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Job share vs. office/ staff expense share

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  • Job share vs. office/ staff expense share

    A friend and I recently had this discussion, as he was speaking about the idea of slowly cutting back.

    If you could choose between the two, which would you prefer?  Would you job share vs. office/staff expense share? Anyone doing that here. Insights? Pros and Cons.

  • #2
    Gotta say I've read this a few times and am not sure what exactly you're asking.

    Comment


    • #3
      LOL.  Maybe this will clarify.

      Option 1- Two physicians share one job as if one person, one practice.  Share patients, money is split evenly after collection and accounting for expenses.

      Option 2- Two physicians each have their own practices (ie each solo practitioner), do not share patients.  All money separate, each physician is responsible for 50% of the rent and overhead expense.

      Does anyone do something similar to Option 1 or Option 2?

      Comment


      • #4
        Option 2 seems less risky to me.

        Comment


        • #5




          LOL.  Maybe this will clarify.

          Option 1- Two physicians share one job as if one person, one practice.  Share patients, money is split evenly after collection and accounting for expenses.

          Option 2- Two physicians each have their own practices (ie each solo practitioner), do not share patients.  All money separate, each physician is responsible for 50% of the rent and overhead expense.

          Does anyone do something similar to Option 1 or Option 2?
          Click to expand...


          Who covers when physician is out of office?  Who is going to do the admin stuff (operations)?  Who is going to make decisions (strategy)?

          Comment


          • #6







            LOL.  Maybe this will clarify.

            Option 1- Two physicians share one job as if one person, one practice.  Share patients, money is split evenly after collection and accounting for expenses.

            Option 2- Two physicians each have their own practices (ie each solo practitioner), do not share patients.  All money separate, each physician is responsible for 50% of the rent and overhead expense.

            Does anyone do something similar to Option 1 or Option 2?
            Click to expand…


            Who covers when physician is out of office?  Who is going to do the admin stuff (operations)?  Who is going to make decisions (strategy)?
            Click to expand...


            Totally imagining this with my perfect ideal world glasses on........

            Option 1-

            Physicians cover each other when out of office, during the week and for vacations.  The practice has a practice manager for operations. If practice is hospital owned, neither physician makes any admin or strategic decisions. If practice owned by the physicians, I guess they make them together, not really that different from general group practice?

            Options 2 -

            Physician cover themselves for regular days off, can cross cover for vacation (like some solo practices do). Yes, truthfully, not totally "off" off technically; just not in the office seeing patients. The two physicians hire a practice manager to deal with operations.  Each physician makes his own strategic decisions.

            Thoughts?  Insights?

             

            Comment


            • #7
              in my experience, unlikely to be long term successful unless two very well matched individuals partner together.  however i think it is very specialty dependent and how long it is acceptable for patients to wait varies significantly.

              if they are well matched, either will work.

              but if they cover each others patients, and one has more patients, or word gets out that they see tricare (used to be very very poor paying but no idea how it is now) or medicaid or something, that can draw disproportionate share of staff time.  practice styles may vary and one person may consume more time than the other.  call responsibilities will be disproportionate if one person starts to work more or hangs on to patients longer or alternately if they choose to take more vacation.  from the staff perspective there is almost always one good doctor and one bad doctor.  bad doctor tells them about pay cuts, and flexing off, and HR issues.  good doctor is their friend that they chat with about life.  if you have two doctors you can't afford an office manager unless you are plastic surgeons.  or at least the office manager is really expensive relative to revenues for two part time doctors.  how many nurses?  how many ma?  how many front office staff?  when to fire?  when to hire?  what about raises?  do you want a fancy office or a bare bones office?  who counts the money at the the end of the day to make sure no stealing?  if one doctor is good and other is bad about it, how to reconcile?  if spouses pitch in, do they get paid?  how to set up retirement account funding?  how to empty accounts at end of year?  how to fund accounts at beginning of year?  physicians ideally would be well matched not just clinically but also from business perspective.  if you want the practice to be run efficiently and profitably, it takes time to manage.  that cannot easily be delegated.  if you just want a place that might break even but you enjoy the freedom of ownership, i think it could work.

              over the course of years, peoples needs vary.  we once had a partner whose husband eventually made high 7 figures and this person could not be motivated to follow what for years had been agreed upon division of labor.  they just didn't need the money and no amount of reduced income would entice them to see what had previously been their share.  conversely, we had another person at the same time whose kid developed special needs and they needed more income and even trying to transfer opportunities to make more for that person didn't work out well as they needed more money and more flexibility with time off.  obviously these are extreme examples.

               

              tl;dr

              two is a hard number.  if you don't want the (substantial) headaches  challenges of ownership, best to find a group and latch on part time.  you will get boned on some of the details, but trust me you will be spared many other tough decisions.

               

              Comment


              • #8
                I don't think either scenario will work well long term.

                But I have seen two couples where the husband and wife were in the same specialty, with the wife choosing to do fellowship in that specialty after the husband was well established in it.

                They have a 1.5 FTE job, where the wife works 0.5-0.6 FTE ( but does the majority of household work and child rearing) and the husband does 0.9-1.0 FTE. Seems to work out well. But the question is how they will transition out when both want to retire.

                Comment


                • #9




                  in my experience, unlikely to be long term successful unless two very well matched individuals partner together.  however i think it is very specialty dependent and how long it is acceptable for patients to wait varies significantly.

                  if they are well matched, either will work.

                  but if they cover each others patients, and one has more patients, or word gets out that they see tricare (used to be very very poor paying but no idea how it is now) or medicaid or something, that can draw disproportionate share of staff time.  practice styles may vary and one person may consume more time than the other.  call responsibilities will be disproportionate if one person starts to work more or hangs on to patients longer or alternately if they choose to take more vacation.  from the staff perspective there is almost always one good doctor and one bad doctor.  bad doctor tells them about pay cuts, and flexing off, and HR issues.  good doctor is their friend that they chat with about life.  if you have two doctors you can’t afford an office manager unless you are plastic surgeons.  or at least the office manager is really expensive relative to revenues for two part time doctors.  how many nurses?  how many ma?  how many front office staff?  when to fire?  when to hire?  what about raises?  do you want a fancy office or a bare bones office?  who counts the money at the the end of the day to make sure no stealing?  if one doctor is good and other is bad about it, how to reconcile?  if spouses pitch in, do they get paid?  how to set up retirement account funding?  how to empty accounts at end of year?  how to fund accounts at beginning of year?  physicians ideally would be well matched not just clinically but also from business perspective.  if you want the practice to be run efficiently and profitably, it takes time to manage.  that cannot easily be delegated.  if you just want a place that might break even but you enjoy the freedom of ownership, i think it could work.

                  over the course of years, peoples needs vary.  we once had a partner whose husband eventually made high 7 figures and this person could not be motivated to follow what for years had been agreed upon division of labor.  they just didn’t need the money and no amount of reduced income would entice them to see what had previously been their share.  conversely, we had another person at the same time whose kid developed special needs and they needed more income and even trying to transfer opportunities to make more for that person didn’t work out well as they needed more money and more flexibility with time off.  obviously these are extreme examples.

                   

                  tl;dr

                  two is a hard number.  if you don’t want the (substantial) headaches  challenges of ownership, best to find a group and latch on part time.  you will get boned on some of the details, but trust me you will be spared many other tough decisions.

                   
                  Click to expand...


                  totally read the whole thing and appreciate all the insight. questions are important; in order to really fully evaluate the possibility and longevity of the set up. i agree that two is a hard number and, there's not much job sharing or expense sharing practice set up out there to really get enough data to consider whether doable in general.  personally, am only aware of one private obgyn practice where two women job share (practice is less than decade old) and a set of private surgical practices where two men space/ overhead expense share (both individual practices have been around for 15+ years each). all 4 individuals seem very happy with their respective set ups and while i think (based on what is said) the space/ overhead share set up seems to be more profitable, I can't tell if it is simply because of reimbursement differences, gender differences, set up differences or a combination of all factors.

                  of note- none the of the 4 individuals are related or connected except professionally.

                   

                  Comment


                  • #10




                    I don’t think either scenario will work well long term.

                    But I have seen two couples where the husband and wife were in the same specialty, with the wife choosing to do fellowship in that specialty after the husband was well established in it.

                    They have a 1.5 FTE job, where the wife works 0.5-0.6 FTE ( but does the majority of household work and child rearing) and the husband does 0.9-1.0 FTE. Seems to work out well. But the question is how they will transition out when both want to retire.
                    Click to expand...


                    agree.  husband and wife practices are almost an entity all in their own.

                    Comment

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