Thinking about hiring Mohs surgeon

[zanzizic]

It’s funny because there’s a thread right now about how hard it is to get hired...but I’m considering hiring a Mohs surgeon.

I trained almost two decades ago and have been solo referral only all this time. I need a little advice on how current fellows are getting reimbursed in their first gig, etc.

Practice structures and starting salaries, etc. I’d appreciate any input you guys could give.

---

Members don't see this ad.

 

[Skindoc83]

Would this be for full time mohs or part time mohs and the rest general derm and cosmetics? Are you thinking of offering equal partnership? Do you have space or will you have to build out?

 

[zanzizic]

Full time Mohs. No cosmetics. I have room already since I expanded this last year.

I’m thinking of offering some kind of ownership but not equal. I’ve built this practice for nearly 20 years and do not want to give up control.

 

[MOHS_01]

Full time Mohs. No cosmetics. I have room already since I expanded this last year.

I’m thinking of offering some kind of ownership but not equal. I’ve built this practice for nearly 20 years and do not want to give up control.

I am of little help, I’m afraid. I was where you are a few years ago, but then personal tragedy struck one referring group while another hired someone in house; needless to say, I’m glad I did not follow through on that impulse.

Q’s for you to answer before making your decision:
- how diversified are your referrals?
- are you wanting / willing to cut back personally
- how far are you booked out
- do you believe you are losing referrals because of your wait time
- do your referring providers plan on expanding operations (more referrals) and do you think they’ll entertain hiring their own

 

[zanzizic]

I’m sorry for the late reply. A close family member has been going through cancer treatments and I’ve been busy with family obligations and work.

I live in a city with 1+ million that is underrepresented with Mohs (compared to the coasts and other metro areas). I’ve been practicing for around 20 years and do approximately 1750 cases/yr.

My referrals are diversified. I have numerous solo derms referring to me. A couple of larger groups as well but I see the writing on the wall that after some time they will hire their own Mohs surgeons. There are a few smaller surrounding towns in a larger geographic region with no Mohs so I get some from derms out in the boonies too. I also work with several plastic surgeons that don’t want the headache of cancer removals and refer to me for Mohs and they do reconstructions. I also have one PA who helps me with Mohs and one day a week sees patients in a small town around 45 min away and biopsies skin cancers and generates more referrals. I’ve been blessed and don’t do any marketing. If I did market to derms and PCPs I’d have more than I could handle I think.

Yes, I’m looking to personally cut back somewhat. I’m booked out for surgeries and consults about a month and I’m doing around 8 Mohs pts (some with multiple sites) and a couple of excisions per day. I don’t think I’m losing referrals necessarily due to this wait time although I think that I work so much that other Mohs surgeons in town are gaining on me due to them having more time (and incentive) to market and schmooze harder...

I’m pushing 50 and want to slow down and do these things in the next few years. So I’m looking for someone to help bring some fresh blood and lighten the load. I want to offer a fair but competitive deal so I’m looking for insight into what the current deals are that new Mohs fellowship grads are getting.

 

[MOHS_01]

I’m sorry for the late reply. A close family member has been going through cancer treatments and I’ve been busy with family obligations and work.

I live in a city with 1+ million that is underrepresented with Mohs (compared to the coasts and other metro areas). I’ve been practicing for around 20 years and do approximately 1750 cases/yr.

My referrals are diversified. I have numerous solo derms referring to me. A couple of larger groups as well but I see the writing on the wall that after some time they will hire their own Mohs surgeons. There are a few smaller surrounding towns in a larger geographic region with no Mohs so I get some from derms out in the boonies too. I also work with several plastic surgeons that don’t want the headache of cancer removals and refer to me for Mohs and they do reconstructions. I also have one PA who helps me with Mohs and one day a week sees patients in a small town around 45 min away and biopsies skin cancers and generates more referrals. I’ve been blessed and don’t do any marketing. If I did market to derms and PCPs I’d have more than I could handle I think.

Yes, I’m looking to personally cut back somewhat. I’m booked out for surgeries and consults about a month and I’m doing around 8 Mohs pts (some with multiple sites) and a couple of excisions per day. I don’t think I’m losing referrals necessarily due to this wait time although I think that I work so much that other Mohs surgeons in town are gaining on me due to them having more time (and incentive) to market and schmooze harder...

I’m pushing 50 and want to slow down and do these things in the next few years. So I’m looking for someone to help bring some fresh blood and lighten the load. I want to offer a fair but competitive deal so I’m looking for insight into what the current deals are that new Mohs fellowship grads are getting.

Aside from the city and diversity, you are quite where I was a few years back -- not drowning but a little busier than I liked, my wait time was a little longer, but we had similar schedules (anywhere from 7-10 MMS / day, 2 excisions, follow ups, new patients, consults added another 15 or so). I was (am still) splitting my time between two locations though, non overlapping cachement areas, and was looking at hiring someone. Things changed with referral stream (murder!, medical retirements, attrition, etc) and the world changed.

I would imagine that you can get a fellowship trained MMS for same or less than a general derm these day -- assuming you are fair in the contract. They'll expect partnership / ownership in a reasonable time period and some assurances that you won't play Calvinball TM and change the rules once under contract and in place.

I understand the want to cut back -- the grind is more grueling than can be believed -- and people are changing. It's a tougher slug for like work these days with the changes in patients' attitudes and behaviors, not to mention the diminishing returns on work.

Best of luck with everything.

 

[hartbot]

One of your top referrers got murdered?

 

[MOHS_01]

One of your top referrers got murdered?

Yeah -- owner of a 3 MD, 4 or 5 midlevel practice. Sad situation.