Her daughter-in-law is a dermatologist in an academic practice in a large city. She is married and her husband is still in school, thus has no income. She is unhappy in her current position and has been interviewing for jobs in the suburbs. She has 2 options, according to my friend. Option A is to join a group, on a partnership tract, for straight salary. Option B is to join a group on a non-partnership tract with a compensation package based on a percentage of collections minus overhead. What sould she do, asked my friend. The answer is, "I don't know" but here are the pitfalls that she should try to avoid and, here are some possible solutions.
First, how can she get screwed. Oh, let me count the ways.
- Options A: She takes a straight salary, and then they work her like a dog with all the patients they don't want to see, at all the times they don't wish to see them.
- Option B: she gets a percentage of what she brings in, minus expenses, right. Ok, she sees all the poor payers and time-consuming diagnoses, and then they give her an "overhead" of 50-65% (don't scoff, it happens). Therefore, no matter how hard she works, she makes relatively little money, for a dermatologist. Overhead for someone joing a group, in my view, should never be > 50%.
- Options A and B: She wants to do cosmetics because it is what she enjoys and is good at, plus it is the most profitable. Only, her partner insists, either directly, or via office policies, on doing all cosmetics. Tough luck, you're an employee.
- Options A and B: "Call is equal" the partners say. Well, there is equal and there is equal. Somehow, the junior person always gets the "extra" call;the 5th weekend, every Mother's Day, all holidays in year one, every Christmas "because your Jewish." What ever you don't want, you'll get. It may sound petty, and it is, but if done consistently to you, it will really grate on you nerves.
- Options A and B: The no-compete clause. This says that if you leave the practice, essentially you are barred from practicing with-in that community for a period of time. For eample, 10 miles, 2 years. Mine was 5 miles, 2 years, which I believe is fair. It is designed to protect the employer, as it should. Unfortunately, if you are an employee and are unhappy and wish to leave, you will have to uproot your family and move. And believe me, no-compete clauses are enforceable in court. You will not win.
- Options A and B: They have multiple offices and guess who does all the driving. Also, makes the no-compete clause even worse.
- Options A and B: You have no hiring and firing power, and you get all the new hires; all the inexoerienced hires.
- Options A and B: You get all the "high risk" liability cases and emergencies.
- Option A: Partner deal to be negotiated later, rather than at the time of initial employ. This is one of the oldest tricks in the book and allows your employers to string you along for the term of your employ and then make the partnership details noxious.
- Nebulous buy-in terms.
So here are some possible solutions:
- Don't sign a no-compete clause.
- Work without a contract.
- Pick a job in a different community from which you live.
- Ensure, in writing, that patients will be assigned on an "as they call" basis. If patients are then assigned by any other method, the contract is nullified (consult a lawyer first).
- Make sure the call schedule is agreeable to you, in writing. Think 3-5 years ahead, when you have kids, etc, and re-think the call schedule.
- Make sure all details of partnership are negotiated before you sign the contract. Consult a lawyer.
- Be prepared to walk from the contract.
- No your own true worth.
- Trust your misgivings. If you don't feel right on the way in, things will only get worse.
- Find out the group's or partner's entire history of associates, talk to the associates and read between the lines.
- You must have a very clear understanding of the buy-in, in real numbers, not "the accounts receivable" or other such fudgable terms.
- Be prepared to go solo.