Please help evaluate partnership

[timtebowner]

Hi everyone,

I’m having trouble deciding about buying in as a partner to my primary care practice. I’m torn between doing this and leaving for another job. I’m located in the NE outside of a major city.

I currently make 215K working 4 days a week as an employee hours are 8-5 and I’m on call roughly once a week plus one weekend out of every 7 (have to work a few hours on Saturdays on those weekends). I see at least 18+ patients a day, and I frequently have to cover our walk ins clinic (which I dislike doing and can sometimes get very busy).

The buy-in is currently 70K spread over 7 years, and I get part ownership with stock and become entirely revenue based with incentives from an ACO. You get partner status immediately once you start paying in. After meeting with management they’ve basically told me that my income will likely decrease by about 40K for the first 2-3 years before I’m back to where I am as an employee, and before I’m really eligible for any profit sharing because my panel is not big enough yet for that. They showed me some numbers that after the first year I would actually be in a negative balance of almost 200K to the company due to the high expenses of initial buy in, which I guess people chip away at over years time with gainshare bonuses going directly to cutting that down. Some of the docs seem to work an extra day a week to supplement this loss of income, and get out of the negatives more quickly. To me, it doesn't make much sense to work harder for what I am making now as employee. What is the purpose of partnership then?

They tell me as a partner I can make in the upper 200s and maybe even 300 eventually depending on how many patients I see (I think this would require 22-25 patients a day). Some docs make in the 400s if they really, really hustle and work extra.

Once you’re a partner you cover all of your own expenses including your own insurance, paying your RN, disability, etc. There’s no PTO, just up to you if you want to not earn and take time off. They tell me that your overhead is roughly 60% of revenue. My own revenue was roughly 500K this last year because I’m seeing so many 99213s at walk ins.

I’m afraid I’m getting screwed here, and that I’m going to have no choice but to move on. I’ve never heard of someone becoming a partner and making less, even if it is more in the short term and can be made back later.

Please give me some advice if anyone else has had similar prior experiences! Would you recommend buying in or leaving?

Thanks!

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[dozitgetchahi]

Hi everyone,

I’m having trouble deciding about buying in as a partner to my primary care practice. I’m torn between doing this and leaving for another job. I’m located in the NE outside of a major city.

I currently make 215K working 4 days a week as an employee hours are 8-5 and I’m on call roughly once a week plus one weekend out of every 7 (have to work a few hours on Saturdays on those weekends). I see at least 18+ patients a day, and I frequently have to cover our walk ins clinic (which I dislike doing and can sometimes get very busy).

The buy-in is currently 70K spread over 7 years, and I get part ownership with stock and become entirely revenue based with incentives from an ACO. You get partner status immediately once you start paying in. After meeting with management they’ve basically told me that my income will likely decrease by about 40K for the first 2-3 years before I’m back to where I am as an employee, and before I’m really eligible for any profit sharing because my panel is not big enough yet for that. They showed me some numbers that after the first year I would actually be in a negative balance of almost 200K to the company due to the high expenses of initial buy in, which I guess people chip away at over years time with gainshare bonuses going directly to cutting that down. Some of the docs seem to work an extra day a week to supplement this loss of income, and get out of the negatives more quickly. To me, it doesn't make much sense to work harder for what I am making now as employee. What is the purpose of partnership then?

They tell me as a partner I can make in the upper 200s and maybe even 300 eventually depending on how many patients I see (I think this would require 22-25 patients a day). Some docs make in the 400s if they really, really hustle and work extra.

Once you’re a partner you cover all of your own expenses including your own insurance, paying your RN, disability, etc. There’s no PTO, just up to you if you want to not earn and take time off. They tell me that your overhead is roughly 60% of revenue. My own revenue was roughly 500K this last year because I’m seeing so many 99213s at walk ins.

I’m afraid I’m getting screwed here, and that I’m going to have no choice but to move on. I’ve never heard of someone becoming a partner and making less, even if it is more in the short term and can be made back later.

Please give me some advice if anyone else has had similar prior experiences! Would you recommend buying in or leaving?

Thanks!

I’m a rheumatologist in a PP where I was paid all of my ancillaries from day one, as well as a solid base salary and bonuses (and a $1000 buy in). I made mid $500s in my first year at this practice. I see about 18-20 pts a day.

I don’t have time right now to go into lots of details, but frankly this is a **** deal and they are exploiting the hell out of you. From what I’ve read about PCP incomes, you could do way better in a hospital system.

Do not buy into this, and don’t stay. Look elsewhere.

 

[timtebowner]

I’m a rheumatologist in a PP where I was paid all of my ancillaries from day one, as well as a solid base salary and bonuses (and a $1000 buy in). I made mid $500s in my first year at this practice. I see about 18-20 pts a day.

I don’t have time right now to go into lots of details, but frankly this is a **** deal and they are exploiting the hell out of you. From what I’ve read about PCP incomes, you could do way better in a hospital system.

Do not buy into this, and don’t stay. Look elsewhere.

Thank you for your reply, I greatly appreciate it. This is what I continue to hear from everyone I talk to, it's just very disheartening after spending 2 years here.

 

[chessknt]

Thank you for your reply, I greatly appreciate it. This is what I continue to hear from everyone I talk to, it's just very disheartening after spending 2 years here.

Sunk cost fallacy--dont make bad decisions based on something that has already happened that can't be changed.

Do you trust anyone you work with? Can you ask them why the clinic is so poorly run that you can't turn a profit with your current panel? Who owns the clinic--is it MD only ownership, MBAs, hospital, a mix? What are you buying for 70k? Do they own the building or a bunch of equipment of good contracts with something tangible?

Even with 100% medicare, 18 x 4 x $180 (that would probably be low balling by assuming mostly level 4 follow ups and 0 private patients)=13k/week x4=52k/month or 624k/yr assuming 0 ancillary or contract income. Fire the RN, pay an MA 35k/yr (or hire 2 for still less than an RN), your medmal should be ~3-5k/yr, health insurance all over the play but im guessing ~15k/yr--youre still looking at high 400s or 500 there. Your office is poorly run if overhead is 60%--that needs to be fixed asap.

 

[InternistDO]

Hi everyone,

I’m having trouble deciding about buying in as a partner to my primary care practice. I’m torn between doing this and leaving for another job. I’m located in the NE outside of a major city.

I currently make 215K working 4 days a week as an employee hours are 8-5 and I’m on call roughly once a week plus one weekend out of every 7 (have to work a few hours on Saturdays on those weekends). I see at least 18+ patients a day, and I frequently have to cover our walk ins clinic (which I dislike doing and can sometimes get very busy).

The buy-in is currently 70K spread over 7 years, and I get part ownership with stock and become entirely revenue based with incentives from an ACO. You get partner status immediately once you start paying in. After meeting with management they’ve basically told me that my income will likely decrease by about 40K for the first 2-3 years before I’m back to where I am as an employee, and before I’m really eligible for any profit sharing because my panel is not big enough yet for that. They showed me some numbers that after the first year I would actually be in a negative balance of almost 200K to the company due to the high expenses of initial buy in, which I guess people chip away at over years time with gainshare bonuses going directly to cutting that down. Some of the docs seem to work an extra day a week to supplement this loss of income, and get out of the negatives more quickly. To me, it doesn't make much sense to work harder for what I am making now as employee. What is the purpose of partnership then?

They tell me as a partner I can make in the upper 200s and maybe even 300 eventually depending on how many patients I see (I think this would require 22-25 patients a day). Some docs make in the 400s if they really, really hustle and work extra.

Once you’re a partner you cover all of your own expenses including your own insurance, paying your RN, disability, etc. There’s no PTO, just up to you if you want to not earn and take time off. They tell me that your overhead is roughly 60% of revenue. My own revenue was roughly 500K this last year because I’m seeing so many 99213s at walk ins.

I’m afraid I’m getting screwed here, and that I’m going to have no choice but to move on. I’ve never heard of someone becoming a partner and making less, even if it is more in the short term and can be made back later.

Please give me some advice if anyone else has had similar prior experiences! Would you recommend buying in or leaving?

Thanks!

Upper 200s is just normal employed practice pay--this sounds like an awful setup for partnership. I would leave this job--you can get a better setup anywhere in the Northeast even inside one of the giant cities.

 

[dozitgetchahi]

Sunk cost fallacy--dont make bad decisions based on something that has already happened that can't be changed.

Do you trust anyone you work with? Can you ask them why the clinic is so poorly run that you can't turn a profit with your current panel? Who owns the clinic--is it MD only ownership, MBAs, hospital, a mix? What are you buying for 70k? Do they own the building or a bunch of equipment of good contracts with something tangible?

Even with 100% medicare, 18 x 4 x $180 (that would probably be low balling by assuming mostly level 4 follow ups and 0 private patients)=13k/week x4=52k/month or 624k/yr assuming 0 ancillary or contract income. Fire the RN, pay an MA 35k/yr (or hire 2 for still less than an RN), your medmal should be ~3-5k/yr, health insurance all over the play but im guessing ~15k/yr--youre still looking at high 400s or 500 there. Your office is poorly run if overhead is 60%--that needs to be fixed asap.

If it’s like a number of PPs that I either have previously worked for or interviewed at, it’s probably more that the “senior partners” of the practice are scalping everyone else for as much as they can possibly get away with, and lining their pockets in the process.

(Sometimes the practice just doesn’t know how to make money, and business acumen is the problem…but more often, it’s the greed of the people at the top.)

 

[anonperson]

Hi everyone,

I’m having trouble deciding about buying in as a partner to my primary care practice. I’m torn between doing this and leaving for another job. I’m located in the NE outside of a major city.

I currently make 215K working 4 days a week as an employee hours are 8-5 and I’m on call roughly once a week plus one weekend out of every 7 (have to work a few hours on Saturdays on those weekends). I see at least 18+ patients a day, and I frequently have to cover our walk ins clinic (which I dislike doing and can sometimes get very busy).

The buy-in is currently 70K spread over 7 years, and I get part ownership with stock and become entirely revenue based with incentives from an ACO. You get partner status immediately once you start paying in. After meeting with management they’ve basically told me that my income will likely decrease by about 40K for the first 2-3 years before I’m back to where I am as an employee, and before I’m really eligible for any profit sharing because my panel is not big enough yet for that. They showed me some numbers that after the first year I would actually be in a negative balance of almost 200K to the company due to the high expenses of initial buy in, which I guess people chip away at over years time with gainshare bonuses going directly to cutting that down. Some of the docs seem to work an extra day a week to supplement this loss of income, and get out of the negatives more quickly. To me, it doesn't make much sense to work harder for what I am making now as employee. What is the purpose of partnership then?

They tell me as a partner I can make in the upper 200s and maybe even 300 eventually depending on how many patients I see (I think this would require 22-25 patients a day). Some docs make in the 400s if they really, really hustle and work extra.

Once you’re a partner you cover all of your own expenses including your own insurance, paying your RN, disability, etc. There’s no PTO, just up to you if you want to not earn and take time off. They tell me that your overhead is roughly 60% of revenue. My own revenue was roughly 500K this last year because I’m seeing so many 99213s at walk ins.

I’m afraid I’m getting screwed here, and that I’m going to have no choice but to move on. I’ve never heard of someone becoming a partner and making less, even if it is more in the short term and can be made back later.

Please give me some advice if anyone else has had similar prior experiences! Would you recommend buying in or leaving?

Thanks!

You are getting screwed.

There are some super partners who have some bogus titles who are skimming extra money off you.

The buy in is $70k but management says you will be $200k in the hole. How exactly does the math work out for this? Doesn't make sense.

What does partnership even get you? Is there ownership in any actual physical assets like a building or property? The value of a practice is nebulous and isn't worth much anyways.

You can make much more as a PCP elsewhere.

You could even open up your own shop pretty easily and be your own boss.

 

[NewYorkDoctors]

agreed with all points

you could set up your own shop

but again this is not as easily done as it sounds

oh sure buying physical space is fine.
but being a solo practitioner (get PA / NP help eventually) is a bit tough in that if you are not part an IPA then you may not able to get the best insurance rates. you could consider concierge perhaps. moreover how would you attract patients? advertisement would cost quite a bit. how do solo PCPs distinguish himself herself in a crowded market? unfortunately that is to do things that patients want but not need.

 

[timtebowner]

You are getting screwed.

There are some super partners who have some bogus titles who are skimming extra money off you.

The buy in is $70k but management says you will be $200k in the hole. How exactly does the math work out for this? Doesn't make sense.

What does partnership even get you? Is there ownership in any actual physical assets like a building or property? The value of a practice is nebulous and isn't worth much anyways.

You can make much more as a PCP elsewhere.

You could even open up your own shop pretty easily and be your own boss.

Partnership would get me some stock in the company, which I can sell back at retirement (not the most enticing prospect for something that might be 20+ years away). I wouldn't own any physical assets, they rent their spaces.

 

[HemeOncHopeful19]

Partnership would get me some stock in the company, which I can sell back at retirement (not the most enticing prospect for something that might be 20+ years away). I wouldn't own any physical assets, they rent their spaces.

Sounds shady IMO. I did interview with a group that did similar (well relative to Oncology) numbers, but they owned multiple office buildings and you were supposedly building equity in that at least. Their buy-in was also $100.

 

[anonperson]

Partnership would get me some stock in the company, which I can sell back at retirement (not the most enticing prospect for something that might be 20+ years away). I wouldn't own any physical assets, they rent their spaces.

Stock that may or may not be worthless in 20 years.

Who even knows if the practice will exist in is current form.

 

[timtebowner]

Stock that may or may not be worthless in 20 years.

Who even knows if the practice will exist in is current form.

Well theoretically I would at least get my money back, because the company would either buy it back when I retire or they'd be acquired and have to pay me whatever the shares cost at their acquisition price (or whatever percent I've paid in at that time if there is an acquisition).

 

[dozitgetchahi]

Well theoretically I would at least get my money back, because the company would either buy it back when I retire or they'd be acquired and have to pay me whatever the shares cost at their acquisition price (or whatever percent I've paid in at that time if there is an acquisition).

Yeah, but the point is that when push comes to shove, who knows what will happen to those “shares”. The practice could implode, and then the shares are worth nothing. The practice could get bought out, at which point you hope you would get some sort of compensation for them, but given how sketchy the rest of the deal seems to be, who knows. Take it from someone who has been in three PPs, one of which was a scam, one of which imploded, and one of which (my current job) is basically a unicorn job…the best way to approach these “shares” is to assume that they will be worth nothing, and to pay as little to buy into getting them as possible.

If you’re not purchasing part of something concrete - real estate, equipment, whatever - then it’s probably not really worth anything.

 

[HemeOncHopeful19]

Yeah, but the point is that when push comes to shove, who knows what will happen to those “shares”. The practice could implode, and then the shares are worth nothing. The practice could get bought out, at which point you hope you would get some sort of compensation for them, but given how sketchy the rest of the deal seems to be, who knows. Take it from someone who has been in three PPs, one of which was a scam, one of which imploded, and one of which (my current job) is basically a unicorn job…the best way to approach these “shares” is to assume that they will be worth nothing, and to pay as little to buy into getting them as possible.

I’m curious if your opinion would change if they were building equity in the building… asking for a friend

 

[dozitgetchahi]

I’m curious if your opinion would change if they were building equity in the building… asking for a friend

Only slightly.

The problem with owning “part of a building” is that there are a litany of associated issues that nobody talks about. Maintenance? Insurance? Who buys you out when you want to get out?

When I worked in Alabama, the CEO of my sleazy PP (this institution later imploded) went in with a portion of the docs at my practice and a neighboring PP in a “joint venture” to buy a nearby medical building so as to expand. They rushed into buying the building, apparently not doing due diligence…and the building turned out to have a ****load of problems that nobody knew about. So approximately six months after the building was purchased, the CEO approaches everybody and goes “guys…guess what we have to do about $1 million of repairs to this building, it doesn’t even meet code and until we do this we can’t use it as a medical office”.

There were something like 15 people in the JV. Divide out $1 million between 15 people…oh and please make the check out to me later this month.

The people in the JV were freaking livid. I was so happy that I didn’t pay into it.

Ya wanna invest in real estate? Save your money up to buy properties that you actually own and control yourself, not ones where a bunch of other clowns are involved who may or may not be maintaining it properly etc.

 

[InternistDO]

Well theoretically I would at least get my money back, because the company would either buy it back when I retire or they'd be acquired and have to pay me whatever the shares cost at their acquisition price (or whatever percent I've paid in at that time if there is an acquisition).

There is almost no universe where staying at this place is a good decision, unless the senior partners have kidnapped your family in exchange for your labour.

You could be starting a new, better paying job in a few months if you started looking today. You do primary care, you're one of the most in demand careers in the country. You don't get extra points for staying in a crappy job for longer than you need to.

 

[dozitgetchahi]

There is almost no universe where staying at this place is a good decision, unless the senior partners have kidnapped your family in exchange for your labour.

You could be starting a new, better paying job in a few months if you started looking today. You do primary care, you're one of the most in demand careers in the country. You don't get extra points for staying in a crappy job for longer than you need to.

Exactly.

OP, if you’re OK with living in the semi rural Midwest I could hook you up with my multispecialty PP and probably double your income next year. We are looking for outpatient IM/FM docs.

But no joke, you’d almost certainly make $300-400k next year without waiting out a years long buy in or dealing with all this other BS. You’d get ancillary income/bonuses starting after 6 months. Become a partner 1 year in. Buy in is $1000. It’s the most fair and lucrative PP deal I ever found, and I scoured the country looking for it. COL is dirt cheap too.

 

[timtebowner]

Exactly.

OP, if you’re OK with living in the semi rural Midwest I could hook you up with my multispecialty PP and probably double your income next year. We are looking for outpatient IM/FM docs.

But no joke, you’d almost certainly make $300-400k next year without waiting out a years long buy in or dealing with all this other BS. You’d get ancillary income/bonuses starting after 6 months. Become a partner 1 year in. Buy in is $1000. It’s the most fair and lucrative PP deal I ever found, and I scoured the country looking for it. COL is dirt cheap too.

Unfortunately I am tied to either northeast or south Florida due to family, but that does sound like a fantastic deal.