Forum Members Official: Job Offer Thread

[podwho]

If you don't have the self determination to learn every aspect of running a medical practice then your not ready to start your practice.

Having said that, there is a lot of nuance and you don't know what you don't know in terms of regulation and basic decision making that you'll encounter. Having a mentor is important. Spending 2-5k on consulting is not the end of the world, they are a shortcut to knowledge. No different than what patients pay you for.

Protip... Everyone offers free consults and will answer most questions to show their value. There's dozens of practice management companies. You see where I'm going with this?

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[Feli]

You will 100% regret your decision to hire a consultant because in fact all of these things ultimately have to be done by you.

The act of credentialing with insurance is something you will have to do for the rest of your career. The consultant isn't going to fill the paperwork out. You are - how can they, its your personal information that goes into the paperwork. You'll have to resubmit that paperwork everytime an insurance changes or a re-credentialing happens so you need to understand the paperwork backwards and forwards. The paperwork is not hard - its just lengthy and requires you to list all of your college dates and things like that.

I joined an IPA. Literally, the paperwork they asked for to take over part of our insurance credentialing was already a excel/pdf the office maintained for maintaining our credentialing.

The majority of insurances requires you to maintain a CAQH profile. You'll be doing this yourself and you'll be reattesting every 3-6 months. This is one of those monstrously huge forms where you list your life story.

You'll sign up with Medicare. Everyone manages to do this - it doesn't take a consultant.

You'll probably have to write a business plan to try and get a business loan. There are business plan templates online and the act of writing the business plan is valuable for looking at how you think the finances of the office will work.

Coming up with inventory for your office isn't complicated. You'll likely buy from some sort of overpriced supplier like Henry Schein. Walk around a private practice office affilitiated with your residency and take pictures of what they have. If someone thought it was valuable I could walk around my office and take pictures of everything we have.

You'll buy some DME. I'll tell you ahead of time as someone who sells orthotics and CAM boots and braces that I don't sell a lot of size 16 orthotics and that woman wear smaller sizes than men. I have a lot of storage space and having excess orthotics and boots doesn't bother me because our mark-up is so high.

In general for your free schedule you'll peruse the Medicare fee schedule and probably multiply all operative codes by at least 2.5x Medicare. You can read previous threads I've written on how to write a fee schedule.

Your EHR will allow you to assign some variation of 15 and 30 minute slots and what not. It doesn't matter how this is set-up because likely as a new provider you will see whatever dregs walks through the door while you try to desperately build your practice. I was seeing 8 new a day when I started.

You believe this person is going to offer you value. They will not. In the end you will do everything and you will be better for it.

Yeah, you can pay biller or credential service to do most of the CAQH and fee schedules (in billing software and cash fee sched), sign up for MCR and insurance sign-ups and renews for you. I think that doing that stuff oneself is painful, so I contract most of it out. You still need to know how to do it... mainly so you'd know if it were being done wrong. Personally, I'd learned it (and that I hated doing it) when working as associate in a poorly run private practice (office manager kept failing to update CAQH, so I'd just do it)... and I did it again as an independent contractor 1099.

The supplies, office meds, etc is pretty easy. Every DPM should find what they like. All of the suppliers have some stuff cheaper and some more expensive than peers, so you need a few companies and occasional comparison shopping. Stuff will come and go, and most will change prices. Many of the podiatry large and supergroups have huuuge inefficiency with supplies since they think they get a real deal from one company, but they are actually getting hosed (maybe the company they buy 99% of stuff from has fair price on bandages, good prices on DME, but terrible prices on meds/injectables). It's important to have options and be able to pivot. This ordering can be delegated to a skilled employee, but again, definitely know how to do it so you can provide oversight. I often have them create the shopping cart and save it, and then I look at it before sending through.

...Whenever I get the texts or PM or messages "do you have a list of all supplies for a podiatry clinic" or "do you have a superbill I can use" or "can you send me a list of the surgery codes you use," I usually send a reply 'no, I just have the one I made for me and for my style. You'll do better if you make your own.' There is just a lot of learning value in customizing and doing it oneself. Shortcuts really only create more work later on... or they make the person dissatisfied that a system they did not create doesn't work very well for them (which is exactly what being an employee always end up being).

 

[air bud]

You are going to be so slow starting out you have time to make mistakes. You aren't going to be reviewing numbers at year end and be like holy crap I blew 100k. You will have caught things by then and figured out how to adjust and what works.

Btw, back to the jobs thing....
I know someone who spoke with Kaiser and it was the same old story...
Recruiter was like holy cow we can't believe the response to the posting, we had to shut it down way sooner than we expected.... because podiatry.

 

[619]

Podiatrist - .6 to 1.0 FTE​

Minneapolis, Minnesota

Malpractice Insurance
Relocation Assistance
Health System
Full Time
Part Time
BE or BC
Podiatric Surgeon

Park Nicollet
Park Nicollet Clinic is seeking a Podiatric Surgeon to join its expanding group of 7 DPM’s in a large multispecialty and hospital group setting. This will be a busy surgical practice that includes all aspects of podiatric surgery, including fore-, mid-, rear-foot surgery and diabetic limb salvage. This is an excellent opportunity. Our practice includes clinic, surgery and hospital call. 3 year surgical residency required and will need to be either Board Certified or working toward Board Eligible/Certification. Six practice locations all within the Minneapolis Metro area. Position is a 0.6 to 1.0 FTE. Salary and benefits are extremely competitive.

Park Nicollet Health Services, member of the HealthPartners Organization, is a large award-winning integrated multi-specialty practice with over 1800 physicians and clinicians in over 55 credentialed medical specialties. Our hospitals and clinics are locally and nationally recognized for clinical quality, disease management, patient safety and leadership. Our health care system includes Park Nicollet Methodist Hospital, Park Nicollet Clinics, Park Nicollet Specialty Centers, TRIA orthopedic centers and Park Nicollet Foundation.

We believe outstanding health care is delivered when we merge the science and intellect of medicine with the compassion, spirit and humanity of our hearts. We place the highest priority on safe, effective and innovative medical care; we also encourage a healthy work-life balance. Excellence at work shouldn’t come at the expense of your family, and we advocate for balance between your professional and personal lives so you can find joy and passion in all your pursuits. Become part of a culture grounded in humility, compassion, respect and shared leadership that inspires personal and professional development and lasting success.

Minneapolis offers extensive recreational and cultural activities, including orchestra, arts and theater, professional sports, the Mall of America, and a large international airport. There is something for everyone here, no matter what the season.
Contact Information
For immediate consideration, please email CV to Jennifer Bredeson, Clinician Recruitment, at [email protected] , or apply online at Twin Cities health care careers focused on you | Park Nicollet

 

[GreenHousePub]

Salary and benefits are extremely competitive.

 

[Hybrocure]

View attachment 377356

By competitive they mean competitive among the 6 other associates

 

[PeaJay]

View attachment 377356

By competitive they mean competitive among the 6 other associates

Unless I am missing something, this is a decent posting. It is a Large MSG associated with Health Partners. If I am not mistaken they are associated with the Regions program. Bound to be leagues ahead of private practice and in a metropolitan area.

In a decent size city (not rural) … check
MSG (no DPM practice owner) … check
Surgical … check

 

[Feli]

Unless I am missing something, this is a decent posting. It is a Large MSG associated with Health Partners. If I am not mistaken they are associated with the Regions program. Bound to be leagues ahead of private practice and in a metropolitan area.

In a decent size city (not rural) … check
MSG (no DPM practice owner) … check
Surgical … check

Yeah, it is sadly better than most DPM jobs. I will say that general geographic area is generally podiatry-friendly.

However: Ownership/partnership... ?
Full scope... ? (says it is, but are refers just pus and toes?)
Good management, staffing... ?
Call or weekends... ?
Good salary or bonus setup... ? (pretty sketch to not at least put up a base figure)

Ortho and MSG jobs in PP are still just jobs in PP.
It comes down to the situation and the compensation.
There are tons of "MSG" and "ortho" jobs that effectively pay 25-35% (just like bad pod PP), no partner path, or just make you build your own office that they then own. It's all variable.

 

[Hybrocure]

Yeah, it is sadly better than most DPM jobs. I will say that general geographic area is generally podiatry-friendly.

However: Ownership/partnership... ?
Full scope... ? (says it is, but are refers just pus and toes?)
Good management, staffing... ?
Call or weekends... ?
Good salary or bonus setup... ? (pretty sketch to not at least put up a base figure)

Ortho and MSG jobs in PP are still just jobs in PP.
It comes down to the situation and the compensation.
There are tons of "MSG" and "ortho" jobs that effectively pay 25-35% (just like bad pod PP), no partner path, or just make you build your own office that they then own. It's all variable.

The last couple years has seen a big rise in poor paying corporate/group jobs with these companies buying PP offices out.

I’m not saying that job offer doesn’t pay well, but podiatry has taught me to question any claim of “competitive salary”.

Ultimately though…just about anything is still gonna pay better than your typical PM News east coast associate opening (including Panda Express and Buccees)

 

[PeaJay]

’m not saying that job offer doesn’t pay well, but podiatry has taught me to question any claim of “competitive salary”

Fair enough

 

[dtrack22]

By competitive they mean competitive among the 6 other associates

HealthPartners pays more per wRVU than most MSG/Hospital Podiatry jobs throughout the country. Not a posting I would be 💩-ing on, personally.

 

[Hybrocure]

HealthPartners pays more per wRVU than most MSG/Hospital Podiatry jobs throughout the country. Not a posting I would be 💩-ing on, personally.

Yeah well I’m sure they’ll get 200 applicants by tomorrow so I doubt they care what I say lol

 

[icebreaker32]

The last couple years has seen a big rise in poor paying corporate/group jobs with these companies buying PP offices out.

I’m not saying that job offer doesn’t pay well, but podiatry has taught me to question any claim of “competitive salary”.

Ultimately though…just about anything is still gonna pay better than your typical PM News east coast associate opening (including Panda Express and Buccees)

A big rise in mediocre paying jobs you mean with less poor paying mustache jobs.

It is not like most PE groups that I have seen have been buying out the good podiatry groups with partners. In my experience at least, I have seen the solo podiatrists or mustache podiatrists with associates selling to PE.

If there is ever a meaningful shift in supply and demand then salaries and benefits will improve regardless of the job setting. Until then…..because podiatry.

 

[bloxxeeey]

I've spoken with an expanding PE group in the East who basically said that I would be the doc they build a practice around. I'd be doc 1 in a new location they want to open and they would add more docs in a couple of years but they said I would have to do marketing in person, they would take care of it online. They didn't specify salary but ranges from the recruiter have been 140-160k. No ownership obviously. Thoughts on this?

 

[Hybrocure]

I've spoken with an expanding PE group in the East who basically said that I would be the doc they build a practice around. I'd be doc 1 in a new location they want to open and they would add more docs in a couple of years but they said I would have to do marketing in person, they would take care of it online. They didn't specify salary but ranges from the recruiter have been 140-160k. No ownership obviously. Thoughts on this?

If they give you a salary and it’s not percentage based it seems like a good gig because I assume you’ll be starting fairly slow. Easy money to sit around.

 

[AttackNME]

I've spoken with an expanding PE group in the East who basically said that I would be the doc they build a practice around. I'd be doc 1 in a new location they want to open and they would add more docs in a couple of years but they said I would have to do marketing in person, they would take care of it online. They didn't specify salary but ranges from the recruiter have been 140-160k. No ownership obviously. Thoughts on this?

Sounds scary dude, like you would have no control over this practice that you’re basically building for yourself. Hope I’m wrong

 

[DYK343]

I've spoken with an expanding PE group in the East who basically said that I would be the doc they build a practice around. I'd be doc 1 in a new location they want to open and they would add more docs in a couple of years but they said I would have to do marketing in person, they would take care of it online. They didn't specify salary but ranges from the recruiter have been 140-160k. No ownership obviously. Thoughts on this?

38 patients a week (7.6 a day) at $100 a patient is a 200k salary.

Shoot higher.

 

[Boba Foot]

I've spoken with an expanding PE group in the East who basically said that I would be the doc they build a practice around. I'd be doc 1 in a new location they want to open and they would add more docs in a couple of years but they said I would have to do marketing in person, they would take care of it online. They didn't specify salary but ranges from the recruiter have been 140-160k. No ownership obviously. Thoughts on this?

If they give you a salary and it’s not percentage based it seems like a good gig because I assume you’ll be starting fairly slow. Easy money to sit around.

Just like everything relating to PE, it's good in the short term, bad in the long run. Yes, you'll have a steady decent paycheck in the early days when you have no patient load. But as you're building up and getting busier, you will eventually get to the point where they're packing your schedule and making a ton off you with little direct incentive to you.

This isn't an @air bud sitch where you're getting a good chunk of change for doing nothing. They're paying you below the median income for doing nothing, but then you're going to stay there when you're busting your ass.

 

[dtrack22]

I've spoken with an expanding PE group in the East who basically said that I would be the doc they build a practice around. I'd be doc 1 in a new location they want to open and they would add more docs in a couple of years but they said I would have to do marketing in person, they would take care of it online. They didn't specify salary but ranges from the recruiter have been 140-160k. No ownership obviously. Thoughts on this?

If people weren’t desperate enough for a job, or to live in certain areas, they would have to pay more. PE backed practice should pay you closer to what they would have to pay a real doctor compared to their employed peers. Meaning, if an employed Anesthesiologist costs a hospital $460k, then a PE owned group isn’t offering Anesthesiologists $230K in guaranteed salary. That’s essentially what they are able to do with Podiatrists. Median employed DPMs are paid $300k. At $150k you are getting a 50% discount. Which wouldn’t be so steep if they didn’t have people to sign up for that.

So a PE group should be paying $200k for anyone to even consider it. Someone will take it though. Many accept far worse.

 

[Hybrocure]

38 patients a week (7.6 a day) at $100 a patient is a 200k salary.

Shoot higher.

The math isn’t mathing here. Even if you’re getting 100% of collections it isn’t 200k

 

[icebreaker32]

I agree with what everyone has said, but the reality is in this profession your most recent offer is not bad. Congratulations on finding a better offer, but this may or may not be the right job for you. You may wish keep looking for a better job. You might accept a worse offer. Maybe you decide this is the right job for now. Your first job will most likely not be your last job.

Yes no one should be making less than 200K with good benefits from a ROI standpoint, even for a first job (unless Cadillac benefits and loan forgiveness etc) but what is one to do this is podiatry?

At this point you life goals become very important.

How long is the base salary offered?

How important is it to live in a large city (entertainment, restaurant, religious concerns, close to major airport etc).

How are non competes in that state? Are there areas you could see yourself living or
opening an office just beyond the non compete radius?

How important is it to live a couple hours from family?

Are you happier by mountains, oceans, want a lot of land etc?

Cost of living and taxes in the state/area.

Professional Goals: how quickly can you become ABFAS certified or good experience for opening your own office

Hours worked, amount on call.

Benefits like maternity/paternity leave and vacation etc

What are the schools like?

Is your spouse OK with moving 2-3 times early in your career?

Are you surrounded by others of the same race, cultural background and education level or is there much diversity if that Is what is important to you?

You know all these things as you have been on here awhile, but it is different when it becomes real. Some are lucky enough to get the hard to get great organizational job offers and turn them down for a mediocre job due to location and spouse’s employment etc. Others will leave a nice enough location at a mediocre job for an organizational job.

 

[619]

I've spoken with an expanding PE group in the East who basically said that I would be the doc they build a practice around. I'd be doc 1 in a new location they want to open and they would add more docs in a couple of years but they said I would have to do marketing in person, they would take care of it online. They didn't specify salary but ranges from the recruiter have been 140-160k. No ownership obviously. Thoughts on this?

How are non competes in that state? Are there areas you could see yourself living or
opening an office just beyond the non compete radius?

I will say to take the offer with your end goal in mind to go solo in a few years and open your own office. I will see the job as a traning tool on how to open a new office. The PE will take care of the online marketing which is the easiest part. When you open your practice, you will also outsourse the online marketing.

Use this first PE office job to learn how to do the ground work. You will learn how to open a new office from scratch. You will be involved in ordering supplies, staffing, marketing etc. Marketing and introducing yourself to docs and building a new practice is the corner stone to going solo and being successful. Different tactic work for different people so now is the time to find which tactic work best for you in terms of marketing. The joy os being the first and only doc in the office means that all the patients are new and they see just you. You get to directly see the effect of your marketing when the doc you just met some days ago sent you a patient.

This is the first hand experience that you need to feel 100% comfortable opening your own practice down the line. Being the first doc also means you have some sort of control over the staff. You may start with one or two staff which is a good thing because you will learn how to work with a skeleton crew and do most things yourself. Dealing with staff day to day is another skill you need to learn before you decide to go solo and hire your own staff. Are you going to be a nice boss or mean boss or a push over. You never know until you are in the drivers seat.

A lot of things to learn in solo practice however you will be learning while making $140-$160k/year. Forget about bonus because the main goal is to go solo in a few years before they add more docs.

 

[icebreaker32]

I will say to take the offer with your end goal in mind to go solo in a few years and open your own office. I will see the job as a traning tool on how to open a new office. The PE will take care of the online marketing which is the easiest part. When you open your practice, you will also outsourse the online marketing.

Use this first PE office job to learn how to do the ground work. You will learn how to open a new office from scratch. You will be involved in ordering supplies, staffing, marketing etc. Marketing and introducing yourself to docs and building a new practice is the corner stone to going solo and being successful. Different tactic work for different people so now is the time to find which tactic work best for you in terms of marketing. The joy os being the first and only doc in the office means that all the patients are new and they see just you. You get to directly see the effect of your marketing when the doc you just met some days ago sent you a patient.

This is the first hand experience that you need to feel 100% comfortable opening your own practice down the line. Being the first doc also means you have some sort of control over the staff. You may start with one or two staff which is a good thing because you will learn how to work with a skeleton crew and do most things yourself. Dealing with staff day to day is another skill you need to learn before you decide to go solo and hire your own staff. Are you going to be a nice boss or mean boss or a push over. You never know until you are in the drivers seat.

A lot of things to learn in solo practice however you will be learning while making $140-$160k/year. Forget about bonus because the main goal is to go solo in a few years before they add more docs.

This is good advice.

One thing to consider is although anything is possible, 90 percent will open their own office just beyond their current non compete. It is 10X easier to open an office close to where you live and are on staff etc versus half way across the country.

If you want to open your own office eventually but don't want to live in this area long term that is something to consider. Obviously with podiatry at some point you have to make a decision and go with it as far as a first job and figure out the rest later.

 

[podiatryresident]

But a lot of what you listed is why I would want a consultant. To set up a flow, start inventory, logistics, documentation, paperwork, credentialing with insurance etc.There is a value to that and that's from the consultant. I can modify after and change as time goes on. I'll be honest with you, it's something I'm heavily considering going forward. I know it's going to suck but I rather bite that bullet now than later when it gets even tougher and tougher to open up shop. I may hold off until 6-8 months into my first year of attending hood but I'm very much leaning towards doing it

I talked to one of the famous company which was mentioned in this forum, the cost for consulting service is 13-15k! and they said I should have about 200k for opening practice and unexpected costs! :|

 

[icebreaker32]

I talked to one of the famous company which was mentioned in this forum, the cost for consulting service is 13-15k! and they said I should have about 200k for opening practice and unexpected costs! :|

That advice is not bad honestly, but lobsters find ways to do things for less.

Not having a nice enough office in a nice enough area with at least one great employee though are not areas you want to go cheap on. You don't need expensive software, a brand new digital X-ray system, new treatment chairs and cabinets full of supplies.

You do need money to live on. That is what is so hard as some can do pretty well after a few months and others it takes much longer. You will not know how quickly ahead of time you go from negative or minimal cash flow to a reasonable salary and from there to a good salary.

That is why a high earning spouse or family money are huge advantages, but many have done it without those.

 

[air bud]

Fantastic MSG opportunity in Central FL. Awesome work culture, great bennies, MGMA. If anyone interested PM me.

- ABFAS BE/BC required per local hospital bylaws.
- Position hoping to start next Spring / Summer more than likely.

I heard it's not legal to require ABFAS. Wen sue?

 

[Shiyuan]

I heard it's not legal to require ABFAS. Wen sue?

I decided not to fight the hospital because I got grandfathered with ABPM. But you are 100% correct.

 

[DYK343]

The math isn’t mathing here. Even if you’re getting 100% of collections it isn’t 200k

$100 pay per patient average (my average per patient is currently 2.24wRVU which is >$100 a patient)
7.6 patients a day x 5 days is 38 patients a week
38 x $100 = $3,800
$3,800 x 52 weeks is $197,600
Math is there. Assuming $100 collections and working 52 weeks a year... But only seeing 7.6 patients a day which is nothing.

Trying to point out the offer is low...

 

[Hybrocure]

$100 pay per patient average (my average per patient is currently 2.24wRVU which is >$100 a patient)
7.6 patients a day x 5 days is 38 patients a week
38 x $100 = $3,800
$3,800 x 52 weeks is $197,600
Math is there. Assuming $100 collections and working 52 weeks a year... But only seeing 7.6 patients a day which is nothing.

Trying to point out the offer is low...

I get that but it’s not realistic to have zero overhead lol

 

[air bud]

$100 pay per patient average (my average per patient is currently 2.24wRVU which is >$100 a patient)
7.6 patients a day x 5 days is 38 patients a week
38 x $100 = $3,800
$3,800 x 52 weeks is $197,600
Math is there. Assuming $100 collections and working 52 weeks a year... But only seeing 7.6 patients a day which is nothing.

Trying to point out the offer is low...

Hey hey hey come on now. 7.6 patient sounds like a nice little Tuesday for me.

 

[DYK343]

I get that but it’s not realistic to have zero overhead lol

They are almost certainly charging facility fees. A PE group is not going to only invest in a DPM solo practice. Blooxey says they are expanding. I assume this is a MSG job.

I have zero personal overhead. What my employer pays in overhead is somewhat meaningless to me. One does have to be savy. Cant use lapiplasty in the private OR suite in the back of the clinic. Gotta be smart on costs. But overhead is not a worry in this job. Its not PP podiatry.

Plus or minus $50 wRVU (up for debate value wRVU) and this job pays nothing. Thats the point of my post. Ask for more. Being low balled (or only see 8 patients a day or less).

 

[DYK343]

Hey hey hey come on now. 7.6 patient sounds like a nice little Tuesday for me.

Not gonna lie im envious of how you have done this over the last several years.

 

[air bud]

Not gonna lie im envious of how you have done this over the last several years.

You would just like the extra time devoted to smoking meats

 

[GreenHousePub]

What would be a fair and reasonable method of selling this practice? It used to be a multiple of 3 or 4 times net proceeds.Net annually $350,000.
So I have a well established mobile chip and clip, minor procedure practice. outsourced billing/collections/scheduling. All Retirement communities have onsite facilities that I set up a mobile office; the facility staff maintains a signup schedule that coordinates with my office. I bring all my supplies, equipment, air filter, and personal chair and patient foot support.
Working 11 months, 5 days a week, seeing a comfortable 20 patients/day, only use contracted office support.
I have 25 communities that I service in the San Francisco Bay Area.
This income number is low since I work less and enjoy life. I could go back to the 9 hour days and increase my income by $50K.
Patients are a captive lot, new ones replace those that die off or move, entire practice is basic c&c, outpatient wound care, ingrowns. I could tranfer all the service contracts over to prospective buyer. They would instantly start making money out of the gate. Reimbursements are all Medicare and supplemental insurance, and private pay, less than 5% Medi-Cal. The breakdown of patient types: 10% SNF, 20% dementia,70% Assisted/Independent living.

Max I would ever give for a setup like that is 75k. And even that is a stretch.

But honestly I'd never even consider buying something like that.

You are dreaming if you think anyone would ever pay 3-4x net, (the ever persistent million-dollar podiatry sale myth)

EDIT:

 

[podiatryresident]

What would be a fair and reasonable method of selling this practice? It used to be a multiple of 3 or 4 times net proceeds.Net annually $350,000.
So I have a well established mobile chip and clip, minor procedure practice. outsourced billing/collections/scheduling. All Retirement communities have onsite facilities that I set up a mobile office; the facility staff maintains a signup schedule that coordinates with my office. I bring all my supplies, equipment, air filter, and personal chair and patient foot support.
Working 11 months, 5 days a week, seeing a comfortable 20 patients/day, only use contracted office support.
I have 25 communities that I service in the San Francisco Bay Area.
This income number is low since I work less and enjoy life. I could go back to the 9 hour days and increase my income by $50K.
Patients are a captive lot, new ones replace those that die off or move, entire practice is basic c&c, outpatient wound care, ingrowns. I could tranfer all the service contracts over to prospective buyer. They would instantly start making money out of the gate. Reimbursements are all Medicare and supplemental insurance, and private pay, less than 5% Medi-Cal. The breakdown of patient types: 10% SNF, 20% dementia,70% Assisted/Independent living.

Some of greedy docs are selling the practice at gross, probably 750-800k. Now you want 3-4x of 350 ?. From my understanding by reading this forum, nobody should by a practice more than the net.

P.S : and thanks forum again, I learnt so many advices from here. I recently found out my parent's city could be potential for me to open practice, not rural. I called 5 different offices to ask for an appointment for infected ingrown paying cash. Non of them can give me the appointment next 2-3 weeks. Now I need a job in that area first! Do you think it's weird if I stop by all offices in the area and hand them my CV ? @@

 

[air bud]

Some of greedy docs are selling the practice at gross, probably 750-800k. Now you want 3-4x of 350 ?. From my understanding by reading this forum, nobody should by a practice more than the net.

P.S : and thanks forum again, I learnt so many advices from here. I recently found out my parent's city could be potential for me to open practice, not rural. I called 5 different offices to ask for an appointment for infected ingrown paying cash. Non of them can give me the appointment next 2-3 weeks. Now I need a job in that area first! Do you think it's weird if I stop by all offices in the area and hand them my CV ? @@

This is how you find a job. Also that is a joke you want to work at a place that is like that? Open up your own place....live at home save money ..easier said than done

 

[heybrother]

What would be a fair and reasonable method of selling this practice? It used to be a multiple of 3 or 4 times net proceeds.Net annually $350,000.
So I have a well established mobile chip and clip, minor procedure practice. outsourced billing/collections/scheduling. All Retirement communities have onsite facilities that I set up a mobile office; the facility staff maintains a signup schedule that coordinates with my office. I bring all my supplies, equipment, air filter, and personal chair and patient foot support.
Working 11 months, 5 days a week, seeing a comfortable 20 patients/day, only use contracted office support.
I have 25 communities that I service in the San Francisco Bay Area.
This income number is low since I work less and enjoy life. I could go back to the 9 hour days and increase my income by $50K.
Patients are a captive lot, new ones replace those that die off or move, entire practice is basic c&c, outpatient wound care, ingrowns. I could tranfer all the service contracts over to prospective buyer. They would instantly start making money out of the gate. Reimbursements are all Medicare and supplemental insurance, and private pay, less than 5% Medi-Cal. The breakdown of patient types: 10% SNF, 20% dementia,70% Assisted/Independent living.

This isn't really the forum you go to for being told your practice is valuable.

-Members of this forum have previously argued that there is no such thing as a "nursing home contract". The nursing home can change the provider to whoever they choose. Selling a nursing home contract is essentially selling something you can't really own. You may or may not believe that.

-I don't believe that increasing your workload is going to increase your sale price. Make of it what you will be but back of the envelope math I essentially bought a practice for 25% of total collections (the price was less than my take home pay the year I bought it). My owner/now partner could have paid some finance guru $10000 to evaluate the practice - it wouldn't have changed my buy-in price.

-My suspicion is you will ultimately sell to some sort of large podiatry group who are looking for more work for their associates. I think the older the age of the podiatrist who buys and the more podiatrists who are involved - the more money you will receive. Essentially people who believe their own practice is valuable will be more likely to believe your practice is valuable.

-Part of me perceives your practice as worthless. That said - when I bought my own practice I didn't see myself as purchasing good will or purchasing equipment. I saw myself as preventing the interruption of my cash flow. Buying the practice meant that instead of spending money to start a new practice and taking the downtime that is associated with it instead I simply continued the current practice I had already built. By that logic, perhaps there is something to be said for your practice. Perhaps someone will want to step into your shoes... just probably not for the number you have in mind. I personally tell other podiatrists to be intensely skeptical of this idea that because someone else received an amount for their work that therefore they should be paid it again so someone else can continue it.

-You also are selling a very specific practice type. A lot of people despise nursing home work and view it as back breaking and time consuming with lots of travel in traffic. You are also located in a city that brings out a lot of mixed emotions.

That said - your marketing post seems tailor made for Medical Mavin. Pick a price. See what you get.

 

[DYK343]

You would just like the extra time devoted to smoking meats

Amongst other meat activities.

 

[Jummy Biffett]

Net annually $350,000.
Working 11 months, 5 days a week, seeing a comfortable 20 patients/day

Don't take this the wrong way...but the math doesn't add up to me here if these are mostly RFC visits. Especially if you're outsourcing billing/admin work that eats into the profit margins. I think if you're looking to sell your operation, any prospective buyer would be very interested as to how exactly you're generating that much profit from only ~100 chip and clip encounters per week. Again, no offense, I would just be prepared to demonstrate that in the sale process.

 

[Feli]

Some of greedy docs are selling the practice at gross, probably 750-800k. Now you want 3-4x of 350 ?. From my understanding by reading this forum, nobody should by a practice more than the net.

P.S : and thanks forum again, I learnt so many advices from here. I recently found out my parent's city could be potential for me to open practice, not rural. I called 5 different offices to ask for an appointment for infected ingrown paying cash. Non of them can give me the appointment next 2-3 weeks. Now I need a job in that area first! Do you think it's weird if I stop by all offices in the area and hand them my CV ? @@

Lol, this is the way. ^

Don't pay over ~1yr net +/- goodwill for a practice.

That was a doc I went to school with who posted that great intel... great advice for gauging an area's saturation - or lack of. He does well. Keep using that method and google to figure out saturation of areas and an area's payer mixes, hospitals, demographics, etc. There are some that are much better than others.

Another hint is to look at what the MDs are doing: If most of the MDs (esp outpt procedure types of specialists) are in PP, it's probably wise for you too; if most of them are hospital FTEs, it might be a mediocre/poor payers area that's risky for PP to thrive. We are talking the difference between seeing 20pt/day to do well versus seeing 30+/day to do just mediocre in a PP office... all based on the area you set up shop. It's worth doing your homework.

@airbud is right... you only need to work in the area if you want to learn how an office works (and there's no non-compete!). If no need to learn or it's an area non-competes hold up, just start your own (maybe learn elsewhere). It's usually not as expensive as you think, and you make a ton more than being PP employed DPM. Not sure about the live with parents part, but that's a personal call.

 

[Boba Foot]

Don't take this the wrong way...but the math doesn't add up to me here if these are mostly RFC visits. Especially if you're outsourcing billing/admin work that eats into the profit margins. I think if you're looking to sell your operation, any prospective buyer would be very interested as to how exactly you're generating that much profit from only ~100 chip and clip encounters per week. Again, no offense, I would just be prepared to demonstrate that in the sale process.

Clearly, this guy is an expert at finding "calluses" to add on to his nails.

 

[DPMcruiser]

My practice is turn key. Once you are signed up for Medicare and 5 of the local major carriers... the patient lists are always full, if there is a covid quarantine that day, i just call over to a dementia unit and fill in the lost appointments, with my patients that hit the 9week interval. Rarely is
a day of work lost.
11721.59 99343.25...initial visits
11721.59 99348.25...subsequent initial annual visits.
Other wise: 11721, 11055, &/or 11730
11042. All dorsal HDs get corn pad. All plantar ones get insole modification... patients are willing to pay out of pocket for this extra"care".
80% repeat patients,20% new patients weekly... so new E/M code.
I don't pay into the RCF staff, they work for their annual fine dining dinner and occasional Uber lunch delivery. I don't pay any rent.
Single independent contractor doing all my AR and scheduling... about 0.08 per claim. Using Office ally...
From all the comments, it seems better to take on a new associate at a percentage, with incremental increasing pay until i feel that they can have the network of facilities.

 

[HeySister]

My practice is turn key. Once you are signed up for Medicare and 5 of the local major carriers... the patient lists are always full, if there is a covid quarantine that day, i just call over to a dementia unit and fill in the lost appointments, with my patients that hit the 9week interval. Rarely is
a day of work lost.
11721.59 99343.25...initial visits
11721.59 99348.25...subsequent initial annual visits.
Other wise: 11721, 11055, &/or 11730
11042. All dorsal HDs get corn pad. All plantar ones get insole modification... patients are willing to pay out of pocket for this extra"care".
80% repeat patients,20% new patients weekly... so new E/M code.
I don't pay into the RCF staff, they work for their annual fine dining dinner and occasional Uber lunch delivery. I don't pay any rent.
Single independent contractor doing all my AR and scheduling... about 0.08 per claim. Using Office ally...
From all the comments, it seems better to take on a new associate at a percentage, with incremental increasing pay until i feel that they can have the network of facilities.

You have come to the wrong party. Unless this is satire. Then you found the right place.

 

[dtrack22]

11721.59 99343.25...initial visits

Might want to update your coding. 99343 was deleted…

it seems better to take on a new associate at a percentage, with incremental increasing pay until i feel that they can have the network of facilities.

Definitely. Even though you admitted almost no overhead, make sure the new associate doesn’t know that (they won’t). That way when you offer them 40% collections, they’ll think they’re getting a good deal. You’ll be able to skim 40% off the top of every mycotic nail they debride. No sense in selling your practice when you have the “Podiatry associate infinite money glitch.”

 

[Feli]

My practice is turn key. Once you are signed up for Medicare and 5 of the local major carriers...

You are forgetting someone (any DPM who has a car) can just start their own competing service for $5k in instruments and basic equipment... make their own schedule or hire that out as they get enough, use any 5% billing service or 3% clearinghouse.

So, there's that.
There is no reason to pay much for work that'll come available anyway.

...Nobody has any contract to "have the network of facilities." It's merely a courtesy arrangement... easily replaced with a different DPM or big mobile pod company or whatever. It's good you see value in what you do, but nobody cares who does C&c work.... they (facility and pts) just take whoever agrees and shows up.

 

[DPMcruiser]

You are forgetting someone (any DPM who has a car) can just start their own competing service for $5k in instruments and basic equipment... make their own schedule or hire that out as they get enough, use any 5% billing service or 3% clearinghouse.

So, there's that.
There is no reason to pay much for work that'll come available anyway.

...Nobody has any contract to "have the network of facilities." It's merely a courtesy arrangement... easily replaced with a different DPM or big mobile pod company or whatever. It's good you see value in what you do, but nobody cares who does C&c work.... they (facility and pts) just take whoever agrees and shows up.

It is true regarding any DPM can do the same. Any of the facilities that I have left, I have vetted my replacement and collected a "referral" percentage from the incoming DPM and the vetting fee from the facility. I got what everyone is saying, my "practice" is worthless as a sale-able item. So the way to go is to find an associate come in to work for a percentage.

 

[Jummy Biffett]

Any of the facilities that I have left, I have vetted my replacement and collected a "referral" percentage from the incoming DPM and the vetting fee from the facility.

Huh? What does the 'vetting' process include: they have a pulse and underwent 7+ years of training to cut non-dystrophic toenails that are barely elongated since you trimmed them 9 weeks ago? And then claim it's a 11721 because all the nails are 'painful'?

Not to mention this 'referral percentage' would directly violate the federal Anti-Kickback statute.

I don't begrudge your success, lord knows it's hard to make it work in this field. But this is just getting out of hand now...

 

[DPMcruiser]

Huh? What does the 'vetting' process include: they have a pulse and underwent 7+ years of training to cut non-dystrophic toenails that are barely elongated since you trimmed them 9 weeks ago? And then claim it's a 11721 because all the nails are 'painful'?

Not to mention this 'referral percentage' would directly violate the federal Anti-Kickback statute.

I don't begrudge your success, lord knows it's hard to make it work in this field. But this is just getting out of hand now...

 

[Feli]

It is true regarding any DPM can do the same. Any of the facilities that I have left, I have vetted my replacement and collected a "referral" percentage from the incoming DPM and the vetting fee from the facility. I got what everyone is saying, my "practice" is worthless as a sale-able item. So the way to go is to find an associate come in to work for a percentage.

It's not necessary worthless, but it just doesn't carry the value you'd think.
You have little/no physical equipment, and just those are not hard gigs to get or create.
PP offices have more quantifiable value based on significant physical equipment, location, reputation and referrals. If another DPM won't buy them, the existing office will generally stay and compete (themselves or via an associate or another buyer)... and the new DPM wastes a ton of time trying to establish a new location in the city and re-acquire those refers piecemeal. It is sometimes better to create a win-win, particularly if the rep and referrals are transferrable.

For someone who wants C&C and that area you've set up travel gigs, there is value to your "practice" having all of the facilities right away versus starting on their own and only having some of them (and competing with you or associate or waiting awhile to get the other ones). It is up to you to find that person and agree as to what that value is. I would concur with @GreenHousePub that the value is definitely 5 figure. There are not a ton of DPMs now who want C&C work five days per week, but it's an eye of the beholder thing as to value and pricing.

...in the future, we'll see the same things happening with DPM surgery/hospital jobs. There will be "referral" expected for retiring or moving surgical DPMs to help grease the wheels for a successor to take the hospital/ortho/MSG job position that they'd otherwise have trouble or time spent to do without the outgoing doc. It basically already happens where "DPM surgical fellow" gives a group a very low paid year to [hopefully] get somewhat more fair pay in the fellowship group afterwards. It's pretty sad, but it happens... and will continue to happen more and more.

It's not totally crazy, though. I paid a roughly 10k finder fee at one time on a MSG job where another DPM had made introductions. I could have just done the deal without him, but it kept the peace and I likely wouldn't have met the group without the connection. I wouldn't have met the group, and he (or anyone else in his employ) didn't have the hospital/surgery skills the MSG wanted... so, whatever. We reached a deal that all sides were happy with. If it had been any substantial amount as the "finder's fee", I would have just sidestepped him, started with MSG, and dealt with whatever happened. There is always something to be said for creating win-win... cutting the cake so that all are happy, not just so that you get the biggest slice.

 

[air bud]

It's not necessary worthless, but it just doesn't carry the value you'd think.
You have little/no physical equipment, and just those are not hard gigs to get or create.
PP offices have more quantifiable value based on significant physical equipment, location, reputation and referrals. If another DPM won't buy them, the existing office will generally stay and compete (themselves or via an associate or another buyer)... and the new DPM wastes a ton of time trying to establish a new location in the city and re-acquire those refers piecemeal. It is sometimes better to create a win-win, particularly if the rep and referrals are transferrable.

For someone who wants C&C and that area you've set up travel gigs, there is value to your "practice" having all of the facilities right away versus starting on their own and only having some of them (and competing with you or associate or waiting awhile to get the other ones). It is up to you to find that person and agree as to what that value is. I would concur with @GreenHousePub that the value is definitely 5 figure. There are not a ton of DPMs now who want C&C work five days per week, but it's an eye of the beholder thing as to value and pricing.

...in the future, we'll see the same things happening with DPM surgery/hospital jobs. There will be "referral" expected for retiring or moving surgical DPMs to help grease the wheels for a successor to take the hospital/ortho/MSG job position that they'd otherwise have trouble or time spent to do without the outgoing doc. It basically already happens where "DPM surgical fellow" gives a group a very low paid year to [hopefully] get somewhat more fair pay in the fellowship group afterwards. It's pretty sad, but it happens... and will continue to happen more and more.

It's not totally crazy, though. I paid a roughly 10k finder fee at one time on a MSG job where another DPM had made introductions. I could have just done the deal without him, but it kept the peace and I likely wouldn't have met the group without the connection. I wouldn't have met the group, and he (or anyone else in his employ) didn't have the hospital/surgery skills the MSG wanted... so, whatever. We reached a deal that all sides were happy with. If it had been any substantial amount as the "finder's fee", I would have just sidestepped him, started with MSG, and dealt with whatever happened. There is always something to be said for creating win-win... cutting the cake so that all are happy, not just so that you get the biggest slice.

Whoa hold on here. We could be charging fees to help people who reach out to you about jobs?