Re: advise for a newbie

[Guest guest]

Give us some more details:

1) What kind of income "guarantee"

2) What duties (inpt/outpt, on call etc).

3) Overhead support from hospital? Staffing, Malp insurance, personal health insurance.

4) Pt base -- private insurance, Medicare, Medicaid

5) Restrictive covenant if "go on own" afterward.

Start with that, then see where it leads. This is the right place to ask!

Matt in Western PA

Solo x 4 years (!)

FP, residency completed 1988

advise for a newbie

I am contemplating an IMP post residency and have the opportunity to be supported by a hospital system in the area that I am looking at starting my IMP. They are offering an income guarantee (i.e. Income loan) for 2 years and 3 year loan forgiveness period. However, I am concerned about moving forward in the current economic atmosphere especially since I am the primary bread winner for my family at this time. ( I have a family with 3 young children cared for by my stay home spouse) I have significant amount of student loans that will be coming due also which further heightens my concerns. I was wondering would it be wiser to settle for an employed position with prospects of starting an IMP later or just go ahead and jump in the IMP river now? The other concern is that I am feeling quite overwhelmed by the sheer amount of information on what needs to be done to start a practice whether it is an IMP or not. Should I be looking at a practice management consulting group to help with this initial phase to help ease the feeling of being in way over my head? I would appreciate some wise counsel on this issue?

Tito Wion

[Guest guest]

This is what I know so far:

The income guarantee will cover the start up expenses is what I am being told such as my salary, my " staff " salary, benefits, malpractice, equipment, supplies etc. The hospital is on its way to setting up a hospitalist group for inpt services and I have expressed that I am only interested in outpt care. I am not sure what the call will entail even though I am planning on taking my own call and will try to find coverage for when I am not going to be available. I am not sure how to set up call otherwise. Pt base is a mixture of medicaid, medicare and private insurance but I am not sure entirely what the percentages are at this time.

Tito Wion

Give us some more details:

1) What kind of income " guarantee "

2) What duties (inpt/outpt, on call etc).

3) Overhead support from hospital? Staffing, Malp insurance, personal health insurance.

4) Pt base -- private insurance, Medicare, Medicaid

5) Restrictive covenant if " go on own " afterward.

Start with that, then see where it leads. This is the right place to ask!

Matt in Western PA

Solo x 4 years (!)

FP, residency completed 1988

advise for a newbie

I am contemplating an IMP post residency and have the opportunity to be supported by a hospital system in the area that I am looking at starting my IMP. They are offering an income guarantee (i.e. Income loan) for 2 years and 3 year loan forgiveness period. However, I am concerned about moving forward in the current economic atmosphere especially since I am the primary bread winner for my family at this time. ( I have a family with 3 young children cared for by my stay home spouse) I have significant amount of student loans that will be coming due also which further heightens my concerns. I was wondering would it be wiser to settle for an employed position with prospects of starting an IMP later or just go ahead and jump in the IMP river now? The other concern is that I am feeling quite overwhelmed by the sheer amount of information on what needs to be done to start a practice whether it is an IMP or not. Should I be looking at a practice management consulting group to help with this initial phase to help ease the feeling of being in way over my head? I would appreciate some wise counsel on this issue?

Tito Wion

[Guest guest]

My two cents:

a) a two year income guarantee for start-up is better than average if you like the other terms.

almost every doctor in America has some mixture of Medicare/Medicaid/Private

c) the economic environment hurts us a little, but it does not hurt doctors as much as non-doctors

d) if your hospital can pay you an income guarantee, they can also pay off your student loans. I would pursue this aggressively, it could make or break the deal. They may even have access to a separate pot of money to do that.

e) you do not need a practice management consulting group, on the other hand if you are feeling overwhelmed, they may well be worth it. Don't feel bad about using a consultant, just remember not all consultants have experience with an IMP/low overhead model. But much of what consultants do (make sure your license/DEA/CLIA/business insurance etc, etc is taken care of properly) is no different between IMP/non-IMP. And if it makes you sleep better to have someone help you with that stuff, then it could be money well spent.

f) It is up to you whether to start with an employed position to "play it safe", but if a hospital was giving me a 2 yr income guarantee AND agreed to pay off most of my student loans, and it was a location I liked, I would not be an employee.

Good Luck!

Give us some more details:

1) What kind of income "guarantee"

2) What duties (inpt/outpt, on call etc).

3) Overhead support from hospital? Staffing, Malp insurance, personal health insurance.

4) Pt base -- private insurance, Medicare, Medicaid

5) Restrictive covenant if "go on own" afterward.

Start with that, then see where it leads. This is the right place to ask!

Matt in Western PA

Solo x 4 years (!)

FP, residency completed 1988

[Practiceimprovemen t1] advise for a newbie

I am contemplating an IMP post residency and have the opportunity to be supported by a hospital system in the area that I am looking at starting my IMP. They are offering an income guarantee (i.e. Income loan) for 2 years and 3 year loan forgiveness period. However, I am concerned about moving forward in the current economic atmosphere especially since I am the primary bread winner for my family at this time. ( I have a family with 3 young children cared for by my stay home spouse) I have significant amount of student loans that will be coming due also which further heightens my concerns. I was wondering would it be wiser to settle for an employed position with prospects of starting an IMP later or just go ahead and jump in the IMP river now? The other concern is that I am feeling quite overwhelmed by the sheer amount of information on what needs to be done to start a practice whether it is an IMP or not. Should I be looking at a practice management

consulting group to help with this initial phase to help ease the feeling of being in way over my head? I would appreciate some wise counsel on this issue?

Tito Wion

[Guest guest]

Tito, my general thoughts: Income guarantees rarely come without

strings attached, so pay very close attention to the strings. If it

means that they dictate your overhead expenses and/or patient volume,

then you'll be stuck with those after the guarantee ends, and your

income could drop precipitously. You'll have better long-term success

if you keep your expenses tightly under your control. If the hospital

really just wants you in the area, they should be willing to give a

set amount for loans for every year you stay.

And the expense concern applies to consultants, too. So many (95%?)

are experienced only in a traditional model, and you can find your

expenses increasing very quickly on their advice. You can do all these

little tasks. But, no matter who does them, they do take time, and you

need income in the meantime. A big startup loan will pay you while you

wait and pay for all the " necessary " expenses...but that loan can end

up being a big millstone around your neck. Are there options to do

some urgent care or something while you get these tasks done on your

own terms?

Where will you be? You'll contract with all payers? What's the payment

level in your area? What's the PCP provider situation? You must know

these to know how quickly the income will come.

I think there is an advantage to getting over some of the medicine

learning curve before taking on the practice management learning

curve. An employed situation can do that. But then you have to decide

whether to do it locally so that patients can follow you to your new

practice or to do it somewhere else so that colleagues won't be angry

with you when you leave.

You'll get lots more good (better) advice here.

Haresch

>

> I am contemplating an IMP post residency and have the opportunity to be

> supported by a hospital system in the area that I am looking at

starting my

> IMP. They are offering an income guarantee (i.e. Income loan) for 2

years

> and 3 year loan forgiveness period. However, I am concerned about moving

> forward in the current economic atmosphere especially since I am the

primary

> bread winner for my family at this time. ( I have a family with 3 young

> children cared for by my stay home spouse) I have significant amount of

> student loans that will be coming due also which further heightens my

> concerns. I was wondering would it be wiser to settle for an employed

> position with prospects of starting an IMP later or just go ahead

and jump

> in the IMP river now? The other concern is that I am feeling quite

> overwhelmed by the sheer amount of information on what needs to be

done to

> start a practice whether it is an IMP or not. Should I be looking at a

> practice management consulting group to help with this initial phase

to help

> ease the feeling of being in way over my head? I would appreciate

some wise

> counsel on this issue?

>

> Tito Wion

>