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Acebecker

Direct Primary Care

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All - 

Is anyone working under this model at this point?  If so, I'd love to PM a bit back and forth. 

Here's my situation: currently in private practice, internal medicine.  Made $120k last year.  Love my job, love my patients.  

 I have a physician friend and colleague who wants me to work in his DPC practice.  The only problem at present is that he doesn't know what PAs in DPC make, so the job offer is a little poor.  Can anyone point me in a direction for PA salaries/benefits in direct primary care?  

Thanks!

 

 

 

 

Edited by Acebecker

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Ugh. Acquaintances who struggle with the notion of paying you too much.... kind of a buzzkill for the friendship. I think the only real number you can accept in those circumstances is something well above what you currently make, since he or she made this purely about business. That means your counter offer needs to be purely about business as well. 

Edited by Lightspeed
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I guess another suggestion you could make is something along the lines of “since you will likely be reimbursed for my services at 85% of what a physician employee of yours would be reimbursed, then 85% of what you’d pay that physician would make it appropriate for me to leave the job that makes me very happy.”

You’ll find out really quick how much he really respects your value. 

Edited by Lightspeed

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4 hours ago, BruceBanner said:

Do you mean DPC as in concierge primary care?

A lot of my current colleagues to refer to it as concierge primary care.  I actually am not certain if that is the accepted nomenclature or not. 

What this guy does is to offer a subscription to his clinic - a flat monthly fee.  For that fee, you get as many visits as needed and most procedures are included.  If there is something above what would be included, the costs are transmitted to the Pt without markup.  He does not accept insurances.  He also has been able to get medications at markedly reduced cost such that they are cheaper through him than through pharmacies and with insurance.

I would not be billing for my time and would not be on a production basis.  It would be a flat hourly rate. 

 

 

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Ok that's concierge care or membership practice. MD VIP is a brand name.

Hard to advise you on that one---I worked for a membership doc a few years back but did not see his membership patients; just the general public. He did it to keep his practice afloat. 

I think at minimum you should make a lateral change--meaning same salary. The default for a physician no matter how good a friend will be to underpay you. Also if you havent already get allll the particulars about taking call, etc. My old boss took calls 24/7 from members. 

 

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Great way to ruin a friendship. Left EM to help him open a FP clinic and what a shock, it wasn’t sustainable. Didn’t stay in touch and he later died. I had also done something similar prior to this event in a business setting and it also didn’t end well (spouse of former professor).

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Maybe we are reading too much into the friend thing here, and I mentioned it, but as a minor segue since it’s coming up and it’s interesting.... I had a business opportunity come up with a physician friend. The possibility tugged at me a little bit. I just can’t see how it ever is successful in the long run. One person could easily end up disappointed by what they see in the other person once they are around them all the time. It’s obviously not going to be a party at work every day. Familiarity breeds contempt. Talking shop is more interesting when you aren’t in the same shop. 

But back to the subject... everyone in a primary care model for concierge care like that seems to be dabbling in it. I don’t know anyone getting rich. I know a doc in a direct care model who has been doing it for a few years, and it seems like it’s more personally rewarding than financially. Customers come and go, and they question whether it’s worth the money when they only go in a few times a year. The regular users often need more than just primary care. Nobody seems to be getting rich there either. In psyche, I know lots of folks supporting themselves well, but your clinic for that could fit in a small backpack. The way to make money is to go where a lot of patients are, or have the patients come to you en masse, not one at a time. Those minutes spent in travel never pay. If you have even just a store front, you can make enough filling an appointment in the space where you’d otherwise be traveling, and could more than cover the physical overhead.

 

The only way I’d jump in to help your buddy is if everything was equal to what I had in hand, (and would also need it to pay more). If that’s obviously not going to pass muster for him, you could always offer to go PRN and cover for days off, vacations, and extra appointments during busy times. I’d ask for $80-$100 an hour, fixed. No demerits for no shows, cancelled appts, etc. the benefit of “helping out” is that you don’t get sucked into having to struggle over whether you are being valued appropriately. You are instead simply showing up to save the day when they need coverage, and when they otherwise wouldn’t be making money. It puts the ball in the doctor’s court to decide how much his time off is worth to him. You don’t feel like you are a rented mule making money for someone else at your expense. Both of you end up being appreciative of each other. Let him hire a stranger to give him the everyday headaches that come with being an employer of full time workers.

Friends do favors for one another. Employers and employees have a conflict of interest when it comes to those (one person ends up doing more work for free). Avoid that by being the friend that helps out sometimes for a fair wage. 

Edited by Lightspeed

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19 hours ago, GetMeOuttaThisMess said:

Great way to ruin a friendship. Left EM to help him open a FP clinic and what a shock, it wasn’t sustainable. Didn’t stay in touch and he later died. I had also done something similar prior to this event in a business setting and it also didn’t end well (spouse of former professor).

If this person is a friend, please listen to this advice.

It is not just a good way to ruin the relationship, it is almost a sure thing.  I refuse to ever go into business with a friend or family member.  My best friend who is a doc years ago offered me a job and it took everything I had to say no.  We are still best friends to this day, but had I of said yes, I don't think we would be.

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Heavy advice to consider.  I appreciate it.  It's taking a lot for me to say no.  I like this model and how much this model can serve the underserved population in our area. 

Would it change any of your opinions if the offer was not a job but a partnership in the clinic?  That is on the table here. 

Andrew

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27 minutes ago, Acebecker said:

Heavy advice to consider.  I appreciate it.  It's taking a lot for me to say no.  I like this model and how much this model can serve the underserved population in our area. 

Would it change any of your opinions if the offer was not a job but a partnership in the clinic?  That is on the table here. 

Andrew

Yes, I would go from 99% no to 100% no.  As an employee there is a little daylight between you guys.  As a partner there is none.  Medical practices are so squirrly now-a-days that it is a virtual guarantee there will be hard times that will strain the relationship.  I would just say this.....is the job worth losing this person as a friend at best and at worst making an actual enemy?  If the answer is yes, the risk is worth it.  Then you have your answer.

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Be aware.  

 

The doc rules the roost 100% no matter what the business is.  I just left a great job as the new medical director and I did not see eye to eye and admin supported him(brand new and practicing outside the accepted norms(read illegal) of medicine). 

 

Every reason son I should have stayed and he should have left but admin sided with the doc “cause they are the doc” 

 

 

you you can never have a fair partnership with a doc that could not melt down in seconds.    

 

Always have a back up doc in doc in the wings if you own your own practice so atleast you take away their leverage

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9 hours ago, Acebecker said:

Heavy advice to consider.  I appreciate it.  It's taking a lot for me to say no.  I like this model and how much this model can serve the underserved population in our area. 

Would it change any of your opinions if the offer was not a job but a partnership in the clinic?  That is on the table here. 

Andrew

Everyone daydreams about owning a practice, and for a PA, what you are being presented with there is one of the few avenues to do it through. But I would suggest that from what I’ve seen NPs go through, owning a practice is overrated given the stress of basically having three jobs as a business-owner/provider/manager vs just showing up to work and making $120,000 and going home every day. And those are the NPs I know in psyche... the specialty best suited for wandering aimlessly with very little overhead. Additionally, everything I’ve seen about going into business with someone you like suggests to me it is a good way to be destroyed financially and emotionally. When you are emotionally invested in someone else, you are more primed to either ignore things you shouldn’t, or else take undue offense when you think you are being slighted (nobody can hurt you as bad as a friend or loved one because betrayal feels so much worse). 

I personally like my idea of offering to help out when your friend needs time off or is in a pinch. There’s no reason to get wrapped up in a formal and complex business arrangement. It’s like every time a multilevel marketer wants to rope me in and I ask, “why can’t I just have this awesome product you sell without having to give you my soul and new customers?”. Can’t we all just make some money without having to go all in? If it’s an awesome opportunity, it will still be there later on. He will be trying to expand, and still welcome you. If you are dead set on this, then ease into it. Have him pay you a flat rate to handle his patient overflow on your days off. 

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