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advice on post-fellowship offer

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  • advice on post-fellowship offer

    My wife has been getting post-fellowship (interventional spine) offers, most are employed job with base salary+production bonus with x number of years to partnership. But also got a different offer that we are considering and wanted to see how common this is or what to negotiate ask more about?

    Offer to run an outpatient office (1 of 3) that doc owns.  Eat what you kill model.  She will be the only doc in that office. Monthly expense is about $20k to run the office. The office building and equipment is already paid off and owned by the doc. Doc will cover office expenses for 1st 6months, and malpractice for first year. Doc provides EMR, billing services, website, etc.  My wife can set her own schedule/vacation time/number of days worked, very little chronic opiate management. She is not asked to pay to lease any of the equipment. There is no mention of partnership, but rather doc mentioned her incorporating.  From #s given the practice is lucrative ($800k-1mil per year in payments collected). She does not have to give doc any % of her earnings, rather run the office so the overall practice can grow.

    This offer is way better than employed positions she is offered. We are wondering if there is some type of catch or its too good to be true?


  • #2
    Sounds like the doc has more than he can handle running 3 offices.

    You need to have an experienced CPA review the tax returns for the last 2 - 3 years (beyond just "#s given") and the financial statements requested by the CPA to back up the numbers. You also need to know the time required to produce those numbers. This could be the opportunity of a lifetime providing valuable experience at a lucrative income. Or your wife could be walking into a 24/7 position where she is out of her depth - or somewhere in between. Just learn as much as possible before committing. If you are comfortable with what you learn, you should also consider a professional contract review.

    The CPA can advise you on incorporating, but that is irrelevant to the offer.

    I look forward to insight from a medical practice perspective by the experienced physicians on this forum.
    Our passion is protecting clients and others from predatory and ignorant advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087


    • #3
      Does the $20K include support staff salaries and benefits?

      What happens when the EMR or website needs to be upgraded. Does the $20K cover it.

      What happens when the equipment becomes obsolete, breaks down or new ones are needed. Who will pay for it and who will own it in the end should she like to terminate the contract or relocate. Is there a non compete?

      Agree with CPA audit. But need more details on what the $20K will cover after the 1st year.


      • #4
        You say interventional spine... to me that implies a fellowship after an ortho or neurosurg, but it sounds like you're describing interventional pain management, which is very different. Did she come from an anesthesia or PM&R background and a pain management fellowship?

        It's not that unusual for a pain management physician who stays busy with procedures and owns her own practice to clear 7-figures in the right market. Employed positions might be making someone else wealthy if the production is high.



        • #5
          Is the $1M/year collection figure gross or net? Because if each of 3 offices is 20k/month overhead, $1M gross collections=$280k net collections. Big difference that is well worth your while clarifying.