Q: negotiations for joining a practice - percentages?

[Guest guest]

I could really use some help from some of you more experienced minds in this regard. I am used to working solo so i haven't had to deal with this for the most part so far. I was approached by a local MD who i've been friendly with to join a practice with him and another practitioner. The two practitioners are partners in this practice and they want me to come on board - i dont know if its as an independent contractor or an employee. They asked that i come up with an offer of an arrangement of how i will be paid. He suggested i start this by relaying how much money i need to bring in each month and going from there. I really don't know what to say. What is customary in this situation? Or what are people finding works really well for them? I also don't know what to do

about medicinary. I will be under them in terms of marketing and their EMR (HelloHealth) and all of the things that go with a practice ie front desk, insurance billing, etc. They are including me in a lot of things such as input on their signage and marketing ideas. This is a practice that suffered some losses for various reasons and now it is essentially mostly a start up again. I would appreciate any input. Thanks so much,Alia Elias, ND, LAc.Newburyport, MA

[Guest guest]

Well, here are some things that I have seen and thought about previously in my 19 years of practice. I have much more information for you to consider.

1. As it should be, others do not know how much money an ND makes, or not. In truth, income is all over the board as ND's have such an eclectic practice.

2. In the conventional medicine world, there usually is a disconnect between how much time we ND's spend with the patient and how many patients an hour we can see. This equals money into a practice. They get it that if they spent that time it would be disastrous monetarily.

3. In other words, a nurse practitioner brings in much more money to the practice, and they may be thinking that will be the range you will bring in. Overhead is high always, and MD's are shocked when they see the reality and punch in the numbers. They wonder how we do it. And well, some of us don't in the end-it can be challenging.

4. That said, first you should figure out how many patients you see an hour and how many hours a day/week you see(or can see) patients and what is that in a $ figure . Here in WA, my MD friend was offered a half time position at 12 hours seeing patients a week, so taking that figure to full time it would be 24 hours a week. They too have much paperwork.

5. How much do you bring in from dispensary on a retail and then a net amount? Who will get that money in the new practice and who will order and deal with the dispensary. Dispensary is one thing that keeps many ND practices afloat.

6. Where is your bottom line for needed income and how much do you think you can make practicing where you are now if you have a mature practice. What about vacations?

Alia, I can talk with you out of the UNDA circle if you want. My cell phone number 425 870-5834. I am on Pacific time. Best to call this weekend (EXCEPT Saturday afternoon and evening) or in the evening after 6 on weekdays.

Sincerely,

Whittaker, RN, ND

Alternative Medicine Clinic, LLC

Stanwood, WA

Q: negotiations for joining a practice - percentages?

I could really use some help from some of you more experienced minds in this regard. I am used to working solo so i haven't had to deal with this for the most part so far. I was approached by a local MD who i've been friendly with to join a practice with him and another practitioner. The two practitioners are partners in this practice and they want me to come on board - i dont know if its as an independent contractor or an employee. They asked that i come up with an offer of an arrangement of how i will be paid. He suggested i start this by relaying how much money i need to bring in each month and going from there. I really don't know what to say. What is customary in this situation? Or what are people finding works really well for them? I also don't know what to do about medicinary. I will be under them in terms of marketing and their EMR (HelloHealth) and all of the things that go with a practice ie front desk, insurance billing, etc. They are including me in a lot of things such as input on their signage and marketing ideas. This is a practice that suffered some losses for various reasons and now it is essentially mostly a start up again.

I would appreciate any input.

Thanks so much,

Alia Elias, ND, LAc.

Newburyport, MA

[Guest guest]

Dear Alia,

I recently took in a young associate, a physician, into my practice. I begin with the knowledge after 30 years of practice that it costs me about 2/3 of what I make to pay for the costs. This includes everything from business taxes to office payroll to pharmacy and lab costs to rent to everything. It has been this way from nearly the beginning. Other docs may have a more efficient operation, I do not know, but this is my reality and that of most I have spoken with. So I get to keep, and then pay income taxes on, about 1/3 of what I bring in. A simple formula, therefor, is to have an associate pay me 2/3 of what they generate. But this give me no guarantee of anything, and is no incentive for them to even come into the office. Whether I come in or not, I have fixed costs, like rent. So I set a minimum to be paid to me each month by the associate, or 2/3 of what they bring in, which ever is greater. Alternatively I would require no less than 50%, and that would be a very generous offer. Then I set a cap on the amount, so that above a fixed amount, they keep all the rest that they may generate. I set the formula so that each year it increases up to a final cap. This is a simple formula that makes sense from my perspective as "landlord". Other things can be negotiated, such as pharmacy percentage, how to compensate for seeing the other doctor's patient, etc.

In terms of salary, a different kind of arrangement, remember that the lowest paid MD, the family practice/general practice doc, makes on average $150,000 annually. The average naturopath, depending upon which study you look at makes between $45,000 and $100,000 annually, depending upon years in practice and perceived expertise. So a good place to start would be no less than $75,000. This depends upon the local (NY City vs Minot, North Dakota, where you can by a nice home for $30,000).

Zeff, ND

[Guest guest]

All that said by Dr Zeff, I would add that you should consider supplying and managing the dispensary as your perk. After all, few people know enough to order and sell dispensary. If they sell stuff out of there like multiple vitamins and general products, then you could give them a cut. This will keep you afloat and keep your practice dispensary available for your needs.

Whittaker, RN, ND

Re: Q: negotiations for joining a practice - percentages?

Dear Alia,

I recently took in a young associate, a physician, into my practice. I begin with the knowledge after 30 years of practice that it costs me about 2/3 of what I make to pay for the costs. This includes everything from business taxes to office payroll to pharmacy and lab costs to rent to everything. It has been this way from nearly the beginning. Other docs may have a more efficient operation, I do not know, but this is my reality and that of most I have spoken with. So I get to keep, and then pay income taxes on, about 1/3 of what I bring in. A simple formula, therefor, is to have an associate pay me 2/3 of what they generate. But this give me no guarantee of anything, and is no incentive for them to even come into the office. Whether I come in or not, I have fixed costs, like rent. So I set a minimum to be paid to me each month by the associate, or 2/3 of what they bring in, which ever is greater. Alternatively I would require no less than 50%, and that would be a very generous offer. Then I set a cap on the amount, so that above a fixed amount, they keep all the rest that they may generate. I set the formula so that each year it increases up to a final cap. This is a simple formula that makes sense from my perspective as "landlord". Other things can be negotiated, such as pharmacy percentage, how to compensate for seeing the other doctor's patient, etc.

In terms of salary, a different kind of arrangement, remember that the lowest paid MD, the family practice/general practice doc, makes on average $150,000 annually. The average naturopath, depending upon which study you look at makes between $45,000 and $100,000 annually, depending upon years in practice and perceived expertise. So a good place to start would be no less than $75,000. This depends upon the local (NY City vs Minot, North Dakota, where you can by a nice home for $30,000).

Zeff, ND

[Guest guest]

HI there and I have shared space with others for all the years that I have been in practice and I have always just shared the rent for the space equally and then simply managed my own practice and my own practice business. If you can't do that, why not just pay rent. It never seemed particularly fair to equate space and cost the way allot of the ND community does and demand that much of a percentage of your work. I didn't;'t like it 20 years ago nor do I like it now regardless of the explanation. Regards and good luck, WhiteND, Ct

-----Original Message-----From: [mailto: ]On Behalf Of Dr. Alia EliasSent: Friday, August 26, 2011 9:50 PMTo: NaturopathicChat ; Subject: Q: negotiations for joining a practice - percentages?

I could really use some help from some of you more experienced minds in this regard. I am used to working solo so i haven't had to deal with this for the most part so far. I was approached by a local MD who i've been friendly with to join a practice with him and another practitioner. The two practitioners are partners in this practice and they want me to come on board - i dont know if its as an independent contractor or an employee. They asked that i come up with an offer of an arrangement of how i will be paid. He suggested i start this by relaying how much money i need to bring in each month and going from there. I really don't know what to say. What is customary in this situation? Or what are people finding works really well for them? I also don't know what to do about medicinary. I will be under them in terms of marketing and their EMR (HelloHealth) and all of the things that go with a practice ie front desk, insurance billing, etc. They are including me in a lot of things such as input on their signage and marketing ideas. This is a practice that suffered some losses for various reasons and now it is essentially mostly a start up again.

I would appreciate any input.

Thanks so much,

Alia Elias, ND, LAc.

Newburyport, MA