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Struggling as a 1099 in private practice

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  • #16
    I think that you need to change your expectations. If you are going to continue to see large portions of patients on medicaid via a contractor model where you get paid what you are reimbursed, you are going to continue to paid poorly. The only way this works in the outpatient setting is when you are being subsidized by a healthcare system that needs to serve this patient population and can save money by serving their needs as an outpatient rather then have them use emergency services, or you are working for some safety net system that receives additional funding via state grants/charitable donations. Either way, you can't expect to be well compensated in such a model because you aren't generating income for anybody, but sometimes you can get a bit more just via supply demand factors (ie they can't fill the position unless they pay enough). If you want to be better compensated, you will have to change your workplace to place with more patients with better payors. It's just a math problem, you are never going to be compensated for income you are not generating.

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    • #17
      I almost hate to say this, but I’ve read through your post 3 times and it gets more bizarre with each reading. Especially that last sentence! Is there anything positive about this position? I agree with the suggestion to consider coaching.
      Our passion is protecting clients and others from predatory and ignorant advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087

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      • #18
        Originally posted by lakeswim View Post
        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?
        Something does not add up. You worked for a large hospital system. You got a good salary. Now you are working 1099, having a 70% pay cut and seeing Medicaid and having no say in your work schedule.

        You may choose not to answer it to us, but unless you can honestly answer that to yourself, you will not get further ahead. Why did you go from a frying pan to the fire. Why are to doing such jobs. Why are you trying to join a single person practice. If you are not cut out for PP, you need to be employed and follow its rules. Or find a coach and see if medicine is not for you.

        The whole thing does not sound kosher.

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        • #19
          My mind is a steel trap for useless nuggets of information and IIRC you are derm, correct? This is crazy.

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          • #20
            Originally posted by Anne View Post
            My mind is a steel trap for useless nuggets of information and IIRC you are derm, correct? This is crazy.
            Whaaat? Derm 2 days a week shouldn't be making <100K!

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            • #21
              Originally posted by lakeswim View Post
              I just wonder if maybe I'm not cut out for private practice



              Yes. Unfortunately you’re not and it’s clear in one paragraph that you’re not. No big deal. You’re probably a great doc and a great person. Just a horrible business person or lacking maybe some common sense or street smarts as You’ve found yourself in the 0.1% income bracket for your profession.

              Go sign up with a hospital. Make 250-350k and just focus on the positives of an employed position.

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              • #22
                Consider working for the VA. You won't get half this screwed over and you'll be on track for a pension. Plenty of bureaucracy to deal with, occasionally unhelpful staff, but at least some patients are appreciative and you'd get decent benefits. Or you could go into academics. Or do locums work. Plenty of ways to get paid far, far more than you are right now without the pressure and stress of putting out your own shingle and running a business.

                The last couple jobs sound pretty terrible, especially the most recent one.

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                • #23
                  just go back to the salaried model?
                  Done.
                  Some people are better off with a boss.
                  You might consider full time. Working full time in a structured environment can be very beneficial.

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                  • #24
                    They’re taking such advantage of you it should be illegal. if it’s true you are in derm, this is one of the worst sounding jobs I’ve ever heard of. I can assure you there are many many ways to ensure your next job is better.

                    you could look for a private practice job with a guaranteed base salary for the first couple years. You could look for a job that does not accept Medicaid or limits the amount of Medicaid, there are plenty of those out there. you could get written into your contract that you have the freedom to decide details such as no-show policies or scheduling based on payer mix. You could take a hospital job that is based on wRVU instead of collections. You could find a job with benefits.

                    this is absurd. There are some real snakes in derm, I was aware of that, but I can’t believe you let yourself be taken advantage like this. For your next contract please hire a lawyer.

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                    • #25
                      Originally posted by Tim View Post
                      just go back to the salaried model?
                      Done.
                      Some people are better off with a boss.
                      You might consider full time. Working full time in a structured environment can be very beneficial.
                      Yes agree
                      I for one have been pretty happy being employed. I'm 100% paid on production, but it's payer blind and collections blind. We treat lots of Medi/Medi. They lose money on me and make it up in the referrals, ancillaries, and hospital-based funds my service contributes to (DSH and 340b). If they paid me what they collect I'd make half or a third less.

                      If I were in private practice I'd be stressed all the time about staffing and bills and collections and lawsuits and keeping up with regulatory requirements. It's not for me.

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                      • #26
                        Originally posted by Hank View Post
                        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.
                        I made $300K at my last job working 0.6 FTE with full benefits. I'm in derm (no cosmetics). I liked that job and was sad to leave it.

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                        • #27
                          Originally posted by Sigrid View Post
                          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.
                          Thank you. It helps to see my situation from a different perspective. I think I'm just trying to decide if I should roll the dice on another PP job or just go back to employed at this point.

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                          • #28
                            Originally posted by Kamban View Post

                            Something does not add up. You worked for a large hospital system. You got a good salary. Now you are working 1099, having a 70% pay cut and seeing Medicaid and having no say in your work schedule.

                            You may choose not to answer it to us, but unless you can honestly answer that to yourself, you will not get further ahead. Why did you go from a frying pan to the fire. Why are to doing such jobs. Why are you trying to join a single person practice. If you are not cut out for PP, you need to be employed and follow its rules. Or find a coach and see if medicine is not for you.

                            The whole thing does not sound kosher.
                            I'll admit I'm not a good negotiator. I've used a physician coach and a lawyer to review contracts and help me with these decisions in the past (including this most recent job change). I spent thousands on both. Here's the thing - I am a quiet, soft-spoken woman, and men tend to talk down to me in these situations. They make me feel guilty for asking for more money. They question why I need a lawyer. I've literally been laughed out of a car dealership when I tried to negotiate, and I'm not sure that would ever happen to a man. I sometimes wonder if I should go into these negotiations with a lawyer literally standing next to me.

                            So now I'm in this position, and of course I'm upset that it happened. Of course I know I'm being taken advantage of. It's frustrating and humiliating. I did apply for another position a couple months ago, but it's in a city I'm not super enthusiastic about living in. But that doc was making seven figures a year, and he ran his practice like a well-oiled machine. I wonder if maybe I should reach out to him again.

                            I do appreciate all the advice on this thread.

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                            • #29
                              Different jobs are for different people. This job sounds terrible for anybody. There’s a lot to be said for being in a stable employed job where you’re respected. There’s no shame in that at all. The best job isn’t the one that pays the most, it’s the one where you’re happiest.

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                              • #30
                                Originally posted by lakeswim View Post

                                I'll admit I'm not a good negotiator. I've used a physician coach and a lawyer to review contracts and help me with these decisions in the past (including this most recent job change). I spent thousands on both. Here's the thing - I am a quiet, soft-spoken woman, and men tend to talk down to me in these situations. They make me feel guilty for asking for more money. They question why I need a lawyer. I've literally been laughed out of a car dealership when I tried to negotiate, and I'm not sure that would ever happen to a man. I sometimes wonder if I should go into these negotiations with a lawyer literally standing next to me.

                                So now I'm in this position, and of course I'm upset that it happened. Of course I know I'm being taken advantage of. It's frustrating and humiliating. I did apply for another position a couple months ago, but it's in a city I'm not super enthusiastic about living in. But that doc was making seven figures a year, and he ran his practice like a well-oiled machine. I wonder if maybe I should reach out to him again.

                                I do appreciate all the advice on this thread.
                                Kudos for assessing yourself honestly and not getting defensive.

                                I think anyone is completely capable of learning to negotiate if they’re motivated and have the right resources. But if you don’t want to invest the time and money in that, you can work in academics or the VA. You can afford to buy your cars at CarMax.

                                There’s nothing wrong with being a quiet soft-spoken woman (RBG was the epitome of this, and she didn’t back down from anyone). But negotiation is challenging if you lack confidence, have a thin skin, and the other party knows it is easy to guilt trip you. Not sure if a coach would be the right person to help you with this, or there is something deeper going on that would be better addressed in psychotherapy. Good luck.

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