Join Mom's Practice or No?

[NutADuc]

Hello Errbody!

I understand this is somewhat early to talk about planning for future employment but I am a planner/dreamer.

My wife is currently in her intern year of OB at a top institution in the midwest and with that, there can be pressure to subspecialize (Oncology, MFM, etc). Unlike me, my wife has decided to not plan too far ahead because she went into med school convinced she wanted to be an ENT and swore up and down she would NEVER do OB/GYN (her mother is one). She is currently excited about oncology because those patients/cases drive her the most, but she always reminds me that it doesn't mean she will end up doing it. Long story short, she says she doesn't know what she will end up deciding.

I on the other hand want her to do Oncology for slightly selfish reasons, but of course she would be the one making the final decision. In the end, as I have read about the plus side of being a business owner (being your own boss, potential for higher income, absolute autonomy, etc), I know there are also some downsides. Her mother owns her own practice and is very profitable. She is a solo practitioner with a NP and a PA on staff. She pays herself around 400k while saving $$ to hire a new OB as an employee.

My questions is, if it were you, would you join the already well established practice to take over it some time in the near future and even growing it as a generalist or would you not mind passing on it and pursuing a subspecialty? I am asking primarily from a financial stand point.

I have asked my mother in law why her daughter couldn't join her practice while being a subspecialist and she said something to the effect of 'it wouldn't be a good fit' or something like that.

Thanks

[LizOB]

The best thing from a financial standpoint is for her to pick a field she enjoys so she won't burn out and want to quit work ASAP

I understand your MIL's concern about not joining forces with gyn onc- the oncs do chemo in the office which would require a lot of logistical efforts and it wouldn't even help your MIL to take less call

[q-school]

there are many reasons why something would or would not be a good fit.

i think the simplest answer is if mother says no and daughter doesn't change mom's mind, you should stay out of it.



there are a lot of roads to travel before this decision has to be made.  you guys are going to have many tough decisions (as do all two professional family situations).  OB/ medicine is demanding for both spouses.  you may face different promotional paths and have to move, you may have different ideas of family responsibilities.  Planning that far in the future is hard, especially as you note, she hasn't even decided on what she wants to do and you have your own ideas.

Best of luck to you.

 

 

[adventure]

LizOB wrote:

The best thing from a financial standpoint is for her to pick a field she enjoys so she won’t burn out and want to quit work ASAP

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Period. Her choice. IMO, Money is irrelevant at this point.

NutADuc wrote:

Long story short, she says she doesn’t know what she will end up deciding.

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Uhh, yeah. She's an intern.

NutADuc wrote:

Her mother owns her own practice and is very profitable. She is a solo practitioner with a NP and a PA on staff. She pays herself around 400k while saving $$ to hire a new OB as an employee.

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ONly 400k? Seems low. And saving to hire another provider? Makes little to zero sense to me. Providers make money, you don't usually want to have to pay to have them around.

NutADuc wrote:

I have asked my mother in law why her daughter couldn’t join her practice while being a subspecialist and she said something to the effect of ‘it wouldn’t be a good fit’ or something like that.

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Shudder.

NutADuc wrote:

My questions is, if it were you, would you join the already well established practice to take over it some time in the near future and even growing it as a generalist or would you not mind passing on it and pursuing a subspecialty? I am asking primarily from a financial stand point.

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Depends if they want to run a business. If not, then potential earnings is a moot point. Earning six figures from a large hospital group has some great advantages. Some disadvantages too, but to me, it's pretty important if the person has any interest in a business. If not, I'd steer clear from such endevours.

[NutADuc]

Thanks for all the input guys. I appreciate it. I was really just looking to see what your thoughts were on joining another practice vs 'inheriting' a practice so to speak. So Adventure, thanks for your last paragraph, that was helpful.

As for the other comments, I don't think it is the worst thing in the world (obviously exaggerating) to think about these things now. Also, in can't emphasize this enough but my wife will always hear my opinion but I'll support her with whatever she chooses to do in the future and she knows this. Not ever going to pressure her to do something she doesn't want to (i thought ENT was meant for her so we were both kinda shocked when she changed her mind). BTW, my MIL and I have a fantastic relationship and so is the relationship between her and her daughter (she would give my wife anything she desired if she could) fyi.

As for the 400K being too low comment, you might be right. I don't know (this was 5 yrs ago and from what I understand her salary has gone up significantly since). But I do know that most docs who hire new docs in a small practice have to pay them a base salary for the first couple of years at least.

 

[Fullhouse11]

Are you thinking that they could be partners and when her mom retires your wife would then employ the OB/gyns? My husband is an oncologist and this would never be something he would want to do on top of having his responsibilities of his own practice. Pick a lane, stay in it. Wherever she goes she has to build a practice, unless she is taking over someone’s practice who is retiring. My husband enjoys a bigger single specialty practice, rather than the multi specialty group he was with for over a decade with only a few oncologists. She will be able to build a practice on her own. Kudos to you for thinking ahead!

[NutADuc]

Thanks @Fullhouse11 for the insight.

I see your point and how that can be difficult setting up a multispecialty practice. I know she (DW) has said in the past that it is actually no guarantee that she would join her Mom's practice even if she does decide to be a generalist. She said this mainly because, like I mentioned above, she doesn't want to be cornered/caged and is open to any thing.

''i think the simplest answer is if mother says no and daughter doesn’t change mom’s mind, you should stay out of it.''

q-school, if it comes to that I will stay out of it. When I asked my MIL about why it wouldn't work with her daughter possibly joining her practice as a subspecialist, it was a convo only between MIL and I. There was no contention during the convo. I was just curious when i asked her the question.

[q-school]

you seem like a nice person.  the kind of answers I think you want are ones that can only be provided by your wife and mother in law, and even they may not know the answers.  I don't think there are universal answers to be had here.  And there are dozens of reasons why it would not work and many reasons why a motivated person could make it work.

a more focused question would probably be likely to provide the types of answers you want, but we would need more data than I think she makes 400k or maybe a lot more depending on when I last spoke with her.  there are lots of ways to make a practice work.  the specific questions you ask do not have one right answer.  too many variables to even begin thinking of it.  people who have been practicing ten years are still asking the same questions.

good luck.

 

"My questions is, if it were you, would you join the already well established practice to take over it some time in the near future and even growing it as a generalist or would you not mind passing on it and pursuing a subspecialty? I am asking primarily from a financial stand point."

"I was really just looking to see what your thoughts were on joining another practice vs ‘inheriting’ a practice so to speak."

[NutADuc]

Thanks q-school. You are probably right. At least I'll know where to go get some input once she gets closer to making her decision.

[Hatton]

I think it would great to give a practice to a child.  Presumably no trust issues on either side.  I believe there would be buy in from the medical staff and L&D nurses etc.  Easy to introduce the new partner.  I have seen some father son transitions so why not mother daughter.  I bet the patients of the practice would like this as well.

[NutADuc]

@hatton1, I agree! If she decides to join her, it would be welcomed by everyone involved. I mean, the staff has known her since she was in high school.

[Ghetto]

NutADuc wrote:

@hatton1, I agree! If she decides to join her, it would be welcomed by everyone involved. I mean, the staff has known her since she was in high school.

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This could actually be a big problem. One reason they tell residents to move on from their training programs instead of taking a job there is that your former attendings will often continue to see you as a resident instead of a colleague.

 

imagine if your staff had known you since high school....that could be a rough transition and they might never take you seriously. No thanks.

[Kamban]

I know two physicians, each of whom have 3 children, all physicians. Both parent physicians own their own practices, including one who is sole owner of a large multiplicity group. None of these 6 children want to join their parent's practice or even take over it. It is a combination of things

Do your own thing.

Not be tied to the medium sized town you grew up with.

See the world when you are young and not take any responsibilities at this age to running a practice.

All have had free education and there is inheritance coming, so why bother with additional headaches of running a practice for more money that is not needed.

Can have better lifestyle and income in their own specialty than taking over father's practice.

 

 

[Zaphod]

Ghetto wrote:

NutADuc wrote:

@hatton1, I agree! If she decides to join her, it would be welcomed by everyone involved. I mean, the staff has known her since she was in high school.

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This could actually be a big problem. One reason they tell residents to move on from their training programs instead of taking a job there is that your former attendings will often continue to see you as a resident instead of a colleague.

 

imagine if your staff had known you since high school….that could be a rough transition and they might never take you seriously. No thanks.

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Ha, yeah that might be odd but in all seriousness they will be reitiring, moving on at some point. If they really couldnt deal, then let them go, and all the sudden the atmosphere would change.

I dont know how it works for medical type practices, but this would be a huge benefit for almost anybody one would think. Unless you felt your mom was lying about the financials or specifics, which is the biggest problem in any practice, you have by far the easiest chance to get a much better than fair deal.

If this was a place I could live at all, I'd be all over it unless there was some amazing other opportunity. I know lots of plastics practices where sons/daughters are joining their dads practices.

@Kamban makes great other side points.

[NutADuc]

Thanks for the input guys. Lots to think about.

@Ghetto, I was exaggerating a bit about the staff knowing her since she was in high school. There has been some turnover with certain staff. But that is a good point to ponder further on.

@Kamban, DW and I have talked several times about how we would prefer to not live in that town. Although, there are two major cities not far (one an hr to the North where my family lives and the other 45mins to the south where we have our closest friends).

All great thoughts guys.

"If this was a place I could live at all, I’d be all over it unless there was some amazing other opportunity. I know lots of plastics practices where sons/daughters are joining their dads practices."

@Zaphod, for the reasons mentioned above, it is really not a bad place to live in. But I like speculating/planning and having vision. We'll see what she decides. But this gives me a good pros/cons list. Thanks again for your thoughts.