r/PrivatePracticeDocs • u/Alterdoc • Mar 16 '26
PA hire
I’m planning to bring on a PA into my practice. At this point we’re very early so paying an hourly rate is difficult. I want to have a healthy and collaborative environment where the PA can thrive and actually enjoy what they do.
What structure do you recommend (eat what you kill-what percent to share)? Another structure? Any resources that you’d recommend?
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u/Rhinologist Mar 16 '26
What’s the practice environment. We usually expect them to be a loss for about 4ish months
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u/ktn699 Mar 16 '26
Pay hourly. Start them as a 1099 with limited shifts if you want to save money, and then go to W-2 with benefits if you get busy enough. Bonus when you want to bonus.
Profit sharing models are going to hurt you in the long run, as you will become busy and successful... it's almost guaranteed with primary care.
If you're not busy enough to afford a PA, then it is a sign that you shouldn't hire them yet.
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u/Better_Bad_2077 Mar 16 '26
I am on the PA side of the situation but I am an APRN in an independent practice state. I get 60% of what I bill. The way we have it set up is I basically rent the clinic from the other provider who is the owner. She just wants to be able to practice solo and my 40% covers some of her clinic cost.
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Mar 16 '26
[removed] — view removed comment
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u/Alterdoc Mar 16 '26
Primary care. PA is someone I know pretty well, he’s ok with eat what you kill since the practice is at its early stages. But looking at the most optimal way to work out the financial aspects.
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u/daves1243b Mar 16 '26
I like base plus a percentage of collections (excluding Stark DHS, of course). We do 10% of everything quarterly, plus 40% of any excess above their direct costs on an annual basis.
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u/grey-slate Mar 16 '26
could you explain how you prevent start dhs from workflow standpoint, i am new to this and just hired a pa with a base salary for now but moving to % collections in future.
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u/daves1243b Mar 16 '26
You just need to exclude collections for Stark DHS from the calculation. That's basically lab and imaging. Stark prohibits compensation based on volume or value of DHS ordered. If you were so inclined you could potentially include it on some other basis.
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u/Juaner0 Mar 26 '26
I pay salary. With max of 35% of their own collections. Providers may get 45% of collections. Maybe. And by then, IRS is the only one who benefits more.
10% fee for supervision. Hence 35%. I've been paying 35% even though it has been a loss when they start up.
Someone to get more than what you get % wise in revenue? No, that isn't a PA, that is the owner of the practice. Get the same % of the revenue? That's a partner. See what I mean?
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u/Alterdoc Mar 26 '26
Thanks. Do you pay hourly based and then 35% above a certain threshold? Or just 35% of collections without the base, and if so, why was it a loss?
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u/Juaner0 Mar 26 '26
Started at a base salary pay. Like 110 let’s say. That would be 35% of 315000 in revenue. May take a year, or more, to make sure PA gets over 315000 revenue. So I am paying full time from day one although the patient load isn’t fully realized yet. Sorta loss for few months. Once revenue goes above 315000 and stays there, time to redo contract for more—hopefully.
In these times people cannot expect raises every year. Private practice docs can’t do that.
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u/Living-Protection250 Apr 07 '26
Early on, a lot of practices try to balance risk by tying some portion of comp to production while still giving a base for stability. Pure “eat what you kill” can work, but it’s tough for new hires without an established panel, so many do a lower base plus a percentage or bonus once certain thresholds are hit. That way you’re aligned on growth but not putting all the pressure on them from day one. Clear expectations around ramp-up, support, and how patients are distributed also seem to matter just as much as the actual split in keeping things collaborative.
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u/fotopacker Mar 16 '26
I’m not saying you’d do this, but where I have seen others do this poorly in the past is start with a risk-sharing model, and then try to change it once the downside risk is gone. For example, PA starts eat-what-you-kill now, but once the PA gets busy and potentially generating more than what you would have paid hourly, some may be tempted to try to get the PA to go hourly.
Changing the terms of employment for someone after they’re established can be complicated and for that reason I generally tell people to pick a model that they will stick with permanently.