too many options

[finalpsychyear]

So I am having a harder time deciding on my next steps as there are so many options in my area.
My goal is to remain independent for the time being although there are a lot of tempting 250k offers on the table. I feel i owe it to myself to start a Private practice as it is something i have always wanted to do.

#1: an independent hospital doing well financially about 40 min from where i am living has no psychiatrist or inpatient psych unit is really wanting to have me join them. They are willing to work it however i want 1-5 day a week, full time, part time, contractor, employment option. They mentioned something called a "hospital guarantee for helping me start a private practice if that is what i wanted." They want some inpatient coverage for floor and ER consults which a behavioral nurse is doing and they have some company who comes to do involuntary admissions to outside places from their ER but essentially they will take anything if i join them.

Would this be 2 contracts? Like a hospital guarantee of like idk 100k for the outpatient private practice and then would i be able to charge a "coverage fee" of like 250-500 per day for inpatient coverage. I would be available by phone or person and then bill the consults i do see face to face independently? I need a good way to present this and my lack of experience is why i am turning to this board to see what others have pulled off or if my daily stipend is too high or low.

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[SmallBird]

So I am having a harder time deciding on my next steps as there are so many options in my area.
My goal is to remain independent for the time being although there are a lot of tempting 250k offers on the table. I feel i owe it to myself to start a Private practice as it is something i have always wanted to do.

#1: an independent hospital doing well financially about 40 min from where i am living has no psychiatrist or inpatient psych unit is really wanting to have me join them. They are willing to work it however i want 1-5 day a week, full time, part time, contractor, employment option. They mentioned something called a "hospital guarantee for helping me start a private practice if that is what i wanted." They want some inpatient coverage for floor and ER consults which a behavioral nurse is doing and they have some company who comes to do involuntary admissions to outside places from their ER but essentially they will take anything if i join them.

Would this be 2 contracts? Like a hospital guarantee of like idk 100k for the outpatient private practice and then would i be able to charge a "coverage fee" of like 250-500 per day for inpatient coverage. I would be available by phone or person and then bill the consults i do see face to face independently? I need a good way to present this and my lack of experience is why i am turning to this board to see what others have pulled off or if my daily stipend is too high or low.

I'm not sure that 'hospital guarantee' is some with a clearly defined meaning - I think you should really ask them to spell this out before you commit too much mental energy to thinking how you can capitalize on it. It is otherwise nice that they seem so flexible - why would you not just ask for $200k salaried and then only work 3.5 days? This will give you a nice stable income while you build up a private practice. Of course you may be less risk averse than me but I'd rather have one of my income streams be stable initially.

Billing on your own for consults is probably bad deal for you. You want to be sure that the hospital is tapping into facility fees in reimbursing you and not only rerouting you what you collect in direct billing.

 

[finalpsychyear]

I'm not sure that 'hospital guarantee' is some with a clearly defined meaning - I think you should really ask them to spell this out before you commit too much mental energy to thinking how you can capitalize on it. It is otherwise nice that they seem so flexible - why would you not just ask for $200k salaried and then only work 3.5 days? This will give you a nice stable income while you build up a private practice. Of course you may be less risk averse than me but I'd rather have one of my income streams be stable initially.



Billing on your own for consults is probably bad deal for you. You want to be sure that the hospital is tapping into facility fees in reimbursing you and not only rerouting you what you collect in direct billing.

I should add i am doing PP in another area already 2 days out of the week but long term this new hospital is closer to where i ultimately want to move in the next few years. But asking for a salary can make it tricky. They will then most likely own the private practice essentially which is not what i want. Some type of RVU based compensation for hospital work plus the coverage fee would be ideal but I don't know the complexities in mixing 3 different ways i am being paid : hospital guarantee, stipend for coverage, and then RVU based compensation for inpt work. Of course for me this would be ideal because ultimately i would own the private practice and be 100% autonomous.

 

[FlowRate]

I'm not sure that 'hospital guarantee' is some with a clearly defined meaning - I think you should really ask them to spell this out before you commit too much mental energy to thinking how you can capitalize on it. It is otherwise nice that they seem so flexible - why would you not just ask for $200k salaried and then only work 3.5 days? This will give you a nice stable income while you build up a private practice. Of course you may be less risk averse than me but I'd rather have one of my income streams be stable initially.

Billing on your own for consults is probably bad deal for you. You want to be sure that the hospital is tapping into facility fees in reimbursing you and not only rerouting you what you collect in direct billing.

Hospital guarantee is usually a fixed salary for X amount of time until you are able to build your practice. It's common in surgical specialties.

OP, you could potentially ask for 250k salary guarantee with productivity bonus for one year and then, if you want, be pure productivity after. They don't necessarily have to own your practice--you could pay overhead but eat what you kill and reserve the ability to take your panel with you. (If they agree to that idea, which they might not since they're paying you to build a practice that will hopefully stay at their hospital.)

You can really ask for whatever you want, I don't know what's standard for outpatient psychiatrists who also take ED/Inpt consults.

 

[Shikima]

Find a hospital to get a medical directorship with benefits and then engage in a 'catch what you kill' to be able to grow your PP as you want. There will be enough business around to generate revenue. Be sure to negotiate that you're using hospital facilities, billing services and office staff for your needs and that you keep 100% of collections.

 

[finalpsychyear]

Find a hospital to get a medical directorship with benefits and then engage in a 'catch what you kill' to be able to grow your PP as you want. There will be enough business around to generate revenue. Be sure to negotiate that you're using hospital facilities, billing services and office staff for your needs and that you keep 100% of collections.

The only problem is once you use hospital facilities/staff/billing can you still be independent? I figure I'm going to have to rent an office offsite from the hospital to truly make it run like an indep venture like my other one.

 

[finalpsychyear]

Hospital guarantee is usually a fixed salary for X amount of time until you are able to build your practice. It's common in surgical specialties.

OP, you could potentially ask for 250k salary guarantee with productivity bonus for one year and then, if you want, be pure productivity after. They don't necessarily have to own your practice--you could pay overhead but eat what you kill and reserve the ability to take your panel with you. (If they agree to that idea, which they might not since they're paying you to build a practice that will hopefully stay at their hospital.)

You can really ask for whatever you want, I don't know what's standard for outpatient psychiatrists who also take ED/Inpt consults.

All i know is once you get any type of guarantee that is a salary you are essentially losing ownership. The hospital guarantee i'm asking for is what many years ago hospitals would offer doctors to come start as a private practice doc in that area... in a sense it is kind of like a loan that is forgiven if your there long enough or you never use it because say you have a 100k hospital guarantee but generate beyond that your first year you essentially never tap into it but it is there just in case. They brought this option up when i was there during the initial meeting so i figure what have i got to lose with it.

 

[PistolPete]

I think the standard is to be employed somewhere and get a salary with benefits, then grow your PP on the side. As the PP grows, cut back on the salaried gig. That's what I'll be doing.

 

[Shikima]

The only problem is once you use hospital facilities/staff/billing can you still be independent? I figure I'm going to have to rent an office offsite from the hospital to truly make it run like an indep venture like my other one.

You can still be employed and have a PP with your own billing. Just because you use facility resources doesn't mean that you can't bill and collect under your own corporation.

 

[finalpsychyear]

You can still be employed and have a PP with your own billing. Just because you use facility resources doesn't mean that you can't bill and collect under your own corporation.

Thanks. I was not aware of this. However, the location of this hospital and if i use their office is about 40 minutes from where i eventually plan to live in 2 years. Will it pose issues if i plan to move the private practice portion 20 minutes closer to my location in this type of setup? The hospital might have an interest in keeping that PP right there instead of 20 min away. Thank you again for any help.

 

[michaelrack]

Thanks. I was not aware of this. However, the location of this hospital and if i use their office is about 40 minutes from where i eventually plan to live in 2 years. Will it pose issues if i plan to move the private practice portion 20 minutes closer to my location in this type of setup? The hospital might have an interest in keeping that PP right there instead of 20 min away. Thank you again for any help.

although it may technically be possible, it's not really your own private practice unless you are doing your own billing. You need to handle your own billing/credentialing with insurance companies if you want to truly own and be able to move the private practice. List the hospital as a practice location and use a separate address for correspondence/insurance company checks (of course you will want to arrange for direct deposit into your business checking acct, but there will always be some physical checks)

 

[finalpsychyear]

although it may technically be possible, it's not really your own private practice unless you are doing your own billing. You need to handle your own billing/credentialing with insurance companies if you want to truly own and be able to move the private practice. List the hospital as a practice location and use a separate address for correspondence/insurance company checks (of course you will want to arrange for direct deposit into your business checking acct, but there will always be some physical checks)

Excellent advice. I have already done my own credentialing/billing for my 2 day a week practice I'm currently doing. Just to be clear, as long as I am proposing to the hospital that I be an independent private practice and do my own billing even though I am potentially using the hospital space, I maintain the ability to move the practice or does this get sticky?

 

[michaelrack]

you would add the hospital outpatient area as an additional practice site to your existing practice. so if you stop practicing there, you would just delete that practice site, and could add other sites at any time. things only get sticky if there is a non-compete preventing you from having other practice locations within a certain distance or otherwise prevent you from recruiting hospital patients

 

[Shikima]

With the scarcity of psychiatric resources, one would never consider a non-compete clause.

 

[finalpsychyear]

you would add the hospital outpatient area as an additional practice site to your existing practice. so if you stop practicing there, you would just delete that practice site, and could add other sites at any time. things only get sticky if there is a non-compete preventing you from having other practice locations within a certain distance or otherwise prevent you from recruiting hospital patients

I am so glad there are people with experience with this. So I guess I will just negotiate to essentially rent office space from the hospital and add that location to my existing information. So if i am paying rent anyways as I would to the hospital in this setup, what benefit is it to rent specifically from the hospital aside from just choosing a spot 5 minutes nearby maybe even a room in a PCP's office? In addition to discussing an employed and rvu model at our first meeting they mentioned a "hospital guarantee for starting a PP in the area" option but I know little about this other than this was something that was done more commonly in the past to attract doctors to the area.

Have a follow up meeting at end of the month so I hope someone can shed some light on this if anyone knows.

 

[Shikima]

You could negotiate a tit for tat arrangement with the hospital where they supply all that you need in order to care for their patients.

 

[finalpsychyear]

You could negotiate a tit for tat arrangement with the hospital where they supply all that you need in order to care for their patients.

Meaning that they would supply a secretary and office space potentially free or much cheaper than me renting down the street? Sounds great and almost too good to be true, although the cynic in me thinks there's always a catch to something like this like a non-compete in the fine print but again I know next to nothing compared to you and dr. michaelrack about this sort of arrangement.

 

[Shikima]

I didn't know anything until I talked to about a dozen hospital administrators. Then it started to make sense.

 

[finalpsychyear]

I didn't know anything until I talked to about a dozen hospital administrators. Then it started to make sense.

Bottom line is I can do the hospital setup where i do my own billing and they provide the space and staff and since they have 0 psychiatrists even if they were to add a non compete clause in their contract with me I have the leverage to have that thrown out. Sounds like an absolute win win for me.