Post-Residency “Privademic” Practice Options... Non-Compete Problem?

[halcyon_]

I want to maintain positive aspects of private practice and academia in my career and want to know if this would be feasible. I have the opportunity to invest in a group of primary care clinics and SNFs (as an owner not practitioner, would not be seeing patients), but would also like to maintain a hospitalist/clinical professor position at my home academic institution.

The flexible hospitalist schedule would allow me time to manage the business while maintaining the academic affiliation would give me easier access to research funding and to teach which I enjoy. Do you know docs who have achieved similar setups? Or would most institutions require a “cease and desist” to the investments bit?

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[gutonc]

I think that's going to vary from one institution's COI office to another. But I'm not sure they'd love the idea of one of their employees owning and operating a competing business across town.

 

[NewYorkDoctors]

this might violate Stark laws? check with hospital admin and your lawyer first.

for the record, I left academics ASAP and opened PP. but I am a nonpaid faculty for one of the hospital's PCCM fellowship. I still engage in intermittent lectures, do bronchoscopy cases, etc.. with the fellows. I just dont get paid by them. the fellows help me see some of my cases now and then but i try not to have them write notes on the boring ones as they are busy enough.
maybe you could make that arrangement happen if you went private as well? just a thought

 

[chessknt]

I am not sure how this 'opportunity' found you but I would be wary of someone soliciting your investment in a clinical enterprise of which you have no direct involvement in. Why would a SNF or a primary care clinic need or want your investment if you aren't helping to make it successful? Manage the business? Do you have some kind of outpatient/SNF special business insight/experience that the current ownership lacks that warrants you being in charge of this?

The SNF ownership is going to be a major violation if anyone you ever see gets referred there at discharge from the hospital.

 

[halcyon_]

I am not sure how this 'opportunity' found you but I would be wary of someone soliciting your investment in a clinical enterprise of which you have no direct involvement in. Why would a SNF or a primary care clinic need or want your investment if you aren't helping to make it successful? Manage the business? Do you have some kind of outpatient/SNF special business insight/experience that the current ownership lacks that warrants you being in charge of this?

The SNF ownership is going to be a major violation if anyone you ever see gets referred there at discharge from the hospital.

Would this change if at my institution, the social workers handle all the placement? Obviously I decide level of care, but don’t ever refer to specific SNFs/rehabs/etc

 

[gutonc]

Would this change if at my institution, the social workers handle all the placement? Obviously I decide level of care, but don’t ever refer to specific SNFs/rehabs/etc

I totally wasn't thinking about Stark law violations in the SNF aspect of the situation in my response above. Thanks to @NewYorkDoctors and @chessknt for bringing it up.

No. An argument can always be made that you somehow influenced the decision. Just the whiff of any evidence of influence could be enough to bring a massive pile of government s*** down on your head.

 

[NewYorkDoctors]

Would this change if at my institution, the social workers handle all the placement? Obviously I decide level of care, but don’t ever refer to specific SNFs/rehabs/etc

im sure if you went through every discharge with a fine tooth comb and made sure they did not go to the SNF you have ownership in things will be fine... but it just takes one slip in the crack and one intrusive lawyer and a ****storm will fall on your head.

chances? not very high something that bad will happen
but no a zero percent chance.
talk to a lawyer or something

 

[halcyon_]

Thanks everyone, this is really helpful. Appreciate you helping me avoid the legal headaches. Will discuss as suggested

 

[HemeOncHopeful19]

Just buy a Chik Fil A

 

[dozitgetchahi]

I want to maintain positive aspects of private practice and academia in my career and want to know if this would be feasible. I have the opportunity to invest in a group of primary care clinics and SNFs (as an owner not practitioner, would not be seeing patients), but would also like to maintain a hospitalist/clinical professor position at my home academic institution.

The flexible hospitalist schedule would allow me time to manage the business while maintaining the academic affiliation would give me easier access to research funding and to teach which I enjoy. Do you know docs who have achieved similar setups? Or would most institutions require a “cease and desist” to the investments bit?

So at least in the outpatient world, there are rheumatologists who are something vaguely akin to what you’re suggesting…but these are usually fairly prominent researchers who have a private outpatient practice that is closely affiliated with an academic institution. They see patients in their own clinic, but then do research with the institution and have access to institutional grants etc that way.

This is significantly different than what you’re suggesting, however, which sounds like some sort of scam. Beware of people hawking random “investment opportunities” to doctors. They’re usually ripoff artists.

But if your question is “can I be truly academic and have a private practice”, the answer is technically yes, but this is uncommon.

 

[NewYorkDoctors]

So at least in the outpatient world, there are rheumatologists who are something vaguely akin to what you’re suggesting…but these are usually fairly prominent researchers who have a private outpatient practice that is closely affiliated with an academic institution. They see patients in their own clinic, but then do research with the institution and have access to institutional grants etc that way.

This is significantly different than what you’re suggesting, however, which sounds like some sort of scam. Beware of people hawking random “investment opportunities” to doctors. They’re usually ripoff artists.

But if your question is “can I be truly academic and have a private practice”, the answer is technically yes, but this is uncommon.

one local rheumatologist near me is like this. has an academic title at NYU.
sees local community patients to make some quick and easy money on MSK stuff.
occassionally gets an SLE or myositis or something and can quickly hook up with the infusion center at NYU or plug into a clinical trial.

 

[end stage fibro]

I agree with everyone telling you this should raise alarm bells in your head.

Regarding the Stark law concerns, you can probably get around it legally. This is not for the faint of heart, but under value based purchasing and ”continuity of care,” you can kinda direct patients to your SNF (not force them or browbeat CM into sending them there). First, become intimately familiar with this document. Second, make sure you have a lawyer and business people. Thrid, pore over your certificate of need to see exactly what this facility is doing. And I do mean exactly… not “i get pts i make money. “ I am not sure how this will play out in your scenario since you aren’t actually seeing patients at the SNF (those alarms are getting awfully loud).

I wish I could give my usual screed about a topic, but this very interdisciplinary work and I am not an expert. As mentioned above, if someone cold called you about this you should wonder why.