Private practice

[Smallmelon]

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I’m working in general hem onc practice in a midwest hospital-employment position. Now the practice is fully ramped up, quite busy seeing 20 patients a day, 4.5 days a week. Support system sucks, MA RN and APP don’t handle much of anything. I end up having to return 10 MyChart messages and address 10 phone calls myself at the end of the day.

I’m looking at an opportunity with a well-established private practice in the south, 3 year partnership track, 1-2 million a year once becomes partner. MD with 1 APP often have to see 40-60 patients a day to beat the overhead. It sounds a whole lot of work, but you do have autonomy which doesn’t exist as hospital employee.

I have mixed feelings about such jobs. Would you mind sharing thoughts on the pros and cons of such a position? Thank you very much

 

[whoknows2012]

I’m working in general hem onc practice in a midwest hospital-employment position. Now the practice is fully ramped up, quite busy seeing 20 patients a day, 4.5 days a week. Support system sucks, MA RN and APP don’t handle much of anything. I end up having to return 10 MyChart messages and address 10 phone calls myself at the end of the day.

I’m looking at an opportunity with a well-established private practice in the south, 3 year partnership track, 1-2 million a year once becomes partner. MD with 1 APP often have to see 40-60 patients a day to beat the overhead. It sounds a whole lot of work, but you do have autonomy which doesn’t exist as hospital employee.

I have mixed feelings about such jobs. Would you mind sharing thoughts on the pros and cons of such a position? Thank you very much

What’s your current compensation ?

40-60 even with mid level support is…something.

 

[Ubba]

I’m working in general hem onc practice in a midwest hospital-employment position. Now the practice is fully ramped up, quite busy seeing 20 patients a day, 4.5 days a week. Support system sucks, MA RN and APP don’t handle much of anything. I end up having to return 10 MyChart messages and address 10 phone calls myself at the end of the day.

I’m looking at an opportunity with a well-established private practice in the south, 3 year partnership track, 1-2 million a year once becomes partner. MD with 1 APP often have to see 40-60 patients a day to beat the overhead. It sounds a whole lot of work, but you do have autonomy which doesn’t exist as hospital employee.

I have mixed feelings about such jobs. Would you mind sharing thoughts on the pros and cons of such a position? Thank you very much

Would you be able to focus on literally 1-2 types of cancer and that's all? Even then, it really doesn't make sense. Let's say you have a midlevel who can handle 15 patients/day. Or stretch it to 20. The MD will see 40 patients/day? There isn't enough time to chart and read imaging/path even if the MD is breezing through pt rooms and using a scribe. You'd have to have encyclopedic knowledge and more or less a brain hooked up to the internet to pull this off.

 

[HemOncCheng]

What’s your current compensation ?

40-60 even with mid level support is…something.

sounds like crazy high number

 

[gutonc]

I’m working in general hem onc practice in a midwest hospital-employment position. Now the practice is fully ramped up, quite busy seeing 20 patients a day, 4.5 days a week. Support system sucks, MA RN and APP don’t handle much of anything. I end up having to return 10 MyChart messages and address 10 phone calls myself at the end of the day.

I’m looking at an opportunity with a well-established private practice in the south, 3 year partnership track, 1-2 million a year once becomes partner. MD with 1 APP often have to see 40-60 patients a day to beat the overhead. It sounds a whole lot of work, but you do have autonomy which doesn’t exist as hospital employee.

I have mixed feelings about such jobs. Would you mind sharing thoughts on the pros and cons of such a position? Thank you very much

Let's break it down:
3 year partnership track? Too long. What's the buy-in? Just sweat equity? How much are you making during those 3 years? Still expected to see 40+ a day for $400K/y?

How much autonomy do you really get if you're grinding that hard? 5-6 patients an hour for 10+ hours a day? Hard pass.

Do you really have to do nothing but see patients? No phone calls at all? No inpatient consults? No talking to referrings/consultants? No reviewing labs or imaging? No answering nurse questions?

Maybe this is the right job for you, but to me it sounds horrible.

 

[whoknows2012]

sounds like crazy high number

Yea that’s my point !

 

[MD46]

Most private practices where there is a 3 year partner track are only making you Junior Partner i.e. giving access to you own productivity which they all took the 1st three years. Then after getting 33%, 66% and 99% of you productivity they make you partner at year 6 so you get full access like them.

However in my experience there is another tier above that that involves partnership in equity if they own some part of the building or they rent it out. Most senior partners will not share that. Also there will be a buyin for this definitely not just sweat equity.

Only go to private if there is a short track 1-2 yrs of full partnership, otherwise its all a façade and ull end up worse than employed.


estimating your current position, 20pts a day 4.5 days a week likely on avg is around 8700 rvus, lets say mid west rate is around 96$ an rvu with the latest CMS conversion you are looking at 835K a year which is pretty darn good.


In terms of patient load, reasonable to carry 20 patients a day your self for 4.5 days, 10-15 for NP. essentially that would easily net 1-1.2 mil in a private setting if you were getting the share from infusion, lab etc. But how soon will you be able to get into that set up is the question. Making 400k =---> 450k ---->500k then if you are lucky partner, otherwise back to square one

good luck

 

[dozitgetchahi]

Let's break it down:
3 year partnership track? Too long. What's the buy-in? Just sweat equity? How much are you making during those 3 years? Still expected to see 40+ a day for $400K/y?

How much autonomy do you really get if you're grinding that hard? 5-6 patients an hour for 10+ hours a day? Hard pass.

Do you really have to do nothing but see patients? No phone calls at all? No inpatient consults? No talking to referrings/consultants? No reviewing labs or imaging? No answering nurse questions?

Maybe this is the right job for you, but to me it sounds horrible.

Yeah. I mean by PP standards this is just insane, even in rheumatology where some docs see higher volumes (and don’t usually do a good job). Heme/onc would be insane. Unfortunately there are a lot of PP jobs out there in medicine that are very exploitative of “fresh meat” new associates.

There is no way that it should take a doc plus midlevel seeing 40-60 patients a day to clear the overhead, especially in Heme/onc where infusion ancillaries are huge. (For the record, as a PP rheumatologist I can clear the overhead at about 13-15 patients per day, 4.5 days a week (7-11 on the half day), with no midlevel. I usually see about 20 on a full day. Ancillaries add a lot to my income after that.) If that is really true, than this is a poorly run practice with overhead that is way out of control - but what is more likely is that the practice is scalping its younger associates and the money is flowing into the pockets of a few rich “senior partners” at the top.

There must be better jobs than this out there. Your current job doesn’t sound great either, so it’s not a bad thing to switch jobs. But keep looking.

 

[gutonc]

Yeah. I mean by PP standards this is just insane, even in rheumatology where some docs see higher volumes (and don’t usually do a good job). Heme/onc would be insane. Unfortunately there are a lot of PP jobs out there in medicine that are very exploitative of “fresh meat” new associates.

There is no way that it should take a doc plus midlevel seeing 40-60 patients a day to clear the overhead, especially in Heme/onc where infusion ancillaries are huge. (For the record, as a PP rheumatologist I can clear the overhead at about 13-15 patients per day, 4.5 days a week (7-11 on the half day), with no midlevel. I usually see about 20 on a full day. Ancillaries add a lot to my income after that.) If that is really true, than this is a poorly run practice with overhead that is way out of control - but what is more likely is that the practice is scalping its younger associates and the money is flowing into the pockets of a few rich “senior partners” at the top.

There must be better jobs than this out there. Your current job doesn’t sound great either, so it’s not a bad thing to switch jobs. But keep looking.

I was thinking the same thing. 40 patients a day, 4 days a week at a conservative rate of $80/wRVU is >$25K a week. Someone's making bank off this but it's not going to be the OP.

 

[osprey099]

Generally agree with this but I think private practice is still the best option, but for the right person.

If you are on the older side and already have family/kids and perhaps have a non working spouse, then an employed position will offer immediate high compensation and more job stability/safety.

However, if you are young and fresh out of fellowship, it is worth it to take the risk/gamble and go for private practice. If things work out well, you will be way ahead financially in the long run. If things don't work out, you can always go for an employed position later on and will just have an opportunity cost of $500k ish over the 2-3 years as employee

 

[dozitgetchahi]

I was thinking the same thing. 40 patients a day, 4 days a week at a conservative rate of $80/wRVU is >$25K a week. Someone's making bank off this but it's not going to be the OP.

Hell, way more than that depending on RVUs vs collections etc.

As a rheumatologist paid on collections, it’s not unusual for me to bill $110k a month at the volumes I noted above - 20/day, 4.5 days a week (325-375 pts a month, give or take). At 40-60 patients a day, just by seat of the pants guessing I’d wager the doc + midlevel team is probably billing at least $250k a month. Quite possibly more, and maybe even a lot more given how big the RVU numbers are. And the ancillaries on top of that, with all that chemo…holy freaking cow.

Yeah, someone is making a ton of cash here. But it ain’t gonna be OP.

 

[dozitgetchahi]

Generally agree with this but I think private practice is still the best option, but for the right person.

If you are on the older side and already have family/kids and perhaps have a non working spouse, then an employed position will offer immediate high compensation and more job stability/safety.

However, if you are young and fresh out of fellowship, it is worth it to take the risk/gamble and go for private practice. If things work out well, you will be way ahead financially in the long run. If things don't work out, you can always go for an employed position later on and will just have an opportunity cost of $500k ish over the 2-3 years as employee

I think PP is great for most people too. I am in PP as well, and if you can find the *right* PP, you can do very well financially and enjoy more autonomy etc.

Problem is, a lot of PPs are exploiting new docs and want to funnel the cash to a few at the top. A Ponzi scheme of sorts. And it looks like OP has found one of these PPs.

 

[gutonc]

I think PP is great for most people too. I am in PP as well, and if you can find the *right* PP, you can do very well financially and enjoy more autonomy etc.

Problem is, a lot of PPs are exploiting new docs and want to funnel the cash to a few at the top. A Ponzi scheme of sorts. And it looks like OP has found one of these PPs.

I agree that PP can be the right thing for many people. But the OPs PP doesn't seem like the right thing for anyone that's not already cashing the checks.

 

[HemeOncHopeful19]

I don't think OP should take this job. BUT...

They did mention total comp was eventually "1-2 million a year"

There's a big difference between $1M and $2M. I might try to convince myself to do this job for $2M a year... it wouldn't work out well in the end, but I might try to convince myself. For $1M no way in hell.

 

[dozitgetchahi]

I don't think OP should take this job. BUT...

They did mention total comp was eventually "1-2 million a year"

There's a big difference between $1M and $2M. I might try to convince myself to do this job for $2M a year... it wouldn't work out well in the end, but I might try to convince myself. For $1M no way in hell.

I’m not sure I’d take the job for any amount of money. At those volumes, you’d be miserable and your quality of care would probably be very subpar.

My observation in rheumatology is that the quality of care delivered seems to drop off substantially beyond about 22-25/day or so. I’ve encountered a number of rheums trying to crank up their earnings by seeing about 30/day…without exception, each of them have been horrible doctors.

40-60 patients/day, even with a midlevel, in a specialty like Heme/onc…that would be a very hard pass.

 

[sloh]

I’m not sure I’d take the job for any amount of money. At those volumes, you’d be miserable and your quality of care would probably be very subpar.

My observation in rheumatology is that the quality of care delivered seems to drop off substantially beyond about 22-25/day or so. I’ve encountered a number of rheums trying to crank up their earnings by seeing about 30/day…without exception, each of them have been horrible doctors.

40-60 patients/day, even with a midlevel, in a specialty like Heme/onc…that would be a very hard pass.

The liability of 40-60 onc patients scares me

 

[cmed21]

Not to mention how would you feel about yourself in a job like that when you finally come home from the day. I think it would be really hard to have to walk out on patients constantly after a perfunctory visit who are hoping with more time with you to explain their diagnosis, treatment plan, prognosis etc.