Hi all, I'm a longtime WCI reader & forum member from Day 1 but essentially a lurker. Thanks to all the regular posters for all of your sharing; you have taught me a lot and I hope to get some feedback about some impending practice choices.
After military residency and 4 yrs of active duty practice payback I've been an obgyn in a rural community for the past 15 yrs, solo for 10 then was very fortunate to have a new attending come 5yrs ago. She and I have separate businesses while sharing staff & office space and call. We have one NP, one PA and ancillaries including urodynamics, office hysteroscopy, a certified ultrasound program, pelvic muscle rehab and the usual gyn stuff. All the business we want is available- I've delivered over 200 babies already this year, she has a one year old so limits her deliveries to 8-10/month- but it's 85% state insurance. We get along great but the pace is tough with QOD call.
The local hospital seemed to shift to a much more supportive view of Women's Health this year. They already supplemented us with call pay & I get a stipend as medical director but they called us in to ask how they could help us further. We told them that 4 partners is a great number for an obgyn group and that the 600/yr deliveries required to support 4 FTEs are out there, especially if we can swipe the 2 employed obgyns in the town 20 miles away. The hospital is on board with the idea. The four of us mds have met and have a shared interest in leaving work and turning off our phones 3 out of every 4 days. We have already discussed pooling all the Ob patients and eating what we kill in gyn. I think the group is going to happen, we already have the office space arranged.
So my question is what would the new practice look like. I think the choices are:
1. Employed with wRVU compensation and all the usual benefits. We would lose our other revenue streams but in the contract negotiations could maybe claw back call pay or mid-level supervision fees. WCI forum has many threads about contract negotiation to help us.
2. Form or join an Independent Practice Association. IPAs have been a growing trend in obygn. An IPA would provide group benefits, negotiate contracts, usually handle billing and staffing issues while we each get paid what we collect, less a percentage. I'm not sure the current W-2 guys are even willing to go this route, they have no interest in the hassles of running even this kind of business- been there, done that.
3. Create a democratic group and negotiate a practice service agreement with total RVU compensation from the hospital. Actually got the idea from this forum so there would have to be some selling to the partners and the hospital.
4. Employ the other three myself with the hospital still providing support in legal ways, like call pay and even overhead support for a period of time. I think this would be as "simple" as negotiating contracts with them, getting good group health insurance and creating a new retirement plan (probably 401K PSP). This is a really appealing choice for a Dahl-ite who is used to the benefits of above the line deductions. I just don't know if I have the energy or political talent to make it work.
Any other models you guys can think of? Any advice on how to proceed? Is there a consultant or advisor that could help me make number 2,3 or 4 happen? What would you do? If it helps I'm at least 5 yrs from FI with no debts besides my home mortgage. AGI is 450-500K after all the business owner deductions.
Thanks in advance.
After military residency and 4 yrs of active duty practice payback I've been an obgyn in a rural community for the past 15 yrs, solo for 10 then was very fortunate to have a new attending come 5yrs ago. She and I have separate businesses while sharing staff & office space and call. We have one NP, one PA and ancillaries including urodynamics, office hysteroscopy, a certified ultrasound program, pelvic muscle rehab and the usual gyn stuff. All the business we want is available- I've delivered over 200 babies already this year, she has a one year old so limits her deliveries to 8-10/month- but it's 85% state insurance. We get along great but the pace is tough with QOD call.
The local hospital seemed to shift to a much more supportive view of Women's Health this year. They already supplemented us with call pay & I get a stipend as medical director but they called us in to ask how they could help us further. We told them that 4 partners is a great number for an obgyn group and that the 600/yr deliveries required to support 4 FTEs are out there, especially if we can swipe the 2 employed obgyns in the town 20 miles away. The hospital is on board with the idea. The four of us mds have met and have a shared interest in leaving work and turning off our phones 3 out of every 4 days. We have already discussed pooling all the Ob patients and eating what we kill in gyn. I think the group is going to happen, we already have the office space arranged.
So my question is what would the new practice look like. I think the choices are:
1. Employed with wRVU compensation and all the usual benefits. We would lose our other revenue streams but in the contract negotiations could maybe claw back call pay or mid-level supervision fees. WCI forum has many threads about contract negotiation to help us.
2. Form or join an Independent Practice Association. IPAs have been a growing trend in obygn. An IPA would provide group benefits, negotiate contracts, usually handle billing and staffing issues while we each get paid what we collect, less a percentage. I'm not sure the current W-2 guys are even willing to go this route, they have no interest in the hassles of running even this kind of business- been there, done that.
3. Create a democratic group and negotiate a practice service agreement with total RVU compensation from the hospital. Actually got the idea from this forum so there would have to be some selling to the partners and the hospital.
4. Employ the other three myself with the hospital still providing support in legal ways, like call pay and even overhead support for a period of time. I think this would be as "simple" as negotiating contracts with them, getting good group health insurance and creating a new retirement plan (probably 401K PSP). This is a really appealing choice for a Dahl-ite who is used to the benefits of above the line deductions. I just don't know if I have the energy or political talent to make it work.
Any other models you guys can think of? Any advice on how to proceed? Is there a consultant or advisor that could help me make number 2,3 or 4 happen? What would you do? If it helps I'm at least 5 yrs from FI with no debts besides my home mortgage. AGI is 450-500K after all the business owner deductions.
Thanks in advance.
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