Employment vs. Sole Practitioner

Many of you have had the benefit of working in a clinical practice prior to your licensure. If you are now contemplating a clinical practice with your former employer or joining a group practice, it is important to keep some fundamental issues in the mind.

Employment

• A monthly income sure looks good right now. Remember that you're now producing greater income for your employer, so your per hour/per month income should markedly increase.
• Question the practitioner's employment guidelines and restrictions (sources state that chiropractors who do not retain a valid LAc license in California may not hire an acupuncturist; you can rent or lease space only).
• Your employer must have workers' compensation for you and be able to provide the name of the carrier. Inquire about the cost of malpractice insurance as a first-year practitioner and request that it be paid by your employer.
• Keep in mind that most of your patients will belong to the "house," meaning they are generated from the principal physician in the group. As such, they will remain part of the group when you terminate your employment. Make sure there is a distinction between "house patients" and those generated by your marketing. Those generated by your marketing should remain with your relocation and should not be subject to clinic ownership.
• Have a clear understanding of patient retention/ownership and any geographic preclusion against your opening your own facility near the one you are leaving. This can be a very important issue as your practice grows.

Sole Practitioner

• As a sole practitioner in a group facility, you will probably rely on inner office referrals as well as the patients you will be able to generate. Be very careful of percentage agreements used to calculate your "rent" per month. Because of the changes made in the workers' compensation labor code in 1991 (LC 139.3), inner office referrals designed to generate monies for the referring physician, whether in the form of rent or compensation, may be interpreted as a referral to one's self and may constitute the basis for fraud. Seek a straight lease agreement from the facility you intend to practice which contains fixed expenses.
• Once you have secured your location and obtained everything in writing, go to an attorney (not a family friend or relative) who specializes in contracts and have it reviewed.
• Make sure you have checked with the appropriate licensing boards if you intend to hang out your shingle in multiple locations (multiple locations-multiple license fee's).

Managed Care or No Managed Care?

The news is full of references to the poor quality health care being provided by a majority of MCOs in California. Physicians cite low reimbursement for services, making it difficult (if not impossible) to see any large volume of patients. When you have no patients to begin with, too many patients is unfathomable, let alone a lowered fee schedule.

"Cocktail" practices are the most desired: practices which are equal parts cash, managed care and workers' compensation/personal injury. Don't be lured into an established practice in which all you do is handle the MCO's patients. In most cases, you're not acknowledged as the primary physician. The facility providing the service remains the primary provider, making your tenure fragile.

Here's the best advice from an old practitioner with 30+ years of service to the community: take your time and explore all regions of the state that have sick people, not just the wealthy neighborhoods. Start your practice where you want to live and raise a family, then concentrate on getting sick people well. When compassion for your patients becomes the foundation of your practice, the financial rewards will flow effortlessly.