Hey guys, long-time lurker here in my mid-40s. I've been a solo employed general ENT in a small town for several years. I'm extremely busy, with very strong reputation and referral base, but hospital administrators are making conditions toxic and unsustainable. I'm planning on leaving but need to figure out my next steps. I'd like to run my options by you and get some opinions.
Option 1: open my own private practice in the same small town as long as I can get my non-compete waived. I would continue to operate at the same hospital. I would be immediately busy from day 1 with 25-30 patients a day with the same great referring docs. My biggest issues are I have zero experience running a practice, and learning it would eat significantly into my personal time. I'm also concerned about our payer mix. We have a very high medicaid and medicare population. I've looked at the rates and figuring overhead at 50% or so, I'm concerned I would take a huge pay cut. This is also why the hospital has become toxic. They're losing a lot of money and we're being accosted about production and "numbers".
Option 2: there is another solo private practice person in his sixties in town. I've thought about approaching him with the intention of eventually acquiring his practice. I figure that a couple of years of mentorship and a turnkey operation may ease the transition. That still doesn't solve the payer mix problem...
Option 3: leaving the town altogether and joining a not-too-far-away large single specialty ENT private practice with ancillaries and ASC. Better payer mix, and the large group would allow for further efficiencies of scale, way less call, but ultimately less control. After having no control for so long, I need more control in my professional life.
Option 4: doing a sleep fellowship and doing sleep telemedicine along with ENT locums. That's the ultimate lifestyle change after being so busy for so long.
Any thoughts?
Option 1: open my own private practice in the same small town as long as I can get my non-compete waived. I would continue to operate at the same hospital. I would be immediately busy from day 1 with 25-30 patients a day with the same great referring docs. My biggest issues are I have zero experience running a practice, and learning it would eat significantly into my personal time. I'm also concerned about our payer mix. We have a very high medicaid and medicare population. I've looked at the rates and figuring overhead at 50% or so, I'm concerned I would take a huge pay cut. This is also why the hospital has become toxic. They're losing a lot of money and we're being accosted about production and "numbers".
Option 2: there is another solo private practice person in his sixties in town. I've thought about approaching him with the intention of eventually acquiring his practice. I figure that a couple of years of mentorship and a turnkey operation may ease the transition. That still doesn't solve the payer mix problem...
Option 3: leaving the town altogether and joining a not-too-far-away large single specialty ENT private practice with ancillaries and ASC. Better payer mix, and the large group would allow for further efficiencies of scale, way less call, but ultimately less control. After having no control for so long, I need more control in my professional life.
Option 4: doing a sleep fellowship and doing sleep telemedicine along with ENT locums. That's the ultimate lifestyle change after being so busy for so long.
Any thoughts?