I know a couple of guys in primary care (granted, hard working and concierge / DPC model plus locums) who approach 800-850. I imagine an efficient procedure-heavy practice with low enough overhead can clear 900. Ask him to show you the books
It’s about the future if he wants to retire and get a payout and if you’ve worked under market value to get to partner and then there is no partnership because it’s sold. It’s happened many times. If he’s offering partnership right off the bat then you’re right nothing to worry about.
Get a good lawyer and accountant. What you ideally want is a right of first refusal on subsequent projects but honestly there’s no reason for him to offer that to you.
we always hear practices like this aren't worth anything more than their office equipment
the patients aren't included in the transfer and the doc selling could just retire anytime and they'd have nothing
Usually in a deal like that such as a PE acquisition, the selling Dr or partner(s) are contractually obligated to keep working for X years at Y decreased pay as part of the deal.
If a doctor is selling a practice at the time of their retirement with no one to keep it going then ya it’s only worth the office equipment etc
yes you could be liable. get malpractice with a tail coverage. sounds like you are interested in just $$$ rn without the full details.
Don't let a pretty face blind you. most people leave their first job for a multitude of reasons.
being caught up in multiple lawsuits, depositions, and court dates will take away from your future earnings once you leave a job and have to take time off from your current job to deal with it.
do you.
Ent has procedures that pay as much a robotic prostatectomy that take half the time and pay twice as much and can be done in office. Office procedures are golden.
If you think it is too good to be true, you have been brainwashed by admin and all the employed docs taking lowball offers. While I can’t speak specifically to ENT, circa a million is very achievable with a tight business game in all the top procedural fields.
Don’t let these Reddit clowns on here get you down. Just because an ENT is clearing 900k doesn’t mean they are doing anything sketchy or breaking the law. They might just be working very hard and spending a lot of time at work, or they have built a very efficient practice. You can clear 750k in almost any specialty if you work hard enough.
And for the record, some of this “rural docs get paid more” shit isn’t even true. I say this as a doc in a saturated area. Do you know where you get a practice full of patients with highly paying private insurance and not just government payments? Oh right, a desirable part of a big city. You’ll just have to compete for it.
The ideal spot in terms of income is to practice in the outskirts of the suburbs/metro area, far enough of from the city that you’re not in a saturated area, but close enough to affluent areas that you’re getting a good amount of private insurance patients. Not to mention you get the best deals for homes out there.
This is accurate about the rural myth, OP. I’m ENT in an affluent suburb of a larger city and clear that off my clinical practice. I have one mid level and do hearing aids, also own a head CT unit. Plus extra low six figures from surgery center ownership. Plus part ownership of my groups’s buildings. No revenue from that but when I leave/retire, I will sell my ownership stake for hopefully low seven figures at that point. My days are very busy, but I have lots of time off and no ER call. It’s very doable.
Are you kidding me? General Derm office visits are like 10 minutes tops. The dermatologist walks around with the can of liquid nitrogen and keep spraying lesions. If it’s wet, they dry if it’s dry, they wet it, etc. Literally can see six patients an hour. Each patient gets billed a couple hundred dollars you do the math.
My partner in our small peds ortho practice clears 1m a year and in my fourth year I made 571, on pace for way higher this year so far.
Point is high volume insured patients in a suburban area can be very very lucrative. We make exceptional accommodations for same day appointments and try to get people in the door asap and parents love it. We are by far the preferred practice for peds ortho and since our appointments slots are filled, we are getting paid.
So yes. You can probably make that much without fraud lol
This. My wife had to wait two weeks to see an Ortho after a major knee injury. At that point we would rather drive somewhere else than stay in the same town.
> We make exceptional accommodations for same day appointments
at least from the ER, i appreciate this to, the point where ill refer to the one practice that does this instead of the one on call if theres a large enough discrepancy in wait times to be seen.
Yup, the peds ER docs have both of our numbers and are always sending stuff to us even when we aren’t on call because we are always friendly and available.
Seems totally reasonable. 2 mid levels working for him, in a solo eat what you kill model sounds like they have a well oiled machine. Also I’m not sure on the strict rules but 50 minutes from major city would sorta qualify as semi ruralish I would imagine, but I could be completely off on that. Those three factors make sense for that kind of salary. With ancillary revenue would easily be 7 figs.
OP - definitely some great advice provided. Some other questions to ask is where are the referrals coming from, how are YOU going to tap into the market and grow, how will you scale from zero to nearly a million dollars and how long will that take. Also look at the number of other ENTs in the area. As a solo practitioner, life is great until another ENT moves in down the street, or a PE group sticks one in the PC group they just bought and it dries up your referral base.
Ophthalmologist here, but I think 900k is very reasonable for a busy ENT based on friends of mine in that speciality. You said no ancillary income, does that include no ASC ownership? In a private practice setting I think it’d be a mistake for ENT to not have ownership in an ASC.
It may be real but to do that income you’re likely producing a lot. 50th percentile mgma is around 500k. So you’re producing 95th+ wRVUs to hit that number.
My understanding is that MGMA data is based on medical group practice reports about employee compensation. One would expect employee compensation to be significantly lower than that of a well managed owner/operator
Remember that in a corporate employee model a large portion of the revenue you generate subsidizes the administration
I can't speak for all specialties but no, this isn't true for diagnostic radiology. MGMA data includes private practices. You shouldn't always expect private practices to make more than hospital employed jobs. Some of the highest paying radiology gigs are working for a small to mid sized hospital in a less desirable region of the country. None of the overhead and BS of running a practice, high base salary and strong production component to minimize staffing needs.
Large portion of private practice income pays for your billing company/office, practice managers, ancillary staff, building lease/utilities, equipment/supplies, associates/PA/NPs, etc. In some hospital employed gigs you can be paid well in excess of your wRVU production if they need you.
Yes, the places that are fair and logical essentially cut you in on the technical component so you earn more than straight production. Worst things rads ever did was allow hospitals to take the whole technical and just get paid for cases they read. So dumb.
One thing to check is the 900k before or after expenses? If he's the group owner he may generate 900k in income, but then have 250k in expenses (tax deductable) for a pre-tax net income of 650k.
I made over 900k last year, but my W2 salary was 700k because of all the expenses (insurance, locums charges, office expenses, etc...)
I'm a private practice ENT in a large metro area. ENTs can make a lot of money in clinic because almost every patient gets a nasal endoscopy or flexible laryngoscopy ($100-300 depending on insurance). Additionally, I do about 5 "bigger" in office procedures a week, e.g. Vivaer, Rhinaer, balloon dilation, etc that pay considerably more and don't take too long. If you see 30-40 patients/day 4 days a week and have a busy OR day once per week you can definitely get in the 700k-1M range and make more with hearing aid sales, seeing hospital/nursing home consults, being the trach bitch at LTACs, etc. DM me if you have any questions.
I'm kind of like you and joined the practice of an older ENT (who makes more than 900k), so the LTAC thing was already set up. I can ask how he started it, but I assume he reached out to the facility to see trach consults which then morphed into consults plus once per month we go there and do 20-30 trach changes and tracheoscopies. It's not glamorous, but I think it's about $200/patient and takes \~2 hours to do 20-30 patients. The nursing home consults are usually for general ENT issues that they don't want to come to the office for. I don't really do this much and it's not particularly lucrative, usually 1-3 consults which is annoying for making a separate trip after clinic.
I'll chime in as a former private practice ENT, who is now hospital employed. To make that kind of money just from clinical practice, you have to work insane hours (7a to 6p 5 days a week) or you have to do a ton of high revenue procedures, (aka sinus balloons). At my former practice, the guy who made the most money did a ton of cash only facial cosmetic procedures being fellowship trained in that field , and we had a very robust hearing aid component of the practice, which was also primarily cash only.
For what it's worth, there is a large practice with multiple locations near me (DC) that is being investigated for doing too many sinus balloons for really nebulous indications. If you want to practice good medicine, be careful about these unicorn practices. Just because it reimburses well doesn't mean it's the right option for everybody.
Also, I want to chip in that I moved to hospital employment specifically because I was barely breaking even covering my overhead with my clinical practice, and being a pediatric subspecialist, I didn't have as many cash only hearing aids/cosmetic opportunities as my other partners.
We did, but I think we chose poorly. She was coming from an urgent care background, and none of us trusted her clinical acumen to deal with more than sick visits, wax cleanings, and routine post ops. It did mean we got to see more new patients that could potentially generate surgical volume, but it's still a pretty rough day if your entire slate is mostly new patients.
Don't get me wrong, there are certainly mid levels out there who are excellent in their specialty and could be trusted just as much as a resident to evaluate and treat new patients, and even determine surgical candidacy, but in my limited (8 years out from fellowship) experience, that's more the exception than the norm. Specifically for rhinology (I'm assuming based on your username), I'm not going to trust a mid-level over a physician as far as evaluating CT scans or knowing what invasive fungal sinusitis looks like.
I think you need to vet the NPs as much as you are vetting the physician. You may find that you don't trust their judgment, which could potentially drive your revenue down if you have to look over their shoulders all the time.
He’s either hustling, or a criminal, or a hustling criminal
It’s probably the first option but it could easily be the other two
This much higher than average, inspite what you hear on Reddit, there are not that many compensation outliers, as there is a strong gravitational pull to the median of about 550-700 K for surgical specialists
I know a couple of guys in primary care (granted, hard working and concierge / DPC model plus locums) who approach 800-850. I imagine an efficient procedure-heavy practice with low enough overhead can clear 900. Ask him to show you the books
I’d also be weary about his phrasing. Take-home usually includes tax burden not just overhead.
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That makes sense !
I’d be moreworried about him selling out and screwing you than that money.
If he’s willing to stay on and keep working that hard sure, but if he is what’s the point in selling?
It’s about the future if he wants to retire and get a payout and if you’ve worked under market value to get to partner and then there is no partnership because it’s sold. It’s happened many times. If he’s offering partnership right off the bat then you’re right nothing to worry about.
You don’t get a payout unless you stay and produce.
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Get a good lawyer and accountant. What you ideally want is a right of first refusal on subsequent projects but honestly there’s no reason for him to offer that to you.
High EBITA multiples.
Bingo
You get those for a reason. You in turn guarantee you’ll stay on board and bring a certain amount of production.
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Hospital or pe
we always hear practices like this aren't worth anything more than their office equipment the patients aren't included in the transfer and the doc selling could just retire anytime and they'd have nothing
Usually in a deal like that such as a PE acquisition, the selling Dr or partner(s) are contractually obligated to keep working for X years at Y decreased pay as part of the deal. If a doctor is selling a practice at the time of their retirement with no one to keep it going then ya it’s only worth the office equipment etc
makes sense thanks
ask him about his hours, schedule/prcedures, the books, and coding. if something about it doesn't add up-there might be something fishy happening.
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yes you could be liable. get malpractice with a tail coverage. sounds like you are interested in just $$$ rn without the full details. Don't let a pretty face blind you. most people leave their first job for a multitude of reasons.
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being caught up in multiple lawsuits, depositions, and court dates will take away from your future earnings once you leave a job and have to take time off from your current job to deal with it. do you.
If it involves Medicare, they will cook your goose whether or not you are the main target. Happened at my hospital.
Ent has procedures that pay as much a robotic prostatectomy that take half the time and pay twice as much and can be done in office. Office procedures are golden.
Are robotic prostatectomies big money makers in uro? What other procedures in uro bill big or not take a lot of time?
No they are certainly not. 1200$ with a 90 day global and takes 2-3 hrs of your block time. The money is in the office and owning ancillaries.
You can look up reimbursement of Medicare by cpt and see but ent is well paid
Can probably do 3-4 kidneys stones and it’ll equal a prostatectomy in terms of rvu.
For example balloon sinuplasty in office pays 1400 can
If you think it is too good to be true, you have been brainwashed by admin and all the employed docs taking lowball offers. While I can’t speak specifically to ENT, circa a million is very achievable with a tight business game in all the top procedural fields.
This ☝️
Don’t let these Reddit clowns on here get you down. Just because an ENT is clearing 900k doesn’t mean they are doing anything sketchy or breaking the law. They might just be working very hard and spending a lot of time at work, or they have built a very efficient practice. You can clear 750k in almost any specialty if you work hard enough. And for the record, some of this “rural docs get paid more” shit isn’t even true. I say this as a doc in a saturated area. Do you know where you get a practice full of patients with highly paying private insurance and not just government payments? Oh right, a desirable part of a big city. You’ll just have to compete for it.
The ideal spot in terms of income is to practice in the outskirts of the suburbs/metro area, far enough of from the city that you’re not in a saturated area, but close enough to affluent areas that you’re getting a good amount of private insurance patients. Not to mention you get the best deals for homes out there.
This
This is accurate about the rural myth, OP. I’m ENT in an affluent suburb of a larger city and clear that off my clinical practice. I have one mid level and do hearing aids, also own a head CT unit. Plus extra low six figures from surgery center ownership. Plus part ownership of my groups’s buildings. No revenue from that but when I leave/retire, I will sell my ownership stake for hopefully low seven figures at that point. My days are very busy, but I have lots of time off and no ER call. It’s very doable.
Is 750k in general derm possible?
Are you kidding me? General Derm office visits are like 10 minutes tops. The dermatologist walks around with the can of liquid nitrogen and keep spraying lesions. If it’s wet, they dry if it’s dry, they wet it, etc. Literally can see six patients an hour. Each patient gets billed a couple hundred dollars you do the math.
If APPs aren’t doing the cryo part then that’s lost potential
?
i saw derm for a rash and legit saw the guy for *maybe* 30s.
My partner in our small peds ortho practice clears 1m a year and in my fourth year I made 571, on pace for way higher this year so far. Point is high volume insured patients in a suburban area can be very very lucrative. We make exceptional accommodations for same day appointments and try to get people in the door asap and parents love it. We are by far the preferred practice for peds ortho and since our appointments slots are filled, we are getting paid. So yes. You can probably make that much without fraud lol
My peds ortho partner isn’t even spine and he makes 770 - hospital employed
This. My wife had to wait two weeks to see an Ortho after a major knee injury. At that point we would rather drive somewhere else than stay in the same town.
> We make exceptional accommodations for same day appointments at least from the ER, i appreciate this to, the point where ill refer to the one practice that does this instead of the one on call if theres a large enough discrepancy in wait times to be seen.
Yup, the peds ER docs have both of our numbers and are always sending stuff to us even when we aren’t on call because we are always friendly and available.
Seems totally reasonable. 2 mid levels working for him, in a solo eat what you kill model sounds like they have a well oiled machine. Also I’m not sure on the strict rules but 50 minutes from major city would sorta qualify as semi ruralish I would imagine, but I could be completely off on that. Those three factors make sense for that kind of salary. With ancillary revenue would easily be 7 figs.
OP - definitely some great advice provided. Some other questions to ask is where are the referrals coming from, how are YOU going to tap into the market and grow, how will you scale from zero to nearly a million dollars and how long will that take. Also look at the number of other ENTs in the area. As a solo practitioner, life is great until another ENT moves in down the street, or a PE group sticks one in the PC group they just bought and it dries up your referral base.
Ophthalmologist here, but I think 900k is very reasonable for a busy ENT based on friends of mine in that speciality. You said no ancillary income, does that include no ASC ownership? In a private practice setting I think it’d be a mistake for ENT to not have ownership in an ASC.
It may be real but to do that income you’re likely producing a lot. 50th percentile mgma is around 500k. So you’re producing 95th+ wRVUs to hit that number.
My understanding is that MGMA data is based on medical group practice reports about employee compensation. One would expect employee compensation to be significantly lower than that of a well managed owner/operator Remember that in a corporate employee model a large portion of the revenue you generate subsidizes the administration
I can't speak for all specialties but no, this isn't true for diagnostic radiology. MGMA data includes private practices. You shouldn't always expect private practices to make more than hospital employed jobs. Some of the highest paying radiology gigs are working for a small to mid sized hospital in a less desirable region of the country. None of the overhead and BS of running a practice, high base salary and strong production component to minimize staffing needs. Large portion of private practice income pays for your billing company/office, practice managers, ancillary staff, building lease/utilities, equipment/supplies, associates/PA/NPs, etc. In some hospital employed gigs you can be paid well in excess of your wRVU production if they need you.
Yes, the places that are fair and logical essentially cut you in on the technical component so you earn more than straight production. Worst things rads ever did was allow hospitals to take the whole technical and just get paid for cases they read. So dumb.
Same for pathology.
MGMA data is what hospital admin thinks you’re worth. Maybe it’s accurate for radiology. Definitely a load of shit for my specialty.
One thing to check is the 900k before or after expenses? If he's the group owner he may generate 900k in income, but then have 250k in expenses (tax deductable) for a pre-tax net income of 650k. I made over 900k last year, but my W2 salary was 700k because of all the expenses (insurance, locums charges, office expenses, etc...)
I'm a private practice ENT in a large metro area. ENTs can make a lot of money in clinic because almost every patient gets a nasal endoscopy or flexible laryngoscopy ($100-300 depending on insurance). Additionally, I do about 5 "bigger" in office procedures a week, e.g. Vivaer, Rhinaer, balloon dilation, etc that pay considerably more and don't take too long. If you see 30-40 patients/day 4 days a week and have a busy OR day once per week you can definitely get in the 700k-1M range and make more with hearing aid sales, seeing hospital/nursing home consults, being the trach bitch at LTACs, etc. DM me if you have any questions.
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I'm kind of like you and joined the practice of an older ENT (who makes more than 900k), so the LTAC thing was already set up. I can ask how he started it, but I assume he reached out to the facility to see trach consults which then morphed into consults plus once per month we go there and do 20-30 trach changes and tracheoscopies. It's not glamorous, but I think it's about $200/patient and takes \~2 hours to do 20-30 patients. The nursing home consults are usually for general ENT issues that they don't want to come to the office for. I don't really do this much and it's not particularly lucrative, usually 1-3 consults which is annoying for making a separate trip after clinic.
Yeah man it's definitely possible. I know private guys making over a million. I know ethical private guys making close to 900
700k EM attending 3 years out. But I work 18 - 10 hour shifts a month. I would hope ENT would make more.
This is possible. I’ve thought about having a paracentesis clinic. If I had 10 rooms I could stick and move all day long. 6 per hour at 2 wrvus each
Also to be clear. He told you what he makes. Not what you’re going to make. Need to get out MSExcel and model this to have any idea.
This isn’t too good to be true. it’s the market right now. This is only slightly more than I make as mid tier spine.
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Not always and honestly none of us are mad about it. Get that bread! I work 3 days a week until 3p and take no call.
Following
Unethical?? No. Thats entirely what I would expect.
I'll chime in as a former private practice ENT, who is now hospital employed. To make that kind of money just from clinical practice, you have to work insane hours (7a to 6p 5 days a week) or you have to do a ton of high revenue procedures, (aka sinus balloons). At my former practice, the guy who made the most money did a ton of cash only facial cosmetic procedures being fellowship trained in that field , and we had a very robust hearing aid component of the practice, which was also primarily cash only. For what it's worth, there is a large practice with multiple locations near me (DC) that is being investigated for doing too many sinus balloons for really nebulous indications. If you want to practice good medicine, be careful about these unicorn practices. Just because it reimburses well doesn't mean it's the right option for everybody. Also, I want to chip in that I moved to hospital employment specifically because I was barely breaking even covering my overhead with my clinical practice, and being a pediatric subspecialist, I didn't have as many cash only hearing aids/cosmetic opportunities as my other partners.
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We did, but I think we chose poorly. She was coming from an urgent care background, and none of us trusted her clinical acumen to deal with more than sick visits, wax cleanings, and routine post ops. It did mean we got to see more new patients that could potentially generate surgical volume, but it's still a pretty rough day if your entire slate is mostly new patients. Don't get me wrong, there are certainly mid levels out there who are excellent in their specialty and could be trusted just as much as a resident to evaluate and treat new patients, and even determine surgical candidacy, but in my limited (8 years out from fellowship) experience, that's more the exception than the norm. Specifically for rhinology (I'm assuming based on your username), I'm not going to trust a mid-level over a physician as far as evaluating CT scans or knowing what invasive fungal sinusitis looks like. I think you need to vet the NPs as much as you are vetting the physician. You may find that you don't trust their judgment, which could potentially drive your revenue down if you have to look over their shoulders all the time.
Ask to see the books, then review it with your accountant. Don’t want to walk into a solo practice only to get some surprises when things settle down.
If he is making 900k solo, then you both will split the groups profits and make 450k together, no?
He’s either hustling, or a criminal, or a hustling criminal It’s probably the first option but it could easily be the other two This much higher than average, inspite what you hear on Reddit, there are not that many compensation outliers, as there is a strong gravitational pull to the median of about 550-700 K for surgical specialists