Private Practice Advice

[RheumMD]

Hi all,

I've posted before regarding jobs, but trying to make a final decision on which private practice to join. Any feedback is recommended. Rheumatology in medium size city, would love to find somewhere for the long term.

Option 1: Partner day 1 with collections minus overhead plus infusion/lab/imaging profits. No salary to start, takes a little while obviously to make. Most partners past few years made nothing first 6 months, then around $160k by end of first year, 400-600 after fully up and running (s-corp with salary and tax-free distributions). 9 month patient wait, great insurance, no medicaid, no need to market and there is a steady stream of good patients with all other partners having full patient panels. 4 days a week, 32 clinical hours. No formal benefits, everything on your own. Only downside is it is 45-60 minutes away and I'm not able to move at this point, which will certainly get old.

Option 2: Salary employee $225k with easily attainable bonuses (~50k, almost everyone gets each year) for first 3 years then partnership, 100% have been asked to be partners past 20 years. As partner get distributions from infusions, labs, imaging (usually another 100k per year). 24 clinical hours per week. No non-compete, gives the ability to bring in more income through side hustles (I already have a side job that makes ~50k working 6 hours per week). 10 minutes from my house. Great benefits, 401k, lots of CME, lots of paid time off, etc.

Any feedback is greatly appreciated. Option 1 overall better but with much more risk and a much further drive. Option 2 safe and a great long term plan. Trying to weigh these two very different options, as I could probably be happy either way. TIA.

[youngDoc]

I'd do option 1 if you are a hard worker, option 2 you are not.. or not inclined to starting out.

Some people lack insight into their own personality and habits. So.. if you consistently stay late on residency, help out when asked, don't snap at scheduler asking to squeeze urgent patient ins, don't have PD or co-residents complaining about your leftover work, then I'd do option 1.

[RheumMD]

I'd do option 1 if you are a hard worker, option 2 you are not.. or not inclined to starting out.

Some people lack insight into their own personality and habits. So.. if you consistently stay late on residency, help out when asked, don't snap at scheduler asking to squeeze urgent patient ins, don't have PD or co-residents complaining about your leftover work, then I'd do option 1.

Thanks for the advice. I agree, the first option is a great opportunity. The only thing I don't like about it is having to drive 2+ hours a day as that adds a significant amount to the work week.

[ENT Doc]

So you’ll have no draw for 6 months with option 1?

[RheumMD]

So you’ll have no draw for 6 months with option 1?

Probably pretty minimal. It will be starting a new patient panel from scratch. Need to keep cash in my work account to pay for infusions and things that require an upfront cost before reimbursement as it is paid directly from each independent business (s-corp). In the past most people have taken very little the first 6 months, maybe $20k or so. But obviously if things ramp up really quickly and collections are quick it could be more than that, or COVID could get worse and be much less for more than that. There is certainly more risk, but overall probably higher reward eventually (unless it is minimal for a while then things average out over the course of 3 years between both options as they likely will).

[Anne]

45-60 minutes commute each way gets very old after not too long. It’s easy to overlook, but on any given day I’ll take 100 minutes less commuting time over the potential increased income of option 1.

[RheumMD]

45-60 minutes commute each way gets very old after not too long. It’s easy to overlook, but on any given day I’ll take 100 minutes less commuting time over the potential increased income of option 1.

That's kind of where I'm at. All it takes is one accident on the highway or a snow storm to turn it into a 90-120 minute trip to get to the office or home. The second option after becoming partner comes out to ~350k plus plenty of time for consulting, speaking, being a sub-investigator on clinical trials, etc and make more on top. Tough choices.

[Anne]

That's kind of where I'm at. All it takes is one accident on the highway or a snow storm to turn it into a 90-120 minute trip to get to the office or home. The second option after becoming partner comes out to ~350k plus plenty of time for consulting, speaking, being a sub-investigator on clinical trials, etc and make more on top. Tough choices.

It once took me over 3 hours to get home after a bad highway accident blocked everything. Never again.

[jfoxcpacfp]

At what point will you be able to move?

[ENT Doc]

Probably pretty minimal. It will be starting a new patient panel from scratch. Need to keep cash in my work account to pay for infusions and things that require an upfront cost before reimbursement as it is paid directly from each independent business (s-corp). In the past most people have taken very little the first 6 months, maybe $20k or so. But obviously if things ramp up really quickly and collections are quick it could be more than that, or COVID could get worse and be much less for more than that. There is certainly more risk, but overall probably higher reward eventually (unless it is minimal for a while then things average out over the course of 3 years between both options as they likely will).

What if you decide you don’t like it after 6 months? Do you own the A/R?

[Sundance]

Option 1 if you’re the hard worker type.. or young and want to churn and burn. I wouldn’t worry about getting up to speed. Any rheumatologist in this country who actually wants to be busy can be full within a period of months.

Option 2 if you like to have a slower pace or if you take a while with patients or with your documentation

Personally I wouldn’t worry about the drive.

for me it nice to unwind and podcasts are awesome these days

plus you don’t have nights/weekends to worry about.

[Tim]

Would you ever consider moving or is it dependent upon successful start up or anyway to mitigate the commute?

The reality is comp, job, and location are the criteria. If the location problem (commute) does not have a solution you will be leaving. Typically a bad choice since it takes you further away from settling down. The payoff does not sound substantial enough to make the location arbitrage play. Too much work to throw away. Even though you might prefer the first two factors, the commute needs to have an answer or your going to fail. Focus on if there is a solution to the commute eventually.

[8arclay]

With regards to the commute, Id say it depends. Id rather do 60 mins traffic free highway driving each way than 30 min fighting traffic. I commute about 45-50 min each way 3-4 times a week. Im a podcast guy, and actually enjoy the "me" time between a busy clinic and a busy home with two young kids.

[Anne]

With regards to the commute, Id say it depends. Id rather do 60 mins traffic free highway driving each way than 30 min fighting traffic. I commute about 45-50 min each way 3-4 times a week. Im a podcast guy, and actually enjoy the "me" time between a busy clinic and a busy home with two young kids.

Not sure how many years into it you are—but one’s perspective on commute time can change the longer you do it. The first few years my attitude towards the commute was similar to yours. As time went on i realized a 10-15 minute commute and then spending the me time working out (can still listen to a podcast while doing it) was a far preferable way to spend that time—and my health is better off for it as well.

[childay]

With regards to the commute, Id say it depends. Id rather do 60 mins traffic free highway driving each way than 30 min fighting traffic. I commute about 45-50 min each way 3-4 times a week. Im a podcast guy, and actually enjoy the "me" time between a busy clinic and a busy home with two young kids.

Good advice. Depends highly on the details of the commute. Even with an easy commute though I would be leery.