they'll gladly take me if I were to ever change my mind so I feel like I'm in a way better place. Thanks for your time guys.

Also, the reason I picked 225k is because that was about the amount of extra income I was going to get a year by being partner, so instead of the 6k a month going into my column to pay off debt, its going to just go directly in my pocket if that makes sense.

 

[Tomiee]

Update: Ironically they offered me partnership unexpectedly last week (which the only perk of that being is that I would make about 6k/month passive income from our in house lab) which was the right time for me to bring up my grievances and reluctance to accept. They had a projection all planned out on spreadsheets saying that I should have my column paid off by 2027 when they came to offer partnership and explained that I would be making alot of money after my column was paid off (implying I'd be making 175k until 2027). I told them that isnt realistic for me with the MGMA for FP being 250k and that I felt like I was set up to fail from the start and that they werent ready and still arent ready to take on new physicians given the lack of interest/concern in helping me obtain new patients and hiring a second physician after seeing my struggle during my first year. They were surprised and apologized. They said they want to make things right. I told them I wanted a guaranteed salary of 225k until my column is paid off and that they would have to agree to aggressive marketing including google search hits, purchasing a large billboard on the main road in town saying "Dr (me) accepting new patients," and other things at THEIR expense. I also did an audit of my overhead and realized I had been charged about 50k more in my overhead than I should have due to accounting errors. They basically agreed to the salary and all my other requirements. We're coming up with a contract stating clearly what theyre agreeing to do for me. Sure... I'll be making 225k for 3 years (which isnt amazing) but all of them are making 500-600k working 4 days a week and theyre wanting to get me there. Its been a very amicable conversation trying to get things straightened out this last week. In short, I'm going to stay. I think things will grow alot faster with the marketing that hadnt been done until now- due to the office manager deflecting my recommendations and concerns which the partners were not happy about. I am really appreciative of all the feedback and recommendations. The jobs I applied to said they'll gladly take me if I were to ever change my mind so I feel like I'm in a way better place. Thanks for your time guys.

Also, the reason I picked 225k is because that was about the amount of extra income I was going to get a year by being partner, so instead of the 6k a month going into my column to pay off debt, its going to just go directly in my pocket if that makes sense.

I’m not sure if you mentioned it, but I definitely think you should get a contract lawyer to give you reassurance with this partnership.

 

[dozitgetchahi]

Update: Ironically they offered me partnership unexpectedly last week (which the only perk of that being is that I would make about 6k/month passive income from our in house lab) which was the right time for me to bring up my grievances and reluctance to accept. They had a projection all planned out on spreadsheets saying that I should have my column paid off by 2027 when they came to offer partnership and explained that I would be making alot of money after my column was paid off (implying I'd be making 175k until 2027). I told them that isnt realistic for me with the MGMA for FP being 250k and that I felt like I was set up to fail from the start and that they werent ready and still arent ready to take on new physicians given the lack of interest/concern in helping me obtain new patients and hiring a second physician after seeing my struggle during my first year. They were surprised and apologized. They said they want to make things right. I told them I wanted a guaranteed salary of 225k until my column is paid off and that they would have to agree to aggressive marketing including google search hits, purchasing a large billboard on the main road in town saying "Dr (me) accepting new patients," and other things at THEIR expense. I also did an audit of my overhead and realized I had been charged about 50k more in my overhead than I should have due to accounting errors. They basically agreed to the salary and all my other requirements. We're coming up with a contract stating clearly what theyre agreeing to do for me. Sure... I'll be making 225k for 3 years (which isnt amazing) but all of them are making 500-600k working 4 days a week and theyre wanting to get me there. Its been a very amicable conversation trying to get things straightened out this last week. In short, I'm going to stay. I think things will grow alot faster with the marketing that hadnt been done until now- due to the office manager deflecting my recommendations and concerns which the partners were not happy about. I am really appreciative of all the feedback and recommendations. The jobs I applied to said they'll gladly take me if I were to ever change my mind so I feel like I'm in a way better place. Thanks for your time guys.

Also, the reason I picked 225k is because that was about the amount of extra income I was going to get a year by being partner, so instead of the 6k a month going into my column to pay off debt, its going to just go directly in my pocket if that makes sense.

You need an attorney to review this.

I have worked in two different private practices at this point, and I am currently a partner in my multispecialty PP. My first PP job was something of a disaster (dishonest leadership, promises not fulfilled, and the PP imploded). My second job has been wonderful, and in some ways is a “unicorn job”. So I know what a good PP deal looks like, and what a **** PP deal looks like. The original deal you were given was (to put it bluntly) very exploitative. The initial salary was quite low, they didn’t promote you or ensure that you had an adequate volume of new patients, and typically if a new associate doctor goes into “the negatives” (this debt is basically an artificial creation), most practices don’t expect them to pay it when they leave (or even if they become a partner, often the “debt” is forgiven). They also overcharged you for overhead (and from my experience in these situations, this probably wasn’t an accident) - that isn’t cool.

These partners may sound reasonable now, but if they were actually reasonable people, they never would have handed you an initial deal that was as lousy as it was. Also, beware of deals promising big money at some vague date in the future…that has a way of not happening. Be sure that your contract has a clearly defined “exit strategy” that doesn’t cost you a fortune if you choose to leave in the future.

And lastly - take a second look at all the other job offers, and maybe consider taking one of those jobs instead. Your current job has vibes that are a lot like my first crappy PP job. I should have left earlier.

 

[moonwake]

Thanks for the input. I know it sounds really bad with me accepting "new terms" at this practice, but let me explain my thought process. As far as the overhead miscalculation, in their defense, we had a horrible accounting firm that we had to terminate 3 months ago because we realized they were doing a lot of **** wrong. The new one we've hired is doing an audit over everything and my 50k overhead overcalculation spread out over 1.5 years wasnt the only thing calculated wrong. It was clearly the old accounting firms fault and not glaringly obvious believe it or not. So I genuinely think it wasnt their fault. One major concern with leaving here is that the contracts everywhere else are only for a few years and from what Ive seen, the hospital systems offer nice contracts up front to build their new clinic and then switch the payment model to something worse and alot of docs end up leaving and finding a new job guaranteeing a certain salary and starting over. All these other job offers arent private practice either and I definitely dont want to take the risk of starting another private practice gig. I do like being my own boss and I am actually really close to breaking even so I think the marketing will make a big difference in changing the rate of growth for me. Of course if 1-2 months go by and the proposed marketing and other things arent in place, I will definitely take the hit and leave by starting another job. Ive invested alot of time in growing my practice literally from scratch with no help at all and want to see if things start improving before I pull the plug. In my eyes, being here 2 more months wouldnt be significantly worsening my situation long term career-wise and is worth waiting.

 

[dozitgetchahi]

Thanks for the input. I know it sounds really bad with me accepting "new terms" at this practice, but let me explain my thought process. As far as the overhead miscalculation, in their defense, we had a horrible accounting firm that we had to terminate 3 months ago because we realized they were doing a lot of **** wrong. The new one we've hired is doing an audit over everything and my 50k overhead overcalculation spread out over 1.5 years wasnt the only thing calculated wrong. It was clearly the old accounting firms fault and not glaringly obvious believe it or not. So I genuinely think it wasnt their fault. One major concern with leaving here is that the contracts everywhere else are only for a few years and from what Ive seen, the hospital systems offer nice contracts up front to build their new clinic and then switch the payment model to something worse and alot of docs end up leaving and finding a new job guaranteeing a certain salary and starting over. All these other job offers arent private practice either and I definitely dont want to take the risk of starting another private practice gig. I do like being my own boss and I am actually really close to breaking even so I think the marketing will make a big difference in changing the rate of growth for me. Of course if 1-2 months go by and the proposed marketing and other things arent in place, I will definitely take the hit and leave by starting another job. Ive invested alot of time in growing my practice literally from scratch with no help at all and want to see if things start improving before I pull the plug. In my eyes, being here 2 more months wouldnt be significantly worsening my situation long term career-wise and is worth waiting.

There’s still more to consider here.

- What are the details of this partnership deal? Is there a buy in? Is there real estate involved? What are the finances of the business? Etc etc, lots of details there.

- Why did they bring in another new doc when you were already struggling? At best, this suggests partners who have no idea what’s going on…at worst, this is a situation where they’re trying to keep the compensation of the associates low by ensuring that they never get adequate volume to earn bonuses etc (seen it happen). Neither of these possibilities is good for the practice. (If they’re trying to deflect blame for not promoting you onto the office manager…that sort of suggests that they’re out of touch with everything, as does the fact that an accounting firm did things wrong for years and nobody noticed.)

- You said the partners are making $400-500k working 4 days a week. How are they making that money? Are they seeing a ton of patients, or are they sitting back and eating a lot of revenue generated by associate doctors and/or other revenue streams?

- Sometimes being a “partner” means a lot, and sometimes very little. Will you have equal voting rights with the rest of these partners, or are they “super partners” who have structured the situation to favor themselves in terms of power or income (sounds like this may be happening)?

- Look into the legal history of the practice…my first PP had already signed a consent decree with CMS years earlier for fraud, and had been fined a huge amount of money (which was part of what ultimately brought it down financially). Make sure you’re not signing into a partnership that is actually a criminal enterprise.

 

[moonwake]

What are the details of this partnership deal? Is there a buy in? Is there real estate involved? What are the finances of the business? Etc etc, lots of details there.

There's a $2000 buy in just to make it official. Only perk is lab revenue monthly which fluctuates between 5-7k a month. Equal voting rights at partner meetings. No debt. Our payroll is very transparent. I evaluated all of the partners progression and earnings over the last few years before I signed my contract 2 years ago- they offered me that information. We have about 500k cash at all times sitting in bank as a cash reserve. We rent 3 floors of the hospital outpatient building.

Why did they bring in another new doc when you were already struggling? At best, this suggests partners who have no idea what’s going on…at worst, this is a situation where they’re trying to keep the compensation of the associates low by ensuring that they never get adequate volume to earn bonuses etc (seen it happen). Neither of these possibilities is good for the practice. (If they’re trying to deflect blame for not promoting you onto the office manager…that sort of suggests that they’re out of touch with everything, as does the fact that an accounting firm did things wrong for years and nobody noticed.)

They thought I was going to grow as fast as the previous docs did (the prior partner started 3 years before I did and had paid off her column before year 3 and is currently making 600k/year). The main reason why things are different is the hospital in town opened a primary care clinic around when I started and is blasting advertising with billboards and are #1 on google when you search primary care, FP, internal medicine, so alot of the potential patients are being taken- they havent needed to advertise in the past. The town is growing quickly and thats why the point of attack at this point is to advertise and see if that makes a big difference for me.

- You said the partners are making $400-500k working 4 days a week. How are they making that money? Are they seeing a ton of patients, or are they sitting back and eating a lot of revenue generated by associate doctors and/or other revenue streams?

They each have 2 NPs and see 20-25 patients a day. There arent any associate doctors besides me and the newer doc. They are all very successful. The practice has been around for 40 years.

- Sometimes being a “partner” means a lot, and sometimes very little. Will you have equal voting rights with the rest of these partners, or are they “super partners” who have structured the situation to favor themselves in terms of power or income (sounds like this may be happening)?

I think I already answered this.

- Look into the legal history of the practice…my first PP had already signed a consent decree with CMS years earlier for fraud, and had been fined a huge amount of money (which was part of what ultimately brought it down financially). Make sure you’re not signing into a partnership that is actually a criminal enterprise.

No history of fraud or law suits. Its a smallish town and reputation is pretty huge. All the docs in town know eachother and all the partners seem to be "good people" just based off my interactions with them and their reputation. I think the cash in reserve also helps confirm the lack of debt in the practice.

 

[FamilymedMD]

10 clinic paints per day is financially untenable for outpatient clinic unless it’s psych. Doesn’t matter if it’s pay by productivity/RVU or W2.

Or DPC.

 

[dozitgetchahi]

What are the details of this partnership deal? Is there a buy in? Is there real estate involved? What are the finances of the business? Etc etc, lots of details there.

There's a $2000 buy in just to make it official. Only perk is lab revenue monthly which fluctuates between 5-7k a month. Equal voting rights at partner meetings. No debt. Our payroll is very transparent. I evaluated all of the partners progression and earnings over the last few years before I signed my contract 2 years ago- they offered me that information. We have about 500k cash at all times sitting in bank as a cash reserve. We rent 3 floors of the hospital outpatient building.

Why did they bring in another new doc when you were already struggling? At best, this suggests partners who have no idea what’s going on…at worst, this is a situation where they’re trying to keep the compensation of the associates low by ensuring that they never get adequate volume to earn bonuses etc (seen it happen). Neither of these possibilities is good for the practice. (If they’re trying to deflect blame for not promoting you onto the office manager…that sort of suggests that they’re out of touch with everything, as does the fact that an accounting firm did things wrong for years and nobody noticed.)

They thought I was going to grow as fast as the previous docs did (the prior partner started 3 years before I did and had paid off her column before year 3 and is currently making 600k/year). The main reason why things are different is the hospital in town opened a primary care clinic around when I started and is blasting advertising with billboards and are #1 on google when you search primary care, FP, internal medicine, so alot of the potential patients are being taken- they havent needed to advertise in the past. The town is growing quickly and thats why the point of attack at this point is to advertise and see if that makes a big difference for me.

- You said the partners are making $400-500k working 4 days a week. How are they making that money? Are they seeing a ton of patients, or are they sitting back and eating a lot of revenue generated by associate doctors and/or other revenue streams?

They each have 2 NPs and see 20-25 patients a day. There arent any associate doctors besides me and the newer doc. They are all very successful. The practice has been around for 40 years.

- Sometimes being a “partner” means a lot, and sometimes very little. Will you have equal voting rights with the rest of these partners, or are they “super partners” who have structured the situation to favor themselves in terms of power or income (sounds like this may be happening)?

I think I already answered this.

- Look into the legal history of the practice…my first PP had already signed a consent decree with CMS years earlier for fraud, and had been fined a huge amount of money (which was part of what ultimately brought it down financially). Make sure you’re not signing into a partnership that is actually a criminal enterprise.

No history of fraud or law suits. Its a smallish town and reputation is pretty huge. All the docs in town know eachother and all the partners seem to be "good people" just based off my interactions with them and their reputation. I think the cash in reserve also helps confirm the lack of debt in the practice.

You pointed out that the partners are making a portion of their money by each supervising two NPs. That’s a lot of NP supervision (and, personally, I’d rather not supervise NPs altogether). Are you OK with handing NPs? If not, then review their compensation and try to figure out what the partners are making if the midlevel income isn’t figured in…because that’s what you’ll be making.

 

[moonwake]

Hey there- just giving an update. I signed on as a partner at my current practice a few weeks ago. We redid the contract. I am going to be making $225k instead of 175k until my column is paid off and I am going to be getting the 60-70k/year lab revenue since my 1 year mark as I requested/they said initially. In February I brought in 30% more revenue (averaged 15 patients a day in Feb) in office visit charges than my previous best month.

We've been meeting once a week going over google analytics, revamping the website, and working on advertising for the new physician and myself. I'm actually relieved that they are so open to changing things and my suggestions without giving me any opposition.

I would be taking a risk regardless of where I choose to work but I believe my potential is going to be better here since it's private practice, even if it means less the next few years while I pay off my column. Underpaid now, but 5+ years I'll be making double or more. Just going to look at it as an investment.