Joining a practice and getting partnership

[DrSpine]

The hot topic always during job interviews with private practice is "Is there an opportunity for partnership?" I always hear stories about people not getting partnership in the end, or the offer they received was a total joke and not at all what they envisioned.

This might be good for new fellows to read. Who here joined a practice and obtained partnership in the end? Were you satisfied? Were you screwed? Did they go back on their word? Any positive or negative experiences? Statistically what have you seen?

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[sdnuser001]

Bump

 

[Doctodd]

it's rare.....why would anyone offer you half of what they built right out of fellowship? Would you?

My buddy from medical school is a plastic surgeon in West Palm Beach....still with his original job out of fellowship for past 15 years....he still isnt partner.

 

[Agast]

You’re more likely to be offered partnership in a group that already has partners, because they’ve done the math on how to structure a buy-in so that it’s mutually beneficial. Solo docs get caught up in their emotions of feeling like they built something special that is priceless and how dare you try to own a piece of that. The norm for surgical specialties is to offer partnership, pain doctors are weirdly petty about this.

 

[MitchLevi]

Partnership does not always benefit you.

 

[Ferrismonk]

When evaluating a partnership opportunity (assuming it's offered of course), I assume that gives you privy to the corporate financials including earnings and existing liabilities (including the details of other partner contracts), correct? If you were buying a business this seems like a no-brainer, but for whatever reason it seems like that's sometimes a stretch for partnership talks.

 

[sloh]

Partnership does not always benefit you.

Please elaborate!

 

[Dr. Ice]

Please elaborate!

Overhead overhead overhead. To be an equal partner in a surgical practice means you’re paying for their equipment. Pain docs don’t cost much and they know it. Unless contracts are solid, high volume, good payor mix, walking into partnership can be a bad idea. Take home after overhead expenses can be less than if you were just employed with fixed overhead.

Can’t speak for exclusive pain practices as that would mean everyone is on equal ground

 

[drusso]

There is no pathway to partnership. It has to be earned. The best way to reach it is to make yourself irreplaceable.

 

[SC Tian]

Also to make yourself profitable.

 

[Dr. Ice]

There is no pathway to partnership. It has to be earned. The best way to reach it is to make yourself irreplaceable.

Everyone is replaceable

 

[lobelsteve]

Everyone is replaceable

Nope. The system cannot replace those generating over 15000 wrvu/year. That is more than double what many of the other docs put out. YOu cannot swap out BobBarker for 2 avg pain docs.

 

[Ronin1]

Although this is true, often the overlords view MDs as fungible. Especially in a HOPD model

 

[Bostonspine]

You’re more likely to be offered partnership in a group that already has partners, because they’ve done the math on how to structure a buy-in so that it’s mutually beneficial. Solo docs get caught up in their emotions of feeling like they built something special that is priceless and how dare you try to own a piece of that. The norm for surgical specialties is to offer partnership, pain doctors are weirdly petty about this.

I think this is the key if the partnership is essential to you then take a job with an established path and objective metrics for partnership.... avoid the solo guy that burned out and only bringing someone on to share expenses and overhead while he maintains control and may consider partnership maybe perhaps someday. If the partnership is not an option and a "maybe we'll see" treat it like an employed gig where you're rewarded for performance with a reasonable contract. I would not do any type of sweat equity deal without a solid contract and understanding of the operating agreement governance ect.

 

[drusso]

Although this is true, often the overlords view MDs as fungible. Especially in a HOPD model

"They will never love you back."

 

[Dr. Ice]

Nope. The system cannot replace those generating over 15000 wrvu/year. That is more than double what many of the other docs put out. YOu cannot swap out BobBarker for 2 avg pain docs.

That is not a belief shared by most system employers. And the “system” can be anything from small to med to large private practice vs hopd. If you live in any “desirable” area, you are going to be viewed as replaceable. Dermatology is relevant because they cap opportunities…and I’m not trying to engage in the fellowship war, I’m just talking about available residency spots towards a specialty. It doesn’t help that pain medicine has opened its doors to just about every specialty. If you wanna talk about ground level ****, that’s it…

 

[mdo1738]

Nope. The system cannot replace those generating over 15000 wrvu/year. That is more than double what many of the other docs put out. YOu cannot swap out BobBarker for 2 avg pain docs.

Yep, as the guy trying to fill Bob’s prior shoes, the numbers there are remarkable.

 

[BobBarker]

About 19000. 4 days per week. 💪

 

[BobBarker]

Lol. @mdo1738 you’ve been misgendering me for a year so I would give you my opinion about my own job. 4D level strategery.

 

[mdo1738]

Lol. @mdo1738 you’ve been misgendering me for a year so I would give you my opinion about my own job. 4D level strategery.

Didn’t know it was you at the time, had changed some minor details to keep it less recognizable as clearly I never know who else is lurking 😂

 

[Status Sciaticus]

About 19000. 4 days per week. 💪

How busy are those 4 days?

 

[MitchLevi]

How busy are those 4 days?

His clinic is located on Deep Space 9, which as you surely know sits in Bajoran space in the alpha quadrant and therefore is a 26 hour day and affords him 22 hr clinic days. That's 88 hrs of pain management per week.

 

[BobBarker]

It was around 50 on clinic days. One OR/ procedure room day per week. 7am to 3:00. No lunch. Telemeds on “vacation”.

 

[BobBarker]

RVU numbers shot up due to the change in wrvu’s for office visits. Huge difference. You can make as much money seeing clinic patients as doing basic procedures in the hopd/employed model.

 

[RoloTomassi]

It was around 50 on clinic days. One OR/ procedure room day per week. 7am to 3:00. No lunch. Telemeds on “vacation”.

50 in 8h is 9.6 min/pt. Does that include notes, orders etc or do you take that home and 9.6 is just reviewing imagine, face to face time?

 

[BobBarker]

I did most of my notes and orders in the room.

 

[BobBarker]

Lots of telemeds included in that 50 also.

 

[MitchLevi]

One of the industry guys practicing on the West Coast told me he did 80-90 per day.

 

[Ducttape]

His clinic is located on Deep Space 9, which as you surely know sits in Bajoran space in the alpha quadrant and therefore is a 26 hour day and affords him 22 hr clinic days. That's 88 hrs of pain management per week.

i wonder how many people understood your references.

wonder what he did when DS9 was taken over by the Dominion.

 

[MitchLevi]

i wonder how many people understood your references.

wonder what he did when DS9 was taken over by the Dominion.

Used whatever needle was necessary depending on the form the Founder took.

 

[Agast]

i wonder how many people understood your references.

wonder what he did when DS9 was taken over by the Dominion.

 

[MitchLevi]

Love that guy

 

[runfastnow]

Other people watch DS9?!

 

[Status Sciaticus]

It was around 50 on clinic days. One OR/ procedure room day per week. 7am to 3:00. No lunch. Telemeds on “vacation”.

50 by yourself, or counting NP/PA pts?

 

[BobBarker]

By myself. This is not unusual in private practice around here. It is unusual for hospital employed. I had a NP that was seeing around 24/day also.

 

[drrosenrosen]

By myself. This is not unusual in private practice around here. It is unusual for hospital employed. I had a NP that was seeing around 24/day also.

I often see 30 in a day with a not very efficient office, and still have time where I'm just sitting at my desk. So I can see how you could get that many

 

[Pain Applicant1]

Solo docs get caught up in their emotions of feeling like they built something special that is priceless and how dare you try to own a piece of that.

As a solo doc in this situation, I would say this is a pretty accurate description.

Plus, most docs are poor business people so I don't want to share business decision-making with them. I'm happy to listen to their opinions, but ultimately I want the final say to rest with me.

 

[Pain Applicant1]

Everyone is replaceable

Agree here.

 

[SeniorWrangler]

I’ve seen plenty of people get frozen out of practices after a clash with the owner or the manager, especially in places where it’s easier to recruit replacements.

Partnership in some clinics seems to serve the same purpose as the fake rabbit that runs ahead of the greyhounds at the dog track.

 

[Dr. Ice]

I often see 30 in a day with a not very efficient office, and still have time where I'm just sitting at my desk. So I can see how you could get that many

You don’t need a full day to see 30

 

[GoBeers]

so safe to say, no one here has successfully joined a solo single specialty private practice and became partner?

 

[jsaul]

I am solo and was approached by a doc who wanted to join me. He basically cold called me and asked for a job. He also asked if I were to offer him a job would that include "partnership" I asked him what does "partnership mean to you"

He responding with some vague response about sharing 50/50 all the profits of the business

Then I told him what partnership meant to me. I stated that he would be responsible for running the payroll every two weeks, calculating, filing and paying state unemployment taxes every quarter, running the inventory and buying supplies, keeping up with the monthy state radiation safety requirements, paying the lease, paying the property taxes, paying the vendors , going to dr's offices to market, dealing with billing company to follow up the A/R and charges not collected from insurance companies for a myriad of reasons, paying the utilities, paying and reviewing the IT charges and IT equipment, dealing with HR and staffing issues, etc, etc ,etc

He never called me back...

 

[Chelsea FC]

I am solo and was approached by a doc who wanted to join me. He basically cold called me and asked for a job. He also asked if I were to offer him a job would that include "partnership" I asked him what does "partnership mean to you"

He responding with some vague response about sharing 50/50 all the profits of the business

Then I told him what partnership meant to me. I stated that he would be responsible for running the payroll every two weeks, calculating, filing and paying state unemployment taxes every quarter, running the inventory and buying supplies, keeping up with the monthy state radiation safety requirements, paying the lease, paying the property taxes, paying the vendors , going to dr's offices to market, dealing with billing company to follow up the A/R and charges not collected from insurance companies for a myriad of reasons, paying the utilities, paying and reviewing the IT charges and IT equipment, dealing with HR and staffing issues, etc, etc ,etc

He never called me back...

This,, why do people think they can just come in and get ownership when you took on all the risk, established all the systems and they gonna walk in and take the profits of all that hard work ? I can see why people get in NP/PA to fill the gap when it comes to workload

 

[drusso]

I am solo and was approached by a doc who wanted to join me. He basically cold called me and asked for a job. He also asked if I were to offer him a job would that include "partnership" I asked him what does "partnership mean to you"

He responding with some vague response about sharing 50/50 all the profits of the business

Then I told him what partnership meant to me. I stated that he would be responsible for running the payroll every two weeks, calculating, filing and paying state unemployment taxes every quarter, running the inventory and buying supplies, keeping up with the monthy state radiation safety requirements, paying the lease, paying the property taxes, paying the vendors , going to dr's offices to market, dealing with billing company to follow up the A/R and charges not collected from insurance companies for a myriad of reasons, paying the utilities, paying and reviewing the IT charges and IT equipment, dealing with HR and staffing issues, etc, etc ,etc

He never called me back...

Most people have no idea what being a partner-physician is really about.

 

[Baron Samedi]

I am solo and was approached by a doc who wanted to join me. He basically cold called me and asked for a job. He also asked if I were to offer him a job would that include "partnership" I asked him what does "partnership mean to you"

He responding with some vague response about sharing 50/50 all the profits of the business

Then I told him what partnership meant to me. I stated that he would be responsible for running the payroll every two weeks, calculating, filing and paying state unemployment taxes every quarter, running the inventory and buying supplies, keeping up with the monthy state radiation safety requirements, paying the lease, paying the property taxes, paying the vendors , going to dr's offices to market, dealing with billing company to follow up the A/R and charges not collected from insurance companies for a myriad of reasons, paying the utilities, paying and reviewing the IT charges and IT equipment, dealing with HR and staffing issues, etc, etc ,etc

He never called me back...

Mo' equity mo' problems.

 

[Pain Applicant1]

Well since it's slow in here...

I don't think private practice is what it's cracked up to be for everyone. Depends on your personality and what you value in life.

Same with housing. Foolish to make home ownership the American dream to strive for. It's not for everyone and can be more harmful than beneficial for many people.

 

[swamprat]

The biggest barrier to starting ones own private practice is getting on insurance panels. After that I think anyone reasonably personable who can hustle could do it. Thats my barrier - then again when u make ~6-700K a year does it really matter? I think it depends how ****ty of a deal you have as an associate. When you make big money you can invest in other things to accelerate your wealth while not having to deal with the staffing issues and other crap of being an owner.. but idk?

 

[Chelsea FC]

Well since it's slow in here...

I don't think private practice is what it's cracked up to be for everyone. Depends on your personality and what you value in life.

Same with housing. Foolish to make home ownership the American dream to strive for. It's not for everyone and can be more harmful than beneficial for many people.

Can you take more about this? Nothing is perfect, ownership seems like trading a lot of problems of empyrean work with other problems . But overall burn out from doctors seem to be linked to lack of autonomy and pay, both of which is normally higher in ownership

 

[Pain Applicant1]

Can you take more about this? Nothing is perfect, ownership seems like trading a lot of problems of empyrean work with other problems . But overall burn out from doctors seem to be linked to lack of autonomy and pay, both of which is normally higher in ownership

For my personality, I couldn't imagine myself working for someone else, especially at this point. I'm obsessed with doing my own labor and I enjoy risk. That's not for everyone. Some people like having a team to support them and don't want to deal with the mundane aspects of running a business. Dealing with insurance is the worst part of PP and they've pushed me to nearly quitting. I can understand how someone else would just have the hospital billing dept deal with it. Pay is good in PP but I think plenty of employed people in here make a lot more than I do. Pros and cons to both like everything else in life.

In PP, if the computer system goes down, you need to figure out what to do. Fluoro down, toilet not working, phone system down, pt complaints about billing... it can add up and the problems can be endless. It all comes down to you having to manage it. Even if you sub out the work you still have to find people you trust. That goes for all small businesses, not just a medical PP.

I value time with my wife and kids, autonomy, freedom, and however ridiculous it may sound being a farmer and manual laborer far more than money so even if I made half of hospital-employed docs I would still do PP. I couldn't have it any other way but not everyone feels that way.

@swamprat is right - anyone can start a PP if they want to. If you've come this far it's a hustle but can be done.

I'm not sure where you are in life but if you're considering PP vs employed consider writing the pros and cons down for each. Then go through them and see which direction your instinct pulls you in.

 

[Pain Applicant1]

Oh, and the lack of autonomy thing... I'm not sure if that is referring to an employed position. If I had to guess I would say it's referring to lack of autonomy in decision-making. You try to help the pt, go through the history, etc and the insurance denies your plan. You're not autonomous because ultimately the insurance dictates the care you can provide. That can be found across the board in all practice environments including PP.