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Oh I forgot: Medicare has limited the number of "transforaminal" epidurals to 1 per level on average (not 2 on everyone or bilateral on everyone like the mills did in the past as well to keep revenue up). This is another 30% or so cut on average for reimbursement since 2021.
Let me go into the economics of HOPD employment vs "Private Practice" now from a salary perspective:
1) HOPD starts physician at 450-500K for first 2-3 years. Private Practice has "3 year partnership" starting the physician at 250-300K or so per year. (Gradient: 500k-275K *3= 675K). So you are essentially starting 700K in the red just signing with the private practice.
Good luck partnering in an increasingly costly "mill" practice that is losing docs considering your share of the overhead you need to "payback" is astronomical. Its even worse if the practice wants you to "indemnify" them for the money before partnership. Could take 4+ years to partner at lower salaries at that point or never partner. This is if the practice survives in the interim or isn't attempted to be sold to PE.
2) Depending on $/RVU structure and efficiency of HOPD vs Private Practice "ceiling" 3 years later is TRICKY. However, with the increases costs and declining reimbursements for PPs, its likely maximum for both is realistically at 800K to 900K. I think its a wash at best.
HOPD can realistically obtain 14k/RVU in an "efficient" practice pretty easily after a few years (depending on location, etc) and even at 62/RVU, its a little under 900K. You would need to work equally hard at a private practice to obtain those numbers in an inflationary environment with increasing costs and decreasing reimbursement. The risk difference is enormous.
3) How much is extra time worth that will be required from "partners" for administrative tasks?
4) Ancillaries of Private Practice: PT is not profitable anymore and can actually be costing the practice money in rent, UDS profit is marginal, etc. I dont really see much opportunity here anymore.
Im really not seeing the advantages of PP at this point if you properly vet a hospital based job or even private equity job. Dr Russo might have a better argument?
Also, remember, you can NEGOTIATE a better deal with a PE group if you join it as an outside physician rather then get taken over as a "non partner" in a private practice. Non partners are not going to do well in a PE deal and have worked for less for nothing.
Most PE deals target practices that are growing with a few "super partners" who get all the money.
Spot on! If I had it to do over again, I'd take my $750K HOPD gig and turn my brain off after 5 PM. Getting paid last and signing other people's paychecks is not all it is cracked up to be.