Would you take this job?

[Status Sciaticus]

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Hey all,

A job opportunity has come up and I wanted to get some of y'alls opinions on the matter. I need help picking between two job options.

1. New pain group in a major TX metro. 450K base, 30% gross collections beyond 800K threshold first year. Second year onwards is pure production at 35% and caps out at 40% year three. Opportunity to buy into ASC that is being built at fair market valuation after first year up to whatever percentage I want to invest/risk. Same opportunity to buy into practice and ancillary services. Partnership is offered based on metrics, not guaranteed. 1/3 commercial, 1/3 medicare, 1/3 PI. 20-25 pts/day, should be able to ramp up appropriately, given 1 month wait time to be seen for new consults. 5 weeks PTO with CME, unpaid after that since its production based. Seems like this job already has some things going for it in the sense that the staff is hired, the workflow is there, and I dont have to build anything from the ground up. Unsure of overhead but was told its around 50%.


2. Alternatively my plan was/am looking to start my own practice from the ground up which comes with its own headaches, but I can supplement with locums. Benefit here would be much more autonomy, having something truly owned fully by myself, and building equity slowly and organically. However, this is in the DFW metro which has a lot of pain docs, albeit with a much larger population than job 1.

Any advice is appreciated!

 

[hyperalgesia]

It seems like there's plenty of money for either scenario so I would set that aside in your calculation for the moment.

The main question is are you gonna be happy doing this job? For the pain group, will you be managing med dumps? Do you sync with the group in terms of approach to pt care/referrals? For example, there are a lot of groups that require pts to undergo regular procedures in exchange for oxycodone refills. That might or might not be acceptable to you.

For the solo practice, if it's in a moderately competitive area, you will need to get in the mindset that you will accommodate all/most referrals, even if they're inappropriate. For example, your largest referral source has a pt that is known to be abusing meds, combining with EtOH, etc and asks that you take over the situation. It doesn't mean you have to prescribe inappropriately, it just means that you will accept and handle the situation or lose that referral source to your competition. Since you will be able to supplement your income with anesthesia, that gives you a nice cushion but the ramp up of your practice will be highly dependent on your competition in the area. In the extreme scenario of competition, you are either a gimp of primary care or your practice fails. The other side of course if you are in a rural, underserved area and you can write your own ticket, become a king and branch off as a real estate mogul. Easy peasy.

The best decision really depends on the details.

 

[Ducttape]

i got turned off by the "1/3 PI" statement.


id reiterate that i dont think you have to coddle to referring sources. you do need to let them know how you would approach their patients.

how much do you feel like spending your spare time marketing?


one other option is to join the pain group for 2 years, get your practice down, learn your techniques, and study billing and how to run your own business, then break off after you've made enough for security and open up your own practice. they should not be forcing a non-compete clause any longer.