Private Practice Finance

The business side and administrative side of practice.

I am just goin to post a montage of some of what I found here and elsewhere:

1. You set up your solo practice. The monies by the hospital are a forgiveable loan. Pay attention to the "interest rate" as that is a taxable figure at time of forgiveness. if you want out before the 3 years, is the payback prorated?

2. are you going to be a "preferred provider" for this hospital? Some hospitals employ groups of physicians in a quasi MSG where all members of the group are expected to refer to others in the group. This is a built in referral source for you.

3. what support are they giving you in terms of marketing? Will they take you around and introduce you to potential referrals, list you on their website, advertise your arrival? Believe me, marketing is a real PITA and you'd be suprised at the rudeness you get "at the door". Having the hospital CEO (or some other bigwig) is like a ticket to the back, circumventing those bitches at the front desk.

4. As solo practitioner (i.e. self employed), you will have to deal with insurance companies/billing/reimbursement rates and/or negotiations.....

5. how long will it take you to get on insurances? Medicare is typically pretty quick but .... If the "major players" in your community aren't accepting any more practitioners, you could be left out in the cold and be limited in what patients you can seen (being denied for >2 years because they have "enough" of a given specialty).

6. what percentage of your patients are required to be MediCal? The reimbursement for MediCal stinks and if the hospital requires you to see X percentage of your daily patients as members of this category, you may have trouble exceeding your overhead.

7. After first year, you are fully accountable for all expenses.... malpractice insurance/rent/overhead/electronic med records/dictation/water/power/phone/internet/marketing/staff salaries/staff benefits/etc...... You need to be sure your practice is actually producing. It is not just your slary. It has taken many at least 2 years to exceed their overhead costs... with a 2 year guarantee with the same payback (ie, 2 years guarantee, forgiven after 3 years).

8. Your staff will want raises..... but they don't actually bill so any raises come from your salary or your increase in production....

9. check your contract for "Consent to Settle". As plaintiffs start to realize that new doctors have empty pockets and hospitals deep ones, they are going after hospitals more and more. When you are *not* an employee of a hospital and are faced with a Settlement Demand, you have the right to refuse consent for your malpractice provider to settle the case. Employees of hospitals are often denied this and the hospital will settle and, I am told, then bill the provider for the amount settled (or some portion thereof, especially for repeat offenders). You are not an employee and it sounds like they aren't providing malpractice for you, but check and see if there is some clause that if they are sued over care you provided that you have some say in the settlement if you can be billed for it.