Am I getting screwed?

[Tim]

As mentioned, there is the efficiency of the billing practice which impacts you AND the “owner”. I call it owner because of the potential for there to be profits diverted outside the partnership. That is perfectly ethical mechanism to reap the benefits of the risk and work in building a successful group. The question is whether the percentage is fair. Owner and partners will benefit in any improvements in collections. No resistance there.

The second issue is developing your own practice.
Advantage is with the partnership since the “owners” take is all based on percentages with the partners. The only risk is the “associates profit/loss. Even that is kindly shared by the other partners. The “owner” has only exposure to his/her partnership share. You are correct, a 4 physician office could open across the street from your new private practice.

A local cal hardware store has difficulty competing with Home Depot.

Build your business plan is the only way you will have numbers and a time frame to compare.

[G]

Thanks for all the replies. Lots of good advice that is appreciated.

I requested the info from the billing department, waiting to hear back. Although historically I've had to chase them down any time I ask for anything as they seem to forget about it the moment the conversation ends. I did consider leaving the practice and going solo. I even have an area that is outside of my non-compete and directly central to the office locations I currently go to, which should help with patient retention. My only concern is the partners have been going on a bit of a hiring-spree and are trying to put 3-4 hand surgeons, at a minimum, in each of our office locations. While myself and several other guys in the group think this is excessive and will hurt each individual surgeon's practice, they seem to be more interested in getting a controlling market share of the area. This worries me because if I leave the group, and they continue to add new surgeons, I will have left what was at least a "sure thing" regarding income and then be surrounded by multiple new hand surgeons. I have a lot to think about, that's for sure.

The evidence increasingly implies that something shady is going on.

It is the cliffhanger at the end of the season. Can you please update us when you have figured it out? Or in a year to let us know you're still ok?

[EntrepreneurMD]

Thanks for all the replies. Lots of good advice that is appreciated.

I requested the info from the billing department, waiting to hear back. Although historically I've had to chase them down any time I ask for anything as they seem to forget about it the moment the conversation ends. I did consider leaving the practice and going solo. I even have an area that is outside of my non-compete and directly central to the office locations I currently go to, which should help with patient retention. My only concern is the partners have been going on a bit of a hiring-spree and are trying to put 3-4 hand surgeons, at a minimum, in each of our office locations. While myself and several other guys in the group think this is excessive and will hurt each individual surgeon's practice, they seem to be more interested in getting a controlling market share of the area. This worries me because if I leave the group, and they continue to add new surgeons, I will have left what was at least a "sure thing" regarding income and then be surrounded by multiple new hand surgeons. I have a lot to think about, that's for sure.

Left my group practice for autonomy despite good income for a PCP at the time ($250K+, generous benefits). Even 80% financed a new construction McMansion the year before. Several hundred PCP's and 4 large groups within a 15 mile radius (my draw area). Took an income guarantee from a local hospital. Butterflies in my stomach. Purchased an office building to house the practice. Practice barely generated $200K first year. Had the good fortune of an employed and patient spouse. Second guessed myself the first 2 or 3 years. But where there's a will there's a way. 13 years later, income has >quintupled over prior employer, plus business valuation seems to be appreciating at >$600K/year (based on this year's appraisal/years in business, consistent and persistent growth) and real estate to house the business appreciating and tax depreciating, with tenants referring as complimentary practices.

Takes a lot more than medical knowledge and surgical skills. Takes grit, compassion, confidence, business skills, cost and risk management, networking and marketing skills, sacrifice, disruption/innovation, stepping out of your comfort zone, a good team for operations and HR as you grow. Not for everyone for sure and only you can decide for yourself, but for those that take the risk no employer to take a cut out of your collections or dictate your routine, rather you're in the position for passive income when hiring others (docs and/or mid-levels). When in Rome. It's how capitalism works. The risk taker creates jobs for a cut of collections. That's the unwritten agreement. If you prefer the stability of employment, your employer's cut is usually a function of market forces. The bigger your group, the less each docs concerns matter to them. The bigger the city, the more suppressed incomes are due to higher overhead (ie. staff salaries) and taxes (state income, county sales) = geographic arbitrage. Most just accept their predicament.

Personally, very glad to be out. Free to decide. Free to cut back or work harder. Free to succeed. Free to fail. It's all on me. No one to share revenues or blame. I like it that way. Not everyone does though. Regardless, is the timing right based on your circumstances? Yes, a lot to think about. Talk to other independent orthopods first, dig deep into the pro's and cons of different scenario's prior to a life altering decision.

Wish you well!

[Medstud21]

I’m ortho, but not hand. I’m in an employed model where we are underpaid on $/rvu, roughly about 25th percentile of MGMA. I do have a hand partner that I am close with. With the kind of volume you’re doing, you’d be making roughly around $800k, even in our underpaid employed model. There’s something going on here, you should ask to see all the books. As far as billing, they should be able to provide you detailed reports on weekly and monthly basis. I get them every other week, and they are custom generated to my specifics.

[GastroMastro]

The evidence increasingly implies that something shady is going on.

It is the cliffhanger at the end of the season. Can you please update us when you have figured it out? Or in a year to let us know you're still ok?

Maybe getting ready for a PE buyout?

[jfoxcpacfp]

Thanks for all the replies. Lots of good advice that is appreciated.

I requested the info from the billing department, waiting to hear back. Although historically I've had to chase them down any time I ask for anything as they seem to forget about it the moment the conversation ends. I did consider leaving the practice and going solo. I even have an area that is outside of my non-compete and directly central to the office locations I currently go to, which should help with patient retention. My only concern is the partners have been going on a bit of a hiring-spree and are trying to put 3-4 hand surgeons, at a minimum, in each of our office locations. While myself and several other guys in the group think this is excessive and will hurt each individual surgeon's practice, they seem to be more interested in getting a controlling market share of the area. This worries me because if I leave the group, and they continue to add new surgeons, I will have left what was at least a "sure thing" regarding income and then be surrounded by multiple new hand surgeons. I have a lot to think about, that's for sure.

So, are you making the case that you are stuck where you are and cannot find holes in their setup? That is sad to me. Just read another thread post in which the partner hired a forensic accountant to clear the opacity. That’s what it may take from you (fwiw, we do NOT a forensic accountant on our team so I’m not fishing for clients).