This position would be joining a group of 6 experienced GIs. They have a great mix of providers with varying levels of experience. Dr. Greg Borak & Dr. Branden Hunter are the most experienced providers, both in their early 50s. Drs. Wiggins and Tharpe are in their mid-40s and Drs. Mansour and Perry are both new grads in their early 30s.
The group is predominantly a general GI group that focuses on Scopes & EGDs (98% of cases are these two procedures) though Dr. Perry who started with the group in 2023 is an Advanced GI trained provider and likes to focus on higher acuity cases. For any patients that have excessively high BMI, comorbidities or are high risk the group will do those cases at the hospital where they have Anesthesiologists and additional support staff.
Overall, this is a very busy and productive group that works extremely efficiently. The ASC, in 2023, did 8,373 procedures with just two exam rooms. 72% of those cases are Colonoscopies, and 25% are EGDs so they stick to the basics and have a completely full schedule. They are at the beginning stages of expanding the ASC from 2 rooms to 4 and anticipate that volume growing to 15,000 cases per year.
The ASC has Fuji Scopes, and uses G-Gastro, which is a ModMed product, is the EMR used in the clinics and the ASC. This is also linked up to the hospitals, so patient records can easily be shared and discussed.
The basic schedule is going to be Monday – Friday, 8am – 5pm. There comes a lot of flexibility within that schedule though. According to Dr. Mansour “If I'm working past five, something is wrong. We knock it off early on Fridays, were usually out by three.”
Dr. Hunter explained as “Most days, my wife and kids are on the neighborhood playground before five o'clock. You know, ever since I started practicing here, I've coached one of my kids in some facet or another, just the whole time, all three boys. I'm now in seventh grade basketball. So, I'd say the flexibility is great.”
He continued; “like if somebody wants to go knock out early on a Thursday to go to their kid’s baseball game. They don't schedule anything, and they're gone. Nobody cares. Nobody. Nobody cares. Nobody's nobody even knows. As a partner, you can do what you want when you want, when you're employed, and not a partner or you don't get those benefits and are expected to work full-time.”
Drs. Wiggins, Hunter and Perry are all based out of Candler Hospital and do a lot of their clinic and outpatient procedures there. Drs. Borak, Tharpe & Mansour are based out of St. Joseph’s hospital and do a lot of their clinic and outpatient procedures there. Dr. Perry (Advanced GI) does one full day in the ASC seeing patients and scoping but the other 4 days he is at the Hospital. Everyone gets 2-3 days (4-6 half days) in the ASC doing procedures, per week. Most of the time they have 2 providers doing procedures in the morning, then they go to clinic in the afternoon and two other providers will do clinic in the morning and procedures in the afternoon and one provider is on call.
The ASC’s turnover time in the procedure rooms is less than 30 minutes, and the facility averaged 34 procedures a day last year, between two rooms. They average 710 cases per month and operate with a 98.5% efficiency rate. Each provider is given one room to scope in, so they will normally have clinic patients as well, to see while the room is being flipped.
The partnership component will start at the end of the first 2 years. This will be a fully equity partnership with equal distribution of all funds. They don’t have varying levels of Partners that get a higher percentage or more “shares,” everyone is treated as an equal. All physicians in the group are W2 employees, no one is 1099 or runs things through an LLC. Partnership distributions are paid out on a K-2 (Partners share of Income).
Call is going to be 1:7 and is broken down between daytime and night call. Day time calls are now taken 1 week at a time which is a new development as of this year, but so far, it’s going very well. The call is only for unassigned and GI Consultants patients and is very light in general. Dr. Mansour explained in this way:
“Did I have to go in, maybe twice last year. Most times I am on call, I don’t even realize it. For example, 2-weeks ago I was on call, and we went to Luke Bryan concert that started at 7pm, I was obviously not drinking but I was there. We get called in so infrequently, we just live our lives.”
Most of the EM providers will just send a text message letting us know they put someone on the schedule for tomorrow and we will just see them then. Dr. Hunter said, regarding call:
“I mean, it’s nothing, they don’t call unless it's a dire emergency. I can count on one hand, the number of nights during the week that I must go in for a call each year.”
Daytime call:
The on-call provider is responsible for covering two hospitals, Candler, and St. Josephs, which are 6 miles apart. You can start your day anytime you would like, and the daytime call provider will have an average daily census of 5-10, between the two hospitals and can see patients whenever they want. Most of the GIs will have a partially full clinic day or even schedule outpatient/ASC procedures when they are on call, and round on patient’s 1st thing in the morning, then spend the rest of the day seeing clinic patients. If someone presents in the ED during the day, they will get a call from the EM or Hospitalist providers, then round on them before the day is over.
Night Call:
Night call will be a true 1:7 weekday and weekend call. Night call starts at 5:30pm and goes till 7am
Advanced GI Call:
The group is responsible for ERCP & EUS calls for the group’s patients. Drs. Perry, Borak, and Hunter split this and take the call evenly so it's just. When they are not on call, they essentially are on back-up call for advanced cases and the ED will call them directly.
Call Pay:
The hospitals pay the group a flat rate per year for calls, so it's equally distributed amongst all the providers in the group at the end of the year.
I spent time with Dr. William Mansour who has been with the group for 2.5 years and is the newest partner. I asked him why he decided on this group when he has so many options.
“I interviewed only in areas where my family is, I'm from Florida. I interviewed all over including here in Savannah; LaGrange, GA; Auburn, Alabama, and then Tuscaloosa. And after interviewing here I was like; I just like to the office and people more. I walked out and I was like, there's no point to me going anymore interviews. I would have been the southeast and really, it was really Georgia, Alabama. Just because I hated Florida. I trained in Florida, and I was like, I got to get out of Florida. And my wife is from Florida. So, she kind of wanted to stay kind of around the area too.
So, it's easy from that aspect. It's kind of like that, like, do I want to do hospital employed or private equity employed like United Digestive or private practice, and I honestly didn't have a preference coming out of fellowship. I didn't know enough about any of it to know if it really mattered. So, I interviewed all over, including with gastro health and decided that private practice was the best for me. It came down to Gastro Consultants and another group in Tuscaloosa. And it just it just I just enjoyed the people and model of this group more than Tuscaloosa.
They actually offered a much higher base, like $575K plus, like every other Friday off and potential for RVU production, so you could potentially make $600K. And my dad's like, you're leaving like $600,000 on the table for two years until I can become a partner and he was like, that makes no sense, lol. In the end, I don't want to do something for two years and later. Like, you know, like when I have my patient population, I don't want to just pick up and leave them all but um, but yeah, that's kind of you know, that's what I thought about and I thought hard. In the end it came down to, my wife and I would rather live in Savannah and build a career here, and the long-term earning potential was incredible, so it made sense to us.”
The 1st 2-Years
When new providers start, the team wants them to ramp up slowly, so they give them a small patient panel. It starts off with all the groups overflowing to get the wait time reduced and make sure patients can all be seen. Dr. Mansour said “Once that is caught up the group tells providers to do as much as you want as little as you want, starting off like we don't want you to feel overwhelmed like most ASCs. So, I started doing like 6-9 cases a day, but quickly I was bored so I was like, okay, can I do more?
And Greg was like, yeah, do whatever you want to do. I don't care like we don't care starting off for these first like months like you know, just build your practice. You know, so I mean, it was not a full clinic, but I think you were doing 30 minute slots at the time instead of 15 minute slots and then when I felt comfortable with that, and then we moved but it was like full and then Greg he is so busy that his overflows gets to goes to me it still does.
I mean, in terms of comfort level and support because I came right out of fellowship. You know, there's any question like, obviously there's two rooms downstairs and I can come out anytime to grab any partner, like hey, I need your help. Like, what is this? You know, coming right out of fellowship just to get a second pair of eyes to make sure was impressive.
Now with Dr. Perry (Advanced GI), which we didn't have before, which was kind of frustrating starting with I was I'd have to be like, alright, well, let me send this to MUSC in Charleston or Mayo Clinic in Jacksonville and now in Dr. Perry I just send complex cases to him, and he is happy to do them all at the hospital here.
Still to this day, I can always ask them for help, and it just makes it a very easy, you know, transition, we don't have our attending us anymore. So, that was very easy, and everyone's as you can tell, very approachable & nice and so it was like you know, not very hard to transition.”
Director of Marketing, Carolyn Woodberry, works on marketing every Wednesday. She takes new providers around the community to talk and collaborate with all the primary care physicians. She is great and has been with the group for 35-years, so she knows everyone in Savannah and helps build your referral base quickly.
In addition to the two hospitals and ASC in Savannah, Gastro Consultants also has a presence at an outpatient surgical hospital in Pooler, GA which is 10 miles west of downtown Savannah. Two to Three days a week they have a provider go out to the Pooler location which has an amazing clinic with 4 exam rooms and a full staff. There is no GI presence in this area, and you would have to travel another 45 minutes to find the next GI, so this is an untapped market.
All patients seen in Pooler will be coming into Savannah for procedures, so this is an easy way to really ramp up the volume, especially for a new provider.
A long-term plan would be to have a permanent presence out in Pooler, if that does come to fruition, Gastro Consultants would build an offsite clinic with more exam rooms and full office space. They would also likely firm up their relationship with Candler County Hospital, which is an independent rural hospital in Metter, GA. They are currently working on PSA with them that will pay providers on RVU basis. This would be extremely lucrative for the group and the physician as Candler County Hospital would be paying for all the expenses and overhead, but the group would get an outstanding RVU rate. In addition to Candler County Hospital, there are 2 additional Rural Hospitals that PSAs could be established at, all under a similar RVU model.
If that plan were to work out, the provider would be in Pooler two or three days per week and the remaining days at outlying hospitals. This physician would still be a full partner in the group, get all the same ancillary income from the ASC and clinics, but would be making significant more money from personal production, due to the RVU structure.