The Tale of Two Surgeons: Optimizing PA-C in Private Practice

Once upon a time in a land far away, there were two surgeons. Just kidding—let's get right to the point.

I specialize in hiring for private practices. With over a decade of experience consulting for more than 300 hiring managers across healthcare, finance, tech, and non-profit sectors, I know one thing for certain:

Scared money does not make money.

So let's talk about how we can optimize a PA-C in private practice, shall we?

This week, I met with a potential client who illustrates this perfectly.

A surgeon who's cycled through three (3) PA-Cs in just 1.5 years.

Yes, you read that right—THREE.

He recruits his own hires and expects them to train themselves - how? I'm not sure.

The HR Manager mentioned he doesn't want to hire a new grad; he wants someone experienced.

And the pay range? A meager $115K - $130K outside of a major metro area.

Seriously?

Curious about potential bonuses, I asked if there was a large upside tied to RVUs or anything similar.

Nope. Nothing. Zero bonus structure. Maybe in year two.

When I inquired about clinic and OR expectations, it was revealed that the PA-C was expected to manage the clinic independently five times a week, even on OR days. The surgeon would leave while the PA-C ran the clinic.

And paid time off? Just 10 days.

This doctor may be a brilliant surgeon, but he's a terrible leader who clearly lacks business acumen.

You get what you pay for.

He's likely lost around $100,000 per PA-C due to turnover costs, which adds up to a staggering $300,000.

Ouch.

The HR Manager wanted to bring me on to recruit for the role, but I made it clear:

I would only work on this position if I could consult with the doctor to suggest a bonus structure, a competitive compensation package, and reset expectations.

Otherwise, I’d just be setting both him and the candidates up for failure.

He refused, insisting on handling his own recruiting because a $15K recruitment fee was too steep.

What he doesn't grasp is that hiring the right person the first time could yield him 30x to 50x that cost.

Womp, womp, womp.

More overhead wasted, physician burnout, OR gaps, clinic gaps, patient dissatisfaction, and the potential risk of other staff members working overtime to cover the gaps. The list goes on.

I can’t save everyone, and I certainly won’t teach doctors basic business strategy for free.

Now, Let’s Flip the Script

Not all doctors are like this. Take another surgeon that I work with.

He approached me with a goal of hiring two (2) PA-Cs to expand his clinical operations and build an ASC.

He wanted to get ahead of the game, ensuring they were trained and ready to go.

He hired me and agreed to pay $40K for finding the right candidates.

They set a competitive market salary with a structured bonus plan, offered over 3 weeks of PTO, additional CME days, and comprehensive benefits outlined from day one.

Of course, I ensured they saw ROI within a reasonable timeframe.

In just three weeks, we found, interviewed, and qualified 4-5 candidates.

Within five weeks, they hired two PA-Cs ahead of schedule, and their clinic opened on time.

They're thriving, and both are still happily employed.

The Difference?

Doctor numero 2 knew what he needed and recognized that while he’s a brilliant doctor, he’s not a recruiter.

He didn’t cut corners to save a few bucks.

He invested in his people because he understands that people are your profit centers.

Your patient care will only be as good as your providers.

Not all recruiting fees are “expensive”—only the ones that don’t yield ROI.

You can’t make money by being afraid to spend money.

If you are, it may be time to close up your private practice and head into the hospital system or academia for some stability.

If you want growth and a strong reputation as a trusted physician in your community, prove it by hiring like you mean it.

That’s the cold, hard truth.

And it’s a conversation I have daily with practices fearful of a $20K expense while ignoring $300,000 in turnover costs.

If you’re reading this and feeling offended, you might be part of the problem.

If it resonates with you, reach out! I’d love to help you win the first time around without pulling you away from patient care.

You’re a doctor—go be a doctor.

I’m a recruiter—let me recruit.

With love,

Maddie