aau22

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What is a typical compensation model for supervising midlevels? What do you all think is fair? To me, it is an easy argument to be made that spending the time supervising and placing your license on the line for their liability should be compensated.
 

werd

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i'm familiar with two models... 1) physician supervises a PA and gets a certain % of their productivity as a bonus to their compensation (e.g. PA collections are 500K, supervising physician gets 50K for supervising), and 2) physician gets credit for a % of the PA's collections as if it were their own productivity, then gets paid more according to their productivity bonus schedule.
 
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asmallchild

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Ha, not even, I used to work for a PE-owned group. It may start at 10% (which is still absurdly low) but they will drive that % lower and lower in the name of "we are losing money by paying the midlevels and the physicians at the same time"
 
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zanzizic

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It’s crap like that that makes me never want to sell to PE
 

MOHS_01

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Ha, not even, I used to work for a PE-owned group. It may start at 10% (which is still absurdly low) but they will drive that % lower and lower in the name of "we are losing money by paying the midlevels and the physicians at the same time"
Yeah, you can't pay out dollars twice is the problem; mid-levels generate the same (possibly more) cost structure per unit volume than an MD does, yet the dollars in are contractually less. For example, let's say that an experienced mid-level is 80% as efficient as an experienced doc. They're receiving 80% of the compensation from payers, so that's 64% of the dollars in per unit time. If the place is a well oiled machine, let's say overhead for the docs sits at 40%, 45-50% overall once factoring in mid-levels. The dollars just aren't there, I'm afraid, which is why many mid-level heavy practices gain the reputation of being biopsy mills..... gotta make that money up somehow -- or have a secondary gain (allowing the MD to focus more on what they prefer to do, be that path or Mohs or cosmetics, whatever).
 

MOHS_01

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It’s crap like that that makes me never want to sell to PE
The only reason to sell to PE is if you are retiring, moving, or terminal.... or your practice is not making any money and you're looking for a lifeline / bailout. That's it.
 

ratherbefishing

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Can anyone else share their experiences with % collections from PAs? I had an offer from a PE-backed group for 6% (revised up from 0 after I said wtf), and another offer of 30% of PA collections from a different practice. I have no way to gauge what is a good number. (Note: the PA would only be seeing my follow ups).
 

asmallchild

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Can anyone else share their experiences with % collections from PAs? I had an offer from a PE-backed group for 6% (revised up from 0 after I said wtf), and another offer of 30% of PA collections from a different practice. I have no way to gauge what is a good number. (Note: the PA would only be seeing my follow ups).
Everyone will view this differently but I wouldn't look at it from a financial viewpoint. Whatever the percentage is, it should pale in comparison to your compensation and should be viewed as the cherry on top instead of a real revenue generator for you. (That being said, I wouldn't seriously entertain a job offer from a PE-backed group foolish enough to offer me 0% to supervise a midlevel.....)

Instead, I would see if the midlevel makes your life easier. Is this someone with experience? I've worked with fresh out of school midlevels and even if I got 50% of their collections, it wouldn't make up for the disruption it caused to my clinic by having to constantly step-in and hold their hands.

As Mohs_01 alluded to, is there some sort of secondary gain? At a prior gig, I supervised multiple midlevels and that allowed me to run an all-Mohs schedule. The difference in revenue between my old schedule and new schedule far eclipsed any collection % I got for supervising the PAs (although obviously, I still insisted on something for overseeing them).
 

doctalaughs

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PAs should be seeing warts and acne. They aren’t qualified to really do more — unless you structure them to just do the biopsies you point at.

Best structure is that they allow you to see 60 patients instead of 35 (assuming you get all that money minus the overhead) and see some of their own Low-low risk stuff. Never forget that the biggest mismanagement on your license usually arises from the skin check.

I realize that most employment gigs don’t allow you to structure them like that. It’s a shame cause the PE execs certainly aren’t the ones taking their liability.
 
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sb247

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I have interviewed with a large multspecialty private group that had dermatologists. The practice group wide was any midlevel hired was the sole profit/expense of the doc that wanted them. They were billed a share of the overhead and all the rvus they generated got credited to the doc who was then responsible to pay the midlevel out of their own money. That’s likely a rare situation
 
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doctalaughs

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I have interviewed with a large multspecialty private group that had dermatologists. The practice group wide was any midlevel hired was the sole profit/expense of the doc that wanted them. They were billed a share of the overhead and all the rvus they generated got credited to the doc who was then responsible to pay the midlevel out of their own money. That’s likely a rare situation
That is the best situation. Our practice (single specialty) is similar. Also the doc supervising the midlevel is their boss. They are taking the liability — they have rights to hire or to fire that PA.
 
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I have interviewed with a large multspecialty private group that had dermatologists. The practice group wide was any midlevel hired was the sole profit/expense of the doc that wanted them. They were billed a share of the overhead and all the rvus they generated got credited to the doc who was then responsible to pay the midlevel out of their own money. That’s likely a rare situation
It is like that for every specialty (not only derm) in that private group?
 

sore eye asses

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As an employed physician in private equity you may be asked to supervise a PA and likely you will have no part in the hiring process. You will take the liability. You will not be their boss. And you will be paid substantially less than 10%. I’m not aware of any PE MD being compensated 10% of PA collections. The norm would be closer to 5%. PAs are revenue generating and will often be given preference over MDs in scheduling and treatment. Especially if they’ve been with the practice for years. The best analogy that I can think of is imagine how a hospital values and treats a floor nurse who’s been with the company for 20 years versus a new intern.
 

kwyjibo

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As an employed physician in private equity you may be asked to supervise a PA and likely you will have no part in the hiring process. You will take the liability. You will not be their boss. And you will be paid substantially less than 10%. I’m not aware of any PE MD being compensated 10% of PA collections. The norm would be closer to 5%. PAs are revenue generating and will often be given preference over MDs in scheduling and treatment. Especially if they’ve been with the practice for years. The best analogy that I can think of is imagine how a hospital values and treats a floor nurse who’s been with the company for 20 years versus a new intern.
Five percent would have been an improvement in my case. The PE group offered a flat 7k per mid level supervised. Mind you the mid levels at this practice collect anywhere from 500k to 700k+ per year.
 
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doctalaughs

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Five percent would have been an improvement in my case. The PE group offered a flat 7k per mid level supervised. Mind you the mid levels at this practice collect anywhere from 500k to 700k+ per year.
That’s just insulting and ridiculous. I don’t see why any Derm would take that deal for the liability, but suspect it’s an “unstated” condition of employment?

When I supervised 2 PAs probably made about 75-100k off each one per year. But at this point, I don’t supervise anymore, even though some of my partners do. The truth is, warts and acne is probably generous — I’ve seen verrucous carcinoma being treated as “warts” and cutaneous lupus mismanaged as acne for years, both situations by midlevels.... sad (for the patients).
 

sore eye asses

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Let’s drop PA-C. I suggest the more accurate professional designation for PAs is PA-DK. This nicely captures the universal Dunning-Kruger effect that permeates their ranks.

“The PA was sooooo nice”

yeah, nice enough to let you go partially blind with cicatricial pemphigoid while treating you for “ocular rosacea” for 3 years.
 
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