Partnership track and buy-in of $900K

[92122]

There are several groups offering partnership tracks where one takes the same call and does the same amount of regular-day work as the partners. The compensation for partners is ~$600K, while those in the track make ~300K for each of the three years in that status.

I tend to look somewhat askance at this situation given the high likelihood of instability once Obamacare hits next year. It seems that unless a person is absolutely amazing in their position, they may very well get cut in favor of another three-year partnership track sucker.

Is my view overly pessimistic or are you ladies and gentlemen feeling similarly at this juncture?

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[Mman]

There are several groups offering partnership tracks where one takes the same call and does the same amount of regular-day work as the partners. The compensation for partners is ~$600K, while those in the track make ~300K for each of the three years in that status.

I tend to look somewhat askance at this situation given the high likelihood of instability once Obamacare hits next year. It seems that unless a person is absolutely amazing in their position, they may very well get cut in favor of another three-year partnership track sucker.

Is my view overly pessimistic or are you ladies and gentlemen feeling similarly at this juncture?

Anything can happen. I'd suggest asking them how many "partnership track" docs they've had that didn't make partner. Has it ever happened? Does it always happen? What time frame do they give you notice of partner status?

Nothing is a given. I'd get a feel for the likelihood of becoming partner at that job and then look at it as 300K/year with x% chance of being partner afterwards. But given the high likelihood of instability, their partner income may very well be much less 3 years from now.

 

[92122]

"But given the high likelihood of instability, their partner income may very well be much less 3 years from now."

That's the biggest concern IMHO. You lose nearly a million up front and your reward is making perhaps $100K more as a partner.

 

[Mac4]

It is all about demand and supply. The offers sound pretty decent if this is in a big city with desirable weather.

 

[NOTJOHN]

It is all about supply and demand. The demand is low now and supply is high. If you start asking probing questions they will move forward with another candidate. Be careful out there.

 

[imfrankie]

I didn't, wouldn't do it. In addition to the very real financial uncertainty, I want to like and respect my partners. If they are making 6+ they are working very hard--that means you are going to work very hard for half. How does that make you feel?

 

[Idiopathic]

"But given the high likelihood of instability, their partner income may very well be much less 3 years from now."

That's the biggest concern IMHO. You lose nearly a million up front and your reward is making perhaps $100K more as a partner.

wait so its a 900K buy in AND 300K less a year on the track? or are you equating the "lost" million with the difference between partner and non-partner compensation. because thats not really a million lost, unless you are turning down a 600K job to take this one, which i doubt.

i think you look at it like a job making 300 with a chance to be partner, especially if you like the area and the group. Like Mman said.

 

[Frank Rizzo]

Anything can happen. I'd suggest asking them how many "partnership track" docs they've had that didn't make partner. Has it ever happened? Does it always happen? What time frame do they give you notice of partner status?

As above. One of the most important things you can ask. If they have a history of screwing people over, or won't answer the question, then move on.

Whats the group like? Is it "THE" group everybody wants to work for in the city? If so, than they do this because they can, and that is not necessarily a bad thing. Don't roll your eyes at 300K/yr either.

 

[dhb]

If you can get 450 elsewhere i wouldn't do it, if you can't find better you could try, if you are certain that they are legit and will not kick you out in your third year then you could try.
There are plenty of other factors that need to be taken into account: is it a place you really want to live in durability of the group , local competition town stability/population, what's the quality of life of the partners hours worked vacation etc...

 

[Mman]

"But given the high likelihood of instability, their partner income may very well be much less 3 years from now."

That's the biggest concern IMHO. You lose nearly a million up front and your reward is making perhaps $100K more as a partner.

Some assumptions:

1) the 300K per year is take home gross salary not including benefits like health and malpractice

2) the partners 600K is gross including benefits, their actual salary is likely lower

3) you only "lose" that amount if their partner income is unchanged all 3 years. If it's lower next year and the year after that, the nonpartner salary becomes very close to the partner salary and the difference is negligible.

4) if the partner income doesn't drop at all, you've worked 3 years for a decent salary and are now a partner in a lucrative practice

 

[imfrankie]

What would the partners be earning for the same amount of work if they weren't making money off underlings?

 

[sevoflurane]

How many have made partnership in the last 5 years? What happened to those who didn't make it? Can you contact them? Is the WAIT worth it? Obamacare is coming down the line. Will your reimbursement drop 20% over the next 3 years as you are making partner?
If you get canned can you collect ALL of your receivables? Are you in a stage in your life you can make this move and not look back? What is your risk tolerance? Lots of questions.

Bottom line, you are taking a chance with a three year partnership. If it works out, then you are golden. If it doesn't, you lost some time and money... but it's not the end of the world.

A buddy made his 2 year partnership in AZ last year (after leaving a job that made him 450K in Oregon). He started with 2 other new recruits. Both of them got canned right before partnership and my buddy made partnership... sweating bullets the last 3 months.
That is one in three for that group.

 

[imfrankie]

Ouch. Only good enough to do cases for a year and three-quarters.

 

[deleted126335]

There are several groups offering partnership tracks where one takes the same call and does the same amount of regular-day work as the partners. The compensation for partners is ~$600K, while those in the track make ~300K for each of the three years in that status.

I tend to look somewhat askance at this situation given the high likelihood of instability once Obamacare hits next year. It seems that unless a person is absolutely amazing in their position, they may very well get cut in favor of another three-year partnership track sucker.

Is my view overly pessimistic or are you ladies and gentlemen feeling similarly at this juncture?

Personal prediction: There will be islands of prosperity in a sea of mediocrity for a long while. There is no magic reliable data point that a prospective partnership track doc can use to evaluate if this will be one of those islands. One question that I would definitely ask: Are all partners equal? Are there any seniority base benefits or rights? If you are a true equal after achieving partnership, this position is worth serious consideration. Also agree with asking about previous docs who may not have made partner.

 

[92122]

I called the projected buy-in the difference between what a partner makes and the earnings of a salaried track person. In this case, it is about $300K.

Someone mentioned that the partners might actually get less due to their having to pay their own benefits, etc. That is true--they said benefits were about $70K, making the difference $230K/year.

There were a few people added to the roster lately. One just made partner; the other two are at various stages in the process.

They did not list any people who weren't made partner in recent times.

 

[Mman]

I called the projected buy-in the difference between what a partner makes and the earnings of a salaried track person. In this case, it is about $300K.

Someone mentioned that the partners might actually get less due to their having to pay their own benefits, etc. That is true--they said benefits were about $70K, making the difference $230K/year.

There were a few people added to the roster lately. One just made partner; the other two are at various stages in the process.

They did not list any people who weren't made partner in recent times.

So after taxes you probably take him about 180K per year (though I don't know your state obviously and the partners probably take home around 310K per year making the difference about 130K per year after taxes. 10K per month difference roughly for 3 years. Relevant questions:

1) what are the odds you'd be made partner?
2) what other jobs are you potentially giving up to take this?
3) how is reimbursement going to change their partner income over the next 3+ years?

#1 sounds like it's reasonably high chance
#2 is up to you
#3 nobody knows but it'll probably slowly decline

 

[IlDestriero]

I've seen worse.

 

[aneftp]

I think you need to look at the benefits very closely.
1. As a W2, you will not have any write offs. Will the group contribute handsomely to your retirement package. You can still defer 17-18K was W2. But some groups will throw in 32K into retirement for max of 50K into your retirement plan.

2. Look at the health insurance cost. If you have a family of 4, many "small groups" do not subsidize your family at all. They will subsdiize you by 60-70%. But won't subsidize your family members.

How much does health care cost? With Obamacare, since the group probably qualifies for exemption for having less than 50 employees, they will do whatever they want and not abide by the ACA.

Vermont, Maryland already came out with their projections. A single person age 30 usualy wouldn't pay more than $100-120/month with a $2500 deductible in 2013. In 2014, that same 30 year old will have to pay $300 a month.

What about a family of 4. Many pay $600-800/month with a $5000-7000 deductible in 2013.In 2014, a family of 4 will pay between $1300-1700 a month in premiums plus a $5000 dedudctible.

Because as an attending you will make more than 400% of poverty (40K for single/90k for family of 4). You will get zero in subsidies.

You are talking close to 15-20K in health premiums you will be required to pay out of pocket if the group's coverage doesn't cover your family plus the deductible.

The ACA is so F up. It makes women who already have hysterectomies carry maternity coverage. That's why the cost skyrocket for people who make over 400% of poverty line.

They want you to have the same type of coverage a university hospital provides its W2 employees but since you will work for an employer with less than 50 employees, you are S up the creek.

3. Last, look at the tail coverage. If you work 3 years as W2 with intend to become a partner. If group doesn't make you partner, would pays the tail? The tail is usually 2.5X your last premium. If you last year's premium is $12K. You tail will be close to 30K. Who pays that $30K tail if you aren't partner.

Add up the numbers. Add up the benefits and see if 300K is a true number.

Health care costs will become a more signficant topic with total "benefits". Paying 20k a year for a family of 4 before the deductible is a lot of money for most people.

 

[Baller MD]

How many have made partnership in the last 5 years? What happened to those who didn't make it? Can you contact them? Is the WAIT worth it? Obamacare is coming down the line. Will your reimbursement drop 20% over the next 3 years as you are making partner?
If you get canned can you collect ALL of your receivables? Are you in a stage in your life you can make this move and not look back? What is your risk tolerance? Lots of questions.

Bottom line, you are taking a chance with a three year partnership. If it works out, then you are golden. If it doesn't, you lost some time and money... but it's not the end of the world.

A buddy made his 2 year partnership in AZ last year (after leaving a job that made him 450K in Oregon). He started with 2 other new recruits. Both of them got canned right before partnership and my buddy made partnership... sweating bullets the last 3 months.
That is one in three for that group.

I'm only a med. student but reading this made me very upset for those 2 who didn't get partnership even though I'm sure they went through a lot just to not get much in the end.

Am I wrong to feel that the way recent trends in Anesthesiology - specifically the spread of AMC and anesthesiologists becoming employees instead of jumping through the hoops for partnership - might be a good thing to a certain extent? I mean, after going through residency and fellowship and garnering tons of debt (more of a problem for current students and residents), is it too much to ask for a decent starting salary? There are even other attendings on this board that blame the current system of old attendings being greedy as hell and taking a huge chunk of the money from newcomers. Personally, I don't want to work my ass off for someone else's comfort. I would much rather have a decent starting salary that is stable throughout my career rather than working my ass off for partnership with no guarantees even if it means making a little bit more in the end.

 

[Arch Guillotti]

Am I wrong to feel that the way recent trends in Anesthesiology - specifically the spread of AMC and anesthesiologists becoming employees instead of jumping through the hoops for partnership - might be a good thing to a certain extent? I mean, after going through residency and fellowship and garnering tons of debt (more of a problem for current students and residents), is it too much to ask for a decent starting salary? There are even other attendings on this board that blame the current system of old attendings being greedy as hell and taking a huge chunk of the money from newcomers. Personally, I don't want to work my ass off for someone else's comfort. I would much rather have a decent starting salary that is stable throughout my career rather than working my ass off for partnership with no guarantees even if it means making a little bit more in the end.

I imagine it stinks when you get sold out to an AMC and don't get a payday. I think it stinks even worse to see someone else profit from your hard work without much work on their end. I think a relatively satisfactory medium is working for a reasonable amount of time and then making partner. Unfortunately practices like this seem to be going by the wayside and there will always be risk involved.

 

[etomidator3]

What do most of these practices do about tail coverage?

 

[Mman]

I'm only a med. student but reading this made me very upset for those 2 who didn't get partnership even though I'm sure they went through a lot just to not get much in the end.

Am I wrong to feel that the way recent trends in Anesthesiology - specifically the spread of AMC and anesthesiologists becoming employees instead of jumping through the hoops for partnership - might be a good thing to a certain extent? I mean, after going through residency and fellowship and garnering tons of debt (more of a problem for current students and residents), is it too much to ask for a decent starting salary? There are even other attendings on this board that blame the current system of old attendings being greedy as hell and taking a huge chunk of the money from newcomers. Personally, I don't want to work my ass off for someone else's comfort. I would much rather have a decent starting salary that is stable throughout my career rather than working my ass off for partnership with no guarantees even if it means making a little bit more in the end.

If you are working for an AMC as an employee, your salary (starting and the rest of your career) will be less than those partnership track anesthesiologists. that's the way it is. Instead of the partners making money off them, it's a faceless corporation. The only difference with the partners is that they eventually let you in on the gig and then you are set. The faceless corporation will never let you in on it. You'll be a low level employee the duration of your career.

 

[aneftp]

If you are working for an AMC as an employee, your salary (starting and the rest of your career) will be less than those partnership track anesthesiologists. that's the way it is. Instead of the partners making money off them, it's a faceless corporation. The only difference with the partners is that they eventually let you in on the gig and then you are set. The faceless corporation will never let you in on it. You'll be a low level employee the duration of your career.

Incorrect. I know many partnership tracks starting people out in the low 200s these days. Some are even going in the high 100s. 3 year partnership track. Parters make 500s. No tail provided. Another group takes 20, 15% and than 10% cut plus 5% billing each year.

Yet similar AMC pays 270k for non boarded and 300k for boarded with occurrence.

I am not pro AMC. I am not pro partnership. I have been independent doing 1099 work most of my career and done quite well. Some of it my own billing. Sure it's not stable. But nothing is stable these days.

My sister and a few other people I know very well have been burned very badly by "partnership tracks". Like losing 1 million plus.

Another friend was in 5 year partnership and group sold out to AMC in year 4.5 of his partnership track. Each full partner took over a 7 figure buyout. He was given chump change $200k as a courtesy.

Look at the track record of the partnership track. Look at it closely. Ask
Questions of these message boards or PM members for advice.

Gotta warn u guys. Finance guys are getting into the anesthesia business. Goldman Sachs just got into the anesthesia business last week.
http://www.businesswire.com/news/ho...te-Anesthesia-Pain-Solutions-LLC-Announcement

HIG Capital. A hedge fund has been buying up surgery centers and calling themsleves Surgery Partners. They are using the OIG ruling last year to try to get into the anesthesia business themsleves

Anesthesia has become a slimy business. Medicine is a business. Remember that. Partnership tracks are a business. One can get screwed if one doesn't do their research.

 

[ProRealDoc]

Incorrect. I know many partnership tracks starting people out in the low 200s these days. Some are even going in the high 100s. 3 year partnership track. Parters make 500s. No tail provided. Another group takes 20, 15% and than 10% cut plus 5% billing each year.

Yet similar AMC pays 270k for non boarded and 300k for boarded with occurrence.

I am not pro AMC. I am not pro partnership. I have been independent doing 1099 work most of my career and done quite well. Some of it my own billing. Sure it's not stable. But nothing is stable these days.

My sister and a few other people I know very well have been burned very badly by "partnership tracks". Like losing 1 million plus.

Another friend was in 5 year partnership and group sold out to AMC in year 4.5 of his partnership track. Each full partner took over a 7 figure buyout. He was given chump change $200k as a courtesy.

Look at the track record of the partnership track. Look at it closely. Ask
Questions of these message boards or PM members for advice.

Gotta warn u guys. Finance guys are getting into the anesthesia business. Goldman Sachs just got into the anesthesia business last week.
http://www.businesswire.com/news/ho...te-Anesthesia-Pain-Solutions-LLC-Announcement

HIG Capital. A hedge fund has been buying up surgery centers and calling themsleves Surgery Partners. They are using the OIG ruling last year to try to get into the anesthesia business themsleves

Anesthesia has become a slimy business. Medicine is a business. Remember that. Partnership tracks are a business. One can get screwed if one doesn't do their research.

I could not agree more. My recommendation to graduating residents and fellows is to look for a job that will net you the most from the get-go. Build those cash reserves, invest into an income-generating endeavor and as JPP says, get rid of your debt.

The future is very uncertain in medicine and if the Wall Street peeps are eyeballing our business, that's a bad deal all around for us.

 

[Mman]

Incorrect. I know many partnership tracks starting people out in the low 200s these days. Some are even going in the high 100s. 3 year partnership track. Parters make 500s. No tail provided. Another group takes 20, 15% and than 10% cut plus 5% billing each year.

Yet similar AMC pays 270k for non boarded and 300k for boarded with occurrence.

I am not pro AMC. I am not pro partnership. I have been independent doing 1099 work most of my career and done quite well. Some of it my own billing. Sure it's not stable. But nothing is stable these days.

My sister and a few other people I know very well have been burned very badly by "partnership tracks". Like losing 1 million plus.

Another friend was in 5 year partnership and group sold out to AMC in year 4.5 of his partnership track. Each full partner took over a 7 figure buyout. He was given chump change $200k as a courtesy.

Look at the track record of the partnership track. Look at it closely. Ask
Questions of these message boards or PM members for advice.

Gotta warn u guys. Finance guys are getting into the anesthesia business. Goldman Sachs just got into the anesthesia business last week.
http://www.businesswire.com/news/ho...te-Anesthesia-Pain-Solutions-LLC-Announcement

HIG Capital. A hedge fund has been buying up surgery centers and calling themsleves Surgery Partners. They are using the OIG ruling last year to try to get into the anesthesia business themsleves

Anesthesia has become a slimy business. Medicine is a business. Remember that. Partnership tracks are a business. One can get screwed if one doesn't do their research.

Here's the thing, though, I can give you contrasting anecdotal stories. I know partnership gigs paying people 300K plus excellent benefits that have never cut somebody out before making partner and I know AMCs barely offering 200K and crappy benefits with little job security.

The devil is in the details.

The only thing that is certain is that the transitioning of private practices to AMCs is bad for physicians incomes long term. Once we are all working for them, nobody will make any money and we will just be widgets in a big machine. That is their ultimate goal.

That's why people need to ask the tough questions when interviewing for jobs. Weed out the crap ones from the good ones.

 

[jbabock]

I would worry more about making sure you are relatively close to friends and family. IMHO, those factors eventually trump everything else.

 

[aneftp]

Here's the thing, though, I can give you contrasting anecdotal stories. I know partnership gigs paying people 300K plus excellent benefits that have never cut somebody out before making partner and I know AMCs barely offering 200K and crappy benefits with little job security.

The devil is in the details.

The only thing that is certain is that the transitioning of private practices to AMCs is bad for physicians incomes long term. Once we are all working for them, nobody will make any money and we will just be widgets in a big machine. That is their ultimate goal.

That's why people need to ask the tough questions when interviewing for jobs. Weed out the crap ones from the good ones.

While I agree with you that transitioning to AMCs (not just anesthesia, but EM, Rads etc). Others like Cardiology and IM are selling out to become hospital employees. It's a trend that's accelerated the past 4-5 years.

But physicians do it to themselves. What's worse? A larger anesthesia group just "stole" my friends exclusive surgery center contract from right under him. They went to the hospital administrators (since hospital owns the surgery center 51/49% partnership with surgeons). The surgeons were out voted by hospital admin. Than offered to "hire him" back at 60% of what he was earning doing his own billing.

Or the AMC stealing his contract and doing the same?

Who's in the wrong? They both are. This is capitalism. And this is why half of America is pissed off at the health care system. In the end, the only thing that can save physicians is gulp.....single payer or some type of national insurance to remove all the middle guys. Than we be dealing with the government as our headaches. Like UK physicians threatening to go on strike or Canadian physicians demanding the government raise reimbursements.

In case you haven't realized it. Some local anesthesia groups in many regions of the country have become de facto AMCs themselves and expanding.

Unfortunately this is a trend (either more AMCs, super groups that become AMCs, or just plain hospital employees.). This is a trend that's become more prevalent.

 

[Mman]

While I agree with you that transitioning to AMCs (not just anesthesia, but EM, Rads etc). Others like Cardiology and IM are selling out to become hospital employees. It's a trend that's accelerated the past 4-5 years.

But physicians do it to themselves. What's worse? A larger anesthesia group just "stole" my friends exclusive surgery center contract from right under him. They went to the hospital administrators (since hospital owns the surgery center 51/49% partnership with surgeons). The surgeons were out voted by hospital admin. Than offered to "hire him" back at 60% of what he was earning doing his own billing.

Or the AMC stealing his contract and doing the same?

Who's in the wrong? They both are. This is capitalism. And this is why half of America is pissed off at the health care system. In the end, the only thing that can save physicians is gulp.....single payer or some type of national insurance to remove all the middle guys. Than we be dealing with the government as our headaches. Like UK physicians threatening to go on strike or Canadian physicians demanding the government raise reimbursements.

In case you haven't realized it. Some local anesthesia groups in many regions of the country have become de facto AMCs themselves and expanding.

Unfortunately this is a trend (either more AMCs, super groups that become AMCs, or just plain hospital employees.). This is a trend that's become more prevalent.

I agree that trend is undeniable and there are lots of parties to blame. Single payer system would be a disaster in this country IMHO.

 

[repititionition]

I agree that trend is undeniable and there are lots of parties to blame. Single payer system would be a disaster in this country IMHO.

Respectfully, why?

 

[aneftp]

Respectfully, why?

There are 2 ways this country (or at least the liberals want for to go)

1. They want something like Medicare which is single payer for most elderly people. We all know now low Medicare reimburses.

2. Social healthcare system like the VA. Docs are paid below average. Have little incentive be more efficient but also protects VA docs from lawsuits. So they tend to order less test. Less surgery. .

 

[Mman]

Respectfully, why?

Our government is terrible at administering anything. A single payer health care system would be more complicated than almost the rest of the government combined. Can you imagine things like what the age cutoff for kidney transplant being debated in House subcomittee? Or what % cut we will make for xxx CPT code this year? It'd be complete and utter chaos and would lead to a lower level of care provided to the majority of Americans than they currently receive.

 

[BLADEMDA]

I agree that trend is undeniable and there are lots of parties to blame. Single payer system would be a disaster in this country IMHO.

I'm a Conservative. I vote Republican. I'm no fan of Obama. I donate to the GOP.
I'm a Believer in Jesus Christ as Lord and Savior. Get the idea?

So, It isn't easy for me to say this but single payer is probably better than our current system which is neither free market or fully Socialized like Canada. I prefer free market 100% but I'm going to get Medicare for all.

Obama might be an old man (or at least 65) before he gets his Canadian style health care system in the USA but he will get it.

The ACA (Ayn Rand would be laughing out loud at the oxymoron use of that name) bleeds the Upper middle class American taxpayer dry while subsidizing the poor and the lazy. These days it is hard to tell the difference between poor and lazy since we reward the lazy with so many benefits. Obama knows the ACA leads to a single payer. Every Liberal Democrat knows it as well. The idea is to create a healthcare system which collapses due to cost over time. While this may take 10-20 years Obama knows the eventual outcome.

This means that the current system is in its last days. Look at the real estate market in 2007. Wall Street thought the housing boom and no down payment loans would never end. They were wrong then just as these investors are wrong now about buying up groups.

A resident graduating today should look at the value or cost of about 6-8 years of his/her time in a group. If over 6 years you make more money in a track then go for it. But, if the track requires 7-8 years to break even compared to an "employment" position then pass on the offer and be an employee.

 

[aneftp]

I'm a Conservative. I vote Republican. I'm no fan of Obama. I donate to the GOP.
I'm a Believer in Jesus Christ as Lord and Savior. Get the idea?

So, It isn't easy for me to say this but single payer is probably better than our current system which is neither free market or fully Socialized like Canada. I prefer free market 100% but I'm going to get Medicare for all.

Obama might be an old man (or at least 65) before he gets his Canadian style health care system in the USA but he will get it.

The ACA (Ayn Rand would be laughing out loud at the oxymoron use of that name) bleeds the Upper middle class American taxpayer dry while subsidizing the poor and the lazy. These days it is hard to tell the difference between poor and lazy since we reward the lazy with so many benefits. Obama knows the ACA leads to a single payer. Every Liberal Democrat knows it as well. The idea is to create a healthcare system which collapses due to cost over time. While this may take 10-20 years Obama knows the eventual outcome.

This means that the current system is in its last days. Look at the real estate market in 2007. Wall Street thought the housing boom and no down payment loans would never end. They were wrong then just as these investors are wrong now about buying up groups.

A resident graduating today should look at the value or cost of about 6-8 years of his/her time in a group. If over 6 years you make more money in a track then go for it. But, if the track requires 7-8 years to break even compared to an "employment" position then pass on the offer and be an employee.

I share many of your sentiments.

The problem I see for physicians in the USA is the public for the most part see us as "public servants". While they want us to make a good income. Their idea of a good income is around 150-200K.

Yet we have many executive government secretaries like one Linda Tripp (aka Bill Clinton Scandal) making over 100K plus government benefits. Heck my wife's college roommate with a BA in psych makes over 100K as a government defense contractor.

The public doesn't understand that physicians incomes as a percentage of total health care spending is less than 9% these days. Only the UK spends less on doctors incomes as a percentage of health care dollars as the US. Germany spends 14% of their dollars on physician income.

When I was in med school in the mid 1990-late 90s, physician income made up 17% of total health spending.

Even accounting for physicians who own their own practices and collect facility fees. The max you are looking at physician income is probably around 12-13%. Because those facility fees have to pay for overhead.

We all know where the problem with health care lies. It's all the middle guys. The big pharma. Hospitals, AMCs, insurance. Some insurance claim on a 2-5% profit margin. It's hard to imagine that number because of the big bonus's they pay to their executives. We know how business manipulate profits.

I think you will see a tremendous pressure downward on physician incomes especially specialists. It will get to the point where the public still won't get it. They still don't get the true players in healthcare. It's not the docs running the show.

 

[bigeyedfish]

This thread really highlights for the med studs and the residents the kinds of decisions and considerations they'll have to make in the job market once they get out. Of course these decisions aren't made in a vacuum and the track that is a wise decision today may not be the right way to go 5 or 10 years from now. No one can predict the future but clearly the trend is toward physicians being employed by someone, whether that someone is a large group that doesn't accept partners, a hospital, a management corporation etc.

I think the partner ship track described is not the best I've ever heard. But it's for sure not the worst. I've talked to people who've been offered 180k for 3 years. OP, do some reconisence but if you can't find any dirt in this group and the location is ideal for you I'd go for it.

Convetional wisdom is there is 1: the job you want 2: the pay you want and 3: the location you want

Don't expect to get all 3. Two out of three is something to be happy with.

 

[anes121508]

Wanted to bump this thread to ask what you guys/gals consider to be a fair buy in to a group These days.

Let’s make it simple and say 100% guarantee u become partner, partner salary is at least what it is today as it is in the future, and 0% chance of buy out, and workload / vacation / call is evenly split amongst all partners and non partners.

How do you evaluate a buy in? For example 500k x3 years for partner track and partners make 600 sounds obviously good. On the flip side, making 275 x 10 years and partner pay is 400 sounds pretty bad. Besides the extremes, what’s the typical fair buyin?

 

[nimbus]

0-20% x 1-3yrs

 

[Mr.S]

Wanted to bump this thread to ask what you guys/gals consider to be a fair buy in to a group These days.

Let’s make it simple and say 100% guarantee u become partner, partner salary is at least what it is today as it is in the future, and 0% chance of buy out, and workload / vacation / call is evenly split amongst all partners and non partners.

How do you evaluate a buy in? For example 500k x3 years for partner track and partners make 600 sounds obviously good. On the flip side, making 275 x 10 years and partner pay is 400 sounds pretty bad. Besides the extremes, what’s the typical fair buyin?

I like to keep things simple when it comes down to these situations.
IM either 100% your partner on day 1 or I am not.

If I am not 100 % your partner on day 1 in anesthesia. I have to believe pretty much i am getting screwed.
Any situation where there is no production incentive, guess who will working and who wont
any situation where it is not entirely transparent. You are getting hosed. How badly? That is anybody's guess!

hey, it could be worse i guess but thats the long and short of it.

 

[AdmiralChz]

I like to keep things simple when it comes down to these situations.
IM either 100% your partner on day 1 or I am not.

If I am not 100 % your partner on day 1 in anesthesia. I have to believe pretty much i am getting screwed.
Any situation where there is no production incentive, guess who will working and who wont
any situation where it is not entirely transparent. You are getting hosed. How badly? That is anybody's guess!

hey, it could be worse i guess but thats the long and short of it.

Then I guess you can just about 100% rule out private practice?

 

[Man o War]

I like to keep things simple when it comes down to these situations.
IM either 100% your partner on day 1 or I am not.

If I am not 100 % your partner on day 1 in anesthesia. I have to believe pretty much i am getting screwed.
Any situation where there is no production incentive, guess who will working and who wont
any situation where it is not entirely transparent. You are getting hosed. How badly? That is anybody's guess!

hey, it could be worse i guess but thats the long and short of it.

But why should you, I, or anyone else be able to just waltz in with equal parity on day 1 having done zero work when these guys/gals have built the business to what it is? Some of them started the practice from zero, took out loans to pay people before AR started rolling in, sat through numerous painful contract negotiations, the list goes on and on.....
I don’t know a single industry that works that way and I’m confused why doctors think they’re special and entitled to that?

 

[anes121508]

But why should you, I, or anyone else be able to just waltz in with equal parity on day 1 having done zero work when these guys/gals have built the business to what it is? Some of them started the practice from zero, took out loans to pay people before AR started rolling in, sat through numerous painful contract negotiations, the list goes on and on.....
I don’t know a single industry that works that way and I’m confused why doctors think they’re special and entitled to that?

Agree, so there has to be some respect for those who have more experience and have built the relationships. It’s obviously a balance though. I guess you could argue buy in should vary depending on value and stability of group and somewhat dependent on the market? Hard to put a number on I guess.

 

[Mr.S]

But why should you, I, or anyone else be able to just waltz in with equal parity on day 1 having done zero work when these guys/gals have built the business to what it is? Some of them started the practice from zero, took out loans to pay people before AR started rolling in, sat through numerous painful contract negotiations, the list goes on and on.....
I don’t know a single industry that works that way and I’m confused why doctors think they’re special and entitled to that?

The list doesn't go on and on. The list doesn't even go. Built what practice? Anesthesia practice? The practice was given to you by the hospital.
If you want to compete with me, I will compete. And I will WIN. But, I am not allowed to compete because of exclusivity of the contract.
This isnt a dental practice where it truly is built.

 

[sevoflurane]

I had a 2 year buy-in. 120k.
Would not go much beyond this if AMCs are still buying up practices.

 

[Mr.S]

Then I guess you can just about 100% rule out private practice?

Not really, but going in with eyes wide open will help immensely

 

[sevoflurane]

Definitely pp groups that get you equal income level on day one. Maybe not voting rights.

 

[Man o War]

The list doesn't go on and on. The list doesn't even go. Built what practice? Anesthesia practice? The practice was given to you by the hospital.
If you want to compete with me, I will compete. And I will WIN. But, I am not allowed to compete because of exclusivity of the contract.
This isnt a dental practice where it truly is built.

It’s clear you’ve never started an anesthesia group and maintained it. I think I’ve told you this before when you were spouting off about average income and “no opportunities for facility buy in anymore for anyone”, so I’ll say it again- you have no idea what you’re talking about here.

 

[Man o War]

Agree, so there has to be some respect for those who have more experience and have built the relationships. It’s obviously a balance though. I guess you could argue buy in should vary depending on value and stability of group and somewhat dependent on the market? Hard to put a number on I guess.

Yes, the number depends on a lot. This is the hardest part of advising/helping residents figure out if they’re getting a fair deal. Sometimes we don’t know all the details or local dynamics. Sometimes we know who the shady PP groups are based on reputation and we can tell them to run.
But if the expectation is totally equal parity on day 1, I would tell them to go work as an employee. That isn’t realistic in general if you want to be a partner in a group.

 

[anes121508]

I had a 2 year buy-in. 120k.
Would not go much beyond this if AMCs are still buying up practices.

Now that you are on the partner end of things , do you guys reevaluate the buyin to match earnings or the market place? I’d imagine as a partner with 20years experience it’s hard to let a new guy in for less than you put in. Also, how was the 120k determined?

 

[anes121508]

I had a 2 year buy-in. 120k.
Would not go much beyond this if AMCs are still buying up practices.

Let’s say AMC is gone and not allowed or you had a guaranteed part of buyout based on percentage of completion of partnership track....how much higher would you go than 120k?

 

[anes121508]

Yes, the number depends on a lot. This is the hardest part of advising/helping residents figure out if they’re getting a fair deal. Sometimes we don’t know all the details or local dynamics. Sometimes we know who the shady PP groups are based on reputation and we can tell them to run.
But if the expectation is totally equal parity on day 1, I would tell them to go work as an employee. That isn’t realistic in general of you want to be a partner in a group.

I realize that’s a hard thing to advise on. That’s why I tried to create an example thy eliminated AMC buyout , eliminated risk of partner pay changing, elinatwd risk of losing contracts, eliminated risk of not making partner and made it a 100% even Steven group other than finances. What’s a starting point in that scenario?

 

[deleted50478]

If it’s a ‘buy-in’ you should get a refund if you don’t become a partner. If you pay 600k for 2/3 of a share in the practice but you end up with 0% of the practice you have been robbed.