Work for big medical group vs. start over from scratch?

[Algiatrist]

Hey there SDN, long time listener . . . first time caller,

I wanted to get input from the bigger brains on this.

My current employer, a multi-specialty group (30 docs, 8 different specialties) that had been in existence since 1960 was run into the ground by poor management and the refusal to evolve with healthcare. Long-story short - I have been given a "red pill" vs. "blue pill" choice.

I have been in this current job for 4 years, but I've been out of fellowship over 10 years. Some guy named Steve Lobel trained me in 2011-2012. I'm decent at this.
I am also 47 years-old, two kids in a great school that they love, and a very supportive wife who "just wants me to be happy".

Okay, here we go:

Red Pill: Joint the big medical group that is acquiring our practice. They are not owned by the hospital, but is an adjacent arm of the overarching healthcare system. Their compensation is totally wRVU based, but cannot exceed the 90th percentile where you are capped. 90th percentile for our specialty/geography based on "fair market value". Also, they will cover my tail insurance, but only if I sign on for minimum of two years.

My meeting with them is next Thursday to discuss my earning potential as well as "what life will be like as their employee".

Blue Pill: Go out on my own, either re-establishing with the other forlorn specialists to form a new multi-specialty group (essentially competing against the big medical group) or move away and find something else. I should add that my current restrictive covenant will be deemed "null and void" as my current practice is being absorbed and they have said that they will not enforce it.


What do you all think? What questions do I want to ask these jokers? Obviously I want my wRVU multiplier to be around $60-65 dollars per unit, and I need to know about where I'll be doing procedures (office vs. HOPD vs. hospital), but what am I missing about this whole scenario?

HELP!!

---

Members don't see this ad.

 

[willabeast]

Sounds to me like you need to get some intel on the big medical group acquiring your practice. The group you are in was poorly run so you know the consequences of poor management.

 

[Agast]

Does your supportive wife bring in any income? You need to pencil out your expenses and how long you can survive off savings while building a practice. It’s doable but lifestyle would probably change.

 

[DrSpine]

Personally, I'd rather pick Option B. I can assure you, the initial safety net of $ with Option A will be short lived happiness. In a year you will regret your decision and always think "what if?" Rarely, especially after being bought out by Private Equity, are employees truly happy. And when they say "nothing will change" it means "Everything will change."

 

[RoloTomassi]

To expound on what your wife said, what does make you happy? Clock in clock out job and income stability are really the only pros of employed, so figure out where those lie on your list of priorities is my advice

 

[lobelsteve]

Despite your substandard training, you will flourish.

Red pill after meeting the bosses and letting them know if they cap you at 90%, you should be free to work 3 days a week or they need to lift the cap.

 

[SSdoc33]

Despite your substandard training, you will flourish.

Red pill after meeting the bosses and letting them know if they cap you at 90%, you should be free to work 3 days a week or they need to lift the cap.

right.

you will just stop working 2/3 of the way through the year.

the "caps" disincentivize both you and the system making money

 

[emergentmd]

I am EM and not pain but maybe my story will help you alittle.

Circa 2017 our private ER group by "forced" to sell out which we had zero choice. Either take a small parachute + 2 yrs work or get nothing. After the 2 yrs, all of our docs had a choice. I was about your age, 45 at the time. I had 3 kids all under 10, a very supportive wife who essentially told me to do whatever I believe is best/makes me happy.

1. Stick with the management group and essentially keep the same pay we had minus our "partner distribution". I would say our pay was top 75% with a top 10% work environment. Have little control over my practice.

2. Do Locums, control my own schedule. Pay in the top 95%. Work environment was bottom 10% but essentially a 75% pay raise. Still under control of a CMG and little control over my practice.

3. Take the risk of opening up our own ER. Work environment great with full control. Pay unknown. Risk very high.

I picked #3. I asked about 10 of my old partners to join me, 3 did and 7 choose the safety of #1.

Fast forward 5 yrs. The four of us that jumped all are making 3x our hospital salary, we control our schedule, daily operations, work pace/environment can be described as unicorn. No one tells us what metrics we need to meet, no meetings we are forced to go to, AND NO nurse/C suite above us. The 7 that decided to stick to #1 - 4 wants to join us but that ship has essentially sailed. 1 left medicine to retirement. 2 still working with CMG. Almost all of my old partners have left #1 because what was promised was not delivered, most going to lower paying jobs for a better work environment.

Medicine will continue to change for the worse so expect work in 5 yrs to be very different than today. Don't have regrets in life. If you have enough money to weather the transition, I always vote for running your own practice.

 

[DrSpine]

I am EM and not pain but maybe my story will help you alittle.

Circa 2017 our private ER group by "forced" to sell out which we had zero choice. Either take a small parachute + 2 yrs work or get nothing. After the 2 yrs, all of our docs had a choice. I was about your age, 45 at the time. I had 3 kids all under 10, a very supportive wife who essentially told me to do whatever I believe is best/makes me happy.

1. Stick with the management group and essentially keep the same pay we had minus our "partner distribution". I would say out pay was top 75% with a top 10% work environment. Have little control over my practice.

2. Do Locums, control my own schedule. Pay in the top 95%. Work environment was worse. Still under control of a CMG and little control over my practice.

3. Take the risk of opening up our own ER. Work environment great with full control. Pay unknown. Risk very high.

I picked #3. I asked about 10 of my old partners to join me, 3 did and 7 choose the safety of #1.

Fast forward 5 yrs. The four of us that jumped all are making 3x our hospital salary, we control our schedule, daily operations, work pace/environment can be described as unicorn. No one tells us what metrics we need to meet, no meetings we are forced to go to, AND NO nurse/C suite above us. The 7 that decided to stick to #1 - 4 wants to join us but that ship has essentially sailed. 1 left medicine to retirement. 2 still working with CMG. Almost all of my old partners have left #1 because what was promised was not delivered, most going to lower paying jobs for a better work environment.

Medicine will continue to change for the worse so expect work in 5 yrs to be very different than today. Don't have regrets in life. If you have enough money to weather the transition, I always vote for running your own practice.

Incredible, thank you for sharing this!

 

[emergentmd]

If this helps you alittle more to take the risk. 2017 me had prob 1M in IRA retirement plus 300K in real estate. 2023 me have over 10M in assets.

High risk but high rewards. I am essentially retired now and work b/c I love my job/work environment. I work as much as much or as little as I want AND involved greatly in my kids activities.

If I didn't take the risk, I prob would have 2M in retirement and still working full time in the hospital as I still have 3 teenagers I have to care for PLUS missing many of the kids activities.

 

[bedrock]

I am EM and not pain but maybe my story will help you alittle.

Circa 2017 our private ER group by "forced" to sell out which we had zero choice. Either take a small parachute + 2 yrs work or get nothing. After the 2 yrs, all of our docs had a choice. I was about your age, 45 at the time. I had 3 kids all under 10, a very supportive wife who essentially told me to do whatever I believe is best/makes me happy.

1. Stick with the management group and essentially keep the same pay we had minus our "partner distribution". I would say our pay was top 75% with a top 10% work environment. Have little control over my practice.

2. Do Locums, control my own schedule. Pay in the top 95%. Work environment was bottom 10% but essentially a 75% pay raise. Still under control of a CMG and little control over my practice.

3. Take the risk of opening up our own ER. Work environment great with full control. Pay unknown. Risk very high.

I picked #3. I asked about 10 of my old partners to join me, 3 did and 7 choose the safety of #1.

Fast forward 5 yrs. The four of us that jumped all are making 3x our hospital salary, we control our schedule, daily operations, work pace/environment can be described as unicorn. No one tells us what metrics we need to meet, no meetings we are forced to go to, AND NO nurse/C suite above us. The 7 that decided to stick to #1 - 4 wants to join us but that ship has essentially sailed. 1 left medicine to retirement. 2 still working with CMG. Almost all of my old partners have left #1 because what was promised was not delivered, most going to lower paying jobs for a better work environment.

Medicine will continue to change for the worse so expect work in 5 yrs to be very different than today. Don't have regrets in life. If you have enough money to weather the transition, I always vote for running your own practice.

Thank you for sharing. Clearly a great move on your part.

 

[mid|ine]

5 years and 9m increase in assets? Were did that come from? Thats just shy of $2m/yr after tax increase in net worth.

 

[buddababa]

5 years and 9m increase in assets? Were did that come from? Thats just shy of $2m/yr after tax increase in net worth.

Dodgecoin

 

[emergentmd]

5 years and 9m increase in assets? Were did that come from? Thats just shy of $2m/yr after tax increase in net worth.

Real estate for the most part.

 

[Iamnew2]

If this helps you alittle more to take the risk. 2017 me had prob 1M in IRA retirement plus 300K in real estate. 2023 me have over 10M in assets.

High risk but high rewards. I am essentially retired now and work b/c I love my job/work environment. I work as much as much or as little as I want AND involved greatly in my kids activities.

If I didn't take the risk, I prob would have 2M in retirement and still working full time in the hospital as I still have 3 teenagers I have to care for PLUS missing many of the kids activities.

how did you make 9M in 6 years?

 

[emergentmd]

how did you make 9M in 6 years?

Bought RE starting in 2017. Now have 9 with 5-6M equity. Business equity prob worth 2-3M. Other stuff prob 2-3M

 

[emergentmd]

Dodgecoin

I will never understand Crypto and do not invest in things I do not understand. But wish I did when it was pennies.

 

[Iamnew2]

Bought RE starting in 2017. Now have 9 with 5-6M equity. Business equity prob worth 2-3M. Other stuff prob 2-3M

what is RE? Where did you get money for that?

 

[emergentmd]

Real estate. Buy out money, Some Locums during my transition, and last 3 yrs have been high income medical business.

 

[Iamnew2]

Real estate. Buy out money, Some Locums during my transition, and last 3 yrs have been high income medical business.

What kind of high income medical business? Sorry for all the questions, just curious!

 

[SpineandWine]

Too many details missing to answer question fully.
- if they cap you, then you should be able to cap your hours
- best if you sign with hospital to see if you can get out of your non compete. That’s essential in this case since it seems you are tied to area. If they can’t support you with this non compete, not worth risk of taking the job
- any nearby hospital gig that pays bills? That’s a little further out- can start there to begin with as you can always go to starting own practice later.
- having children, being older - not worth starting own practice from scratch unless you buds with all the referral base already - too much work imo and luck is involved. Do it only if you can keep overhead low and are okay with eating rice and beans
- can get a meeting with all the physicians impacted and do bulk contract negotiation with the hospital.

 

[Ducttape]

um... so you are telling people to go in to private practice but you made all that money doing real estate?


do you think, without the real estate, you would have been in such a great financial situation?


no offense, but your story is somewhat misleading only inasmuch as it is your skill in RE rather than your skill in the ER that made you all that money. i see myself doing what you did and being in the same measly situation of working for each day, because i do not have RE skills such as you, while my ER skills (though i am definitely rusty) is possibly on par with yours....

 

[emergentmd]

The thread started with OP asking if he should stick with his current group through a buyout of go out on his own. I gave him a similar story when I had the same choice, picking to go on my own and how it was a high risk/reward decision.

RE only came up when someone asked, and had nothing to do with this thread.

But in reality, My RE success had a lot to do with opening up my own practice as I work less/less stressful job/more control over my life/much higher income.

It would have been impossible, even with the recent RE run up, to do what I did on an ER doc salary with 3 expensive young kids and stay at home wife.

I am not sure how my ER skills have anything to do with this nor did I ever pretend that my ER skills were exceptional.

 

[SpineandWine]

The thread started with OP asking if he should stick with his current group through a buyout of go out on his own. I gave him a similar story when I had the same choice, picking to go on my own and how it was a high risk/reward decision.

RE only came up when someone asked, and had nothing to do with this thread.

But in reality, My RE success had a lot to do with opening up my own practice as I work less/less stressful job/more control over my life/much higher income.

It would have been impossible, even with the recent RE run up, to do what I did on an ER doc salary with 3 expensive young kids and stay at home wife.

I am not sure how my ER skills have anything to do with this nor did I ever pretend that my ER skills were exceptional.

I’m happy for your success!
There may be a bias about posts on this thread as most people are not likely to post their failure stories.
Kudos on making money rapidly- would love to be in similar situation in 10-15 years

 

[Doc_with_a_skull]

Honestly I think the finance portion is under-discussed and it's difficult to really feel the reality of it until you're out of training. I think getting at least exposed to financial literacy early can help with a lot of the whiplash of stress right after residency.

 

[mid|ine]

@emergentmd
I would be interested in learning more. I have ~170 apartment units. The past 6 years have not been good buying years, so curious what type of strategy you have been using.

 

[SpineandWine]

@emergentmd
I would be interested in learning more. I have ~170 apartment units. The past 6 years have not been good buying years, so curious what type of strategy you have been using.

How do so many of you have so much accumulated wealth. I’m two years post training and just trying to save 40-50% of my salary (just to accumulate **** you money).
Did you accumulate these rather quickly or did it take time for apartments. My personal plan is to tap into facility fees- rest put in portfolios or ibonds etc. my assumption is facility may make me wealthy in next 10-15 years but always a risk it’s a bust


Agree with financial literacy as I’ve had to do lot of research on this - I’ve read WCI and some other books but none of them truly tell you to branch out into businesses. Think it’s a risk taking personality.

 

[sevo00]

@emergentmd
I would be interested in learning more. I have ~170 apartment units. The past 6 years have not been good buying years, so curious what type of strategy you have been using.

You have 170 units and you still need help? Lol. You already won the investment game

 

[emergentmd]

@emergentmd
I would be interested in learning more. I have ~170 apartment units. The past 6 years have not been good buying years, so curious what type of strategy you have been using.

I thought about larger apt units but you need a whole team to manage the place and its just not worth my time/risk. So I have concentrated recently in apt syndications as I have connections on good operators. There is a magnitude of scale to such a large place which I do not have.

I mostly invest in LTR, MTR, STRs with the majority bought pre covid which was alot of good fortune. My strategy currently is moving away from LTRs and concentrate on STRs/MTRs which IMO overall is less work, less property wear/tear, higher income.

Most of my current cash will be on the sideline until probably winter when I think prices will go down. I typically buy fixer upper duplexes. Put in 50-100K to rehab, turn them to MTRs, and refinance most/all of the money out for new projects.

 

[Doc_with_a_skull]

I thought about larger apt units but you need a whole team to manage the place and its just not worth my time/risk. So I have concentrated recently in apt syndications as I have connections on good operators. There is a magnitude of scale to such a large place which I do not have.

I mostly invest in LTR, MTR, STRs with the majority bought pre covid which was alot of good fortune. My strategy currently is moving away from LTRs and concentrate on STRs/MTRs which IMO overall is less work, less property wear/tear, higher income.

Most of my current cash will be on the sideline until probably winter when I think prices will go down. I typically buy fixer upper duplexes. Put in 50-100K to rehab, turn them to MTRs, and refinance most/all of the money out for new projects.

That's an interesting point. You think MTR and STR are less work and property wear/tear? I haven't hear it put that way before, and traditionally thought LTR was that way. Would you be able to expand more?

 

[emergentmd]

That's an interesting point. You think MTR and STR are less work and property wear/tear? I haven't hear it put that way before, and traditionally thought LTR was that way. Would you be able to expand more?

I think for the most part this is correct. My LTRs are duplexes with property managers and lower end areas so I have found that on the low end people do not take care of the place. Once they leave in 2-3 yrs, I typically have to put 10-30K in to renovate it so cash flow is nonexistent esp in my HCOL area where RE is an appreciation game.

I renovated 2 of my duplexes, furnished it, put them on the MTR market. I now manage it, communication over VRBO/Airbnb is easy. I spend 2 hrs every time someone leaves to make sure everything is set right after cleaners. My occupancy rate has been about 90% and rental rate 75% higher than LTR. People who rent MTR due to higher rates keeps the place exceptionally clean. I plan on eventually converting my other 2 duplexes the same way. Plus when I renovate it, I can refinance to pull more money out for other projects.

People who rent LTR duplexes have weekend parties, more family members live than they quote, and never do even the smallest repairs. Place always looks trashed when they leave after 2 yrs. Almost always require new paint, sheetrock work, yard work, etc.

 

[hyperalgesia]

Hey there SDN, long time listener . . . first time caller,

I wanted to get input from the bigger brains on this.

My current employer, a multi-specialty group (30 docs, 8 different specialties) that had been in existence since 1960 was run into the ground by poor management and the refusal to evolve with healthcare. Long-story short - I have been given a "red pill" vs. "blue pill" choice.

I have been in this current job for 4 years, but I've been out of fellowship over 10 years. Some guy named Steve Lobel trained me in 2011-2012. I'm decent at this.
I am also 47 years-old, two kids in a great school that they love, and a very supportive wife who "just wants me to be happy".

Okay, here we go:

Red Pill: Joint the big medical group that is acquiring our practice. They are not owned by the hospital, but is an adjacent arm of the overarching healthcare system. Their compensation is totally wRVU based, but cannot exceed the 90th percentile where you are capped. 90th percentile for our specialty/geography based on "fair market value". Also, they will cover my tail insurance, but only if I sign on for minimum of two years.

My meeting with them is next Thursday to discuss my earning potential as well as "what life will be like as their employee".

Blue Pill: Go out on my own, either re-establishing with the other forlorn specialists to form a new multi-specialty group (essentially competing against the big medical group) or move away and find something else. I should add that my current restrictive covenant will be deemed "null and void" as my current practice is being absorbed and they have said that they will not enforce it.


What do you all think? What questions do I want to ask these jokers? Obviously I want my wRVU multiplier to be around $60-65 dollars per unit, and I need to know about where I'll be doing procedures (office vs. HOPD vs. hospital), but what am I missing about this whole scenario?

HELP!!

I would keep an open mind and get a better understanding of the new mgmt before committing.

I get that they'll cover tail insurance and 2 year contract. Critical question is if there's a non-compete clause in the contract and if so, how restrictive it is.

The other question is the region you are practicing. What is the current wait time to get a high quality interventional pain appt in your area?

For me, there is a set of circumstances that would warrant accepting a 2 year contract with the new mgmt but I would need more info.

 

[drusso]

Hey there SDN, long time listener . . . first time caller,

I wanted to get input from the bigger brains on this.

My current employer, a multi-specialty group (30 docs, 8 different specialties) that had been in existence since 1960 was run into the ground by poor management and the refusal to evolve with healthcare. Long-story short - I have been given a "red pill" vs. "blue pill" choice.

I have been in this current job for 4 years, but I've been out of fellowship over 10 years. Some guy named Steve Lobel trained me in 2011-2012. I'm decent at this.
I am also 47 years-old, two kids in a great school that they love, and a very supportive wife who "just wants me to be happy".

Okay, here we go:

Red Pill: Joint the big medical group that is acquiring our practice. They are not owned by the hospital, but is an adjacent arm of the overarching healthcare system. Their compensation is totally wRVU based, but cannot exceed the 90th percentile where you are capped. 90th percentile for our specialty/geography based on "fair market value". Also, they will cover my tail insurance, but only if I sign on for minimum of two years.

My meeting with them is next Thursday to discuss my earning potential as well as "what life will be like as their employee".

Blue Pill: Go out on my own, either re-establishing with the other forlorn specialists to form a new multi-specialty group (essentially competing against the big medical group) or move away and find something else. I should add that my current restrictive covenant will be deemed "null and void" as my current practice is being absorbed and they have said that they will not enforce it.


What do you all think? What questions do I want to ask these jokers? Obviously I want my wRVU multiplier to be around $60-65 dollars per unit, and I need to know about where I'll be doing procedures (office vs. HOPD vs. hospital), but what am I missing about this whole scenario?

HELP!!

Blue pill and never look back. No one who has tasted freedom has ever asked for the shackles back.

 

[runfastnow]

How do so many of you have so much accumulated wealth. I’m two years post training and just trying to save 40-50% of my salary (just to accumulate **** you money).
Did you accumulate these rather quickly or did it take time for apartments. My personal plan is to tap into facility fees- rest put in portfolios or ibonds etc. my assumption is facility may make me wealthy in next 10-15 years but always a risk it’s a bust


Agree with financial literacy as I’ve had to do lot of research on this - I’ve read WCI and some other books but none of them truly tell you to branch out into businesses. Think it’s a risk taking personality.

Being a good equities investor vs bond investor vs real estate investor +/- landlord vs good business owner are all separate skillsets. Personally, I am very good at equities + mediocre at bond investing and real estate but do not have the skills or appetite for primary business ownership or people management.

I put my financial energy into continuing my ~15%/yr gains through equities and investing without having to worry about tennants or employees blowing me up.

.... and being a physician will never get you to **** you money level.

 

[Doctodd]

relocate to south miami and buy my office condo and practice next to the hospital with PT and ortho tenants who pay you rent.....join my ortho umbrella group for great contracts and control your own life

 

[bedrock]

relocate to south miami and buy my office condo and practice next to the hospital with PT and ortho tenants who pay you rent.....join my ortho umbrella group for great contracts and control your own life

I’m surprised no one has claimed this yet!

 

[Doctodd]

I’m surprised no one has claimed this yet!

it's not really out there

 

[emergentmd]

Blue pill and never look back. No one who has tasted freedom has ever asked for the shackles back.

This is so true and I would tell every doc who asks my advice. I never give it first as I do not want to be the reason for them failing.

If you asked an MBA if they would go out on their own if given the opportunity, 90%+ would. Ask a doctor this and you might be lucky to get 25%. Its just a different mindset and most docs are just not built to run a business.

Medicine will continue to go down. Reimbursement going down across the board. More VC/hospital oversight. More gov oversight.

I have a Dentist friend who runs her own office and a one person show. Works 5 dys a week, booked out for months, rarely takes vacations or have to close down shop. She is hispanic which serves a big niche.

I told her to hire a spanish speaking new grad, pay them a good salary, cut back to 1-2 dys a wk. Open up another office, run it until the schedule is full, hire another new grad then cut to 1-2 dys a week. Prob in 5 yrs, she could have 5 offices churning passive cash flow or she can sell it to a VC and sip tea in bora bora.

 

[10KHertz]

I’d go blue pill or solo practice .
However the cost of entry is high (ie 500k equipment, advertising, etc)
Sounds like your skill set is well established, which is important. Don't brake away if you can’t perform almost every procedure (ie cervical procedures, stim, etc).
Healthcare “appears” to be imploding for hospital based physicians. But not necessarily for efficient private practices(parallel system). You have to engage aggressively with insurance carriers . They are not as infallible as you think… good luck and let us know what you choose .

 

[Doc_with_a_skull]

I think for the most part this is correct. My LTRs are duplexes with property managers and lower end areas so I have found that on the low end people do not take care of the place. Once they leave in 2-3 yrs, I typically have to put 10-30K in to renovate it so cash flow is nonexistent esp in my HCOL area where RE is an appreciation game.

I renovated 2 of my duplexes, furnished it, put them on the MTR market. I now manage it, communication over VRBO/Airbnb is easy. I spend 2 hrs every time someone leaves to make sure everything is set right after cleaners. My occupancy rate has been about 90% and rental rate 75% higher than LTR. People who rent MTR due to higher rates keeps the place exceptionally clean. I plan on eventually converting my other 2 duplexes the same way. Plus when I renovate it, I can refinance to pull more money out for other projects.

People who rent LTR duplexes have weekend parties, more family members live than they quote, and never do even the smallest repairs. Place always looks trashed when they leave after 2 yrs. Almost always require new paint, sheetrock work, yard work, etc.

Fantastic insights. Thank you

 

[Medman2737]

Okay, here's the two-month update from my original post.

The choice was red pill vs. blue pill: Join the hospital system owned multi-specialty group or join the well-established pain clinic down the street from my current office. Again, my non-compete is annulled so I do whatever I want.

Pro's vs. Con's:

Red Pill- Hospital system owned multi-specialty group-
-Compensation based on wRVU's. Conversion is $67 per RVU. Not bad.
-I am allowed (for now) to continue doing procedures in office and in the ASC which I am a shareholder. Until they build their own, which is likely.
-I get to keep my current staff and basically get to continue "cooking". No change to my current flow.
-Another pro: Hospital system says if I sign their new contract, they will not enforce the new non-compete, so long as I join a group with less than 4 physicians (basically they don't want me joining the competition, but they could care less if I join a small private practice).

My question: What's to stop the hospital group to start decreasing the RVU conversion factor to $65 then $60 and so on?


Blue Pill- Join the well-established pain doc down the street-
-I'd be starting from scratch in terms of salary for two years before the doc is willing to start talking buy-in and eventually buy the practice (the current owner is 57 and will be practicing another 7 years)
-No in-office procedure suite, I'd have to try and do everything out of the ASC's. This will be rough at first (trying to find block time, getting into a new routine, etc.)
-I can't bring my mid-levels with me at first. Although I see all new patients, they see all my follow-up's which allows me the time to do more procedures.
-The current pain doc ONLY does bread and butter shots, where I do most advanced interventions (kypho, stim, SI fusions, spacers, etc.)
-A big pro is that I can advertise where I'll be going and literally take all 2500 of my patients with me.


I am leaning toward blue pill. Thoughts?

 

[drusso]

Okay, here's the two-month update from my original post.

The choice was red pill vs. blue pill: Join the hospital system owned multi-specialty group or join the well-established pain clinic down the street from my current office. Again, my non-compete is annulled so I do whatever I want.

Pro's vs. Con's:

Red Pill- Hospital system owned multi-specialty group-
-Compensation based on wRVU's. Conversion is $67 per RVU. Not bad.
-I am allowed (for now) to continue doing procedures in office and in the ASC which I am a shareholder. Until they build their own, which is likely.
-I get to keep my current staff and basically get to continue "cooking". No change to my current flow.
-Another pro: Hospital system says if I sign their new contract, they will not enforce the new non-compete, so long as I join a group with less than 4 physicians (basically they don't want me joining the competition, but they could care less if I join a small private practice).

My question: What's to stop the hospital group to start decreasing the RVU conversion factor to $65 then $60 and so on?


Blue Pill- Join the well-established pain doc down the street-
-I'd be starting from scratch in terms of salary for two years before the doc is willing to start talking buy-in and eventually buy the practice (the current owner is 57 and will be practicing another 7 years)
-No in-office procedure suite, I'd have to try and do everything out of the ASC's. This will be rough at first (trying to find block time, getting into a new routine, etc.)
-I can't bring my mid-levels with me at first. Although I see all new patients, they see all my follow-up's which allows me the time to do more procedures.
-The current pain doc ONLY does bread and butter shots, where I do most advanced interventions (kypho, stim, SI fusions, spacers, etc.)
-A big pro is that I can advertise where I'll be going and literally take all 2500 of my patients with me.


I am leaning toward blue pill. Thoughts?

Blue pill. “They will never love you back.” Stake your claim and never look back.

 

[anonperson]

Okay, here's the two-month update from my original post.

The choice was red pill vs. blue pill: Join the hospital system owned multi-specialty group or join the well-established pain clinic down the street from my current office. Again, my non-compete is annulled so I do whatever I want.


My question: What's to stop the hospital group to start decreasing the RVU conversion factor to $65 then $60 and so on?

Nothing.

If the CEO thinks you are earning too much they can easily try to impose a pay cut.

Most reasonable people would assume that if a physician is busy and generating a lot of RVUs, the health system would be happy and not want to rock the boat. Don't underestimate the stupidity of hospital administration though.

I'm not in pain but was apart of a 10 person health system affiliated OBGyn group. Admin decided that we were overpayed and found some bogus consultant to support their claim. Several of us left and promptly found new jobs in the area for better pay and less work

 

[hyperalgesia]

Okay, here's the two-month update from my original post.

The choice was red pill vs. blue pill: Join the hospital system owned multi-specialty group or join the well-established pain clinic down the street from my current office. Again, my non-compete is annulled so I do whatever I want.

Pro's vs. Con's:

Red Pill- Hospital system owned multi-specialty group-
-Compensation based on wRVU's. Conversion is $67 per RVU. Not bad.
-I am allowed (for now) to continue doing procedures in office and in the ASC which I am a shareholder. Until they build their own, which is likely.
-I get to keep my current staff and basically get to continue "cooking". No change to my current flow.
-Another pro: Hospital system says if I sign their new contract, they will not enforce the new non-compete, so long as I join a group with less than 4 physicians (basically they don't want me joining the competition, but they could care less if I join a small private practice).

My question: What's to stop the hospital group to start decreasing the RVU conversion factor to $65 then $60 and so on?


Blue Pill- Join the well-established pain doc down the street-
-I'd be starting from scratch in terms of salary for two years before the doc is willing to start talking buy-in and eventually buy the practice (the current owner is 57 and will be practicing another 7 years)
-No in-office procedure suite, I'd have to try and do everything out of the ASC's. This will be rough at first (trying to find block time, getting into a new routine, etc.)
-I can't bring my mid-levels with me at first. Although I see all new patients, they see all my follow-up's which allows me the time to do more procedures.
-The current pain doc ONLY does bread and butter shots, where I do most advanced interventions (kypho, stim, SI fusions, spacers, etc.)
-A big pro is that I can advertise where I'll be going and literally take all 2500 of my patients with me.


I am leaning toward blue pill. Thoughts?

If you can do procedures in office, that might be tempting. If you have to do everything in someone else's ASC, that's gonna be a real slog to make any money.

 

[Status Sciaticus]

Okay, here's the two-month update from my original post.

The choice was red pill vs. blue pill: Join the hospital system owned multi-specialty group or join the well-established pain clinic down the street from my current office. Again, my non-compete is annulled so I do whatever I want.

Pro's vs. Con's:

Red Pill- Hospital system owned multi-specialty group-
-Compensation based on wRVU's. Conversion is $67 per RVU. Not bad.
-I am allowed (for now) to continue doing procedures in office and in the ASC which I am a shareholder. Until they build their own, which is likely.
-I get to keep my current staff and basically get to continue "cooking". No change to my current flow.
-Another pro: Hospital system says if I sign their new contract, they will not enforce the new non-compete, so long as I join a group with less than 4 physicians (basically they don't want me joining the competition, but they could care less if I join a small private practice).

My question: What's to stop the hospital group to start decreasing the RVU conversion factor to $65 then $60 and so on?


Blue Pill- Join the well-established pain doc down the street-
-I'd be starting from scratch in terms of salary for two years before the doc is willing to start talking buy-in and eventually buy the practice (the current owner is 57 and will be practicing another 7 years)
-No in-office procedure suite, I'd have to try and do everything out of the ASC's. This will be rough at first (trying to find block time, getting into a new routine, etc.)
-I can't bring my mid-levels with me at first. Although I see all new patients, they see all my follow-up's which allows me the time to do more procedures.
-The current pain doc ONLY does bread and butter shots, where I do most advanced interventions (kypho, stim, SI fusions, spacers, etc.)
-A big pro is that I can advertise where I'll be going and literally take all 2500 of my patients with me.


I am leaning toward blue pill. Thoughts?

whats to say the PP owner wont screw you after those years?
Why not consider opening up a solo practice? I would imagine the money from doing those advanced procedures in office would yield you higher revenue rather than doing them in an ASC that you dont own or can reliably get block time for.

I'm a noob though so take it with a grain of salt.

 

[BobBarker]

You will make absolutely no money without in office procedures.

 

[swamprat]

I feel like the barrier to entry for PP solo is getting on insurance panels - not even negotiating rates (which I am sure will be **** as a solo new doc). Where I am a lot of panels are closed they won't take in new physicians. Ridiculous.

 

[Status Sciaticus]

I feel like the barrier to entry for PP solo is getting on insurance panels - not even negotiating rates (which I am sure will be **** as a solo new doc). Where I am a lot of panels are closed they won't take in new physicians. Ridiculous.

Can you apply for insurance panels while working at a HOPD or another group? Perhaps that may be the way to go

 

[drusso]

I feel like the barrier to entry for PP solo is getting on insurance panels - not even negotiating rates (which I am sure will be **** as a solo new doc). Where I am a lot of panels are closed they won't take in new physicians. Ridiculous.

You can pay people to get you on panels and negotiate rates.

 

[swamprat]

You can pay people to get you on panels and negotiate rates.

I know you can pay but I did once speak to them and they said if its locked out not much they can do.