RE: solo start up practice..right out of residency

[Guest guest]

Dear ,

I just went through what u are planning to do. I finished residency in jan and moved from MI to palm Springs with a wonderful contract in place. 4 mos later things fizzled out, all the promises made were being broken. We had different visions and had to part.

I was lucky the hospital that initially recruited me stood behind me and continued the income guarantee.

I am now in solo practice. Its been 3 mos, credentialing with insurances are almost done and checks are rolling in. I love it, I come to work with a smile and leave with one.

I started the practice on my own with help from other local physicians who reached out to me. There's nothing like working for yourself and taking care of patients.

Make sure u get an attorney who understands medical contracts to review your contract. But, from my experience it really dosen't matter because no matter who reads it if the two physicians don't understand each other it is destined for failure.

I was blessed to find good people here and hope u make the right decision.

Good Luck

Mala

[Guest guest]

Dear ,

I just went through what u are planning to do. I finished residency in jan and moved from MI to palm Springs with a wonderful contract in place. 4 mos later things fizzled out, all the promises made were being broken. We had different visions and had to part.

I was lucky the hospital that initially recruited me stood behind me and continued the income guarantee.

I am now in solo practice. Its been 3 mos, credentialing with insurances are almost done and checks are rolling in. I love it, I come to work with a smile and leave with one.

I started the practice on my own with help from other local physicians who reached out to me. There's nothing like working for yourself and taking care of patients.

Make sure u get an attorney who understands medical contracts to review your contract. But, from my experience it really dosen't matter because no matter who reads it if the two physicians don't understand each other it is destined for failure.

I was blessed to find good people here and hope u make the right decision.

Good Luck

Mala

[Guest guest]

Oh, I love your enthusiasm ! How much would you go in debt with the hospital ? Divide all happy numbers by 0.7 and if it works, you will do probably great. Try to remain as independent as you can. Also, if you don't have kids now but you plan to have some, plan for less procedures and shift them to some consultants. I know it may sound exciting now but you will get tired. Is there a large medicaid population in the area ? If so, you won't be able to have a low overhead. What is the major insurer in the area ? Do you have to accept any capitation ? That is another no-no in this type of practice. Also, would you have many fee-for-service HMOs ?Plan to attend some billing and coding classes. Hi I am , I am a 3rd yr family medicine resident at Hospital in Fort Worth, TX. JPS is the largest family medicineprogram in the country and we really do alot here. I am one of the 2chiefs this year and have loved every minute of residency. I willfinish in July 07 and have been on the job search for TEXAS ONLY. Mywife and I do not want to leave TX and prefer to stay within a couplehrs of Dallas/Fort Worth. The market looks pretty good and between therecruiters and small towns, my phone never stops ringing (I usuallyget 3-7 calls/day for the past 6wks). I have found several smallcommunities where I can haved a somewhat traditional practice managingmy patients in the clinic and as inpatients. The particular place I ammost interestd in is offering what I think is a fairly standard dealfor solo start up with an income guarantee, plus lots of other perks(stipend, moving allowance, sign on bonus, loan payoff, bonus at 12moif I am off of the guarantee, marketing advisor and $$, medical officestartup consultant, will pay for the emr of my choice-eMDs) and bestof all it is in the area we want to live. I can also lease or purchasemy space in the new medical office building within walking distance tothe new hospital they are building to open a month or so before I getthere. With this space, I can start small and have first right ofrefusal for nearby office space so I can expand if I need to. My wifewho is a veterinarian could even keep her current job with if we go tothis location. The community is in great need and they promise not tobring in any other pcps until I am well established and off of myguarantee. For all of this I will owe them 4 years after the guaranteeyr to have this all paid off free and clear. Now this sounds good tome and I think I can make it work well. I have talked to many of theother local docs and they are positive about it as well. The last oneto do this there was off his guarantee after 6 months and had to hirea mid level practitioner before he had been there even 2 yrs due tothe patient load. Not to mention it is a small enough place that I cando pretty much whatever is within my comfort zone. Personally I loveinpatient as well as clinic and want to manage all my inpatient stuff(i do my own lines, I & Ds, lesion removal, chest tubes, manage patientson the ventilator, in residency I even do endoscopy, but may not beable to do that here due to the GI/surgeons there), this place willallow for me to do what I love and make a difference. I have spokenwith the manager of the ER (a family physician) and he has extended anoffer to let me do "as many ER shifts as I want" as my practice isstarting up to make some extra $$. I have good experience in the ERand this sounds great to me as well. The bigger thing for me isgetting used to the business side of it all and making sure this worksout well. I have a great buddy who is an accountant and willing to gowith me for little pay at the beginning as my office manager. I havelearned that I could get by with a medical assistant instead of anurse if I need the help and save money. I am excited and want to moveforward with this but sure would like to hear what some of you withmore experienc have to say about it. The money is good(more thanaverage around here, but nearly all JPS grads make more than avgbecause they do more) but I could make much more ($250-350k tostart)if I were willing to move to a more remote area in Texas andwork even more hours but I really don't think I need more money forliving in a location I don't really want to be in. I amexcited...should I be? I really want to make a decision sometimesoon.Let me know what you think. I know many resident seek out anemployed position because they are scared of running the business, butthis is what excites me most. Also about EMR, how feasible do youthink it would be for me to set up eMDs on a central server, then seepts with a notebook/tablet both in the office and hospital so that myoffice manager could bill for it all (eMDs is supposed to have a newadd on out in December that would allow the use of it outside of mylocal wireless network and sync when I return). My goal is to keep theoverhead as low as possible. To start I could use the hospital lab,imaging services etc which will be across the breezway from my officeand add more equipment as I can afford it.

[Guest guest]

Oh, I love your enthusiasm ! How much would you go in debt with the hospital ? Divide all happy numbers by 0.7 and if it works, you will do probably great. Try to remain as independent as you can. Also, if you don't have kids now but you plan to have some, plan for less procedures and shift them to some consultants. I know it may sound exciting now but you will get tired. Is there a large medicaid population in the area ? If so, you won't be able to have a low overhead. What is the major insurer in the area ? Do you have to accept any capitation ? That is another no-no in this type of practice. Also, would you have many fee-for-service HMOs ?Plan to attend some billing and coding classes. Hi I am , I am a 3rd yr family medicine resident at Hospital in Fort Worth, TX. JPS is the largest family medicineprogram in the country and we really do alot here. I am one of the 2chiefs this year and have loved every minute of residency. I willfinish in July 07 and have been on the job search for TEXAS ONLY. Mywife and I do not want to leave TX and prefer to stay within a couplehrs of Dallas/Fort Worth. The market looks pretty good and between therecruiters and small towns, my phone never stops ringing (I usuallyget 3-7 calls/day for the past 6wks). I have found several smallcommunities where I can haved a somewhat traditional practice managingmy patients in the clinic and as inpatients. The particular place I ammost interestd in is offering what I think is a fairly standard dealfor solo start up with an income guarantee, plus lots of other perks(stipend, moving allowance, sign on bonus, loan payoff, bonus at 12moif I am off of the guarantee, marketing advisor and $$, medical officestartup consultant, will pay for the emr of my choice-eMDs) and bestof all it is in the area we want to live. I can also lease or purchasemy space in the new medical office building within walking distance tothe new hospital they are building to open a month or so before I getthere. With this space, I can start small and have first right ofrefusal for nearby office space so I can expand if I need to. My wifewho is a veterinarian could even keep her current job with if we go tothis location. The community is in great need and they promise not tobring in any other pcps until I am well established and off of myguarantee. For all of this I will owe them 4 years after the guaranteeyr to have this all paid off free and clear. Now this sounds good tome and I think I can make it work well. I have talked to many of theother local docs and they are positive about it as well. The last oneto do this there was off his guarantee after 6 months and had to hirea mid level practitioner before he had been there even 2 yrs due tothe patient load. Not to mention it is a small enough place that I cando pretty much whatever is within my comfort zone. Personally I loveinpatient as well as clinic and want to manage all my inpatient stuff(i do my own lines, I & Ds, lesion removal, chest tubes, manage patientson the ventilator, in residency I even do endoscopy, but may not beable to do that here due to the GI/surgeons there), this place willallow for me to do what I love and make a difference. I have spokenwith the manager of the ER (a family physician) and he has extended anoffer to let me do "as many ER shifts as I want" as my practice isstarting up to make some extra $$. I have good experience in the ERand this sounds great to me as well. The bigger thing for me isgetting used to the business side of it all and making sure this worksout well. I have a great buddy who is an accountant and willing to gowith me for little pay at the beginning as my office manager. I havelearned that I could get by with a medical assistant instead of anurse if I need the help and save money. I am excited and want to moveforward with this but sure would like to hear what some of you withmore experienc have to say about it. The money is good(more thanaverage around here, but nearly all JPS grads make more than avgbecause they do more) but I could make much more ($250-350k tostart)if I were willing to move to a more remote area in Texas andwork even more hours but I really don't think I need more money forliving in a location I don't really want to be in. I amexcited...should I be? I really want to make a decision sometimesoon.Let me know what you think. I know many resident seek out anemployed position because they are scared of running the business, butthis is what excites me most. Also about EMR, how feasible do youthink it would be for me to set up eMDs on a central server, then seepts with a notebook/tablet both in the office and hospital so that myoffice manager could bill for it all (eMDs is supposed to have a newadd on out in December that would allow the use of it outside of mylocal wireless network and sync when I return). My goal is to keep theoverhead as low as possible. To start I could use the hospital lab,imaging services etc which will be across the breezway from my officeand add more equipment as I can afford it.

[Guest guest]

be careful, very very careful. I too was promised the moon only to

have it fall. Get it in writing, know what you will have to pay back

if do not meet goals. Hospital administrations change. Hospital

finances in some places can not pay for the promises they make.

Make sure you meet all the doctors in the community and ask the ones

that left, WHY? If you do not do lab and some extras you may very

well lose a huge part of your income potential. Most of us in real

life make a heck of a lot less. I wonder why? You might ask

yourself that question. I see myself years ago in what you write.

Brent Hrabik, MD

>

> Hi I am , I am a 3rd yr family medicine resident at

> Hospital in Fort Worth, TX. JPS is the largest family

medicine

> program in the country and we really do alot here. I am one of the

2

> chiefs this year and have loved every minute of residency. I will

> finish in July 07 and have been on the job search for TEXAS ONLY.

My

> wife and I do not want to leave TX and prefer to stay within a

couple

> hrs of Dallas/Fort Worth. The market looks pretty good and between

the

> recruiters and small towns, my phone never stops ringing (I usually

> get 3-7 calls/day for the past 6wks). I have found several small

> communities where I can haved a somewhat traditional practice

managing

> my patients in the clinic and as inpatients. The particular place

I am

> most interestd in is offering what I think is a fairly standard

deal

> for solo start up with an income guarantee, plus lots of other

perks

> (stipend, moving allowance, sign on bonus, loan payoff, bonus at

12mo

> if I am off of the guarantee, marketing advisor and $$, medical

office

> startup consultant, will pay for the emr of my choice-eMDs) and

best

> of all it is in the area we want to live. I can also lease or

purchase

> my space in the new medical office building within walking

distance to

> the new hospital they are building to open a month or so before I

get

> there. With this space, I can start small and have first right of

> refusal for nearby office space so I can expand if I need to. My

wife

> who is a veterinarian could even keep her current job with if we

go to

> this location. The community is in great need and they promise not

to

> bring in any other pcps until I am well established and off of my

> guarantee. For all of this I will owe them 4 years after the

guarantee

> yr to have this all paid off free and clear. Now this sounds good

to

> me and I think I can make it work well. I have talked to many of

the

> other local docs and they are positive about it as well. The last

one

> to do this there was off his guarantee after 6 months and had to

hire

> a mid level practitioner before he had been there even 2 yrs due to

> the patient load. Not to mention it is a small enough place that I

can

> do pretty much whatever is within my comfort zone. Personally I

love

> inpatient as well as clinic and want to manage all my inpatient

stuff

> (i do my own lines, I & Ds, lesion removal, chest tubes, manage

patients

> on the ventilator, in residency I even do endoscopy, but may not be

> able to do that here due to the GI/surgeons there), this place will

> allow for me to do what I love and make a difference. I have spoken

> with the manager of the ER (a family physician) and he has

extended an

> offer to let me do " as many ER shifts as I want " as my practice is

> starting up to make some extra $$. I have good experience in the ER

> and this sounds great to me as well. The bigger thing for me is

> getting used to the business side of it all and making sure this

works

> out well. I have a great buddy who is an accountant and willing to

go

> with me for little pay at the beginning as my office manager. I

have

> learned that I could get by with a medical assistant instead of a

> nurse if I need the help and save money. I am excited and want to

move

> forward with this but sure would like to hear what some of you with

> more experienc have to say about it. The money is good(more than

> average around here, but nearly all JPS grads make more than avg

> because they do more) but I could make much more ($250-350k to

> start)if I were willing to move to a more remote area in Texas and

> work even more hours but I really don't think I need more money for

> living in a location I don't really want to be in. I am

> excited...should I be? I really want to make a decision sometime

> soon.Let me know what you think. I know many resident seek out an

> employed position because they are scared of running the business,

but

> this is what excites me most. Also about EMR, how feasible do you

> think it would be for me to set up eMDs on a central server, then

see

> pts with a notebook/tablet both in the office and hospital so that

my

> office manager could bill for it all (eMDs is supposed to have a

new

> add on out in December that would allow the use of it outside of my

> local wireless network and sync when I return). My goal is to keep

the

> overhead as low as possible. To start I could use the hospital lab,

> imaging services etc which will be across the breezway from my

office

> and add more equipment as I can afford it.

>

[Guest guest]

be careful, very very careful. I too was promised the moon only to

have it fall. Get it in writing, know what you will have to pay back

if do not meet goals. Hospital administrations change. Hospital

finances in some places can not pay for the promises they make.

Make sure you meet all the doctors in the community and ask the ones

that left, WHY? If you do not do lab and some extras you may very

well lose a huge part of your income potential. Most of us in real

life make a heck of a lot less. I wonder why? You might ask

yourself that question. I see myself years ago in what you write.

Brent Hrabik, MD

>

> Hi I am , I am a 3rd yr family medicine resident at

> Hospital in Fort Worth, TX. JPS is the largest family

medicine

> program in the country and we really do alot here. I am one of the

2

> chiefs this year and have loved every minute of residency. I will

> finish in July 07 and have been on the job search for TEXAS ONLY.

My

> wife and I do not want to leave TX and prefer to stay within a

couple

> hrs of Dallas/Fort Worth. The market looks pretty good and between

the

> recruiters and small towns, my phone never stops ringing (I usually

> get 3-7 calls/day for the past 6wks). I have found several small

> communities where I can haved a somewhat traditional practice

managing

> my patients in the clinic and as inpatients. The particular place

I am

> most interestd in is offering what I think is a fairly standard

deal

> for solo start up with an income guarantee, plus lots of other

perks

> (stipend, moving allowance, sign on bonus, loan payoff, bonus at

12mo

> if I am off of the guarantee, marketing advisor and $$, medical

office

> startup consultant, will pay for the emr of my choice-eMDs) and

best

> of all it is in the area we want to live. I can also lease or

purchase

> my space in the new medical office building within walking

distance to

> the new hospital they are building to open a month or so before I

get

> there. With this space, I can start small and have first right of

> refusal for nearby office space so I can expand if I need to. My

wife

> who is a veterinarian could even keep her current job with if we

go to

> this location. The community is in great need and they promise not

to

> bring in any other pcps until I am well established and off of my

> guarantee. For all of this I will owe them 4 years after the

guarantee

> yr to have this all paid off free and clear. Now this sounds good

to

> me and I think I can make it work well. I have talked to many of

the

> other local docs and they are positive about it as well. The last

one

> to do this there was off his guarantee after 6 months and had to

hire

> a mid level practitioner before he had been there even 2 yrs due to

> the patient load. Not to mention it is a small enough place that I

can

> do pretty much whatever is within my comfort zone. Personally I

love

> inpatient as well as clinic and want to manage all my inpatient

stuff

> (i do my own lines, I & Ds, lesion removal, chest tubes, manage

patients

> on the ventilator, in residency I even do endoscopy, but may not be

> able to do that here due to the GI/surgeons there), this place will

> allow for me to do what I love and make a difference. I have spoken

> with the manager of the ER (a family physician) and he has

extended an

> offer to let me do " as many ER shifts as I want " as my practice is

> starting up to make some extra $$. I have good experience in the ER

> and this sounds great to me as well. The bigger thing for me is

> getting used to the business side of it all and making sure this

works

> out well. I have a great buddy who is an accountant and willing to

go

> with me for little pay at the beginning as my office manager. I

have

> learned that I could get by with a medical assistant instead of a

> nurse if I need the help and save money. I am excited and want to

move

> forward with this but sure would like to hear what some of you with

> more experienc have to say about it. The money is good(more than

> average around here, but nearly all JPS grads make more than avg

> because they do more) but I could make much more ($250-350k to

> start)if I were willing to move to a more remote area in Texas and

> work even more hours but I really don't think I need more money for

> living in a location I don't really want to be in. I am

> excited...should I be? I really want to make a decision sometime

> soon.Let me know what you think. I know many resident seek out an

> employed position because they are scared of running the business,

but

> this is what excites me most. Also about EMR, how feasible do you

> think it would be for me to set up eMDs on a central server, then

see

> pts with a notebook/tablet both in the office and hospital so that

my

> office manager could bill for it all (eMDs is supposed to have a

new

> add on out in December that would allow the use of it outside of my

> local wireless network and sync when I return). My goal is to keep

the

> overhead as low as possible. To start I could use the hospital lab,

> imaging services etc which will be across the breezway from my

office

> and add more equipment as I can afford it.

>

[Guest guest]

I

signed on in 2004 with a similar setup here in Ohio: 18-month income

guarantee with a 3 year forgiveness period. I used every dollar they

allowed & was not in a hurry to be off the guarantee early. My

accountant explained it as “the cheapest loan you’ll ever get”

(ie, is repaid only with time). BUT, the big catch with these setups is

in the requirements. In order to offer these, the hospital is required to

demonstrate a “need” for primary care doctors & that these

doctors will accept Medicare & Medicaid as a tradeoff for the $$$ they are

fronting you. Another catch: you are required to see all Medicare &

Medicaid for the entire forgiveness period & not just while on the

guarantee! That means you will have to remain open to Medicare/Medicaid

for at least 5 years! Therein usually lies the “catch”:

the big “need” they sell you on basically = Medicaid & more

Medicaid, which makes an IMP/low overhead style tough. Still, running my

own solo practice is great & I personally would not have done it without

the hospital assistance & guarantee, though you’ll hear varying

opinions of these arrangements here. There is no way to afford eMDs etc

without that assistance, the debt would sink you. Just beware of the

Medicaid requirement and the huge tax burden that you will be hit with down the

road as all of that money they advance you will later be reported to the IRS as

income that you are taxed on.

solo start up practice..right out of residency

Hi I am , I am a

3rd yr family medicine resident at

Hospital in Fort Worth, TX. JPS is the largest family medicine

program in the country and we really do alot here. I am one of the 2

chiefs this year and have loved every minute of residency. I will

finish in July 07 and have been on the job search for TEXAS ONLY. My

wife and I do not want to leave TX and prefer to stay within a couple

hrs of Dallas/Fort Worth. The market looks pretty good and between the

recruiters and small towns, my phone never stops ringing (I usually

get 3-7 calls/day for the past 6wks). I have found several small

communities where I can haved a somewhat traditional practice managing

my patients in the clinic and as inpatients. The particular place I am

most interestd in is offering what I think is a fairly standard deal

for solo start up with an income guarantee, plus lots of other perks

(stipend, moving allowance, sign on bonus, loan payoff, bonus at 12mo

if I am off of the guarantee, marketing advisor and $$, medical office

startup consultant, will pay for the emr of my choice-eMDs) and best

of all it is in the area we want to live. I can also lease or purchase

my space in the new medical office building within walking distance to

the new hospital they are building to open a month or so before I get

there. With this space, I can start small and have first right of

refusal for nearby office space so I can expand if I need to. My wife

who is a veterinarian could even keep her current job with if we go to

this location. The community is in great need and they promise not to

bring in any other pcps until I am well established and off of my

guarantee. For all of this I will owe them 4 years after the guarantee

yr to have this all paid off free and clear. Now this sounds good to

me and I think I can make it work well. I have talked to many of the

other local docs and they are positive about it as well. The last one

to do this there was off his guarantee after 6 months and had to hire

a mid level practitioner before he had been there even 2 yrs due to

the patient load. Not to mention it is a small enough place that I can

do pretty much whatever is within my comfort zone. Personally I love

inpatient as well as clinic and want to manage all my inpatient stuff

(i do my own lines, I & Ds, lesion removal, chest tubes, manage patients

on the ventilator, in residency I even do endoscopy, but may not be

able to do that here due to the GI/surgeons there), this place will

allow for me to do what I love and make a difference. I have spoken

with the manager of the ER (a family physician) and he has extended an

offer to let me do " as many ER shifts as I want " as my practice is

starting up to make some extra $$. I have good experience in the ER

and this sounds great to me as well. The bigger thing for me is

getting used to the business side of it all and making sure this works

out well. I have a great buddy who is an accountant and willing to go

with me for little pay at the beginning as my office manager. I have

learned that I could get by with a medical assistant instead of a

nurse if I need the help and save money. I am excited and want to move

forward with this but sure would like to hear what some of you with

more experienc have to say about it. The money is good(more than

average around here, but nearly all JPS grads make more than avg

because they do more) but I could make much more ($250-350k to

start)if I were willing to move to a more remote area in Texas and

work even more hours but I really don't think I need more money for

living in a location I don't really want to be in. I am

excited...should I be? I really want to make a decision sometime

soon.Let me know what you think. I know many resident seek out an

employed position because they are scared of running the business, but

this is what excites me most. Also about EMR, how feasible do you

think it would be for me to set up eMDs on a central server, then see

pts with a notebook/tablet both in the office and hospital so that my

office manager could bill for it all (eMDs is supposed to have a new

add on out in December that would allow the use of it outside of my

local wireless network and sync when I return). My goal is to keep the

overhead as low as possible. To start I could use the hospital lab,

imaging services etc which will be across the breezway from my office

and add more equipment as I can afford it.

[Guest guest]

I

signed on in 2004 with a similar setup here in Ohio: 18-month income

guarantee with a 3 year forgiveness period. I used every dollar they

allowed & was not in a hurry to be off the guarantee early. My

accountant explained it as “the cheapest loan you’ll ever get”

(ie, is repaid only with time). BUT, the big catch with these setups is

in the requirements. In order to offer these, the hospital is required to

demonstrate a “need” for primary care doctors & that these

doctors will accept Medicare & Medicaid as a tradeoff for the $$$ they are

fronting you. Another catch: you are required to see all Medicare &

Medicaid for the entire forgiveness period & not just while on the

guarantee! That means you will have to remain open to Medicare/Medicaid

for at least 5 years! Therein usually lies the “catch”:

the big “need” they sell you on basically = Medicaid & more

Medicaid, which makes an IMP/low overhead style tough. Still, running my

own solo practice is great & I personally would not have done it without

the hospital assistance & guarantee, though you’ll hear varying

opinions of these arrangements here. There is no way to afford eMDs etc

without that assistance, the debt would sink you. Just beware of the

Medicaid requirement and the huge tax burden that you will be hit with down the

road as all of that money they advance you will later be reported to the IRS as

income that you are taxed on.

solo start up practice..right out of residency

Hi I am , I am a

3rd yr family medicine resident at

Hospital in Fort Worth, TX. JPS is the largest family medicine

program in the country and we really do alot here. I am one of the 2

chiefs this year and have loved every minute of residency. I will

finish in July 07 and have been on the job search for TEXAS ONLY. My

wife and I do not want to leave TX and prefer to stay within a couple

hrs of Dallas/Fort Worth. The market looks pretty good and between the

recruiters and small towns, my phone never stops ringing (I usually

get 3-7 calls/day for the past 6wks). I have found several small

communities where I can haved a somewhat traditional practice managing

my patients in the clinic and as inpatients. The particular place I am

most interestd in is offering what I think is a fairly standard deal

for solo start up with an income guarantee, plus lots of other perks

(stipend, moving allowance, sign on bonus, loan payoff, bonus at 12mo

if I am off of the guarantee, marketing advisor and $$, medical office

startup consultant, will pay for the emr of my choice-eMDs) and best

of all it is in the area we want to live. I can also lease or purchase

my space in the new medical office building within walking distance to

the new hospital they are building to open a month or so before I get

there. With this space, I can start small and have first right of

refusal for nearby office space so I can expand if I need to. My wife

who is a veterinarian could even keep her current job with if we go to

this location. The community is in great need and they promise not to

bring in any other pcps until I am well established and off of my

guarantee. For all of this I will owe them 4 years after the guarantee

yr to have this all paid off free and clear. Now this sounds good to

me and I think I can make it work well. I have talked to many of the

other local docs and they are positive about it as well. The last one

to do this there was off his guarantee after 6 months and had to hire

a mid level practitioner before he had been there even 2 yrs due to

the patient load. Not to mention it is a small enough place that I can

do pretty much whatever is within my comfort zone. Personally I love

inpatient as well as clinic and want to manage all my inpatient stuff

(i do my own lines, I & Ds, lesion removal, chest tubes, manage patients

on the ventilator, in residency I even do endoscopy, but may not be

able to do that here due to the GI/surgeons there), this place will

allow for me to do what I love and make a difference. I have spoken

with the manager of the ER (a family physician) and he has extended an

offer to let me do " as many ER shifts as I want " as my practice is

starting up to make some extra $$. I have good experience in the ER

and this sounds great to me as well. The bigger thing for me is

getting used to the business side of it all and making sure this works

out well. I have a great buddy who is an accountant and willing to go

with me for little pay at the beginning as my office manager. I have

learned that I could get by with a medical assistant instead of a

nurse if I need the help and save money. I am excited and want to move

forward with this but sure would like to hear what some of you with

more experienc have to say about it. The money is good(more than

average around here, but nearly all JPS grads make more than avg

because they do more) but I could make much more ($250-350k to

start)if I were willing to move to a more remote area in Texas and

work even more hours but I really don't think I need more money for

living in a location I don't really want to be in. I am

excited...should I be? I really want to make a decision sometime

soon.Let me know what you think. I know many resident seek out an

employed position because they are scared of running the business, but

this is what excites me most. Also about EMR, how feasible do you

think it would be for me to set up eMDs on a central server, then see

pts with a notebook/tablet both in the office and hospital so that my

office manager could bill for it all (eMDs is supposed to have a new

add on out in December that would allow the use of it outside of my

local wireless network and sync when I return). My goal is to keep the

overhead as low as possible. To start I could use the hospital lab,

imaging services etc which will be across the breezway from my office

and add more equipment as I can afford it.

[Guest guest]

RE startup and enthusiasm

1) If you have an income guarantee, use your " extra time " to work on

process, training staff, setting up your EMR and customization. Why you

would want to do shifts in the ER at that point is really not the best use

of your time.

2) You really need to check on the Medicaid population issues, taking all

unreferred despite inability to pay. If these become the majority of your

practice, you will have a rough time at the exit point making the practice

pay.

3) If you set up to do all the inpt AND outpt AND ER, when will you sleep?

Working 7 days a week indefinitely will ultimately not work. You need to

make some choices from the onset. Decide which procedures make sense for

you to do, and defer the rest. CVP lines may sound great, but doing this at

2 am with an office full of pts the next day may not be the greatest

decision.

4) New hospital? Just before you open? Sounds strange. What if that

doesn't open?

5) Use an attorney from THAT area. Get advise from local medical society.

You must have an exit strategy " just in case " things don't work out. What

if their funding dries up? Can you buy the practice out early and NOT have

to take all unreferreds, as other doc had mentioned. Would there be a

restrictive covenant if you don't see " eye to eye " with administration?

6) Meet with others whom you'd cross cover with, even if just for a short

time while out of town or illness.

Golden opportunities on start-up; Pennsylvania hasn't resolved its

malpractice issues yet, glad you have!

Good luck to you, feel free to email me directly, as I just did this about 2

years ago, but had been in practice working for others since 1988.

Dr Matt Levin

FP

Solo since Dec 2004

Finished residency 1988

East of Pittsburgh, PA

SOAPware since 1997

solo start up practice..right out of

residency

> Hi I am , I am a 3rd yr family medicine resident at

> Hospital in Fort Worth, TX. JPS is the largest family medicine

> program in the country and we really do alot here. I am one of the 2

> chiefs this year and have loved every minute of residency. I will

> finish in July 07 and have been on the job search for TEXAS ONLY. My

> wife and I do not want to leave TX and prefer to stay within a couple

> hrs of Dallas/Fort Worth. The market looks pretty good and between the

> recruiters and small towns, my phone never stops ringing (I usually

> get 3-7 calls/day for the past 6wks). I have found several small

> communities where I can haved a somewhat traditional practice managing

> my patients in the clinic and as inpatients. The particular place I am

> most interestd in is offering what I think is a fairly standard deal

> for solo start up with an income guarantee, plus lots of other perks

> (stipend, moving allowance, sign on bonus, loan payoff, bonus at 12mo

> if I am off of the guarantee, marketing advisor and $$, medical office

> startup consultant, will pay for the emr of my choice-eMDs) and best

> of all it is in the area we want to live. I can also lease or purchase

> my space in the new medical office building within walking distance to

> the new hospital they are building to open a month or so before I get

> there. With this space, I can start small and have first right of

> refusal for nearby office space so I can expand if I need to. My wife

> who is a veterinarian could even keep her current job with if we go to

> this location. The community is in great need and they promise not to

> bring in any other pcps until I am well established and off of my

> guarantee. For all of this I will owe them 4 years after the guarantee

> yr to have this all paid off free and clear. Now this sounds good to

> me and I think I can make it work well. I have talked to many of the

> other local docs and they are positive about it as well. The last one

> to do this there was off his guarantee after 6 months and had to hire

> a mid level practitioner before he had been there even 2 yrs due to

> the patient load. Not to mention it is a small enough place that I can

> do pretty much whatever is within my comfort zone. Personally I love

> inpatient as well as clinic and want to manage all my inpatient stuff

> (i do my own lines, I & Ds, lesion removal, chest tubes, manage patients

> on the ventilator, in residency I even do endoscopy, but may not be

> able to do that here due to the GI/surgeons there), this place will

> allow for me to do what I love and make a difference. I have spoken

> with the manager of the ER (a family physician) and he has extended an

> offer to let me do " as many ER shifts as I want " as my practice is

> starting up to make some extra $$. I have good experience in the ER

> and this sounds great to me as well. The bigger thing for me is

> getting used to the business side of it all and making sure this works

> out well. I have a great buddy who is an accountant and willing to go

> with me for little pay at the beginning as my office manager. I have

> learned that I could get by with a medical assistant instead of a

> nurse if I need the help and save money. I am excited and want to move

> forward with this but sure would like to hear what some of you with

> more experienc have to say about it. The money is good(more than

> average around here, but nearly all JPS grads make more than avg

> because they do more) but I could make much more ($250-350k to

> start)if I were willing to move to a more remote area in Texas and

> work even more hours but I really don't think I need more money for

> living in a location I don't really want to be in. I am

> excited...should I be? I really want to make a decision sometime

> soon.Let me know what you think. I know many resident seek out an

> employed position because they are scared of running the business, but

> this is what excites me most. Also about EMR, how feasible do you

> think it would be for me to set up eMDs on a central server, then see

> pts with a notebook/tablet both in the office and hospital so that my

> office manager could bill for it all (eMDs is supposed to have a new

> add on out in December that would allow the use of it outside of my

> local wireless network and sync when I return). My goal is to keep the

> overhead as low as possible. To start I could use the hospital lab,

> imaging services etc which will be across the breezway from my office

> and add more equipment as I can afford it.

>

>

>

>

>

>

[Guest guest]

Topic

#1 below brings up a good point re: income guarantees. If he works extra

shifts in the ER, or any outside work, he will be required to report that to

the supporting hospital as income & the amount they advance him will be

decreased accordingly. So, it makes no sense to do any moonlighting type work

while on an income guarantee.

Re:

solo start up practice..right out of residency

RE startup and enthusiasm

1) If you have an income guarantee, use your " extra time " to work on

process, training staff, setting up your EMR and customization. Why you

would want to do shifts in the ER at that point is really not the best use

of your time.

2) You really need to check on the Medicaid population issues, taking all

unreferred despite inability to pay. If these become the majority of your

practice, you will have a rough time at the exit point making the practice

pay.

3) If you set up to do all the inpt AND outpt AND ER, when will you sleep?

Working 7 days a week indefinitely will ultimately not work. You need to

make some choices from the onset. Decide which procedures make sense for

you to do, and defer the rest. CVP lines may sound great, but doing this at

2 am with an office full of pts the next day may not be the greatest

decision.

4) New hospital? Just before you open? Sounds strange. What if that

doesn't open?

5) Use an attorney from THAT area. Get advise from local medical society.

You must have an exit strategy " just in case " things don't work out.

What

if their funding dries up? Can you buy the practice out early and NOT have

to take all unreferreds, as other doc had mentioned. Would there be a

restrictive covenant if you don't see " eye to eye " with

administration?

6) Meet with others whom you'd cross cover with, even if just for a short

time while out of town or illness.

Golden opportunities on start-up; Pennsylvania hasn't resolved its

malpractice issues yet, glad you have!

Good luck to you, feel free to email me directly, as I just did this about 2

years ago, but had been in practice working for others since 1988.

Dr Matt Levin

FP

Solo since Dec 2004

Finished residency 1988

East of Pittsburgh, PA

SOAPware since 1997

solo start up practice..right out of

residency

> Hi I am , I am a 3rd yr family medicine resident at

> Hospital in Fort Worth, TX. JPS is the largest family medicine

> program in the country and we really do alot here. I am one of the 2

> chiefs this year and have loved every minute of residency. I will

> finish in July 07 and have been on the job search for TEXAS ONLY. My

> wife and I do not want to leave TX and prefer to stay within a couple

> hrs of Dallas/Fort Worth. The market looks pretty good and between the

> recruiters and small towns, my phone never stops ringing (I usually

> get 3-7 calls/day for the past 6wks). I have found several small

> communities where I can haved a somewhat traditional practice managing

> my patients in the clinic and as inpatients. The particular place I am

> most interestd in is offering what I think is a fairly standard deal

> for solo start up with an income guarantee, plus lots of other perks

> (stipend, moving allowance, sign on bonus, loan payoff, bonus at 12mo

> if I am off of the guarantee, marketing advisor and $$, medical office

> startup consultant, will pay for the emr of my choice-eMDs) and best

> of all it is in the area we want to live. I can also lease or purchase

> my space in the new medical office building within walking distance to

> the new hospital they are building to open a month or so before I get

> there. With this space, I can start small and have first right of

> refusal for nearby office space so I can expand if I need to. My wife

> who is a veterinarian could even keep her current job with if we go to

> this location. The community is in great need and they promise not to

> bring in any other pcps until I am well established and off of my

> guarantee. For all of this I will owe them 4 years after the guarantee

> yr to have this all paid off free and clear. Now this sounds good to

> me and I think I can make it work well. I have talked to many of the

> other local docs and they are positive about it as well. The last one

> to do this there was off his guarantee after 6 months and had to hire

> a mid level practitioner before he had been there even 2 yrs due to

> the patient load. Not to mention it is a small enough place that I can

> do pretty much whatever is within my comfort zone. Personally I love

> inpatient as well as clinic and want to manage all my inpatient stuff

> (i do my own lines, I & Ds, lesion removal, chest tubes, manage patients

> on the ventilator, in residency I even do endoscopy, but may not be

> able to do that here due to the GI/surgeons there), this place will

> allow for me to do what I love and make a difference. I have spoken

> with the manager of the ER (a family physician) and he has extended an

> offer to let me do " as many ER shifts as I want " as my practice

is

> starting up to make some extra $$. I have good experience in the ER

> and this sounds great to me as well. The bigger thing for me is

> getting used to the business side of it all and making sure this works

> out well. I have a great buddy who is an accountant and willing to go

> with me for little pay at the beginning as my office manager. I have

> learned that I could get by with a medical assistant instead of a

> nurse if I need the help and save money. I am excited and want to move

> forward with this but sure would like to hear what some of you with

> more experienc have to say about it. The money is good(more than

> average around here, but nearly all JPS grads make more than avg

> because they do more) but I could make much more ($250-350k to

> start)if I were willing to move to a more remote area in Texas and

> work even more hours but I really don't think I need more money for

> living in a location I don't really want to be in. I am

> excited...should I be? I really want to make a decision sometime

> soon.Let me know what you think. I know many resident seek out an

> employed position because they are scared of running the business, but

> this is what excites me most. Also about EMR, how feasible do you

> think it would be for me to set up eMDs on a central server, then see

> pts with a notebook/tablet both in the office and hospital so that my

> office manager could bill for it all (eMDs is supposed to have a new

> add on out in December that would allow the use of it outside of my

> local wireless network and sync when I return). My goal is to keep the

> overhead as low as possible. To start I could use the hospital lab,

> imaging services etc which will be across the breezway from my office

> and add more equipment as I can afford it.

>

>

>

>

>

>

[Guest guest]

If you

try to get covered for all of those procedures, ER work, etc your malpractice

will be astronomical. It is very unlikely you will do enough of those

procedures to pay for the increase in your malpractice insurance. There

is a big difference between what you are trained for & covered to do under

the residency umbrella and what you can reasonably expect to do in practice.

I know TX has a better malpractice climate right now, but I assure you those

things will drastically raise your malpractice IF they will even cover you at

all. You won’t be doing central lines as an FP, unless you are in a

very, very, very rural area. Residency training still often bears little

resemblance to actual day to day practice of a typical FP, especially in larger

more academic programs. A lot of programs still have trainees doing 6-8

months of inpatient obstetrics, multiple MICU rotations, etc & that is

silly in my opinion (internal medicine yes, FP no).

solo start up practice..right out of residency

Hi I am , I am a

3rd yr family medicine resident at

Hospital in Fort Worth, TX. JPS is the largest family medicine

program in the country and we really do alot here. I am one of the 2

chiefs this year and have loved every minute of residency. I will

finish in July 07 and have been on the job search for TEXAS ONLY. My

wife and I do not want to leave TX and prefer to stay within a couple

hrs of Dallas/Fort Worth. The market looks pretty good and between the

recruiters and small towns, my phone never stops ringing (I usually

get 3-7 calls/day for the past 6wks). I have found several small

communities where I can haved a somewhat traditional practice managing

my patients in the clinic and as inpatients. The particular place I am

most interestd in is offering what I think is a fairly standard deal

for solo start up with an income guarantee, plus lots of other perks

(stipend, moving allowance, sign on bonus, loan payoff, bonus at 12mo

if I am off of the guarantee, marketing advisor and $$, medical office

startup consultant, will pay for the emr of my choice-eMDs) and best

of all it is in the area we want to live. I can also lease or purchase

my space in the new medical office building within walking distance to

the new hospital they are building to open a month or so before I get

there. With this space, I can start small and have first right of

refusal for nearby office space so I can expand if I need to. My wife

who is a veterinarian could even keep her current job with if we go to

this location. The community is in great need and they promise not to

bring in any other pcps until I am well established and off of my

guarantee. For all of this I will owe them 4 years after the guarantee

yr to have this all paid off free and clear. Now this sounds good to

me and I think I can make it work well. I have talked to many of the

other local docs and they are positive about it as well. The last one

to do this there was off his guarantee after 6 months and had to hire

a mid level practitioner before he had been there even 2 yrs due to

the patient load. Not to mention it is a small enough place that I can

do pretty much whatever is within my comfort zone. Personally I love

inpatient as well as clinic and want to manage all my inpatient stuff

(i do my own lines, I & Ds, lesion removal, chest tubes, manage patients

on the ventilator, in residency I even do endoscopy, but may not be

able to do that here due to the GI/surgeons there), this place will

allow for me to do what I love and make a difference. I have spoken

with the manager of the ER (a family physician) and he has extended an

offer to let me do " as many ER shifts as I want " as my practice is

starting up to make some extra $$. I have good experience in the ER

and this sounds great to me as well. The bigger thing for me is

getting used to the business side of it all and making sure this works

out well. I have a great buddy who is an accountant and willing to go

with me for little pay at the beginning as my office manager. I have

learned that I could get by with a medical assistant instead of a

nurse if I need the help and save money. I am excited and want to move

forward with this but sure would like to hear what some of you with

more experienc have to say about it. The money is good(more than

average around here, but nearly all JPS grads make more than avg

because they do more) but I could make much more ($250-350k to

start)if I were willing to move to a more remote area in Texas and

work even more hours but I really don't think I need more money for

living in a location I don't really want to be in. I am

excited...should I be? I really want to make a decision sometime

soon.Let me know what you think. I know many resident seek out an

employed position because they are scared of running the business, but

this is what excites me most. Also about EMR, how feasible do you

think it would be for me to set up eMDs on a central server, then see

pts with a notebook/tablet both in the office and hospital so that my

office manager could bill for it all (eMDs is supposed to have a new

add on out in December that would allow the use of it outside of my

local wireless network and sync when I return). My goal is to keep the

overhead as low as possible. To start I could use the hospital lab,

imaging services etc which will be across the breezway from my office

and add more equipment as I can afford it.

[Guest guest]

One

other thing to watch for in these setups: the practice consultants. Our

local hospital tried to have them come in & help us too. They usually

are clueless about any type of IMP style practice. All they typically

know is volume, volume, volume. No matter how many you are seeing they

will tell you that it is not enough. Rather than promote overhead trimming they

will usually promote the “standard MGMA” staffing, etc. (ie, high

overhead/high volume). I found them to be almost no help.

They will compile some impressive appearing reports but all that info can

easily be gathered yourself via EMR.

solo start up practice..right out of residency

Hi I am , I am a

3rd yr family medicine resident at

Hospital in Fort Worth, TX. JPS is the largest family medicine

program in the country and we really do alot here. I am one of the 2

chiefs this year and have loved every minute of residency. I will

finish in July 07 and have been on the job search for TEXAS ONLY. My

wife and I do not want to leave TX and prefer to stay within a couple

hrs of Dallas/Fort Worth. The market looks pretty good and between the

recruiters and small towns, my phone never stops ringing (I usually

get 3-7 calls/day for the past 6wks). I have found several small

communities where I can haved a somewhat traditional practice managing

my patients in the clinic and as inpatients. The particular place I am

most interestd in is offering what I think is a fairly standard deal

for solo start up with an income guarantee, plus lots of other perks

(stipend, moving allowance, sign on bonus, loan payoff, bonus at 12mo

if I am off of the guarantee, marketing advisor and $$, medical office

startup consultant, will pay for the emr of my choice-eMDs) and best

of all it is in the area we want to live. I can also lease or purchase

my space in the new medical office building within walking distance to

the new hospital they are building to open a month or so before I get

there. With this space, I can start small and have first right of

refusal for nearby office space so I can expand if I need to. My wife

who is a veterinarian could even keep her current job with if we go to

this location. The community is in great need and they promise not to

bring in any other pcps until I am well established and off of my

guarantee. For all of this I will owe them 4 years after the guarantee

yr to have this all paid off free and clear. Now this sounds good to

me and I think I can make it work well. I have talked to many of the

other local docs and they are positive about it as well. The last one

to do this there was off his guarantee after 6 months and had to hire

a mid level practitioner before he had been there even 2 yrs due to

the patient load. Not to mention it is a small enough place that I can

do pretty much whatever is within my comfort zone. Personally I love

inpatient as well as clinic and want to manage all my inpatient stuff

(i do my own lines, I & Ds, lesion removal, chest tubes, manage patients

on the ventilator, in residency I even do endoscopy, but may not be

able to do that here due to the GI/surgeons there), this place will

allow for me to do what I love and make a difference. I have spoken

with the manager of the ER (a family physician) and he has extended an

offer to let me do " as many ER shifts as I want " as my practice is

starting up to make some extra $$. I have good experience in the ER

and this sounds great to me as well. The bigger thing for me is

getting used to the business side of it all and making sure this works

out well. I have a great buddy who is an accountant and willing to go

with me for little pay at the beginning as my office manager. I have

learned that I could get by with a medical assistant instead of a

nurse if I need the help and save money. I am excited and want to move

forward with this but sure would like to hear what some of you with

more experienc have to say about it. The money is good(more than

average around here, but nearly all JPS grads make more than avg

because they do more) but I could make much more ($250-350k to

start)if I were willing to move to a more remote area in Texas and

work even more hours but I really don't think I need more money for

living in a location I don't really want to be in. I am

excited...should I be? I really want to make a decision sometime

soon.Let me know what you think. I know many resident seek out an

employed position because they are scared of running the business, but

this is what excites me most. Also about EMR, how feasible do you

think it would be for me to set up eMDs on a central server, then see

pts with a notebook/tablet both in the office and hospital so that my

office manager could bill for it all (eMDs is supposed to have a new

add on out in December that would allow the use of it outside of my

local wireless network and sync when I return). My goal is to keep the

overhead as low as possible. To start I could use the hospital lab,

imaging services etc which will be across the breezway from my office

and add more equipment as I can afford it.

[Guest guest]

Wow, what a refresshing post. Thanks! I have a great lawyer, he has

helped many of our past grads from JPS negotiate their contracts and I

feel that he is a great asset to " protect " me as much as a lawyer can.

The practice consultant is to help me get all of my licenses etc and

make sure I hire and appropriately train my staff...I think this is

invaluable and is included in my startup budget. I know the big thing

is budgeting for the excess taxes to come in the future years after

the guarantee. Please keep me posted on your opinion and point out

more to help me with an organized approach to this all. Thanks again!

>

> Dear ,

>

> I just went through what u are planning to do. I finished residency

in jan

> and moved from MI to palm Springs with a wonderful contract in

place. 4 mos

> later things fizzled out, all the promises made were being broken.

We had

> different visions and had to part.

>

> I was lucky the hospital that initially recruited me stood behind

me and

> continued the income guarantee.

> I am now in solo practice. Its been 3 mos, credentialing with

insurances

> are almost done and checks are rolling in. I love it, I come to

work with a

> smile and leave with one.

>

> I started the practice on my own with help from other local

physicians who

> reached out to me. There's nothing like working for yourself and

taking care of

> patients.

>

> Make sure u get an attorney who understands medical contracts to

review your

> contract. But, from my experience it really dosen't matter because no

> matter who reads it if the two physicians don't understand each

other it is

> destined for failure.

>

> I was blessed to find good people here and hope u make the right

decision.

>

> Good Luck

>

>

> Mala

>

[Guest guest]

Wow, what a refresshing post. Thanks! I have a great lawyer, he has

helped many of our past grads from JPS negotiate their contracts and I

feel that he is a great asset to " protect " me as much as a lawyer can.

The practice consultant is to help me get all of my licenses etc and

make sure I hire and appropriately train my staff...I think this is

invaluable and is included in my startup budget. I know the big thing

is budgeting for the excess taxes to come in the future years after

the guarantee. Please keep me posted on your opinion and point out

more to help me with an organized approach to this all. Thanks again!

>

> Dear ,

>

> I just went through what u are planning to do. I finished residency

in jan

> and moved from MI to palm Springs with a wonderful contract in

place. 4 mos

> later things fizzled out, all the promises made were being broken.

We had

> different visions and had to part.

>

> I was lucky the hospital that initially recruited me stood behind

me and

> continued the income guarantee.

> I am now in solo practice. Its been 3 mos, credentialing with

insurances

> are almost done and checks are rolling in. I love it, I come to

work with a

> smile and leave with one.

>

> I started the practice on my own with help from other local

physicians who

> reached out to me. There's nothing like working for yourself and

taking care of

> patients.

>

> Make sure u get an attorney who understands medical contracts to

review your

> contract. But, from my experience it really dosen't matter because no

> matter who reads it if the two physicians don't understand each

other it is

> destined for failure.

>

> I was blessed to find good people here and hope u make the right

decision.

>

> Good Luck

>

>

> Mala

>