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Clinic overhead/Joining a practice

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I am just finishing residency and had a question for other graduating residents, recent grads, or established family docs.  I have agreed to stay on at my preceptors clinic (2 of the 3 docs at the clinic recently retired and there are many patient that need to be seen) for a period of 6 months and am leaning heavily towards staying on at the clinic and starting a practice with a certain percentage of the leftover patients who are left without a family doc (due to the recent retirements), many of whom I am already familiar with from residency.  

Since there would only be 2 docs there, I have been told I would need to see around 30 patients/day for 3.5 days a week to make the clinic financially viable (my current preceptor owns the clinic).  

They would expect 30% of payments to go to overhead.  It is great EMR and I am familiar with the local community.  I would also have access if I wanted, to a lot of residential care patients to supplement my income.  I have also been told I would have a lot of input into how the clinic is run.  

I will note, I have an interest in addictions and have applied and been hired tentatively for 2 separate positions, each a half day a week which pays sessional unless I bill more than the sessional, then I can keep the difference (I assume I would be able to keep all this money, not have to pay it into the clinic).

From reading around it seems like 30% is on the lower end of competitive (though still typical).  My concern is that he would like to retain the majority of MOA's and office manager.  I personally don't see the need for an office manager with a two person clinic (I could be mistaken) and don't see why two physicians would require >2 MOA's.  Is it at all typical to have more MOA's than physicians in a practice?  Also, is the 30% overhead typically fixed based on your billings or are practices open to charging a fixed amount to sustain the practice (ie. so the more you bill the less your overhead percentage is).  

If anyone has any thoughts on what I have shared please feel free to post.  Thanks in advance.

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30% is the typical overhead amount in BC. Can't speak for other provinces. Some clinics have 30% for just clinic work, while stuff you bill outside of clinic hours or paperwork is usually at a lower overhead percentage, either 10% or even 0%. Some clinics have incentives like no overhead for the first 3 months, or only 20% to 25% overhead.

For a clinic with only two doctors, I don't see the need for an office manager. At the clinic I work at, it's three doctors including me, and one of our MOAs double as an office manager along with the doctor who owns the clinic. If you do a lot of procedures then an extra MOA can be helpful with one attending calls and patients, and another uploading labs or investigations into the EMR or getting things ready for procedures. You'll have to see what's better for you since everyone's practice differs slightly.

Some practices also have a fixed amount for overhead, and some clinics charge a percentage. You'll have to see what's more financially sound to you, especially on your vacation weeks. For me given that I work in Vancouver, percentage based is pretty much on par with a fixed cost. If you work in less expensive areas then a fixed cost might make more sense to you.

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You would need a bare minimum of 2 support staff in a 2-MD clinic.

You need someone to answer the phone, check-in people and book/cancel appointments. And you need someone to room people. I know that on evenings where I work with a 2nd MD, the nurse + receptionist really scrambles to keep up with us.

Ideally you need 3, because there's a lot of other stuff that happens and you'd need other people to handle referrals and all the other bullshit.


This is why 1-3 MD clinics are not common and not profitable unless there's no other way

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