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  • #16
    How do you deal with the fact that the PP might be sold to a venture capitalist and the younger members may end up holding the bag? These are some of the fears out there

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    • #17
      That's the risk you take unfortunately. You always hear grumbling from senior partners about selling the practice or asc.

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      • #18
        Originally posted by Uromamba View Post
        How do you deal with the fact that the PP might be sold to a venture capitalist and the younger members may end up holding the bag? These are some of the fears out there
        This is why it’s so important to look under the hood a bit at a private practice. Need to look at who is making decisions and their ages. Look at the overall age dispersion of the practice too. I would also ask about this specifically, especially if you already have an offer. Ask if they’ve had offers and if so why they haven’t entertained them. You may want to even email/talk to a younger member of the group who might be in a similar situation and more in the know. Ask for their contact info if you don’t have it already. Path to partnership matters too. More time, more risk of missing out. Strongly consider renting until you have made partner and do your best with negotiating to reduce the non compete radius and time so you can stay in the same area if you like it.

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        • #19
          As ENT doc has said try to find out how many docs have left the practice and why. If this number is large I would pass. It is an abusive practice. A healthy practice with a variety of aged partners and a defined buy out plan will be the safest bet.

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          • #20
            Originally posted by ENT Doc View Post

            This is why it’s so important to look under the hood a bit at a private practice. Need to look at who is making decisions and their ages. Look at the overall age dispersion of the practice too. I would also ask about this specifically, especially if you already have an offer. Ask if they’ve had offers and if so why they haven’t entertained them. You may want to even email/talk to a younger member of the group who might be in a similar situation and more in the know. Ask for their contact info if you don’t have it already. Path to partnership matters too. More time, more risk of missing out. Strongly consider renting until you have made partner and do your best with negotiating to reduce the non compete radius and time so you can stay in the same area if you like it.

            words of wisdom

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            • #21
              Originally posted by Medstud21 View Post

              kind of disagree with this. I have seen so many dumb administrators getting in a rift with surgeons to keep them in check, with disastrous results. But they never learn. As soon as they recruit new talent, they repeat the cycle. One of my buddies is an ortho, nicest guy in the world. Just left his employed position along with 3 of his partners because new CEO cut the OR and clinic staff to save cost. When they complained, he doubled down and demanded the same production. They all left and now the hospital is losing millions of dollars. They are paying locums to cover trauma call, no elective surgery.

              I have seen this happen repeatedly, they antagonise the existing physicians and push them to leave, only to then lose millions of dollars and running services with locums. And when they are able to recruit again, cycle restarts. Just in my system currently, we have no neurologists, or endocrinologist, while our competitor has no trouble hiring them. They keep bringing it up in meetings and I said, how about paying more? CMO literally said we can’t do that and we have to keep the salaries where they are to sustain the system. Ok good luck then.
              That is tough. If you can, you may be better off leaving. Hospitals can be driven into the ground. Inability to hold on to successful docs is a major warning sign. My admins are hardly great, but they are good to the people who keep the operation afloat.

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              • #22
                It depends.

                If you can find a private practice that is positioned well, where you can get a piece of ownership, and where you can flourish and have an impact -- that is still the best way to go. However, the % of PP jobs like that are much less, I think, than "good enough" hospital jobs.

                I am in PP and love it.

                PE is the biggest concern. Make no mistake -- if the PP you are evaluating is talking to PE, you'll have no idea because they will have already signed a NDA. I think the best hedge is a democratic partnership with multiple young partners. Typically, shares aren't fully vested in terms of a buy-out for several years. Multiple young partners that would get screwed over by a buy-out will be able to raise ************************/band together/out-vote the older guys/gals trying to sell. Is this scenario even realistic? I don't know. But, it's probably the best hedge you'll see. Otherwise, trust your gut. I was promised "the world" and got it. Not everybody is out to screw you.

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                • #23
                  Hospital employees get vaccines sooner in pandemics.

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                  • #24
                    Guess it depends on specialty, location and hospital. Around me there's basically 3 hospital systems expanding, gobbling up PP's, eating into referral streams, providing more patient services and the like, etc. I'm employed and my hospital I tend to think is doctor friendly, usually listening to doctors and working with them, minimal turnover. It's not perfect but i can't complain much. But the hospital across town readily fires doctors, midlevel driven, big egos, some of the problems are the doctors themselves, etc. Personally I don't think I have the personality/mindset for PP. Doesn't help either when most of the old timer PP guys around here say not to do it. I know folks who've had good/bad experiences in both setups so hard to say.

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                    • #25
                      Another example of administrator dumbassery:

                      One of our competing group had a joints surgeon quit recently after the hospital admin asked their group to take a 20 percent paycut due to “covid”. He was by far the busiest joints surgeon in the area with easily 600-800 a year. They basically told him to take it or leave, he quit and cleaned out his locker the same day, with hours notice and 80 plus cases scheduled. Guy easily brought 10 mil plus to the hospital, it couldn’t have been more than 200-300k of pay cut. Now they are scrambling as other partners are also threatening to leave and demanding call pay. Already have locums ads trying to cover call, forget elective lucrative joints.

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                      • #26
                        As time goes I only see more regulations and hoops to jump through: Quality, EMR, complications, legal, insurance....

                        As these health systems get so big they also have the ability to lobby against certificates of need for surgery centers

                        Hospitals systems also currently get away with more revenue generation per case than private centers


                        These are all odds against PP...
                        I want to be in private practice, I just see it getting harder for many specialties...

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                        • #27
                          Originally posted by Otolith View Post
                          As time goes I only see more regulations and hoops to jump through: Quality, EMR, complications, legal, insurance....

                          As these health systems get so big they also have the ability to lobby against certificates of need for surgery centers

                          Hospitals systems also currently get away with more revenue generation per case than private centers


                          These are all odds against PP...
                          I want to be in private practice, I just see it getting harder for many specialties...
                          It'll swing the other way. It always does. These major systems are becoming more on the chopping block soon. We had a national PP meeting recently and lots of the inside people at the congressional and presidential level see more scrutiny and disallowing these mega hospitals coming soon.

                          The future is gonna be smaller, localized care, low cost in surgery centers.

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                          • #28
                            Originally posted by ACN View Post

                            It'll swing the other way. It always does. These major systems are becoming more on the chopping block soon. We had a national PP meeting recently and lots of the inside people at the congressional and presidential level see more scrutiny and disallowing these mega hospitals coming soon.

                            The future is gonna be smaller, localized care, low cost in surgery centers.
                            I really hope you are right...

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                            • #29
                              Originally posted by Medstud21 View Post
                              Another example of administrator dumbassery:

                              One of our competing group had a joints surgeon quit recently after the hospital admin asked their group to take a 20 percent paycut due to “covid”. He was by far the busiest joints surgeon in the area with easily 600-800 a year. They basically told him to take it or leave, he quit and cleaned out his locker the same day, with hours notice and 80 plus cases scheduled. Guy easily brought 10 mil plus to the hospital, it couldn’t have been more than 200-300k of pay cut. Now they are scrambling as other partners are also threatening to leave and demanding call pay. Already have locums ads trying to cover call, forget elective lucrative joints.
                              If you look at BPCI and CJR data, doing 800 cases a year brings in a revenue of at least $16M (and well over than $20M if the hospital is inefficient and gets higher bundle allowances). That’s revenue and not profit of course, but it also doesn’t include all the pre-op visits and injections and imaging he generates. It’s insane that they asked him to take a pay cut. Good for him for calling them on it.

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