"When your practice owns 100% of the ASC" question...

[A Deep Breath]

the EBIDTA of medical practices without equipment is little to nothing. Without the “good will” and physicians there is no real multiplier. This is not a SaaS business that can scale.

For lurkers, this is valuable advice I wish I’d understood sooner.

You should view starting a private practice as self-employment, rather than a business. It can be great because you’re in charge and have the ability to maximize your revenue.

But ultimately, you’re trading time for money, just like any other job. If you’re not working, you’re losing money. Unlike a business, where the owner can eventually step back.

You might think you can skim a little from each physician you bring in. You can, and people do. But you can see in this thread how well that goes over. How many pain doctors do you know who are kicking back in retirement enjoying the cash flow from their practice?

Then you realize the only remaining potential jackpot is to eventually sell the practice. To maximize that payday, you need happy, long term partners. So no skimming.

If (and it’s a big if) you find someone to sell to, deals these days suck. To summarize, you’d probably be better off just continuing to run your own practice for x years than suffering through an x year earn-out period.

Slight tangent, but CleanUp’s wisdom here was too good not to expand upon.

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[nvrsumr]

This is why I like my solo pp. very efficient time spent for the money and control.

Though if you have a 20 employed doc practice you really are a businessman at that point

 

[CleanUp]

some baller docs on sdn. Good for you

Thanks. Sorry if that came off as humble brag.

Once the infrastructure is in place adding more physicians is the easier part because the demand is high. I will be honest there was multiple times where I wanted to quit setting up the infrastructure. I spent far too much time on it and it takes continual maintenance. But I’m in a much better spot now because I have set aside time to maintain it and it is humming along.

We are very selective with the physicians that want to join the group. I’m not talking about pedigree or religion. We found the best fit are physicians who are willing to put in a little self time learning, understand general tenants of a business (ie you may not get paid right away and that’s not because we are screwing you), put the patient first (profit will come second if we’re all in alignment and we’re running a solid business model), and finally have emotional intelligence (don’t yell at your MA - teach her. Make a form to improve efficiency).

Honestly, if we treat them well, then they refer their friends. They get a big referral bonus. Their friend gets a referral bonus. And yes, we ultimately end up making more money.

We are extremely proactive and reaching out to them to see how we can make their life easier. We do not wait for problems to fester. It could be a text message or email sent every few weeks to check in. This is not some wishy-washy wellness stuff. Does the physician wanna make more money? OK, let’s develop a plan in order to do that.

 

[CleanUp]

For lurkers, this is valuable advice I wish I’d understood sooner.

You should view starting a private practice as self-employment, rather than a business. It can be great because you’re in charge and have the ability to maximize your revenue.

But ultimately, you’re trading time for money, just like any other job. If you’re not working, you’re losing money. Unlike a business, where the owner can eventually step back.

You might think you can skim a little from each physician you bring in. You can, and people do. But you can see in this thread how well that goes over. How many pain doctors do you know who are kicking back in retirement enjoying the cash flow from their practice?

Then you realize the only remaining potential jackpot is to eventually sell the practice. To maximize that payday, you need happy, long term partners. So no skimming.

If (and it’s a big if) you find someone to sell to, deals these days suck. To summarize, you’d probably be better off just continuing to run your own practice for x years than suffering through an x year earn-out period.

Slight tangent, but CleanUp’s wisdom here was too good not to expand upon.

Correct. My mentor encouraged me to set up a plan from day one to extract myself from the business. Have the exit plan in mind. Have it run without me. Like you said it is much easier said than done and requires constant surveillance and planning.

IMHO It’s not as simple as stacking up 99214s and seeing more patients.

Just like you, I saw some sweeping trends in medicine and society in general. These are bets that I made. I could be wrong. I don’t feel that CMS will increase reimbursement. I see the number of patients seen by mid levelers going up. I see the number of private practices going down in the future. I see insurance companies being more restrictive in what they approve. I see artificial intelligence playing a key role. I don’t see the next wave of workers having the same mentality as the old wave. These are all nonjudgmental statements. I am not knocking the doctor at Kaiser or the VA who really enjoys getting the same exact paycheck every two weeks and a pension. Everyone has different values and I respect that.

 

[gdub25]

You hiring?

View attachment 396929

Yes, actively looking to hire currently. Would like to have a decision made by the end of the month.

Sounds great for your employees but you must be running incredibly low overhead to be able to pay this well and still profit. If HOPD pays 65/wRVU, you're talking about 130/wRVU? 1.3M for 10k wRVUs would be a dream job.

no. 15000 rvu minimum.

Bob is correct, we don't make that much per RVU, we just do way more RVU than a typical hospital practice. In fact, we make much less per RVU than a hospital doc would.

 

[buddababa]

Yes, actively looking to hire currently. Would like to have a decision made by the end of the month.







Bob is correct, we don't make that much per RVU, we just do way more RVU than a typical hospital practice. In fact, we make much less per RVU than a hospital doc would.

this, because collections, overhead, etc, if you have a few thousand rvu that dont pay, well then it brings the $/rvu down

 

[nvrsumr]

Thanks. Sorry if that came off as humble brag.

Not at all. There are 4 million people in 70 mile radius of my office. I can’t think of a pp pain practice with more than 4 pain docs.
Kudos