Benefits of partnership track?

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Mehd School

Mehd School

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I'm a CA3 and am very grateful to have 3 job offers currently. But they are ... wildly different.

First is private practice, no partnership track. Straight $400k per year no real opportunity to make more. Home call but very busy OB so you get called in often. Staff seems happy and has been there a long time.

Second is academic tied to a major university system. Pay is $375k, in house call, but a ton of time off for "academic encounters". Which staff say is vacation time. Or moonlighting time. Most staff make around $500k with moonlighting. Twice as much time off as other jobs, but way more academic B.S. to deal with. Probably more risk too working with trainees. 2x the commute time compared to the other two jobs.

Final is private practice with partnership track. $325k first three years, then $500k as partner. Profit sharing into 401k, fully funding HSA, by far best benefits. But also work the hardest by far. In house call and you are busy.

I'm more or less split between the second and third. I'm fine being academic but never truly saw myself staying in academic medicine. They approached me. I do enjoy teaching those junior to me, but I also enjoy being the one driving the needle. I think I like driving the needle more than talking others through how to drive it.

My biggest question is, what are the main benefits of becoming partner? I've asked my mentors and none of them have been in a practice with a partnership. It seems in that job you make significantly less your first three years but more than make up for it afterwards. And while your salary says $325k, after all of the retirement money and other benefits the package is closer to $380.
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Mehd School said:
I'm a CA3 and am very grateful to have 3 job offers currently. But they are ... wildly different.

First is private practice, no partnership track. Straight $400k per year no real opportunity to make more. Home call but very busy OB so you get called in often. Staff seems happy and has been there a long time.

Second is academic tied to a major university system. Pay is $375k, in house call, but a ton of time off for "academic encounters". Which staff say is vacation time. Or moonlighting time. Most staff make around $500k with moonlighting. Twice as much time off as other jobs, but way more academic B.S. to deal with. Probably more risk too working with trainees. 2x the commute time compared to the other two jobs.

Final is private practice with partnership track. $325k first three years, then $500k as partner. Profit sharing into 401k, fully funding HSA, by far best benefits. But also work the hardest by far. In house call and you are busy.

I'm more or less split between the second and third. I'm fine being academic but never truly saw myself staying in academic medicine. They approached me. I do enjoy teaching those junior to me, but I also enjoy being the one driving the needle. I think I like driving the needle more than talking others through how to drive it.

My biggest question is, what are the main benefits of becoming partner? I've asked my mentors and none of them have been in a practice with a partnership. It seems in that job you make significantly less your first three years but more than make up for it afterwards. And while your salary says $325k, after all of the retirement money and other benefits the package is closer to $380.
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2. Publish or perish. If true at your shop. Your income is limited to whatever the department/school is set. (For the most part)

3. If you’re not at the table, you’re on the menu. You have “more” autonomy. (Relative to what, that’s the question.)

Also I would consider. Are you doing your own cases? Do you want to actually giving anesthesia? In house call is okay when young, can get a little tiring when you have a family. Driving is also fun to me, my last job was 45mi one way. It does add up.

Good luck.

Edit: that was my first attempt to answer. Let me add a little more, will sound little preachy, but hey you asked. And I wish I had more of these discussions while I was in residency. Also sounds like you’re from a academic place, without anyone to give you a come to Jesus talk.

Money is important, but not everything. When you enter a partnership, you’re essentially trading your time for a “buy in” in hope for a potential salary increase for x years down the road, potential 401k, profit sharing, even a pension……. It’s very difficult to quantify what’s consider income and “working hours” as you’ve seen from many of very spirted discussions here.

We all know what “a lot of money” is. I would say >750 a year. I also know what “a lot of hours” mean. Probably >60 hrs a week on average. But most jobs are not going to be those. Only you can really decide what’s really worth it to you.

Then there’s the question that you asked, what’s the benefit. Hopefully it’s getting a group of like minded physicians together and working towards a common goal. Sounds simple yet lofty at the same time. They should have your back, they should be cordial to one another, they should be fair, most importantly they should put the “group” interest above theirs. All these are common sense, but harder and harder to come by….. these are some of the conditions that I expect, but….

Moreover, these are not what most AMCs or corporate jobs “usually” provide. Lastly, AMCs/academic departments/schools can and will make decisions without physicians (your) inputs, same thing shouldn’t happen in a true “partnership.

I think that’s my time to get off my soapbox.

Good luck and almost congratulations to be done.
 
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If you want some form of control in a profession with very little control, go pp
 
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2.

Ownership is BS.

1 probably is fine for 1st job.

More than 50% new graduates change their first job in 2 years. Some as short as half a year. Why slave for a 3 year partner track which you very likely leave?
 
Partnership gives you the ability to self manage. Want to take on a new surgicenter or not? How much vacation are we going to take? Do we want to pick up OB or not? Do we want to work pre and post call or not? Do we like this candidate or not? Do we want to let old folks stop taking call or not? With partnership you have a say in the matter instead of having things dictated to you.
 
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narcotics999 said:
2.

Ownership is BS.

1 probably is fine for 1st job.

More than 50% new graduates change their first job in 2 years. Some as short as half a year. Why slave for a 3 year partner track which you very likely leave?
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Sometimes ownership is BS. More now than it used to be. But there are still some gems out there.
 
narcotics999 said:
2.

Ownership is BS.

1 probably is fine for 1st job.

More than 50% new graduates change their first job in 2 years. Some as short as half a year. Why slave for a 3 year partner track which you very likely leave?
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What’s the alternative? Join AMC, join hospital practice? Become the millennials that we come to despise?

That’s why most of the group now will give you a 80% of “partner” salary to start, but basically “observe” you for those 2 year…. Sure still making money off your back, but not the crazy 50%, 5 year partnership track that it used to be. Or people can think of it as, whoever can sell already sold. No groups has any real values anymore.
 
IMGASMD said:
3. If you’re not at the table, you’re on the menu. You have “more” autonomy. (Relative to what, that’s the question.)
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Felt this in my soul. It takes money, sacrifice to make money.

Keep in mind that I am just a year ahead of you OP, super optimistic and fresh out of residency.

A lot of these PP groups are borderline pyramid schemes but assuming you are willing --like?-- to do the work, no super partners i.e. fairly equitable governance, competent and forward thinking group management as well as good sustainable relationships with the hospitals I think partnership track is the way to go.

A lot of assumptions I know, but the upside could translate to actual millions over 20-30 years.

I am currently paying the equivalent of 5% of my income for 2 years to get to partner. I honestly think it's the best move. That said, I thoroughly enjoy my practice, like all my partners and about 85% of the surgeons. I also believe in the management.

I think I would start looking at locums instead of straight PP no partnership track.

The assumption that academic practices aren't taking their cut of your $ relies on opacity. Anesthesiologists generate revenue in these academic places and subsidize all the goofy bs that happens. At my residency program, the block man in our ASC generated the most RVUs several years in a row.

Maybe I'm wrong or the whole bottom falls out of the health care market. After going multiple hundreds of thousands of debt why stop betting on myself now? Someone is going to say 'sunken cost' fallacy, right? Effectively nothing has changed, though. I am still doing what I paid -- in money and good good years -- to do.
 
Mehd School said:
I'm a CA3 and am very grateful to have 3 job offers currently. But they are ... wildly different.

First is private practice, no partnership track. Straight $400k per year no real opportunity to make more. Home call but very busy OB so you get called in often. Staff seems happy and has been there a long time.

Second is academic tied to a major university system. Pay is $375k, in house call, but a ton of time off for "academic encounters". Which staff say is vacation time. Or moonlighting time. Most staff make around $500k with moonlighting. Twice as much time off as other jobs, but way more academic B.S. to deal with. Probably more risk too working with trainees. 2x the commute time compared to the other two jobs.

Final is private practice with partnership track. $325k first three years, then $500k as partner. Profit sharing into 401k, fully funding HSA, by far best benefits. But also work the hardest by far. In house call and you are busy.

I'm more or less split between the second and third. I'm fine being academic but never truly saw myself staying in academic medicine. They approached me. I do enjoy teaching those junior to me, but I also enjoy being the one driving the needle. I think I like driving the needle more than talking others through how to drive it.

My biggest question is, what are the main benefits of becoming partner? I've asked my mentors and none of them have been in a practice with a partnership. It seems in that job you make significantly less your first three years but more than make up for it afterwards. And while your salary says $325k, after all of the retirement money and other benefits the package is closer to $380.
Click to expand...

It’s hard to evaluate these jobs against each other without a better understanding of workload, call burden, and time off.

Here are my thoughts with the above in mind:

1.) No. You’re going to have a tiered structure job with partners funding their material addictions with money made from your hard work. They will always be partners and you will always be their employee. There is no room for growth here. Dead end job.

2.) Sounds decent for academics if that’s your thing. Might not be a bad gig to get your feet wet for a few years if you are not 100% sure this is the place you want to live.

3.) 500k seems low for a hard-working busy private practice with in-house call.

I would eliminate #1 right away. This comes down to job 2 or 3 and a lot depends upon the details and what you are looking for. Number 3 could be a good job, but I would have A LOT of questions before I signed up for a 3 year track. On the plus side, $375k is not horrible salary for a partnership track if it’s legit and workload is fair.
 
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Are you geographically limited?

If not, you could keep looking for #4 ... plenty of time to find something better before July.

I would never accept a 3 year partner track but I'll concede that people who want to break into "desirable" areas sometimes have no other option.

Given those three choices, I'd take the employed position at #1 and start looking for a better job now. $400K employed is an OK place to start a career.
 
Thanks to all that have responded. Extremely helpful.

I am geographically limited, and no practices in my region are MD only.
 
Silo004 said:
A lot of these PP groups are borderline pyramid schemes
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Not an uncommon sentiment around here however almost all the private practices that I am familiar with in my state are absolutely equitable. the ones that aren't at least let you know you will be an employee drone for the duration. A lot of the "pyramid schemes" sold out long ago.
 
Arch Guillotti said:
Ownership and a vested interest in the practice.
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nimbus said:
Partnership gives you the ability to self manage. Want to take on a new surgicenter or not? How much vacation are we going to take? Do we want to pick up OB or not? Do we want to work pre and post call or not? Do we like this candidate or not? Do we want to let old folks stop taking call or not? With partnership you have a say in the matter instead of having things dictated to you.
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Control over your schedule, who and what types of cases you cover. Plus the giant bonus checks at the end of the year.


Plus keeping the decision entirely yours whether or not you want to help out with random pandemic nonsense.
 
SnapperRocks said:
Control over your schedule, who and what types of cases you cover. Plus the giant bonus checks at the end of the year.


Plus keeping the decision entirely yours whether or not you want to help out with random pandemic nonsense.
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Well……no bonus checks in my group but we have a hand in our own fate.
 
So something to consider with job #2 is your ability to stay hands on/do your own cases, especially as someone fresh out of residency.

Personally I went the private practice/partnership route. The last couple years with Covid and the staffing shortages have been a nightmare and it has not been as lucrative as I hoped, but that is the risk you take. You also need to toe the line with surgeons/administrators carefully because you may be one RFP away from losing your contract, but if your group has a history of providing excellent anesthesia care and is perceived well by those groups you have some decent say in your practice. Theoretically there is an equity component but I think the days of 7 figure AMC buy-outs are limited unless you are part of a very lucrative practice with great commercial pay mix.

If you would rather “clock in, clock out” and not get stuck doing admin tasks/research/recruiting work/credentialing on your post call days or evenings off, go with option 1. Option 1 is probably the easiest job to walk away from if you don’t love it.
 
How is the retirement for the academic job? Often they have a good match - where I did residency it was 2:1 and they had a 457 without a match The catch was that you had to put in 3 years for it to be vested. Don’t want to leave a lot of money on the table if you end up leaving early. Additionally, if the commute is double that’s a lot of extra time you’re not doing **** you want to do.

I spent 3 years at a gig like #1. The fact the group takes home call says a lot. Sure there are nights you will have to go back in but there must be enough that you don’t to make taking home call feasible. In house sucks. There are other retirement vehicles that I used if you are disciplined - HSA, back door Roth, taxable brokerage.
 
You are about to make the most important decision of your career: Picking your first job.
Academia provides stability and immunity against all the other people who pretend to be doctors and want to take your job. On the other hand if you start your career as an academic anesthesiologist it might be hard to transition later to private practice.
Knowing what I know now I would pick the academic job and stick with it to the end of my career.
 
Planktonmd said:
You are about to make the most important decision of your career: Picking your first job.
Academia provides stability and immunity against all the other people who pretend to be doctors and want to take your job. On the other hand if you start your career as an academic anesthesiologist it might be hard to transition later to private practice.
Knowing what I know now I would pick the academic job and stick with it to the end of my career.
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Reading back on old posts, the things that got me are ildestriero thinking about pp ten years ago but deciding against it and dodging an amc bullet, milmd building his group then losing it and jet getting his contract stolen from him. The best is probably to get a nice stable job and keep it vs make hay in bfe then move to where you want.
 
Not to derail this thread too much, but what $ value would you guys put on the ability to take home call? Assuming two PP gigs are exactly equal, but one has home call and one stays in house, what pay differential would you need to do the in house gig?
 
Lookingforlolz said:
Not to derail this thread too much, but what $ value would you guys put on the ability to take home call? Assuming two PP gigs are exactly equal, but one has home call and one stays in house, what pay differential would you need to do the in house gig?
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Consider how nice or ****ty the call rooms are.

Worked in a place with 24H in house call where the call room was literally a converted storage closet in a high traffic, noisy area. Twin bed with ****ty mattress, flat pillows. No window. Door didnt lock.

If you happened to have some down time, it wasnt really a reasonable place that you could retreat to for a respite because it was so noisy.
 
Lookingforlolz said:
Not to derail this thread too much, but what $ value would you guys put on the ability to take home call? Assuming two PP gigs are exactly equal, but one has home call and one stays in house, what pay differential would you need to do the in house gig?
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$50K minimum. For others it may be even more money. This is an individual opinion as no 2 PP gigs are ever exactly the same.
 
Lookingforlolz said:
Not to derail this thread too much, but what $ value would you guys put on the ability to take home call? Assuming two PP gigs are exactly equal, but one has home call and one stays in house, what pay differential would you need to do the in house gig?
Click to expand...
I’d imagine they probably aren’t very equal when it comes to call. If one gig is home call, they are likely not very busy at night or get called in <50% of the time. In house call is usually required if you are busy most nights.
 
Planktonmd said:
Academia provides stability and immunity against all the other people who pretend to be doctors and want to take your job.
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This has not been my experience. Many top academic leaders absolutely disdain clinical anesthesia and view faculty as above it, meaning good clinicians are often not valued or respected. Combine this with CRNAs who wanted to build their own ‘academic’ reputations at local nursing schools, throw in an SRNA program, all with the approval of the leadership who is 5-10 years from retirement anyway and you’ll find yourself spending all day with people who want to take your job.

I’ll agree the stability is definitely a plus, especially the last couple years. But this ‘stability’ would often be consider equivalent to the worst case scenario at a good private practice with a currently uncertain future.
 
Volatile said:
I’d imagine they probably aren’t very equal when it comes to call. If one gig is home call, they are likely not very busy at night or get called in <50% of the time. In house call is usually required if you are busy most nights.
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True. The real world options I am considering aren’t equal as far as call burden goes. Just was curious if it somehow were apples to apples, how much people value sleeping in their own bed
 
GassYous said:
Home call is awesome. Eat my own food, in my own bed, phone on and sometimes I sleep like a baby. Staying in house to wait for a case to start sucks a fat one.
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Just to add a different opinion, I used to take home call and now I have in house call. I hate home call, I hate the idea of getting a page at 2 am, having to get up, rush around, race in to be there in 30 min or whatever. Try not to fall asleep at the wheel, don’t wake everyone up, etc. It got so bad that I would just sleep in the hospital. YMMV.
The one time I didn’t mind home call was when I was in the .mil living 5 minutes away.
I would probably take job #2. But what is the % time doing your own cases, 1:2, 1:3, 1:4 in all of those jobs? There’s no free lunch.
Also just to add to the horror of #1, a group with 4 partners recently sold out for >$8M each. The fleet of CRNAs and “fairly” compensated non partners who built the practice over a decade or so got a nice shïte sandwich and a new private equity boss.
 
IlDestriero said:
Just to add a different opinion, I used to take home call and now I have in house call. I hate home call, I hate the idea of getting a page at 2 am, having to get up, rush around, race in to be there in 30 min or whatever. Try not to fall asleep at the wheel, don’t wake everyone up, etc. It got so bad that I would just sleep in the hospital. YMMV.
The one time I didn’t mind home call was when I was in the .mil living 5 minutes away.
I would probably take job #2. But what is the % time doing your own cases, 1:2, 1:3, 1:4 in all of those jobs? There’s no free lunch.
Also just to add to the horror of #1, a group with 4 partners recently sold out for >$8M each. The fleet of CRNAs and “fairly” compensated non partners who built the practice over a decade or so got a nice shïte sandwich and a new private equity boss.
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Encountered two “academic” job recently. Neither have the opportunity to do own cases. So that’s another YMMV.

One is the “private” division of an academic group. Basically covering a local smaller hospital and will have the clinical instructor or whatever designation for an ivory tower. You’re 1:3 CRNA all day every day. They don’t even have any residents yet from the ivory tower. Eventually, they say. They do train SRNA too….

The other one, 1:2 residents/crna. No opportunities for own cases, even in cardiac. I don’t think they train SRNA, which may be a blessing.

I don’t know if these are the norm or the outliers. Even in academics there can be a lot of variation.
 
Lookingforlolz said:
Not to derail this thread too much, but what $ value would you guys put on the ability to take home call? Assuming two PP gigs are exactly equal, but one has home call and one stays in house, what pay differential would you need to do the in house gig?
Click to expand...


We used to take home call. Then when we transitioned to Level 1 trauma, we started taking in-house call with a healthy stipend. I think most people agreed that was good for us and call became much more desirable. Before we would have trouble giving away calls. Now they are taken within minutes of an email blast going out. I suppose the best option would be home call with a good stipend.
 
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nimbus said:
We used to take home call. Then when we transitioned to Level 1 trauma, we started taking in-house call with a healthy stipend. I think most people everyone agreed that was good for us and call became much more desirable. Before we would have trouble giving away calls. Now they are taken within minutes of an email blast going out. I suppose the best option would be home call with a good stipend.
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Out of curiosity - how much is that call worth?
 
What is ultimately the difference between W2 and 1099?

Say an employee job pays 600K W2 with good, inexpensive insurance and all that, other job as partner is 600K 1099 (insurance on open market vs through group etc).

Just curious if anyone can reasonable estimate three differences financially?
 
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I have yet to find a hospital call room with Frette sheets and a Tempurpedic matress. Forget about Calida, Hanro or Zimmerli pajamas. 😉
 
Drwine said:
I have yet to find a hospital call room with Frette sheets and a Tempurpedic matress. Forget about Calida, Hanro or Zimmerli pajamas. 😉
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The docs bought a decent mattress in my practice.
 
abolt18 said:
What is ultimately the difference between W2 and 1099?

Say an employee job pays 600K W2 with good, inexpensive insurance and all that, other job as partner is 600K 1099 (insurance on open market vs through group etc).

Just curious if anyone can reasonable estimate three differences financially?
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I’ve been a W2 from residency to present date. Getting a group rate for any insurance is better than being an individual making a purchase, but that is not dependent on W2 vs 1099, per se.

If the 1099 is your own corporation, you can hire your spouse and pay them a salary, fill their retirement account (possibly a SEP) and allow the salary to count for SS credit.
You’ll still have to pay their taxes, SS, fed, state, local, etc.
 
D P356 said:
I’ve been a W2 from residency to present date. Getting a group rate for any insurance is better than being an individual making a purchase, but that is not dependent on W2 vs 1099, per se.

If the 1099 is your own corporation, you can hire your spouse and pay them a salary, fill their retirement account (possibly a SEP) and allow the salary to count for SS credit.
You’ll still have to pay their taxes, SS, fed, state, local, etc.
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What possible legit, audit-proof "job" could a 1099 anesthesiologist hire a spouse to do?

Are we just wink-winkng this obvious BS away and hoping we don't get audited?
 
pgg said:
What possible legit, audit-proof "job" could a 1099 anesthesiologist hire a spouse to do?

Are we just wink-winkng this obvious BS away and hoping we don't get audited?
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I’ve not been 1099 and had to navigate that. Plus if I told my wife that I was officially her boss, I don’t think that would go well for me.

Credentialing, licensure, “consultant,”Corporate manager, assistant? I don’t know. I’d ask a CPA, and then a 2nd CPA.
 
D P356 said:
I’ve been a W2 from residency to present date. Getting a group rate for any insurance is better than being an individual making a purchase, but that is not dependent on W2 vs 1099, per se.

If the 1099 is your own corporation, you can hire your spouse and pay them a salary, fill their retirement account (possibly a SEP) and allow the salary to count for SS credit.
You’ll still have to pay their taxes, SS, fed, state, local, etc.
Click to expand...

I guess that is the original question…how much are the tax loophole gymnastics really worth? My sense with many jobs that are 1099 is that the employer is using it as a way skirt providing benefits and avoid payroll taxes. I’ve seen jobs that advertise that they can pay you W2 or 1099…which makes no sense to me unless they are giving you the freedom to truly be a contractor.

As to the original question…I would say that 600k W2 with benefits is a better job than 600k 1099. There are a lot of details missing to truly make an assessment, but that is my baseline assumption before evaluating the details. The 1099 job could be a better job if you truly have independent contractor status…for 600k, I do X number of shifts and Y number of calls per year.
 
GravelRider said:
I guess that is the original question…how much are the tax loophole gymnastics really worth? My sense with many jobs that are 1099 is that the employer is using it as a way skirt providing benefits and avoid payroll taxes. I’ve seen jobs that advertise that they can pay you W2 or 1099…which makes no sense to me unless they are giving you the freedom to truly be a contractor.

As to the original question…I would say that 600k W2 with benefits is a better job than 600k 1099. There are a lot of details missing to truly make an assessment, but that is my baseline assumption before evaluating the details. The 1099 job could be a better job if you truly have independent contractor status…for 600k, I do X number of shifts and Y number of calls per year.
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Depends on the monetary value of the benefits of the W2 job plus the employer portion of Social security/Medicare tax. Sometimes this can add up to ~100k in value
 
GravelRider said:
I guess that is the original question…how much are the tax loophole gymnastics really worth? My sense with many jobs that are 1099 is that the employer is using it as a way skirt providing benefits and avoid payroll taxes. I’ve seen jobs that advertise that they can pay you W2 or 1099…which makes no sense to me unless they are giving you the freedom to truly be a contractor.

As to the original question…I would say that 600k W2 with benefits is a better job than 600k 1099. There are a lot of details missing to truly make an assessment, but that is my baseline assumption before evaluating the details. The 1099 job could be a better job if you truly have independent contractor status…for 600k, I do X number of shifts and Y number of calls per year.
Click to expand...

I know people who hire their spouse as 'secretary' to do bookkeeping, keep track of income/expenses. Of course this is all BS to decrease tax burden and save more for retirement. This is also the same people who are very aggressive with their deductions...vacations, meals, TVs/laptops, etc... Would this be a problem if/when IRS audit you? their CPA seems to be ok with it. For me, idk if its worth it do all this tax loophole gymnastic. Same income of W2+benefits and 1099...I think i'll take the W2 too. How about if 500k W2 with good benefits (healthcare/malpractice/paid vacation/pension) vs. 600k 1099? That’s more difficult but I think I still take the W2
 
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