Fed up with employed/group practice

[brianmartin]

I live in a semi-rural area working for a small hospital system that is a RHC.
It's my first job and it's been a couple years now, and I'm fed up already. I can't make my own schedule, I get told how to practice medicine, and really, it's just not good. The consistent paycheck is nice but there are RVU production targets that must be met to get that. Administrators are out of touch with reality of daily practice, etc. Every day I come to work i think about leaving and going solo or independent group practice. I like my patients and staff, and I don't feel particularly over-worked. But I do feel like I'm always being told what to do and how to do it, and it really irks me. There are some weird politics in the organization and thinking outside the box is punished.

I know private practice has huge drawbacks but honestly it sounds better than what I'm doing right now. Anyone else ever been in this position?

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[FrustratedFamDoc]

I'm now almost 7 years out from residency and had very similar feelings when I first started out. After my 2 year guarantee expired, I had a very rude awakening salary wise. After my numbers got to where they should be, they really left me alone. My autonomy is thankfully good where I'm at. I come and go as I please and take time off when I want. I make sure to make hay when the sun shines and my total revenues have grown every year I've been here. The ever increasing complexity from PCMH is a pain, but at the end, It's likely just another couple clicks on our inefficient EMR.

 

[VA Hopeful Dr]

I live in a semi-rural area working for a small hospital system that is a RHC.
It's my first job and it's been a couple years now, and I'm fed up already. I can't make my own schedule, I get told how to practice medicine, and really, it's just not good. The consistent paycheck is nice but there are RVU production targets that must be met to get that. Administrators are out of touch with reality of daily practice, etc. Every day I come to work i think about leaving and going solo or independent group practice. I like my patients and staff, and I don't feel particularly over-worked. But I do feel like I'm always being told what to do and how to do it, and it really irks me. There are some weird politics in the organization and thinking outside the box is punished.

I know private practice has huge drawbacks but honestly it sounds better than what I'm doing right now. Anyone else ever been in this position?

Not all employed groups are the same, its possible your employer just sucks. That definitely happens. Its also possible that as mark v noticed that once you're making enough money, you often get left alone more.

 

[brianmartin]

well I just got an email today that I am hitting my production comfortably, so its not that.
The problem isn't really with production or compensation, it feels more like a cultural issue.
Like just for example, the administration will randomly do 3rd party chart reviews without telling you, and then call you in and question how you practice medicine based on 10 random charts, and they don't seem to understand the pitfalls of doing that.
If you have a dissenting opinion about something, like for example, automatically doing fluoride varnishes on kids teeth at all well child visits, I was made to feel like I was "against dental health" when in fact I was just being diligent about asking questions before implementing something...etc.
They tried to outsource flu treatment to pharmacies allowing them to give tamiflu per a protocol, I said I didn't think it was a good idea and I was made to feel like I was some kind of detractor to patients health.
Just bizarre stuff like that, I can't stand it.

 

[namethatsmell]

I'm EM but FWIW...

I was made to feel like I was "against dental health" when in fact I was just being diligent about asking questions before implementing something...etc.

Don't let them bully you. It's your license, your rules. People who push back on/are afraid of questions are hiding something (even if it's just their own lack of knowledge).

They tried to outsource flu treatment to pharmacies allowing them to give tamiflu per a protocol, I said I didn't think it was a good idea and I was made to feel like I was some kind of detractor to patients health.
Just bizarre stuff like that, I can't stand it.

Are these docs or non-clinical admins setting this policy? If it's the latter it's them basically practicing medicine without a license. If it's the former than perhaps some education is in order since the risk:benefit profile for giving tamiflu is generally abysmal.

 

[deleted87716]

Sounds like typical health system B.S. I knew when I finished residency that I never wanted to work for a health system, so I joined a physician-owned multispecialty group instead, and have never regretted it. I'll likely retire in a few years from the same group. How often do you hear that these days?

 

[Sushirolls]

I live in a semi-rural area working for a small hospital system that is a RHC.
It's my first job and it's been a couple years now, and I'm fed up already. I can't make my own schedule, I get told how to practice medicine, and really, it's just not good. The consistent paycheck is nice but there are RVU production targets that must be met to get that. Administrators are out of touch with reality of daily practice, etc. Every day I come to work i think about leaving and going solo or independent group practice. I like my patients and staff, and I don't feel particularly over-worked. But I do feel like I'm always being told what to do and how to do it, and it really irks me. There are some weird politics in the organization and thinking outside the box is punished.

I know private practice has huge drawbacks but honestly it sounds better than what I'm doing right now. Anyone else ever been in this position?

Take the plunge, and go hang your own shingle. Create it and make it your own.

 

[QueenJames]

Any thoughts about DPC???

 

[Sushirolls]

OP, so what's your game plan? Staying put or changing it up?

 

[brianmartin]

well, just to update, I am now seriously thinking about going independent. I've found a small private practice in the town I live in, run by a PA who is about to retire and he wants to pass on the business to someone. I am about 90% sure I want to accept that offer. However, there are a lot of financial details to figure out. My employer has not changed much. I still just don't like the overall philosophy. They want everyone in the group to practice medicine in the same standardized way, no exceptions. I definitely feel that I am not meant for employed practice. I'm very aware of the difficulties of independent practice but I'm almost okay with them because at least I can run things in my clinic the way I want to. We'll see what happens. Will update when I figure it all out.

 

[FrustratedFamDoc]

PA who about to retire (typically older) usually means that he will have an older/aging population. Acquiring these types of patients can be challenging in many ways, especially if they expect you to practice just like he used to. You may want to shadow for a week and observe the volume of refills on scheduled medications that the practice sees, and get a peek at his patient population. You may be moving in to a gold mine, or on top of a land mine.

 

[deleted87716]

You may be moving in to a gold mine, or on top of a land mine.

This. PA...? Probably the latter.

 

[Merely]

How does a PA have his own practice? Doesn’t he need a doctor to oversee him? How can that possibly be legal he didn’t even do residency????

 

[deleted87716]

How does a PA have his own practice? Doesn’t he need a doctor to oversee him? How can that possibly be legal he didn’t even do residency????

Probably has a long-distance "supervising" physician.

 

[Merely]

Probably has a long-distance "supervising" physician.

So messed up and such a disservice to pt

 

[brianmartin]

Good concerns raised.

This is a PA who has been in the community for 30 years, previously working side by side with a several beloved "old family docs" (several of whose patients I have actually taken over), but who have since retired, and since he wasn't anywhere close to retirement age yet, it wouldn't have made any sense to quit and move away, after serving our little local community for years. So he started his own practice, and, having no options for direct supervision, had to get a remote guy (only 30 min away) to oversee his charts. He has more primary care experience than I do.

A few more details.
My wife and I are both FPs. We would both be using the office.
He does have an aging population, but we have a solution in mind for that (get a midwife to share office space with us).
He knows perfectly well some of his patients will move on when he retires, but some won't.
We will be bringing a handful of younger, private insurance patients with us from our current panels, and even some peds whos parents like us.
He sees about 75% private insurance and appears to be financially solvent and healthy (although we need much more information before that is ultimately confirmed)
There is a good chance that there will be a large number of patients on controlled substances. Not the greatest situation but nothing is perfect and we have good legal/political backing to wean anyone that needs to be weaned.
My wife did shadow, just a day, and felt like it was a well run clinic with pretty average patients, she didn't see anything sketchy going on.
It's a well maintained building in a good central location
He does not own the land, he gets a $500/month lease from the landowner who has a personal interest in medicine and having an independent clinic there. It's pretty likely we could get the same deal for "99 years"

 

[deleted87716]

Not worth "buying out." Building belongs the landowner, and used fixtures are worth zilch. Leased space is worth nothing. "Goodwill" is bull****. Patients are under no obligation to stay with you. Don't pay anything for that practice.

Take it over, sure...if you're up for that. But don't pay anything for the "privilege."

 

[brianmartin]

Good points.
Leased space is not worth nothing, it's worth whatever revenue you can generate in it. Also, the LAND is leased, I don't know about the building yet.
He knows we are in debt and not in any financial position to pay a bunch of money to him for an old clinic, but he still wants to see if we can make it work.
IF and when we come up with a proposal, if it puts us in a bad financial position we won't do it, obviously. We have an accountant too.
I agree, that we should not be paying anything for the privelege
But there are buildings involved, and I fully expect he'll want something for the building (which was not financed by the landowner).
A building inspection, would of course be done.
There are a lot of details, rest assured we won't be signing any checks without turning over every stone.

 

[Keona]

As a PA with indirect supervision would the state or dea allow controlled substances? I know our nps can’t write for anything stronger than tramadol and most of our nps don’t have deas.

 

[deleted87716]

Good points.
Leased space is not worth nothing, it's worth whatever revenue you can generate in it. Also, the LAND is leased, I don't know about the building yet.
He knows we are in debt and not in any financial position to pay a bunch of money to him for an old clinic, but he still wants to see if we can make it work.
IF and when we come up with a proposal, if it puts us in a bad financial position we won't do it, obviously. We have an accountant too.
I agree, that we should not be paying anything for the privelege
But there are buildings involved, and I fully expect he'll want something for the building (which was not financed by the landowner).
A building inspection, would of course be done.
There are a lot of details, rest assured we won't be signing any checks without turning over every stone.

He should walk away with his accounts receivable. That's it. If you want to take over his practice, that's between you and the landlord. Don't be a sucker.

 

[DoubleBogey]

As a PA with indirect supervision would the state or dea allow controlled substances? I know our nps can’t write for anything stronger than tramadol and most of our nps don’t have deas.

In my state they certainly can and do
To the OP, not enough objective information regarding the practice to make an informed decision, most of the info you provided is subjective and general. Certainly is worth looking in to, as talking doesn’t cost you anything.
I would look in to your non-compete with current employer, which if one exists can play an important role.
Additionally, I would pay more attention to the current supervising physician-Pa relationship and wouldn’t be flippant about the supervising physician being a “remote” guy.
As far as controlled substances go, it’s not fun walking in to a “legacy patient” on opioids/BZs/sleep aids and telling them the times are changing. However, if you stick to how you practice then it’s not as stressful - if they leave then the liability leaves as well (for the most part). UDS everyone and likely a 1/3rd fail

 

[FrustratedFamDoc]

The housecleaning process can and will be quite painful but as long as you stay focused on the long game, you'll be ok.

Beware of inheriting staff that can't or won't pivot from the 'old way of doing things.' I finally have a wonderful staff in place after several years, but it took quite a while. I've had thieves, rude, substance users, lazy and some that just plain sucked at dealing with people. Red alert if anyone in the office is friends/relative with any of the providers/admin people.

Bringing your previous patients with you can be great if the non-compete doesn't apply.

 

[brianmartin]

no non-compete clause in my contract
To address the building issue, I would need to find out exactly who financed its construction and how, and who financed ongoing maintenance and updates over the years (which there have been some). If the guy borrowed money to finance the construction and then did all the upkeep on it himself then he definitely deserves something for the building. Am I wrong on that?

 

[brianmartin]

just an update with some numbers, I took a look at their tax returns
the PA who runs the practice, works 3.5 days per week, and typically brings in about 220k gross, and they have pretty high expenses, around 140k, and so he got taxed on around 80k in net income. Pretty lackluster numbers in my opinion, but to be fair, I would make 10-20% more on each visit because i'm an MD, and I also wouldn't have to pay for an MD to review his charts, which he paid around 20,000 dollars for last year.
His wife is an RN and she runs the business and also does MA duty, so they save a substantial amount of money there.
My wife and I, both MDs, would be taking over, I'd probably work 3 days a week, and she'd work 2 or 3 depending. So we'd be making more than him.
But we'd also need to hire an MA, or even two.
The assessed value of the building is 320,000. They are getting a commercial appraisal, and he threw out a number of "500-600k" as the value for the whole practice. I thought that seemed really high-ball.
We have 340k in med school debt at 7% and a new mortgage with about 220k in principle left, at 4%. We have about 100k savings in the bank.
I told him we have no intention of going even more heavily into debt.
My thinking is that we might be able to get a small business loan for around 200k and simply offer to pay him off with that cash and he can set off in his RV for retirement. They even offered to hand the practice over and "loan" us the money and we would pay them off over time. I told them I don't want to do that and the only way it will change hands is cleanly, with nobody owing anything to anyone except a bank.

I'm meeting up soon with his supervising physician, who runs his own private practice the next town over, where I will get some straight answers.

The problem is that they really have put a lot of their personal money into this building over the years, and they built the building from scratch with a big loan which they paid off themselves. The landowner has nothing to do financially with the building. Just offered the guy a cheap lease. So from their perspective, they have to get something back.

 

[deleted87716]

The assessed value of the building is 320,000. They are getting a commercial appraisal, and he threw out a number of "500-600k" as the value for the whole practice. I thought that seemed really high-ball...The problem is that they really have put a lot of their personal money into this building over the years, and they built the building from scratch with a big loan which they paid off themselves. The landowner has nothing to do financially with the building. Just offered the guy a cheap lease. So from their perspective, they have to get something back.

Wait, what...? You're considering buying a building on leased land...? Not only no, but HELL, no! The landowner will have you by the balls. He could raise the rent, sell the land, or decide to develop the property (kiss your building goodbye). And, good luck ever getting your money out of it. You should either lease the whole thing (building and land), or own the whole thing. Sounds to me like that PA made some poor business decisions, and is looking for you to bail him out. I'd take out a small business loan and open my own practice before I'd do that.

The Pros and Cons of Buying Property on Leased Land

Learn about the pros and cons of buying property on leased land and if this solution makes sense for your budget and lifestyle.

acpm1.com

In addition to that, bear in mind that a medical practice has essentially no real value aside from real estate and accounts receivable. Furniture, fixtures, and equipment, if fully depreciated (after 4 years) have virtually no value. "Goodwill" isn't worth anything in this day and age, as patients have no obligation whatsoever to remain with the practice after it changes hands, and many will not (unless you're the only doctor in town). Buying a practice is a great way to get screwed.

 

[brianmartin]

I'd take out a small business loan and open my own practice before I'd do that.

And that is a very good point, which I have asked myself many times.
It's true, patients can go anywhere they want.
He has a large patient panel of pretty loyal patients, which is a draw. The other draw is that the building is already built and completely set up to be a medical practice. All the equipment is there. We wouldn't have to buy anything or do any construction.
However, I am pretty confident I could build my own patient panel, even partially composed of his patients after he retires, from anywhere, and I certainly have considered just starting from scratch myself. It's just a bit daunting.

 

[Lurts]

And that is a very good point, which I have asked myself many times.
It's true, patients can go anywhere they want.
He has a large patient panel of pretty loyal patients, which is a draw. The other draw is that the building is already built and completely set up to be a medical practice. All the equipment is there. We wouldn't have to buy anything or do any construction.
However, I am pretty confident I could build my own patient panel, even partially composed of his patients after he retires, from anywhere, and I certainly have considered just starting from scratch myself. It's just a bit daunting.

As silly as it may sound, the thought of being a physician -much less a pair of physicians- and purchasing a practice from a physician ASSISTANT just rubs me the wrong way. I would pass for that reason alone.

 

[deleted87716]

As silly as it may sound, the thought of being a physician -much less a pair of physicians- and purchasing a practice from a physician ASSISTANT just rubs me the wrong way. I would pass for that reason alone.

I'd be concerned about the type of panel that I'd inherit.

 

[brianmartin]

Yup, he insists he has a "great" panel of "loyal" patients, but I don't really know what he means by that. It could be interpreted multiple ways.

 

[Lurts]

Yup, he insists he has a "great" panel of "loyal" patients, but I don't really know what he means by that. It could be interpreted multiple ways.

Loyal to whom? Not you when you buy his practice.

 

[MidwestPAC]

As silly as it may sound, the thought of being a physician -much less a pair of physicians- and purchasing a practice from a physician ASSISTANT just rubs me the wrong way. I would pass for that reason alone.

Give me a break dude! That is like saying I wont buy this practice cause the guy doesn't go to church or he is from a different state or country. Might as well throw the discrimination card out. Just because we re a PA doesn't mean we cant make business decisions and take care of a business. This response sickens me and the closed mind you have. There are several PA own clinics in my area. We are here to take care of our community and make a living. We are not here to acree doctors over if that's what you think...

 

[deleted87716]

Just because we re a PA doesn't mean we cant make business decisions and take care of a business.

It actually sounds like this PA has made some really poor business decisions as far as real estate goes.

 

[anonperson]

Good concerns raised.

This is a PA who has been in the community for 30 years, previously working side by side with a several beloved "old family docs" (several of whose patients I have actually taken over), but who have since retired, and since he wasn't anywhere close to retirement age yet, it wouldn't have made any sense to quit and move away, after serving our little local community for years. So he started his own practice, and, having no options for direct supervision, had to get a remote guy (only 30 min away) to oversee his charts. He has more primary care experience than I do.

A few more details.
My wife and I are both FPs. We would both be using the office.
He does have an aging population, but we have a solution in mind for that (get a midwife to share office space with us).
He knows perfectly well some of his patients will move on when he retires, but some won't.
We will be bringing a handful of younger, private insurance patients with us from our current panels, and even some peds whos parents like us.
He sees about 75% private insurance and appears to be financially solvent and healthy (although we need much more information before that is ultimately confirmed)
There is a good chance that there will be a large number of patients on controlled substances. Not the greatest situation but nothing is perfect and we have good legal/political backing to wean anyone that needs to be weaned.
My wife did shadow, just a day, and felt like it was a well run clinic with pretty average patients, she didn't see anything sketchy going on.
It's a well maintained building in a good central location
He does not own the land, he gets a $500/month lease from the landowner who has a personal interest in medicine and having an independent clinic there. It's pretty likely we could get the same deal for "99 years"

This sounds like a mess.

Loyal patient panel means nothing. If they are loyal, they are loyal to HIM. Once hes gone, there is a decent change they will move on.

Also, he is probably beloved because he hands out narcotics and antibiotics like candy. Good luck corralling this patient population.

He sees 75% insured patients and is only making $80K a year? You costs will be higher with malpractice insurance for the both of you.

The practice has no inherent value. The building is built on leased land which is a huge issue. What's to stop the landowner from screwing you over with a higher monthly lease. Trying to sell the building in the future if you decide to leave will be challenging because of this and you will have a huge albatross to deal with. No one will want to deal with this. Sure the building technically has some value but its built on land that is not owned by the PA.

Would you "buy" a house on land you could never own and had to pay a monthly lease that could fluctuate? I wouldn't.

Why not open up shop down the street and just wait him out while you build up your own practice? Why pay for an old building and old equipment? The actual practice itself has no value.

 

[deleted941485]

If the area really needs a doctor, then opening your own practice might actually be more doable and carry less risk then buying into a bussiness like this.

Start fresh and the way you want it. You don’t need this noise. Even if you rent space in a professional building, it’s probably be better than making any real estate purchases.

Let the guy sell the building to some other poor sucker

 

[MidwestPAC]

It actually sounds like this PA has made some really poor business decisions as far as real estate goes.

Sure that's fine just to say that but what @Lurts Said about him being a PA and that he would pass on that alone is literally discrimination against another profession. Terrible racist people out there makes me sick.

 

[deleted87716]

Sure that's fine just to say that but what @Lurts Said about him being a PA and that he would pass on that alone is literally discrimination against another profession. Terrible racist people out there makes me sick.

How is that racist...?

 

[brianmartin]

If the area really needs a doctor, then opening your own practice might actually be more doable and carry less risk then buying into a bussiness like this.

Start fresh and the way you want it. You don’t need this noise. Even if you rent space in a professional building, it’s probably better than making any real estate purchases.

Let the guy sell the building to some other poor sucker

It would be doable if I waited for the right opportunity, but there aren't a multitude of little commercial buildings around me with office space available. It's a remote, rural area and there is a reason he built that building--that was his only real option, literally. So my interest in the building is purely material. Any other place around here, such as one of the many abandoned old down-town store fronts, would need to be gutted and renovated. There are some newer, small commercial buildings with office space, but availability is sporadic. Most of them have established businesses like hair salons, massage places, that, do turnover every few years, but it could be a couple years before something opens up. Again, maybe that's fine and I should just bide my time and grab one when one becomes available.

The area has a severe shortage of primary care and people already drive over 50-100 miles to see me at my job with the RHC hospital owned group. I'm actually not too worried about getting patients and building a panel from scratch. It would be easy. I probably could even achieve a panel with about 75% private insurance patients.

The PA, I believe, has fairly unreasonable expectations about what he is going to get for his building. Also remember that he is 71, wants to retire yesterday, and there are no other buyers lined up. Him and his wife are facing the prospect of delaying retirement and being stuck in town trying to liquidate this property. We are the only people they are talking to, so we do have some negotiating power.

People are stuck on saying "this practice has no value." Well, no, that's not quite true. It has value in that it is a building already set up to be a medical clinic. The clinic exam tables may be "old" but they work. If I wanted to re-build this building from scratch right now, it would cost me at least 300,000 probably more. So, yes it does have value. How much? That's debatable, but WHETHER it has any value at all is not debatable. It does. So, its not super helpful to keep insisting it doesn't.

 

[deleted87716]

People are stuck on saying "this practice has no value." Well, no, that's not quite true. It has value in that it is a building already set up to be a medical clinic. The clinic exam tables may be "old" but they work. If I wanted to re-build this building from scratch right now, it would cost me at least 300,000 probably more. So, yes it does have value. How much? That's debatable, but WHETHER it has any value at all is not debatable. It does. So, its not super helpful to keep insisting it doesn't.

Whatever. You've been warned.

 

[deleted941485]

It would be doable if I waited for the right opportunity, but there aren't a multitude of little commercial buildings around me with office space available. It's a remote, rural area and there is a reason he built that building--that was his only real option, literally. So my interest in the building is purely material. Any other place around here, such as one of the many abandoned old down-town store fronts, would need to be gutted and renovated. There are some newer, small commercial buildings with office space, but availability is sporadic. Most of them have established businesses like hair salons, massage places, that, do turnover every few years, but it could be a couple years before something opens up. Again, maybe that's fine and I should just bide my time and grab one when one becomes available.

The area has a severe shortage of primary care and people already drive over 50-100 miles to see me at my job with the RHC hospital owned group. I'm actually not too worried about getting patients and building a panel from scratch. It would be easy. I probably could even achieve a panel with about 75% private insurance patients.

The PA, I believe, has fairly unreasonable expectations about what he is going to get for his building. Also remember that he is 71, wants to retire yesterday, and there are no other buyers lined up. Him and his wife are facing the prospect of delaying retirement and being stuck in town trying to liquidate this property. We are the only people they are talking to, so we do have some negotiating power.

People are stuck on saying "this practice has no value." Well, no, that's not quite true. It has value in that it is a building already set up to be a medical clinic. The clinic exam tables may be "old" but they work. If I wanted to re-build this building from scratch right now, it would cost me at least 300,000 probably more. So, yes it does have value. How much? That's debatable, but WHETHER it has any value at all is not debatable. It does. So, its not super helpful to keep insisting it doesn't.

Still would not be totally jazzed about buying a building especially if someone else holds the land. The guy may need a serious reality check about the current situation. Meaning a serious haircut on the price.

Also if you ultimately don’t buy the building maybe you could get a deal on some of the equipment he has.

Fortunately, you definitely have some leverage here.

 

[anonperson]

It would be doable if I waited for the right opportunity, but there aren't a multitude of little commercial buildings around me with office space available. It's a remote, rural area and there is a reason he built that building--that was his only real option, literally. So my interest in the building is purely material. Any other place around here, such as one of the many abandoned old down-town store fronts, would need to be gutted and renovated. There are some newer, small commercial buildings with office space, but availability is sporadic. Most of them have established businesses like hair salons, massage places, that, do turnover every few years, but it could be a couple years before something opens up. Again, maybe that's fine and I should just bide my time and grab one when one becomes available.

The area has a severe shortage of primary care and people already drive over 50-100 miles to see me at my job with the RHC hospital owned group. I'm actually not too worried about getting patients and building a panel from scratch. It would be easy. I probably could even achieve a panel with about 75% private insurance patients.

The PA, I believe, has fairly unreasonable expectations about what he is going to get for his building. Also remember that he is 71, wants to retire yesterday, and there are no other buyers lined up. Him and his wife are facing the prospect of delaying retirement and being stuck in town trying to liquidate this property. We are the only people they are talking to, so we do have some negotiating power.

People are stuck on saying "this practice has no value." Well, no, that's not quite true. It has value in that it is a building already set up to be a medical clinic. The clinic exam tables may be "old" but they work. If I wanted to re-build this building from scratch right now, it would cost me at least 300,000 probably more. So, yes it does have value. How much? That's debatable, but WHETHER it has any value at all is not debatable. It does. So, its not super helpful to keep insisting it doesn't.

Repeat after me, it has no value. If you want to argue semantics, then sure, it has little value.

The fact that he doesn't own the land is a major negative. Let's say you buy the practice and the building. Do you think anyone would be interested in buying a building on leased land if you wanted to sell in 10 years? You will be stuck with this building and it's monthly cost.

You just said he wanted to retire yesterday. Why is he having trouble selling? For the very reasons repeated by several other posters. If he actually owned the land and the building, he would have sold in a minute.

Honestly, you seem burned out by your job and are looking for a quick exit.

Work part time and take a breather before getting into even more debt.

Don't just do something, stand there.

 

[Lurts]

Sure that's fine just to say that but what @Lurts Said about him being a PA and that he would pass on that alone is literally discrimination against another profession. Terrible racist people out there makes me sick.

Lol, nice.

 

[Lurts]

Give me a break dude! That is like saying I wont buy this practice cause the guy doesn't go to church or he is from a different state or country. Might as well throw the discrimination card out. Just because we re a PA doesn't mean we cant make business decisions and take care of a business. This response sickens me and the closed mind you have. There are several PA own clinics in my area. We are here to take care of our community and make a living. We are not here to acree doctors over if that's what you think...

Sure, call it discrimination I suppose. If I were a lawyer I wouldn’t be buying a practice from a paralegal either.

I whole heartedly believe my education and training are different than a PAs. As such, my approach to and management of patients is different than a PAs. And I would thus not be willing to roll the dice on inheriting a patient population used to being treated by a PA compared to one used to being treated by a physician.

I went through a lot of school and training to have the skill and privilege to treat patients. I appreciate the role of a PA in healthcare but I’ll be damned if I’m going to sell short my training.

 

[MidwestPAC]

Sure, call it discrimination I suppose. If I were a lawyer I wouldn’t be buying a practice from a paralegal either.

I whole heartedly believe my education and training are different than a PAs. As such, my approach to and management of patients is different than a PAs. And I would thus not be willing to roll the dice on inheriting a patient population used to being treated by a PA compared to one used to being treated by a physician.

I went through a lot of school and training to have the skill and privilege to treat patients. I appreciate the role of a PA in healthcare but I’ll be damned if I’m going to sell short my training.

Now that sounds better when you actually state why. Not just no because he is a assistant bull****. Of course your education is superior and you practice different but doesn't mean you can pick those patients up and change their farxiga to a different sglt2 or change their beta blocker to something else. I mean really. You could go in there and slowly change the things you dont like. I would like some examples of medications and or practices you have seen by PAs in family practice that you would change? I am being serious and genuine. I know my education is inferior and I didnt have residency etc but I'm still here to help out my community and would love to hear from doctors what us family practice (midlevels) do so wrong that you wont buy out a practice.