Prelim job offer from ortho group

[painfan]

Large 22 ortho md group
Has 5 spine surgeons

Verbal offer, waiting on draft agreement

Guaranteed base salary 250 k
Benefits (health, retirement, cme etc. )

Bonus potential: 50 % of professional fee collections

Basically

If I bring in less than 500K a year, I take home 250k
I bring in 650k, I take home 325k

Prelim discussion: they are not willing to raise base, maybe flexible on 50% figure

Needless to mention will do cases at physician owned ASC, and I get no portion of facility fee ( the usual "it's against the law" story)

Will appreciate any Feedback?

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[mid|ine]

50% of professional fee? WTF?
Sounds abusive.

 

[painfan]

I wasn't sure how to take it either
Laugh at it
Or take offense

 

[emd123]

I love how anytime anyone posts job offer specifics, we all blow it up like it's the biggest rape job on earth. Lol

Not sure about this one, because my mind is a little too fried from a long day at work after being out a week, to crunch any contract/collections/pay numbers in my head right now.

But it does seem that if you were a Pain guy in a group with 20+ orthos, and 5, count 'em, no less than FIVE spine surgeons, you be busy enough to blow the lid off if 75th-90th%tile MGMA for pain within a couple of years. So they're basically saying 50% of gross collections? Or gross collections minus overhead? Plus beni's, minus beni's? Give more specifics.

 

[Yo GabbaPentin]

Your procedure collections will be relatively low if all injections done in ASC. If no overhead is taken into consideration, then you may be ok. If 50% after overhead, then it's unreasonable. I'd ask for 75% physician fees since they will be making a fortune off of you in facility fees.

 

[Birdstrike]

Error

 

[emd123]

Your procedure collections will be relatively low if all injections done in ASC. If no overhead is taken into consideration, then you may be ok. If 50% after overhead, then it's unreasonable. I'd ask for 75% physician fees since they will be making a fortune off of you in facility fees.

Good point. The physician component at an ASC is much lower than in office, ie, $74 for a Medicare CESI in an ASC (plus a few bucks for fluoro). So, Painfan, you get 50% of that, or $37 while the group gets the other $34 plus the $370 for the ASC fee for the CESI?

If that's the arrangement, that's not very good, especially if overhead is taken out of that. See below:

http://www.asipp.org/documents/Physicians2014F.pdf

http://www.asipp.org/documents/ASC2014F.pd

Also, is the base salary a guarantee or an advance on future collections? If it's an advance on future collections, you could owe money if your collections minus overhead, don't meet your base number. If it's base guarantee PLUS 50% of excess collections over your base, then that could be better. If you're not experienced at reading contracts (which I can't claim to be) these two arrangements are way different, but may look and sound very much alike.

There's a hundred ways for a contract attorney and accountant to make apples look like oranges in the way these contracts are drawn out. How they play out in real time is a whole other matter, also.

Personally, my base salary is actually not a guarantee, it's an advance on future collections, but the portion I keep of what's generated over my base is very high. There's some risk with that, but the upside is very good if my production exceeds my base draw.

 

[painfan]

Thanks guys

Base of 250 guaranteed
Not an advance

All of the overhead ( including my malpractice, health, cme, retirement, paid vacation) comes out of their 50% of the total collections.

So if I bring in total of 700k:
I get base of 250
Plus 100 k incentive bonus
Total 350 ( 50% of 700k)

Does this make it sound any better

 

[Yo GabbaPentin]

Bringing in 700k with all ASC procedures won't be a cakewalk. I would think that is likely your ceiling. You will make them a fortune in the meantime. Are you allowed to buy into ASC in future?

In my experience, pain guys in surgeon owned groups are viewed as nothing more than needle monkeys hired to make money off of. A lot of egos to consider.

 

[hyperalgesia]

Thanks guys

Base of 250 guaranteed
Not an advance

All of the overhead ( including my malpractice, health, cme, retirement, paid vacation) comes out of their 50% of the total collections.

So if I bring in total of 700k:
I get base of 250
Plus 100 k incentive bonus
Total 350 ( 50% of 700k)

Does this make it sound any better

I think it's a reasonable offer. For the first year, I would look at the no compete clause and how it will affect your life. Next year, I would try to whittle the 50% pro fee cut down. That's kind of negligible for a group this size that is also getting facility fees. Once you demonstrate how much you are bringing to the ASC, all numbers will change.

 

[Yo GabbaPentin]

Just to clarify, when I said bringing in 700k, I meant in collections not income.

On the very PLUS side, you will have FIVE spine surgeons referring to you! There is no chance you won't be busy.

 

[Ducttape]

agree with hyperalgesia - ask for base 250, no compete. remind them that they are getting a lot out of facility fees - you'd rather do in-office injections.

you might also mention that you have little to no interest in "taking over" opioids, but you will be happy in creating taper schedules...

 

[bedrock]

Need to first establish very clearly if you can buy into ASC after first year and how much that would cost.

I would ask for both to be put into writing as part if the initial contract.

If you can't promptly buy into ASC, or for a reasonable amount, then this is a bad offer.

Doesn't matter that you'll be "busy ", if you're just busy making them money from the facility fees.

 

[Jcm800]

is there partnership opportunity?

 

[painfan]

I've been told that
" we can talk about partnership"
Obviously would need that in writing

 

[OffPiste]

This is a very bad deal, there is no way I would accept. % collections for pro fees from ASC without getting a take of facility fee is a recipe for you working like a dog, and making the orthos a ton of money, while you struggle to meet your "bonus," if and when you reach it, will still be a bad deal since you will have earned then 5x that amount for a little extra.
Ask for a very clear written pathway to buy into ASC. If they balk, walk.
(You will also most likely become the opiate repository for the group).

 

[BobBarker]

It is terrible. No way. Base is ok but bonus is complete crap considering the million they will make off of your facility fees. Tell them sure, but you want 96% of collections.

 

[nvrsumr]

I think 50% overhead for office is reasonable. I would get 100% of procedure professional fee.
The overhead is included in the Asc so double dipping on their part.

You need to be able to buy some shares in the Asc after year one

 

[bedrock]

I think 50% overhead for office is reasonable. I would get 100% of procedure professional fee.
The overhead is included in the Asc so double dipping on their part.

You need to be able to buy some shares in the Asc after year one

Agree with the 50% in office and 100% of procedural fees. Good point by NVR, that if they get part of your procedure fees from an ASC that they own, they are double dipping since their ASC costs are already covered in ASC facility fee.

In addition to ASC buy-in, I would ask if they will let you run two rooms simultaneously in ASC. Turnover is much slower in ASC, compared to office procedures, and running two rooms in ASC, will save you time and make u more money.

 

[painfan]

Thanks to all
Appreciate the feedback

 

[powermd]

You need to be able to buy some shares in the Asc after year one

The challenge with buying shares will be setting the appropriate initial number, as your income will be disparate from your ortho colleagues- plus it will be lower at first, then rise as your practice matures. Unfortunately share number in an ASC can only be adjusted when one first buys in, or when someone else buys in and the shares are again in flux. It can't be done on the fly simply because you are suddenly making more money for the ASC than expected.

 

[Ligament]

With that referral volume, you will make them an ASS TON of money in the ASC. You may make more than some of them if you were appropriately compensated; ie. get shares of the ASC facility fee...

 

[powermd]

Think you need to be upfront an just ask if they are willing to ink a path to fair and equal partnership based on collections, or are they seeking to skim off your collections in perpetuity- and if so can they at least give you a number? The opp is valuable and you should expect to pay for that, but it needs to be fair or it will never work out.

 

[bronchospasm]

In a group of 22 orthopods, it is important to consider your personality type.
Can work great if you are a yes man ...... Read as team player.
Your needs and requirements will ALWAYS come second.
Also get ready for them to bring in someone else as soon as you hit the 50-75 %ile MGMA salary.

Ortho groups typically have a high volume, high overhead situation and they are always looking to reduce overhead without sharing the profits from the ancillary income like PT, Imaging etc.

I know of 3 fellowship trained pain guys who joined ortho groups only to leave few years later.

This can be a good situation if you can adjust to less autonomy and they offer partnership.

YMMV..

 

[drusso]

Large 22 ortho md group
Has 5 spine surgeons

Verbal offer, waiting on draft agreement

Guaranteed base salary 250 k
Benefits (health, retirement, cme etc. )

Bonus potential: 50 % of professional fee collections

Basically

If I bring in less than 500K a year, I take home 250k
I bring in 650k, I take home 325k

Prelim discussion: they are not willing to raise base, maybe flexible on 50% figure

Needless to mention will do cases at physician owned ASC, and I get no portion of facility fee ( the usual "it's against the law" story)

Will appreciate any Feedback?

You have to start at the bottom and work your way up. This is the bottom. Go show them you're a tiger! If you do a good job, you'll be rewarded.

 

[lonelobo]

Worked for large ortho group that was good experience, was offered partnership after 2 years. Basically shaped my own practice. 90% positive experience...wife couldn't stand Midwestern winters.

The offer for you is very one sided and nothing like I had, I would evaluate other opportunities

 

[clubdeac]

50% professional fee at an ASC sounds ridiculous. You need to look at the professional fees and then ask yourself if that even makes sense. 50-60 procedures a week will get you what, ~$5k in revenue of which you get 50%, $2500/week. No thanks