Struggling as a 1099 in private practice

[lakeswim]

I'm the only employed doc in a practice with four partners. I really like the work environment, but, well, I'm not making enough money. I took a 70% pay cut from my last job, and yet I see a lot more patients at this job. I think part of the issue is some practice inefficiencies that are hard to fix, but also my practice sees all the Medicaid patients in town (none of the other practices take them). Some days, I see over 50% Medicaid. I also see free clinic patients (totally pro bono; no pay at all). My no-show rate is close to 20%, but we can't charge a no-show fee to these patients.

I barely make enough to cover childcare costs, which are a lot for me because I have three young kids and need reliable backup care. I'm collections only, so if I don't work, I don't get paid. No benefits, either. Last year I made less than six figures working half-time.

I don't think the practice is going to let me limit the Medicaid population, even though I wonder sometimes if the partners are seeing fewer of these patients than I am (I have no idea). They also don't discharge no-shows from the practice, and I don't want my colleagues seeing these patients if I decide to boot them. That doesn't seem fair. They've also said no to charging no-show fees to private payers. I have asked many times to work through lunch, but that's also a no. Volume is not an issue; I have a 4 month wait for new patients even though I literally offer "unlimited" open slots for add-ons.

Any ideas? Am I kind of stuck? I really do like the people I work with.

[Kamban]

Why are you still in this job

You say you like the people yet your partners treat you this way with Medicaid dump

[Kamban]

You are based on collections. So say no Medicaid. Unless they pay you better.

Be prepared to walk. Look for better job. Even a hospital employed position will pay far better.

[Savedfpdoc]

This is not a good situation. Even for part time. I’m fm, working 26hrs per wk seeing 10-15 pts per half day and made 250k last yr
plan your exit, look at locums until you figure out a more permanent situation

[FIREshrink]

This is a terrible job. Why are you working there?

[abds]

This job sounds so bad I’m shocked that you’re working there. Leave.

[lakeswim]

Well, sounds like the consensus is that I should leave. I guess I'm worried about landing in a similar situation next time around. Should I just reach out to random private practices and inquire? I really did NOT like the single-owner practices I talked to because if the owner is a strange person (and I talked to a few), it won't be a good experience. I am on a partnership track at my current practice, and the doctors are all really nice people, so I am reluctant to abandon that. I also have the flexibility that comes with private practice, which I need.

I just wonder if maybe I'm not cut out for private practice since I am so financially stressed out with every patient. I didn't feel this way when I worked for a massive hospital system. Would it be better if I worked somewhere with a better payor mix? Is that something I should look for in my job search? Or should I just go back to the salaried model?

Honestly my real hesitation in looking for a new job is that I will stumble into something even worse. I also will have to pay tail insurance (tried very hard to negotiate that, used a lawyer, etc., but failed).

[Random1]

If you need to make more money , learn the business of medicine. Learn how to code/ You need to get paying patients through the door.

Limit MA to 2 patients a day. Open the rest of your schedule to open access , same day scheduling and make sure it is filled every day. You are much less likely to have no shows if they schedule the same day. Call the patients the day before, send them a text and verify insurance before they come in. You can't just expect to show up have a full schedule the way you want it with out a little effort on your part.

[wideopenspaces]

How long until you make partner? Why don't you refuse to see free patients? Why don't you ask to see how the medicaid patients are being divvied up? Why would you waste time feeling bad about discharging no shows as your employers would be entirely free to do the same. And I know having a nanny is nice but with 3 kids ( is your oldest in school now?) and needing reliability I think it makes sense to revisit your daycare options. This situation may be salvageable if you want it to be but really depends on the answers to some of those questions.

[Sigrid]

1) If you are a 1099, you are not an employee. You are an independent contractor.
2) By hiring you as a 1099, the partners have decided that they value getting the most financial bang for their buck rather than investing in you as a colleague. You're on a strict eat-what-you-kill payment system. They're not paying for benefits. They're not even paying for tail coverage! They are insisting you see patients for free, in an eat-what-you-kill payment system. They are insisting you see mostly Medicaid patients and won't charge a no-show fee. There's nothing wrong with this choice on their part, morally speaking. They are looking out for themselves. However, that leads to:
3) You need to look out for yourself. The partners may be nice people, but they do not have your best interests at heart. You need to have your best interests at heart. They are making business decision in how they treat you, and you need to make business decisions in how you treat this job. You can do that respectfully, but you need to do it practically.

And practically speaking, I highly doubt you're going to be able to turn this into something worth your time. You can try and negotiate certain changes -- limiting Medicaid patients, discharging no-show patients, etc. -- but given their response to your attempts to negotiate in the past, I doubt that's going to get you anywhere. So I'm going to agree with the previous commenters and advise you to start looking seriously at moving elsewhere. A genuine employed position at a hospital may not be ideal, but it's undoubtedly better than this. I have to imagine most PP jobs are also better than this. This is terrible. Do not accept it.

[Hank]

What’s your specialty / area of practice?
Did you take a pay cut to 70% of your previous compensation, or did you really take a 70% pay cut down to less than a third of what you used to make?

Making less than $100K per year is wholly unacceptable unless you’re doing medical mission work in the third world or something. Even then, you still need to do something to plan for your retirement once you’re too old to keep practicing.

[Lithium]

Saying this as someone who recalls the OP’s previous posts, struggles with negotiating and asserting expectations, I honestly think career and possibly life coaching would be worth the investment.

[Tim]

"I am on a partnership track at my current practice," A partnership to what is the question.
So many inefficiencies beyond your control or they just say no. The reality is with the current set up, payor mix and restrictions, you are putting in alot of time and not getting paid or paid well. You can get a lot of satisfaction practicing for the "under served" populations, but you won't make much money in this set up.
You need to check out options: comp, job, location. Sounds like you couldn't do much worse from comp standpoint.

[childay]

"I am on a partnership track at my current practice," A partnership to what is the question.
So many inefficiencies beyond your control or they just say no. The reality is with the current set up, payor mix and restrictions, you are putting in alot of time and not getting paid or paid well. You can get a lot of satisfaction practicing for the "under served" populations, but you won't make much money in this set up.
You need to check out options: comp, job, location. Sounds like you couldn't do much worse from comp standpoint.

Why would they offer partnership to a half-timer who they are dumping all the MCD and free care patients?
You should be on straight salary if they want to dump on you like this

[Bmac]

Working as employed physician in outpatient primary care is not the worst thing in the world. At least you would have a decent and predictable salary. Do that for a few years and then maybe evaluate other private practice positions if still wanting to go that route.