Finding a Job and Starting Your Own Medical Practice

Transcription

1 Finding a Job and Starting Your Own Medical Practice Jeffrey Young, M.D., BSEE, DABPMR Private Practice Assistant Clinical Professor, UCDMC President, California Society of Physical Medicine and Rehabilitation Specialty delegate, California Medical Association Qualified Medical Examiner University of California Davis, Department of Physical Medicine and Rehabilitation, 1999

2 Objectives Discuss the various job opportunities for the rehabilitation specialist Formulate a plan for a career in physical medicine and rehabilitation Prepare to look for a job Prepare to get the job and negotiate a contract Learn the basics of starting a small private practice Allow residents to say they learned something about business during residency

3 Pearls from my career in physiatry

4 Trust no one

5 You gotta have a theme song

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7 Learn from other people s mistakes

8 You have to have a plan What is your purpose for working? What is most important to you? How do you plan to achieve your goal? When do you plan to retire? How do you plan to retire?

9 Conventional Opportunities in Rehabilitation Academic Hospital based Group practice Health maintenance organization Solo practice Occupational medicine Stock analyst Sales Pharmaceutical

10 Unique Opportunities Pharmaceutical consultant/lecturer Medical reviewer Expert witness Independent medical examiner Team doctor

11 Preparation Consult SO Do Consider work, personal needs and work environment Research Talk to mentors and colleagues Consider additional training Don t Move with SO unless married or lived together > 5 years (anectdota) Move for job unless you have a signed contract Rush

12 Career strategy How do you wish to practice medicine? How much compensation Managed care? How important is practice ownership? Urban, suburban, or rural School system Hours per week How many days of call How important is the location where you practice? Autonomy Involvement in practice management

13 Academic Pros Job security Track to advancement Prestige Benefits Retirement Disability Medical Cons Tenure not guaranteed Bureaucracy Research requirement Politics

14 Hospital Based Pros Intradisciplinary Gratification Diversity of practice No overhead Integration of outpatient service Cons Hospital call Rehabilitation seen as a turf service Pressure to keep a full ward

15 Health Maintenance Organization Pros Job security Regular hours Opportunity for increased income Benefits Retirement Disability Medical Cons Under supervision of others Bureaucracy Cog in a wheel

16 If you like being a resident, you ll love working for Kaiser Regular hours Mentoring Opportunity for Advancement Retirement Benefits

17 Group Practice Multispecialty Physiatric

18 Group practice Pros Increased income opportunities Variable hours Attached to reputation of group Group plan benefit rates Cons Partners will inevitably fight Loss of control of AR and billing Loss of individuality

19 Solo Practice Pros Autonomy Flexible hours Variable income potential No call if desired Cons No benefits No retirement No coverage Responsibility over business aspect Employees Practice has life of itself

20 Creating your own practice

21 Solo Practice Sample Costs Plan on $50k or more startup money Rent $1.00-$5.00 per square foot Furniture $5000 Biller 7-10% to $500k then cheaper to bring billing in house Front and back office $10-20 per hour ($ /mo.) EMG machine $10-15k Phone and computers $2-10k Software $1-25k Practice consultant $50-200/hr

22 Solo Practice Costs Alternatively, may rent space from another doctor. Can spend $75-$100 per day with use of staff and equipment.

23 Occupational Medicine Pros Regular hours Variation in patient mix No call Benefits Retirement Disability Medical Cons Under supervision of others Schedule variable Outside pressure clouds medical decisions

24 Starting The Job Search Identify jobs and location Prepare CV The application process The interview The offer The counteroffer Acceptance

25 Job leads Residency directory AAPMR State Societies e.g. CSPM&R Colleagues Alumni Mentors Human resources

26 Curriculum Vitae Highlights Education Residency Research/publications Honors References 1-2 pages Read your CV backwards Catch the eye

27 The Application Medical school diploma Proof of residency Proof of state licensure Board score Action report Proof of prior insurance DEA certificate Recent picture

28 The interview First 5 minutes set the tone Dress the part Grooming Hygeine Eye contact Firm handshake Be prepared to discuss anything on application Be prepared to discuss salary needs Ask intelligent questions as if you were interested in the job Optional- follow-up thank you letter

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31 The offer May be a letter of a phone call Offer may be in letter or contract sent with letter Usually, it is in the form of a congratulatory letter or phone call. If you accept, a credentialling packet and contract will follow

32 The Counteroffer Done before contract finalized Money Signing bonus Moving expenses Salary vs. hourly wages Productivity split Paid vacation Moonlighting Parking CME

33 The Counteroffer Job description day notice Call, vacation call Tail coverage- lawsuit after policy terminated Nose coverage- prior acts Arbitration and court costs Practice location, medical records Noncompete clause unenforcable in CA

34 The Contract Contracts are usually only used when relationships go wrong. Send it to a lawyer licensed in the state you are getting the job. Look for a specialist in healthcare law. Cost $200-$300/hour. Plan on a total cost of approximately $1000-$1500. Consider authorizing attorney to negotiate on your behalf. Usually, a retainer is required up front.

35 The Contract Regardless of how long the terms of the contract are, they are only as good as the notice time. They can be terminated at any time by any party for any reason. Sign when you feel that you and your attorney have made the best deal. A good deal usually occurs when both sides aren t entirely happy

36 Private practice Up to 50% of your time may be spent on nonrevenue generating activities 30-40% of residents pursue private practice opportunities (Mayo clinic) $3745/mo. take home pay for net income of $120k after taxes

37 Start planning now Sign up for to be a provider for medical plans The Blues Independent physician associations Workers compensation insurers Look at malpractice insurance Look at liability Insurance

38 Make an employee manual Get a business license Consider incorporating (S corp) Become a QME Obtain a mailing address Business cards

39 Gather Information Get every piece of paper in your clinic (build a better mousetrap) Patient intake forms Consent forms H&P Medical release Lien Authorization to treat a minor

40 Self Defense Plan Malpractice Worker s compensation Liability Umbrella Disability Health Don t forget COBRA HSA ACA

41 Plan for the future Think of a retirement plan Roth IRA- 1 st year 401K SEP IRA Defined benefit plan Long-term care insurance

42 Why do I need to plan for retirement now?

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44 Kaiser retirement Used as a model for physician pension plans The old retirement plan: 100% after 20 years 2% of highest salary in the last 3 years of employment for every year of service = 40% after 20 years, 70% after 35 years, etc. Pension starts at age 65 Trick = Pension plan only for physician partners

45 How much is a pension worth? Example $300k highest salary Worked 20 years Pension= 40% highest salary (20 yrs. x 2%/yr.) Value of pension in today s dollars= ~$3 M

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47 Start-up costs Rent deposit $ /mo. Fax $300 Copier $ Phone system $ Computer $ each Desk $500 Chair $100

48 Start-up costs Exam table $1000 Waiting room chairs $50 each EMG machine $12000 Biller EMR software $ /month Telephone (connect) $120 Total

49 Monthly costs (based on gross collections of $240k/yr.) Office assistant $1920 Electricity $100 Telephone $100 Rent $ Internet $50 Health insurance $ Liability insurance $45

50 Monthly costs Retirement $3667 (25% of $210k) Employee benefits $500 Malpractice insurance $350 Office supplies $100 Medical supplies $50 Biller $1400 Income tax $5000 Total ~$14000

51 How to get patients For California workers compensation you must belong to a medical provider networks (MPN) Sign-up for HMO/PPO QME panel Sign up for Medicare Sign up for MediCal Visit law offices

52 Advertise Announcement in the paper Send out announcements to all physicians in the area Give a grand round presentation Become a pharmaceutical speaker Meet the doctors and their staff Provide offices with a referral pad Go to drug rep dinners

53 Keeping costs low Rent space from another provider PT Chiropractor Orthopedist Occupational medicine specialist Arrange to have staff make appointments Online or paper

54 Seed money Work as an substitute doctor for a clinic Perform qualified medical evaluations Subcontract to do physiatry consults for an occupational medicine clinic EMG contractors Utilization review Locum tenums

55 Running your practice It s not about talent Treat your referral sources well Follow-up with providers Make appointments promptly Answer the provider s question Send a copy of the report to the referring physician

56 Billing Outsource billing in the beginning Superbill at the end of the day Bill everything you do Monitor the accounts receivable Keep track of your cash flow

57 Managing your riches Don t forget to pay your estimated taxes Consider filing a tax extension Open a business checking account Consider using bill pay Business credit card Deductions Home banking

58 Enjoy