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Prelim job offer from ortho group

Discussion in 'Pain Medicine' started by painfan, Sep 25, 2014.

  1. painfan

    painfan 5+ Year Member

    Nov 23, 2010
    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


    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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  3. mid|ine

    mid|ine Interventional Spine Physician 10+ Year Member

    Aug 2, 2006
    Cincinnati, OH
    50% of professional fee? WTF?
    Sounds abusive.
  4. painfan

    painfan 5+ Year Member

    Nov 23, 2010
    I wasn't sure how to take it either
    Laugh at it
    Or take offense
  5. emd123

    emd123 7+ Year Member

    Feb 25, 2010
    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.
    Last edited: Sep 25, 2014
  6. Yo GabbaPentin

    Yo GabbaPentin 5+ Year Member

    Feb 15, 2011
    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.
  7. Birdstrike

    Birdstrike 7+ Year Member

    Dec 19, 2010
  8. emd123

    emd123 7+ Year Member

    Feb 25, 2010
    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:

    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.
    Last edited: Sep 25, 2014
  9. painfan

    painfan 5+ Year Member

    Nov 23, 2010
    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 :)
  10. Yo GabbaPentin

    Yo GabbaPentin 5+ Year Member

    Feb 15, 2011
    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.
  11. hyperalgesia

    hyperalgesia member Lifetime Donor Classifieds Approved 7+ Year Member

    Jan 9, 2010
    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.
    Ducttape likes this.
  12. Yo GabbaPentin

    Yo GabbaPentin 5+ Year Member

    Feb 15, 2011
    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.
    Last edited: Sep 26, 2014
  13. Ducttape

    Ducttape SDN Lifetime Donor Lifetime Donor Classifieds Approved 5+ Year Member

    Oct 7, 2011
    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...
  14. bedrock

    bedrock Member 10+ Year Member

    Oct 23, 2005
    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.
  15. Jcm800

    Jcm800 7+ Year Member

    Jul 13, 2008
    is there partnership opportunity?
  16. painfan

    painfan 5+ Year Member

    Nov 23, 2010
    I've been told that
    " we can talk about partnership"
    Obviously would need that in writing
  17. OffPiste

    OffPiste 10+ Year Member

    Nov 18, 2006
    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).
    H2H likes this.
  18. BobBarker

    BobBarker Member 10+ Year Member

    Dec 13, 2005
    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.
  19. nvrsumr

    nvrsumr Member 10+ Year Member

    Apr 25, 2002
    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
  20. bedrock

    bedrock Member 10+ Year Member

    Oct 23, 2005
    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.
  21. painfan

    painfan 5+ Year Member

    Nov 23, 2010
    Thanks to all
    Appreciate the feedback
  22. powermd

    powermd Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Mar 30, 2003
    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.
  23. Ligament

    Ligament Interventional Pain Management Physician Lifetime Donor SDN Advisor Classifieds Approved 10+ Year Member

    Jan 8, 2002
    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...
  24. powermd

    powermd Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Mar 30, 2003
    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.
  25. bronchospasm

    bronchospasm Junior Member Lifetime Donor Classifieds Approved 10+ Year Member

    Jul 15, 2006
    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.

  26. drusso

    drusso Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Nov 21, 1998
    Over the rainbow
    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.
  27. lonelobo

    lonelobo PAIN DOC 10+ Year Member

    Jun 1, 2005
    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
  28. clubdeac

    clubdeac 10+ Year Member

    Aug 16, 2007
    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

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