Private practice partnership track

[Mass Effect]

---

Members do not see this ad.

How does private practice partnership track work? I get these recruiter emails all the time and recently, they've been emailing about opportunities for private practice on the partnership track with established practices. They all have inflated salaries. Some say you can choose partnership versus non-partnership track. Obviously, once you're a partner you're a partner, but what's the difference between the jobs in the pre-partnership years? Or more to the point, what does partnership track mean in terms of the day-to-day job?

 

[TexasPhysician]

In most psychiatry practices, partnership has no value. Partnership is generally a term for specialties with multiple streams of ancillary income. If the practice has lab services, x-ray/CT, PT, surgical center, etc, only partners split that income. You then want to be on a partnership track.

I assume that some large psychiatry practices with multiple midlevels, counselors, labs services, etc., there may be some value to being a partner. Otherwise, start your own practice or take the guaranteed rate to work as a non-partner. Don’t get into a complicated partnership agreement for a regular practice.

 

[Sushirolls]

Every practice is different, and you'll need to see the contract to know the details and ask the practice to know what day to day is.

 

[Mass Effect]

Ok thanks. I'm not actively looking as I'm happy where I am, but I was getting the emails so I figured I'd ask since I don't expect my current job will be my forever job.

 

[Merovinge]

In most psychiatry practices, partnership has no value. Partnership is generally a term for specialties with multiple streams of ancillary income. If the practice has lab services, x-ray/CT, PT, surgical center, etc, only partners split that income. You then want to be on a partnership track.

I assume that some large psychiatry practices with multiple midlevels, counselors, labs services, etc., there may be some value to being a partner. Otherwise, start your own practice or take the guaranteed rate to work as a non-partner. Don’t get into a complicated partnership agreement for a regular practice.

With the rise of ketamine and TMS locations I can imagine this being increasingly relevant in psychiatry, although as a CAP I feel very distant from all this.

 

[TexasPhysician]

With the rise of ketamine and TMS locations I can imagine this being increasingly relevant in psychiatry, although as a CAP I feel very distant from all this.

Maybe. The only $ made from esketamine is by J&J. TMS has potential, but it’s very limited with high up front costs. Partnership buy-ins when costs are high can be in the 6 figures.

 

[Sushirolls]

TMS needs more than the volume of a single medication management focused psychiatrist to support the volume. Its possible to get referrals from other Psychiatrists/ARNPs/PCPs, but don't count on it. Not sure what the magic number for a group size to be, 3? 4? 5 docs?

Offering the trifecta of ECT/TMS/Ketamine can clearly define a practice as the go to referral for more refractory cases. However, being a consultative heavy practice also comes with issues of more charting/documentation/staff connected with the consults compared to a stable follow up. New patient/consults relatively pay less than what follow up codes do per hour by insurance. One time consult patients also exposes a practice to greater risks of bad debt. Currently this is my greatest bad debt exposure, and when some insurance companies state you can't pre-charge, it keeps your bad debt risk high with patients not paying for their consults.

TMS machines need to be cheaper for greater clinical expansion.

 

[dl2dp2]

TMS machines need to be cheaper for greater clinical expansion.

Maybe, unless manufacturers start to have a better pricing model that's more aligned with practice. The equipment is not that expensive to make. The issue here is they bulk charge, and a lot of equipment time is idle. I think if you lease per case it'd encourage utilization and might actually make the manufactuerers more money in the long run.

 

[finalpsychyear]

Maybe, unless manufacturers start to have a better pricing model that's more aligned with practice. The equipment is not that expensive to make. The issue here is they bulk charge, and a lot of equipment time is idle. I think if you lease per case it'd encourage utilization and might actually make the manufactuerers more money in the long run.

I know a doc who bought one and it cost him dearly. I spoke to him and the thing cost nearly 100k plus service contract like 10k a year. The company takes 70 bucks every time its used on top of that plus you pay a technician either hourly or per case and of course additional insurance for the machine itself.
The worst part is while it was 300-400 4 or 5 years ago per session now it has dwindled to 150-180 with half going to overhead. Sorta laughable to do and invest that much to net 75 bucks and you still have billing, insurance, annual service costs to figure into that. You'd be way better off hiring an NP or PA.

This is for larger groups who can absorb the cost and have the volume that even a small profit like that makes sense with 4 providers splitting the overhead.

 

[dl2dp2]

I know a doc who bought one and it cost him dearly. I spoke to him and the thing cost nearly 100k plus service contract like 10k a year. The company takes 70 bucks every time its used on top of that plus you pay a technician either hourly or per case and of course additional insurance for the machine itself.
The worst part is while it was 300-400 4 or 5 years ago per session now it has dwindled to 150-180 with half going to overhead. Sorta laughable to do and invest that much to net 75 bucks and you still have billing, insurance, annual service costs to figure into that. You'd be way better off hiring an NP or PA.

This is for larger groups who can absorb the cost and have the volume that even a small profit like that makes sense with 4 providers splitting the overhead.

Right, and the treatment effect isn't good enough that as a cash pay psychiatrist I'd advise people to do cash pay. I'd be like, why don't we try notriptyline first. And really, do you expect real TRD patients to respond to nothing BUT TMS? Gimme a break. Most of them have severe PDs and respond to nothing. If I want a Hail Mary I can do luxury Spravato in my office and charge less.