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Employer choice - Private vs academic if there is a chance I need to leave in 4 years

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  • Employer choice - Private vs academic if there is a chance I need to leave in 4 years

    Hello, so a little bit about my current situation. The TLDR of this is whether joining a private practice makes any sense if there is a fairly possible chance I would need to move in 4 years.

    My wife and I are currently in different stages of our careers. She is entering into residency this summer (4 years) and has a strong inclination to likely do a fellowship (3 more years) after that. Her new program does have that specialty and is well regarded in it. I myself am leaving training in a procedural subspecialty at the end of June. Leading up to the Match, I had applied mainly to employed positions in places I thought it was likely she was going to end up at, ready to sign when match day came. Well the Match being what it is takes you sometimes unexpected locations and I couldn’t apply everywhere preemptively.

    So now the current city in the NE we are moving to does not have available “hospital employed” positions and is very high cost of living. There is an academic center hiring, who primarily run on a wRVU model for its clinical faculty. Im not particularly inclined towards academic medicine and research, but education sits well with me. I worry about the cost of living and ludicrous rent/property values of the area on a more academic salary (obviously I’m still blessed to be a physician and making what I will).

    The second option is a small (imagine 4 to 8) group who is hiring. They are offering a 12-24 month partnership track, with a base + wRVU bonus for the employee with a much better compensation. This would be an expansion hire rather than taking over for an existing member. They seem like great people for what it’s worth.

    my question comes down to whether, in a time frame where I may have to leave in 4 years due to the match, does working at a private practice even make sense. Would it make sense to just stay as an “employed” member of the practice for 4 years and buy in only if my wife successfully matches there, or would 3 years as partner ina a generic sense be enough. Obviously that in part entails what the financial benefit of partner vs employed would mean, but I guess if someone could explain the typical “buy out” type system I would appreciate it. I’m worried buying in and then potentially buying back out would be messy in a 4 year span.

    thank you all very much
    Last edited by Billynye; 04-02-2022, 12:04 PM.

  • #2
    You didn't mention the numbers but you'll need to run the numbers to see if it makes sense. Is the buy in all sweat equity or are you buying into other things? The buy out will be practice dependent and these are all questions you should be asking them.

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    • #3
      It sounds like you are in a great position, but there are pros and cons to both situations. In the old days, staying in academics, if you expect that you will be leaving an area in a few years, made you a better candidate for the next job. Nowadays, people move between jobs a lot more, it is not considered to be a red flag, and it is widely accepted. It sounds like the PP job is a better fit for you. I would be upfront with them and tell them that your wife is in training, and you may or may not remain in the vicinity beyond her training period.

      You might find that you like the job a lot, you and your wife grow to like the area, make friends, your kids (if you have any) make friends, and you end up staying. People, including myself, end up in cities that they never dreamed they would stay in after completing training. I matched in a city that I did not like but in a top program, and I "knew" that I would be gone in four years. 31 years later, I am still here.

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      • #4
        Originally posted by VagabondMD View Post
        It sounds like you are in a great position, but there are pros and cons to both situations. In the old days, staying in academics, if you expect that you will be leaving an area in a few years, made you a better candidate for the next job. Nowadays, people move between jobs a lot more, it is not considered to be a red flag, and it is widely accepted. It sounds like the PP job is a better fit for you. I would be upfront with them and tell them that your wife is in training, and you may or may not remain in the vicinity beyond her training period.

        You might find that you like the job a lot, you and your wife grow to like the area, make friends, your kids (if you have any) make friends, and you end up staying. People, including myself, end up in cities that they never dreamed they would stay in after completing training. I matched in a city that I did not like but in a top program, and I "knew" that I would be gone in four years. 31 years later, I am still here.
        Appreciate you getting back to me. Yes definitely makes sense as far as being up front with the private practice about a potential move. I guess my ongoing concern, which is partially born out of ignorance (which I am trying to rapidly correct) derives from this idea that I would end up buying into a group, and then having to immediately sell back out. I dont have the financials, so I dont necessarily expect an exact answer. I guess my question is more regarding in the "typical" buy out of a practice, will that cause major headaches to accomplish? While I have to look out for myself first, would a partner leaving that quickly be a huge issue for a small practice (as far as "cashing out" their shares)? I wouldnt plan to buy into say an ambulatory surgical center unless I know I'm staying long term, but I just dont know how the typical process works for the practice side of things. And if it would be considered a black mark to do so.

        Apologize that I am short on details at the moment, Im just tying to get a sense of the way things generally work to buy back out if I had to leave.

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        • #5
          Surprised the PP is offering more than the hospital?

          Seems like an easy choice. Join the PP and buy into all the ancillaries. This will cause you to have loans for the buyins, but since the value of the asc typically increases, your buyout will be higher once you decide to leave.

          Biggest caveat is that most PP groups have longer notices to leave. 12-24 month notice.

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          • #6
            Maybe your spouse will decide that she does not want to do a fellowship. It is hard to cover all contingencies when planning a life.

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            • #7
              You need to know the details about buying in. How much do you have to put up? What are the terms for getting your money out if you were to leave?

              I gather this is not a location where the two of you would want to stay after training is over? That means you are leaving at some point for sure? Unless it grows on you.

              A large city in the NE may have multiple fellowship programs, making it possible to stay put for the full 7 years.

              The main reasons to take the academic job would be:

              You want to do academics. That is not you.

              You want to develop a microspecialty and reputation that you can take with you. That might argue for a major academic medical center if there is room for you to build such a career. But you would have to re-establish yourself if you move to a new area. Even leaving the med center and going private in the same city might mean giving up most of your referring docs, who may stay with the center.

              You are probably better off with the private job, provided the buy is is not too painful. Depending on your field and the practice, you might make enough more in private to cover a worst case scenario with the buy in.

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              • #8
                Appreciate your alls input. Sounds like (other than a longer leave notice), buying in and the. Buying out of a private practice in such a potential time frame in and of itself wouldn’t be a disastrous type decision, pending the details of the buy in of course. Thank you all

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