Negotiating new contract with boss

[deleted993114]

Please explain.

All of the med management patients were seen by my NPs.

Of the patients seen, some were scheduled for procedures and did not need them. Most were new patients, as I would tend to see most of the new patients unless they were specifically med mgmt. The rest were scheduled procedures, which I did.

I would see every pt and examine them prior to any procedure. I have been told that in some practices, a provider just stands back in the procedure room and does procedures without examining or talking to the patient up front. I would feel very uncomfortable doing that, as symptoms/exams change, and many times patients sent for a particular procedure were not candidates at all for the scheduled procedure.

I worked in concert with a group of four neurosurgeons, so many of the procedures I did were "teed up" with someone actually knowing what the hell was going on examining the patient, reading the films, and scheduling a procedure. I would do the same, but sometimes our guys would order a procedure I did not agree with.

With that schedule, I was pretty tired at the end of the day. I am considered to be "very fast" with procedures, but that is all I wanted. I would do 1/2 day a week at the surgery center, where I would do stims and stim trials, as they obviously cannot be done in the office.

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[Ligament]

Hey all,

I wanted to updated everyone on the situation. This forum has been extremely helpful.

So after I met with my Boss he agreed to some sort of base salary + productivity incentive. He stated the reason we are so busy is because of marketing costs and we have a lot of costs associated with maintaining an ASC and multiple offices. One issue I have is he isn't being completely transparent. He tells me they are paying 50,000 a month on marketing which I find to be excessive. Also, he said he is ok with some sort of productivity incentive BUT it certainly won't be 50:50 after costs because he feels like the patients are being handed to me on a platter. I don't get why 50/50 wouldn't be fair or at least 55/45 AFTER costs. That's just pure money in his pocket. Also, if im going to make a longer term commitment I want to have some say in terms of how business is run. For example, how many patients I see in a day, who are these marketers and why are we paying the so much, etc. Is that a fair expectation? He is also making me see a ton of PI which I kind of hate because I can't do any newer procedures on these patients and overall they are not very medically complicated so I feel like I'm not honing my skills which is important for me as a fresh grad.


I have another option of joining this internal medicine doctor who is now an administrator. He is offering me a 2 year guarantee salary of $350,000 first year and $400,000 the second with 50:50 split after costs. I asked him what would costs be defined as on contract and he replied that it would be mutually agreed upon. Is this a sufficient answer? I feel like there should be a cold hard number. Also he said that he is ok with all hiring and firing decisions to be made mutually. He is ok to limiting the practice to being 20% Personal Injury. His idea is eventually growing a pain/neurology/rehab practice with me starting it. The thing is this would probably be more work as its something I would have to grow but Ill have the stability of salary and all of his resources and network (He is very well connected and has been a doctor in the area for a very long time).

I am planning on using the two against eachother to get the best possible deal. The thing is I am honestly not looking for an easy way out or to make money off of someone. I just want a fair deal and to practice in a setting where I have some degree of control and can practice ethically under my terms. I still think pain practices can make a lot of money operating this way.

$50k / month on marketing is insane...totally insane. However, you guys seems to have insane volume too so perhaps that is not a lie.

the internal medicine doctor would be risky. This guy sounds like he is living 10 years in the past. The time for this model was a while ago. Do not believe he understands the market forces as they are today. Seems risky to you.

 

[painconfidential]

Hmmm the more I think about it , it seems the only way I get a fair deal is by going out on my own....I’m just hesitant to take a loan out and will have to make all new connections with referrals

 

[Laryngospasm]

For sure the only way you will really know what is going on is to be on your own.

 

[Cholula]

I don't understand how one doc can have one million dollar overhead. My overhead is about 30% (and could be better but I choose to pay my employees well). Go out on your own, the revenue will come, but focus on expenses. Income = revenue - expenses. You can work less and take home more money.

 

[Ligament]

I don't understand how one doc can have one million dollar overhead. My overhead is about 30% (and could be better but I choose to pay my employees well). Go out on your own, the revenue will come, but focus on expenses. Income = revenue - expenses. You can work less and take home more money.

My overhead is similar. Depends on region and what you do in the office.