Private Equity in Ophthalmology

[dantt]

Ophthalmology and optometry is rapidly succumbing to acquisition and consolidation by private equity firms nationwide. The primary motive of private equity appears to be extraction of profit out of the practice and of older practice owners to maximize profit and exit strategy. Ophthalmologists will now become a commodity.

Much has been said about the pros and cons of selling one's practice to private equity. There appears to be little upside for current associate doctors to stay or join a practice without any potential for partnership and profit sharing. Is anybody willing to share their experiences anonymously? Unfortunately, private equity's entry into ophthalmology has now created an environment where frank comment on the matter risks one's job. This is not right.

A points of context I ask commentators to include.

1. Position prior to sale. Fully vested partner? New partner? Partnership track associate? Non partnership track associate?
2. Practice size. Single specialty? Multi specialty? Optometrists?
3. Practice location. Urban? Suburban? Rural?
4. Passive income opportunities before and after. Optical? ASC? Real estate?
5. Compensation. Pre and post sale. Above market? Below market? Fair market?
6. Contentment. Pre and post sale. Ability to practice medicine the way you choose? Satelliting? Vacation/flexible hours? Forced to sell patients optos photos/multifocal IOLs?

---

Members don't see this ad.

 

[increscence]

I second the request for people's firsthand experiences. As someone entering the job market, I have biased/preconceived notions about PE, but I would like to know whether my concerns are founded.

 

[LightBox]

1) Full-vested partner. Not close to retirement age.
2) General Ophthalmology practice with employee optometrists.
3) Suburban
4) Own ASC, Optical, and Real Estate before sale to PE. Own only real estate after sale to PE.
5) Obviously, compensation is lower after the acquisition. After all, you get an 8-digit buy-out taxed at capital gains rate
6) No pressure to upsell stuff. Practicing basically the same as before. It is annoying to ask permission to buy stuff (e.g. expensive equipment) now though.

I'll probably retire after a few more years and just do something else. Or maybe just start anew! It's nice having the financial cushion of a PE buy-out to allow you this flexible in career. There is zero chance I will be grinding it out seeing patients at age 60.

 

[Dusn]

Thanks for your insight, LightBox. I'm glad it worked out well for you! If they're regularly paying out 8 figures, it still seems unlikely to me that PE groups will make money off of most of their acquisitions... but what do I know? For new grads it still seems to emphasize the importance of being a partner: either start your own practice or be sure the practice you join will not be bought out before you make full partnership.

 

[airplanes]

1) Full-vested partner. Not close to retirement age.
2) General Ophthalmology practice with employee optometrists.
3) Suburban
4) Own ASC, Optical, and Real Estate before sale to PE. Own only real estate after sale to PE.
5) Obviously, compensation is lower after the acquisition. After all, you get an 8-digit buy-out taxed at capital gains rate
6) No pressure to upsell stuff. Practicing basically the same as before. It is annoying to ask permission to buy stuff (e.g. expensive equipment) now though.

I'll probably retire after a few more years and just do something else. Or maybe just start anew! It's nice having the financial cushion of a PE buy-out to allow you this flexible in career. There is zero chance I will be grinding it out seeing patients at age 60.

Great stuff and glad it seems to have worked out well for you.

What do you think about the potential and opportunity for new associates joining PE owned groups? The starting salaries tend to be higher (sometimes much higher), but passive income streams seem to be non-existent aside from the opportunity to eventually buy and flip shares.

 

[LightBox]

Great stuff and glad it seems to have worked out well for you.

What do you think about the potential and opportunity for new associates joining PE owned groups? The starting salaries tend to be higher (sometimes much higher), but passive income streams seem to be non-existent aside from the opportunity to eventually buy and flip shares.

I have no clue, but my inkling is that PE is basically a Ponzi-type scheme. These PE groups don't want to run Ophthalmology practices in the long-run. They have a 5-7 year horizon, and they all hope to sell to the next bigger fish (fund) for a 15-20%/year premium on the original share price. I probably would rank joining a PE group as a "better Kaiser model" since working for a private practice is much better overall than working for Kaiser in terms of efficiency, salary ceiling, etc.

 

[Fascia Lata]

Can someone tell me why it may not be a terrible idea to join a group practice that is PE firm owned? I am really interested in this job, like the practice a lot, really like the docs in the practice and we click great, but as elaborated above, passive income is non-existent.

I don't want to feel stupid I am joining a PE owned practice.

 

[dantt]

I probably would rank joining a PE group as a "better Kaiser model" since working for a private practice is much better overall than working for Kaiser in terms of efficiency, salary ceiling, etc.

Comparing Kaiser head-to-head with private practice in general, it appears you get better starting salary, job security, and benefits. You have a higher salary potential in private practice, but only if you become a partner or owner. Unfortunately, it also appears most private practice owners are greedy and partnership is dangled but only rarely fairly offered. Also unfortunately, that "increased efficiency," if it even truly exists under private equity, is returned to private equity as profit, not shared with the employee.

 

[dantt]

Can someone tell me why it may not be a terrible idea to join a group practice that is PE firm owned? I am really interested in this job, like the practice a lot, really like the docs in the practice and we click great, but as elaborated above, passive income is non-existent.

I don't want to feel stupid I am joining a PE owned practice.

How old are the doctors? You may like them now but they may be like lightbox and retire or move on after their contract finishes.

 

[Fascia Lata]

How old are the doctors? You may like them now but they may be like lightbox and retire or move on after their contract finishes.

They are in their late 30s

 

[MstaKing10]

Comparing Kaiser head-to-head with private practice in general, it appears you get better starting salary, job security, and benefits. You have a higher salary potential in private practice, but only if you become a partner or owner. Unfortunately, it also appears most private practice owners are greedy and partnership is dangled but only rarely fairly offered. Also unfortunately, that "increased efficiency," if it even truly exists under private equity, is returned to private equity as profit, not shared with the employee.

Limitations with Kaiser are likely salary ceiling and location (limited number of spots in only a few states). Upside is benefits. Job security as an employee is equal in either case. Salary ceiling is higher in private practice wether you are owner or employee. Yes, partnership is sometimes dangled and not offered, but the question is which is the better option, joining a PE owned grouped vs Kaiser? Employment not partnership is only model in both. To me, increased efficiency means a better working environment, with less beurocracy and more focused duties, which is beneficial to the employee and more likely in a private practice setting. A clear pertnership track continues to be the ideal model if I was looking for a job right now, but agree that these too are hard to come by

 

[MstaKing10]

I have no clue, but my inkling is that PE is basically a Ponzi-type scheme. These PE groups don't want to run Ophthalmology practices in the long-run. They have a 5-7 year horizon, and they all hope to sell to the next bigger fish (fund) for a 15-20%/year premium on the original share price. I probably would rank joining a PE group as a "better Kaiser model" since working for a private practice is much better overall than working for Kaiser in terms of efficiency, salary ceiling, etc.

Ponzi scheme?? Not quite. It’s a business transaction. PE will purchase, use their economies of scale and access to capital to grow, repackage, rebrand then sell to a larger entity. Perhaps a larger PE fund or some other healthcare system. Each successive transaction making some multiple on their investment. If you own shares (which partners and employees both should) then this is returned as a multiple on your shares. It’s not unlike what happens in many other sectors outside of healthcare, and has already happened successfully in other specialties (ie anesthesia).

 

[dantt]

Limitations with Kaiser are likely salary ceiling and location (limited number of spots in only a few states).

Very true. Kaiser is concentrated mostly on the west coast. However, in the areas where Kaiser operates, the typical salary of employed doctors in private practice, and even in many cases owner/partner doctors, is consistently much lower. The main way you make more in private practice is when you employ your own doctors and make money off of them. PE will typically want a minimum of 20% return. Kaiser jobs in ophthalmology are not easy to come by.

 

[Fascia Lata]

Limitations with Kaiser are likely salary ceiling and location (limited number of spots in only a few states). Upside is benefits. Job security as an employee is equal in either case. Salary ceiling is higher in private practice wether you are owner or employee. Yes, partnership is sometimes dangled and not offered, but the question is which is the better option, joining a PE owned grouped vs Kaiser? Employment not partnership is only model in both. To me, increased efficiency means a better working environment, with less beurocracy and more focused duties, which is beneficial to the employee and more likely in a private practice setting. A clear pertnership track continues to be the ideal model if I was looking for a job right now, but agree that these too are hard to come by

Thanks, that was helpful

 

[percyeye]

Private equity in any profession is so short-sighted. And terrible for any profession.
I wonder if they are banking on that most new Doctors are going to want to go into private practice that is PE owned. It seems that most that want to go into private practice want to be owners some day. It doesn't seem appealing at all to join a group that is owned by some fund in NYC and that will probably change ownership 3-4x over the next 10-15 years being bought out by the next highest bidder looking to squeeze every ounce of profit out of an office.

 

[dantt]

It is probably worth mentioning that many of the PE practices will have pretty large non competes. The bigger they are the bigger the non compete. You'd think if they were such a great deal they wouldn't rely on that to sustain their business. Again, the point of this thread is to discuss and learn about some of the experiences people have been through. I've yet to hear a public accounting of what it's like to work for one.

 

[LightBox]

Non-competes are negotiable even with PE groups. Obviously, we (as sellers) had much more leverage with our non-competes than probably the newbie associate will have. Our non-competes are localized to just our offices (and not to all of the offices owned by the large group).

Again, I think PE-owned groups will have the same feeling as working for some big organization like Kaiser, except it will likely be a bit more efficient like private practice.

 

[dantt]

Salary ceiling is higher in private practice wether you are owner or employee. To me, increased efficiency means a better working environment, with less beurocracy and more focused duties, which is beneficial to the employee and more likely in a private practice setting.

With PE buying these practices at 10x EBITDA, how do they hope to turn a profit? I suspect it will mean squeezing the physicians, whether by decreasing their salary, or decreasing overhead (letting staff go, not upgrading/maintaining equipment, etc which may increase the financial efficiency of the practice but not your actual practice).

 

[LightBox]

They aren't paying 10x for every practice. Typically, only the "platform" practices are able to get those multiples. PE just wants to churn it to the next buyer...

 

[MstaKing10]

The 10x figure is pretty rare. The purchase is made partially in cash, other part in shares. Thus, there is skin in the game for all parties to work hard and improve efficiencies. If your practice is the only one purchased with no plan to merge with others then yes, only way to turn a profit would be to slash costs across the board. That wouldn’t work and that’s not what’s happening. The purchase of your practice is being done in concert with prior and subsequent practice acquisitions, thus, as part of a merger of many practices and many doctors. Economies of scale apply here. Cost cutting occurs to the benefit of all the practices as MSOs take over the administrative component of practice management. There would be no benefit to you or PE to cut staff etc that would make you more efficient and profitable. I think this is a common misconception. Some of this depends on the partner, as some PE firms are more involved in the day to day running of the practice than others.

 

[Etorphine]

Cost cutting occurs to the benefit of all the practices as MSOs take over the administrative component of practice management. There would be no benefit to you or PE to cut staff etc that would make you more efficient and profitable. I think this is a common misconception. Some of this depends on the partner, as some PE firms are more involved in the day to day running of the practice than others.

It seems this would be highly dependent on the administrator's beliefs and real life experience with running a practice to decide what entails 'efficient' cost cutting. I think we've all seen examples of poor execution

 

[Bgladney]

PE just wants to churn it to the next buyer...

The question that I have is WHO are going to be the buyers? Has the PE really increase the value of the practice that much in a few years to justify 2 or 3 times what they paid for it?

This seems to me like another version of Physician Resource Group (PRG) back in the day. That worked out well for those on the front end, not so much later on. Especially not the Shareholders when they closed the doors.

 

[MstaKing10]

The question that I have is WHO are going to be the buyers? Has the PE really increase the value of the practice that much in a few years to justify 2 or 3 times what they paid for it?

This seems to me like another version of Physician Resource Group (PRG) back in the day. That worked out well for those on the front end, not so much later on. Especially not the Shareholders when they closed the doors.

There’s always a bigger fish (ie larger, better funded firm). Though ophthalmology is relatively new to this space, this has been going on for quite some time in ER, anesthesia, dentistry etc. The question of appreciation and future valuation is very valid and a big unknown. Only time will tell if these acquisitions and mergers truly add enough value to warrant the steep asking price in the coming years.

The big difference between what’s going on now and what took place in the 90s is the high upfront cash payout and the better funding of these firms. We all know the 90s version ended poorly. Who knows if this will be more of the same.

 

[Bgladney]

I am seeing it become a larger and larger concern when it comes to recruitment. Folks don't want to join the PE Firms and are leery of joining a practice considering them in the future.

All due to the great unknown of what is to come.

 

[deleted941485]

I am seeing it become a larger and larger concern when it comes to recruitment. Folks don't want to join the PE Firms and are leery of joining a practice considering them in the future.

All due to the great unknown of what is to come.

We know how it ends because it’s already played out and is playing out in other specialties and health systems. PE is looking for short run payout. For anyone other than the founders to think otherwise is foolish.

These guys roll it up into a giant mega holding from all the groups they acquire cut some costs and then pass it on to another group. It becomes a hot potato just keep passing it around cutting a bit here and there and move on. No greater Vision other than that.

Look at Anesthesia. Private practice group in Florida becomes Sheridan Anesthesia becomes Envision then becomes KKR then who knows.

EM merge a few groups make a CMG then buy other CMGs then go IpO or sell to PE who then take some it cuts some costs and sells to another PE.

Derm the same

Hospital chains the same thing.

My hospital has been bought and sold so many times in the last 10 years nobody can even remember who they’re Working for (or kicking up to lol)

Even if you found out that these groups were more valuable than PE could have ever imagined what the hell does that change for the people who work there? Really nothing. Maybe a Christmas bonus bone for the peons but really means very little outside of that.

 

[KobeB]

Two things I cant understand:
1. why would anyone take a PE job after the partners were paid out
2. why would an associate agree to stay on without a major bonus (like 7x yearly earnings)
The future profitability of the practice has been sold. Forever. Almost 2/3 of the pie is gone why would you stay or join when only 1/3 is left.
We work so many years to throw away your future profitability which benefits only the PE firm and retiring partners is baffling to me. Many of these deals are built on the backs of underpaid employees and future underpaid employees. I know these groups throw carrots at people like "you will benefit from second bite" or " you will be a partner in the future" its all nonesense. If you didn't get paid initially its a bad deal. Even if you get paid initially its probably a bad deal unless you're nearing retirement. Wake up people.

 

[LightBox]

As someone who went through the PE process, I agree that the original owners are the ones that make out like bandits from these deals. No one is looking at the very long-term horizon of these practices (e.g. 20 years from now). But then again, no associates/newbies can match the $$ amount that these PE firms are offering. You can't blame the owners for taking the best deal possible -- it's too good to pass up.

Chronologically, I'm not near retirement age. But what people forget, is that I can just re-start an Ophthalmology practice and re-create an empire. The true value is in the doctor/surgeon's reputation and not your practice's "name." Your patients will follow you. And no, my non-compete is not very restrictive. I know of a few Ophthalmologists who got bought out a decade ago. Moved away for a year or two, 20 miles away. And then moved back into the area just to be bought up by a PE group! Now that's accelerating your returns!

As for "why would anyone take a PE job...?" -- the answer to that question is the same for "why would anyone work at Kaiser or at the VA?" Some people just want a guaranteed salary without any administrative hassles or financial risk or intrusion into their time after work. I'm not saying I would choose that for myself, but running a business or taking some financial risk is just not everyone's cup of tea. Some people just want to clock-in and clock-out, collect a decent amount of money, and then live their lives outside of Medicine. Everyone makes their own choices about their desired money:lifestyle ratios. What baffles me is why people feel that working for Kaiser is "superior" to working for a PE-controlled private practice. At least in a private practice, the techs/staff still have a fire under their butts to make your life easier.

Lastly, some people are not geographically as mobile and need or want to be in a certain area. If a PE mega-group or Kaiser dominate an area, then turnkey jobs are fewer and farther between. For example, your negotiation position withers in SoCal if there are 20 other newbies waiting to fill a position.

Remember: just because you trained at the top institutions, does not mean you are entitled to any type of perfect job. If you want to control your Destiny, then start a practice de novo. That's what many of the original owners did. No one says it will be easy, but if that's what you want, just get it done!

 

[KobeB]

My understanding of Kaiser is a stable organization that offers physicians decent salary without killing them with volume and then pays a % of their salary for life after retirement. I dont believe any of those apply to PE. i.e not a stable organization (the entity will likely turnover twice every decade creating a new boss whose sole goal is to squeeze out more profit each round), PE is all about churning out volume, and I dont think PE pays for a pension for life.

 

[deleted941485]

My understanding of Kaiser is a stable organization that offers physicians decent salary without killing them with volume and then pays a % of their salary for life after retirement. I dont believe any of those apply to PE. i.e not a stable organization (the entity will likely turnover twice every decade creating a new boss whose sole goal is to squeeze out more profit each round), PE is all about churning out volume, and I dont think PE pays for a pension for life.

Yeah I hear this about Kaiser and organizations. It’s a big selling point for a lot of docs. They get a good salary no real pressure to do a ton of work or unnessesary things and you get a pensions. There are organizations that try to emulate the Kaiser method but I have heard rumors that some of these organizations not nessesarily kaiser are going to start getting away from the straight salary and pensions.

There are at least some proposals seeking to tie more salary to an RVU target model which I think completely undermines the whole selling point of kaiser for the docs but hey we don’t run the show.

Kaiser like all other organizations is only as stable as its finances allow it to be. You introduce a low cost competitor insurance or a health system and BAM all of a sudden your stable cushy job is a nightmare with admin looking to squeeze every last dime out of you.

 

[LightBox]

It will be interesting to see if the Kaiser pension plan is actually sustainable. I always felt like it was a Ponzi scheme.

Just remember: money in-hand today is worth much more than promised-money 30 years from now!

 

[deleted941485]

It will be interesting to see if the Kaiser pension plan is actually sustainable. I always felt like it was a Ponzi scheme.

Just remember: money in-hand is worth much more than promised-money 30 years from now!

When you think of all those pension plans that go poof. Think about all those steel workers, electrical line workers who put money in the company pension only to have it severally reduced or non existent when **** hits the fan.

Pensions sound awesome. A defined benefit. Risk totally in the hands of the employer until it becomes your problem.

If there are too many people are collecting rather than generating then it becomes a problem.

 

[Bgladney]

From my experience, Kaiser does not pay close to what private practice does for similar volume. While you might have a higher salary, your bonus is capped. And it is high volume. After two years working at Kaiser, I see folks either stay on and become a lifer (usually can't move or don't want to) or they leave for greener pastures. Hence why there is so much turnover at Kaiser.

Can't speak on the pensions, but as RadsWFA1900 said, look around at the unions or Cities and their pension funds. Not a sustainable situation any longer.

 

[MstaKing10]

Pay for employees at a PE owned group will far outpace a Kaiser or VA option. Given the expense of a buy in to a private practice (which nowadays has gotten unreal) it could be argued that a higher upfront salary is worth more than a future promise of partnership after you have paid in to the tune of 7 figures to buy in. Also, no guarantees your private practice won’t sell to PE after you join, leaving you high and dry.

 

[Dusn]

What's the typical pay and benefits at Kaiser? What about for a PE owned group? And for how much work (# of patients/hours per week/time off, etc)

 

[dantt]

As someone who went through the PE process, I agree that the original owners are the ones that make out like bandits from these deals. No one is looking at the very long-term horizon of these practices (e.g. 20 years from now). But then again, no associates/newbies can match the $$ amount that these PE firms are offering. You can't blame the owners for taking the best deal possible -- it's too good to pass up.

Chronologically, I'm not near retirement age. But what people forget, is that I can just re-start an Ophthalmology practice and re-create an empire. The true value is in the doctor/surgeon's reputation and not your practice's "name." Your patients will follow you. And no, my non-compete is not very restrictive. I know of a few Ophthalmologists who got bought out a decade ago. Moved away for a year or two, 20 miles away. And then moved back into the area just to be bought up by a PE group! Now that's accelerating your returns!

As for "why would anyone take a PE job...?" -- the answer to that question is the same for "why would anyone work at Kaiser or at the VA?" Some people just want a guaranteed salary without any administrative hassles or financial risk or intrusion into their time after work. I'm not saying I would choose that for myself, but running a business or taking some financial risk is just not everyone's cup of tea. Some people just want to clock-in and clock-out, collect a decent amount of money, and then live their lives outside of Medicine. Everyone makes their own choices about their desired money:lifestyle ratios. What baffles me is why people feel that working for Kaiser is "superior" to working for a PE-controlled private practice. At least in a private practice, the techs/staff still have a fire under their butts to make your life easier.

Lastly, some people are not geographically as mobile and need or want to be in a certain area. If a PE mega-group or Kaiser dominate an area, then turnkey jobs are fewer and farther between. For example, your negotiation position withers in SoCal if there are 20 other newbies waiting to fill a position.

Remember: just because you trained at the top institutions, does not mean you are entitled to any type of perfect job. If you want to control your Destiny, then start a practice de novo. That's what many of the original owners did. No one says it will be easy, but if that's what you want, just get it done!

These situations are certainly variable, by the acquiring PE firm and even individual practices inside the PE firm. No 2 situations are alike which is why I've polled the forum before about peoples experiences. Lightbox's view of using PE as a way to build empires and make money is probably on the optimistic side. The reality is if the PE firm is consolidating practices, especially locally combining both ophthalmology and optometry practices, there's a good chance the non compete will force you to move when you leave. As the practices grow whether through organic growth or acquisition (usually acquisition), the non compete continues to expand. You may not be able to come back to the same place and build a new empire if your referrals have been consolidated.

Lesson I learned from all this from the associate side is never trust when money is involved. Never agree to a non compete that would require you to relocate unless it had a reasonable buy out; it's just not worth it.

 

[Dusn]

These situations are certainly variable, by the acquiring PE firm and even individual practices inside the PE firm. No 2 situations are alike which is why I've polled the forum before about peoples experiences. Lightbox's view of using PE as a way to build empires and make money is probably on the optimistic side. The reality is if the PE firm is consolidating practices, especially locally combining both ophthalmology and optometry practices, there's a good chance the non compete will force you to move when you leave. As the practices grow whether through organic growth or acquisition (usually acquisition), the non compete continues to expand. You may not be able to come back to the same place and build a new empire if your referrals have been consolidated.

Lesson I learned from all this from the associate side is never trust when money is involved. Never agree to a non compete that would require you to relocate unless it had a reasonable buy out; it's just not worth it.

That brings up another upside to the VA and Kaiser over a PE practice. No noncompete.

 

[MstaKing10]

What's the typical pay and benefits at Kaiser? What about for a PE owned group? And for how much work (# of patients/hours per week/time off, etc)

Can't comment on typical pay for all specialties, but I was investigating a Kaiser position for a retina specialist that was literally one third of my current income in private practice. Even including benefits it was hardly worth my time continuing the process. Pretty sure the VA would be along those lines.

 

[dantt]

Can't comment on typical pay for all specialties, but I was investigating a Kaiser position for a retina specialist that was literally one third of my current income in private practice. Even including benefits it was hardly worth my time continuing the process. Pretty sure the VA would be along those lines.

Can you give an approximate range of starting salary and 5 year salary? It would be nice for people to know what to expect without getting into confidential specifics.

 

[airplanes]

~280-300k starting for comprehensive (the applicant was anterior segment fellowship trained but applying for a comprehensive job and expected to have a comprehensive practice). In Kaiser, that means everything from chalazions, to basic neuro, to retinal tears, to MIGS and of course, cataracts.

 

[MstaKing10]

Can you give an approximate range of starting salary and 5 year salary? It would be nice for people to know what to expect without getting into confidential specifics.

It was $200-300k (Kaiser) vs $500-$700k (private) + bonus for both

 

[dantt]

~280-300k starting for comprehensive (the applicant was anterior segment fellowship trained but applying for a comprehensive job and expected to have a comprehensive practice). In Kaiser, that means everything from chalazions, to basic neuro, to retinal tears, to MIGS and of course, cataracts.

MstaKing10's numbers seem rather low for retina.

I have seen airplanes numbers for comp in the past. You start out at that number for seeing 20 pts per day and doing about 5 surgeries a week. After you're there for a few years it goes up 100k or so + incredible benefits for the same amount of work, no pie in the sky. What will you start out at in private practice in California? (~ 180-200k?). How long will it take you to reach 300k? 400k? Can you even reach that without selling the multi-focals hard? (Assuming you ever hit that, practice doesn't get sold to PE, etc). Your benefits will also never be nearly as good.

 

[Dusn]

MstaKing's numbers seem unusual for retina - probably was looking at a position that Kaiser did not really need to fill. Several years ago, when I was asking around, I heard that mid-atlantic Kaiser was offering 500-600K starting for retina. I also heard that job was brutal, however, in terms of workload and had high turnover despite the starting salary. From what I hear 20 patients at Kaiser is much harder than 20 patients in private practice; the optoms weed out the easy patients and all your patients have advanced "train-wreck" eye disease; on the other hand your surgical skills can grow significantly in this type of system.

Kaiser also generally operates in highly saturated areas where starting physicians constantly get lowballed by private practices (west and, now, east coast) and so their salaries for those areas are probably more competitive than compared to the midwest or parts of the south.

The VA could never compete for retina, and it sounds like Kaiser may be the same, but for other comprehensive and sub-specialists they may not be bad compared to a private practice where you have no chance of becoming partner.

The point I'm trying to make for new graduates is the only reason to do private practice is to become a partner with a reasonable buy in. Private groups started implemented ridiculous non-competes, they starting lowballing salaries, they got rid occurrence based malpractice so you may have to pay 20K to leave a practice for your tail coverage, they started implementing ridiculously high buy-ins to become partner, and now they're getting rid of the possibility of partnership altogether by selling to private equity. Don't accept it. Start your own practice if you need to.

 

[airplanes]

The surgical numbers for comprehensive were/are closer to 15 cases/week within 3-4 months of practice.

I agree the private practice route can be a minefield, which is a big reason why many so many people change jobs within a few years.

 

[OphthoApplicant04]

For anyone interested, I have a few friends who recently accepted jobs at Kaiser in Northern California. They are comprehensive positions. Salary is approximately 290k in a very high CoL environment. A full clinic day is 26 patients. As another poster mentioned, these are not your typical patients. Optoms are seeing all the mild NPDR and glaucoma suspects. Every patient has pathology, often surgical or procedural. Comprehensivists are expected to do laser retinopexies, LPIs, chalazia, etc. There is no freedom whatsoever to expand practice beyond their (fairly broad) comprehensive practice. Fellowship in glaucoma, cornea, etc are irrelevant - you are not allowed to do any specialty procedures if you are hired as a comprehensivist.

 

[Bgladney]

Aren't the bonuses capped at 20% of your salary? It was that way before.

 

[Medicalretina]

I thought Kaiser schedules were really easy 9-3 with an hour lunch and 15-20 patients ranging from routine refractions to macular degeneration follow-ups. What is the reality? What are the schedules really like? What type of patients do the comprehensive ophthalmologist see? Do the medical retina doctors get to do just medical retina? Thanks.

 

[LightBox]

I thought Kaiser schedules were really easy 9-3 with an hour lunch and 15-20 patients ranging from routine refractions to macular degeneration follow-ups. What is the reality? What are the schedules really like? What type of patients do the comprehensive ophthalmologist see? Do the medical retina doctors get to do just medical retina? Thanks.

This is definitely not the experience that my friends at Kaiser relate to me. Most of them are seeing very complex patients (e.g. needing sutured IOLs, limbal stem cell deficiency, etc). I often hear from my Kaiser colleagues how they are doing emergency surgeries at 10 pm at night when they are on call. All of my friends in private practice just ship those patients to the local academic center.

 

[deleted941485]

This is definitely not the experience that my friends at Kaiser relate to me. Most of them are seeing very complex patients (e.g. needing sutured IOLs, limbal stem cell deficiency, etc). I often hear from my Kaiser colleagues how they are doing emergency surgeries at 10 pm at night when they are on call. All of my friends in private practice just ship those patients to the local academic center.

Yeah these supposed secure and “cushy” jobs at kaiser where there is no pressure to do more or see more patients is really not the case. Many of them are planning on more production based measures now as these organizations take more and more patients.

 

[iballme]

What's the forum's opinion on joining a health system in terms of salary, bonus, benefits, etc compared to Kaiser, PE, or private group? I think health systems generally go by wRVUs rather than collections. Wouldn't that be a better method for the doc instead of collections given that the doc has no control over the payor mix?

 

[dantt]

I am seeing it become a larger and larger concern when it comes to recruitment. Folks don't want to join the PE Firms and are leery of joining a practice considering them in the future.

All due to the great unknown of what is to come.

Is this based on any personal experience? Are the PE firms really having a hard time with recruitment?