Subsidies, partnership, and other woes from the job search.

[2ndyear]

I've interviewed at a fair number of private practice groups now, talked to even more on the phone, emailed more, and now have blocked the numbers of some really sleazy recruiters trying to convince me that Worcester is not only a suburb, but a nice suburb within driving distance of Boston. Here's my questions from those who have been there.

1) The dreaded subsidy. At least in the northeast, I think I came across only one private group that did NOT have a subsidy. Only 1 group told me how much their's was (10 doc practice, 2-something mil subsidy!). 1 group would not tell me if they had one (said it was proprietary info), meaning, they had one and it was likely large. Hospital employed positions don't have this hassle I guess. My fear? There are some large AMC's out here, probably able to staff a hospital without or with less subsidy. Also, there have been 2 recent shake-ups at mid sized hospitals, each with 8-10 docs out of jobs. Not cool, and I don' want that to be me in a year. So, should I fear the subsidy?

2) Non-disclosure of partnership monies. I really liked a certain group in a nice suburb. Great hospital, great practice, all nice and well trained MD's with a mostly supervision model. Up front it was made clear what first year salary would be, and it was on the low end. Said second and third year would get a raise, of some amount. Also said you would never know what partners made until you were one, and you would never, ever know how much your other partners made. These seemed like really honest people, too. What's up with this? Dealbreaker?

3) Disability insurance. All groups offer short term, that means I have to buy supplemental long term and/or specialty specific, right?

And to all those who have not reached this stage yet, it's really pretty fun. The job market seems healthy. It's just hard to pick out the packages that are 'above average'. And it's true, these are really hardly ever on gaswork.com.

---

Members don't see this ad.

 

[coprolalia]

Do not underestimate the importance of transparency, my friend. I've heard many stories from friends in PP land about greedy bastards who are going to milk you for all you're worth then show you the curb. Be very careful.

-copro

 

[Planktonmd]

The sad reality is that the majority of private practice groups are run by crooks, and the more desirable the location is the more likely they will be controlled by professional con artists.

 

[Fooper]

"Do not underestimate the importance of transparency"

I could not agree more. You and your potential partners are already members of the "fellowship" of medicine & the "brotherhood" of anesthesiologists and you are interviewing to enter their "family" of business partnership. Is this any way to treat a family member? So many physicians (including anesthesiologists) seem to just piss on these relationships, especially the last, so beware!

 

[Noyac]

1) Subsidies are nice until they go away. I have limited knowledge of these since I am a hosp employee and don't have to worry about it. But it seems to me that they are always changing which makes for some uncertainty. I wouldn't necessarily count heavily on the subsidy ie: stipend.

2) Non-disclosure. My first group was very reluctant to disclose any monies to me when I interviewed at first. I just continued communications and they were very interested in me so the numbers came eventually when they thought they may lose a candidate. If you are a strong candidate and they need help, they will disclose the information in one form or another. I never saw it on paper but their lifestyle gave me an idea nad the numbers they quoted seemed to match the lifestyle. Then as an associate the numbers really started to become apparent. The partners I made close friends with also began to inform me. When I showed interest in moving on for my own reasons the W2's came out. You need to understand their side as well. The last thing they want is for the people they work with, surgeons, nurses, administrators, etc to know how much they make. Believe me there is a lot of jealousy when those folks know your income and nothing good comes from it. Plus income changes from year to year with most of these groups. My advice is for you to maintain your interest in the job. Inform them of your understanding of confidentiality. And ask them for some general idea with as much verification as you need.

3) I added disability. And specialty specific is good.

 

[Pilot Doc]

Also said you would never know what partners made until you were one, and you would never, ever know how much your other partners made. These seemed like really honest people, too. What's up with this? Dealbreaker?

Not knowing what a partner makes is annoying, but probably something you'd have to accept for a desirable job. Not knowing - ever - what other partners make? That's a major, major dealbreaker. First of all, as a part owner of a business you should have access to all the financial records. Calling the arrangement you describe a "partnership" is laughable. That is 100% completely a set up to enrich some part of the group at the expense of the other. I'd definitely avoid that.

 

[Noyac]

Not knowing what a partner makes is annoying, but probably something you'd have to accept for a desirable job. Not knowing - ever - what other partners make? That's a major, major dealbreaker. First of all, as a part owner of a business you should have access to all the financial records. Calling the arrangement you describe a "partnership" is laughable. That is 100% completely a set up to enrich some part of the group at the expense of the other. I'd definitely avoid that.

Agreed.

 

[pd4emergence]

I've interviewed at a fair number of private practice groups now, talked to even more on the phone, emailed more, and now have blocked the numbers of some really sleazy recruiters trying to convince me that Worcester is not only a suburb, but a nice suburb within driving distance of Boston. Here's my questions from those who have been there.

1) The dreaded subsidy. At least in the northeast, I think I came across only one private group that did NOT have a subsidy. Only 1 group told me how much their's was (10 doc practice, 2-something mil subsidy!). 1 group would not tell me if they had one (said it was proprietary info), meaning, they had one and it was likely large. Hospital employed positions don't have this hassle I guess. My fear? There are some large AMC's out here, probably able to staff a hospital without or with less subsidy. Also, there have been 2 recent shake-ups at mid sized hospitals, each with 8-10 docs out of jobs. Not cool, and I don' want that to be me in a year. So, should I fear the subsidy?

2) Non-disclosure of partnership monies. I really liked a certain group in a nice suburb. Great hospital, great practice, all nice and well trained MD's with a mostly supervision model. Up front it was made clear what first year salary would be, and it was on the low end. Said second and third year would get a raise, of some amount. Also said you would never know what partners made until you were one, and you would never, ever know how much your other partners made. These seemed like really honest people, too. What's up with this? Dealbreaker?

3) Disability insurance. All groups offer short term, that means I have to buy supplemental long term and/or specialty specific, right?

And to all those who have not reached this stage yet, it's really pretty fun. The job market seems healthy. It's just hard to pick out the packages that are 'above average'. And it's true, these are really hardly ever on gaswork.com.

1. Subsidies: good for the group as long as the hospital is willing to pay. Good questions to ask are How willing has the hospital been in paying it? and What will happen if the subsidy disappears? Ideally you could go to a group that takes no money from the hospital but in some regions this is not possible. I would rather go to a good, honest, equitable group that takes a subsidy than to a group of crooks that does not. The fact is nothing is ever certain. The best you can do is go to a stable group with honest people.

2. If all partners in a group can't look at the books anytime they want there is something wrong. You as an interviewee and as a nonpartner employed by the group should not expect to get to look the books. You do have a right to know a ballpark estimate as to what the average income for a partner has been over the past few years. You can't make a decision to work for less for 2-3 years ("your buy in") if you don't know what your buy in is worth. If they can't tell you this you should walk.

3. Disability: get it before you finish residency (ie 2-3 months before your last year ends). Get as much as you can at the time. Once you start with the group then your personal disability insurance company will count your possible group benefit against the total you can get for your personal. You need to carry the best personal policy you can. Group policies have a tendency to change either by changing groups or by a group finding a cheaper option.

As for finding good jobs, talk to residents who are 1-2 years ahead of you and are in practice, talk to your program director, expand your search to other regions. You are correct in that most good jobs are filled before the headhunters get the listing. Good Luck

 

[coprolalia]

Most importantly, use the connections you made in residency to help you out. More often than not, someone knows someone (or knows someone who knows someone) where you're going to be applying (unless you are doing residency in Miami and looking for a job in Seattle).

Reputations are very big in what is still a fairly small cadre of individuals. There's a lot of info out there. Just have to ask the right people.

-copro

 

[Jeff05]

hey,
as you're looking around, have you been able to get a sense of the market for pain management? are there practices that are looking for someone to do part time pain, part time gas?
thanks,
jeff

 

[2ndyear]

Interesting Jeff, Of the groups I've interviewed at 4 had pain docs.
1) All pain guys took general OR call, including late call. No scheduled anesthesia days, only pain clinic. Looking for a pain doc willing to do that.

2) All hospital employed. Essentially separate pain docs, took OR call only for money. I don't think they needed anymore pain guys.

3) Group of 10 looking to spin off their pain group. So 2 pain docs would be separate, no OR call or duties, with adding 2 to their general private group. As to where the pain revenue would go, well they couldn't tell me. Nor would I know as this is the aforementioned group above where you never know what your partners make. I've talked to some more people about this, and apparently it's called 'tiering'? whereby you reach certain tiers in the practice and basically take less call and make more money.

4) Group of 16 had pain docs, also all taking OR call, and all working 50% pain, 50% gas. Just hired a guy finishing pain fellowship, still looking for someone to do 100% gas.

So, interesting note about #3 above, the secretive group. This is heresay from someone supposedly in the know, but apparently when you get the nod, you meet in an undisclosed location with the business manager. Before you enter, you are sworn to secrecy not to tell anyone what goes on in the little room. You enter a small room, no windows, just a chair and a table. On the table is a book. Open the book, and there is a contract with your name on it, as well as a ballpark about what to expect as partner. You can't take the book or the contract out of the little room, it's sign now or see ya. No lawyers, no negotiation, nada. So you sign, again sworn to never tell anyone how much you make or what goes on in the little room. Again, some of this may be BS, but apparently someone did go into the little room bragged to me and that's as much as I know.

 

[fastosprintini]

hi 2nd year, there was'nt a burning candle on a scull and a black raven in this little room by any chance....? fasto

 

[Pilot Doc]

undisclosed location with the business manager. Before you enter, you are sworn to secrecy ....

Assuming that's all true...

Is there something really, really desirable about this practice? I can't imagine they can compete for employees in this market with that behavior.

 

[pmichaelmd]

Assuming that's all true...

Is there something really, really desirable about this practice? I can't imagine they can compete for employees in this market with that behavior.

Unless what's in that little book is a 7-figure contract.

 

[fastosprintini]

hi 2nd year, you opened up an excellent thread with many important connotations....
mind you though , it's not over once you are in practice, the goalposts keep moving at short notice...! our group receives a stipend /backfill whatever from the hospital in exchange for our promise to run x# of rooms, now the hospital has second thoughts about this, as i said its never cut and dried...
again , good post, keep it coming people, fasto

 

[Noyac]

Assuming that's all true...

Is there something really, really desirable about this practice? I can't imagine they can compete for employees in this market with that behavior.

Typically, these groups make JACK. Big Jack. Thats why all the secrecy.