As has already been alluded to, the details of the "buy-in" are infinitely more important than the presence or absence of a "buy-in." Some groups are shady, some are honest. It's up to you and the connections you've hopefully made to figure out who you're dealing with. If it's a quality group offering a legit partner track position, then everything should be explicitly laid out in the contract:
-Duration of track
-Pay during track
-What happens if group is sold
-What are provisions for termination (with/without cause)
-Malpractice coverage
They should also be up front with you with regards to how many people have started the track and failed to become partner. They should provide contact info for people who have left the group. You should know how many current members are partners and if all partners are equal. Essentially, nothing should be taken on good faith alone, and nothing should be left up to nebulous "maybe you'll make partner at the end of the track if we feel like it and you've shown adequate fellatio skills BS"
I wouldn't let the presence of a track scare you off if it's the right group in the right locale doing the right kind of work with the right kind of colleagues. Think of a PP group like an exclusive club and the buy-in is the membership fee. Is belonging to that club worth the membership fee? Is this really a club you want to be a part of, or would you rather be part of crappier club with no membership. You wanna play at Augusta or the local public course. Is the fraternity worth the rushing/hazing. All these are personal questions and a lot probably depends on what your options are.
From the group's view-point, the track is a way to protect and insulate your group. It provides for a vetting period for them to see if a new hire is a good clinician, a good human, and a good fit (I agree this shouldn't take more than a year and excessively long tracks are abusive). A quality group also wants stability and not a revolving door of people just looking to come through, make a few bucks, and move on. People are more likely to stay if they are financially/temporally invested with the group.
As to this whole business of exclusive contracts being the Devil's work, have you ever worked at a facility without an exclusive contract for anesthesia?? My first gig was like that. Open staffing with 2 groups splitting the anesthesia department. Not all it's cracked up to be. Talk about herding cats. Talk about competition for cases (despite an exceedingly fair scheduling/reimbursement system). Talk about not being able to get rid of a problem anesthesiologist (both clinically and interpersonally) unless they do something so heinous as to actually get kicked off the medical staff which is nearly impossible. Talk about an inefficient system since taking over cases gets messy from a billing standpoint. Talk about not being able to negotiate with the hospital who will play each group off the other and then throw a price-fixing lawsuit at you when you try to negotiate the same fair deal for both groups. An anesthesia department runs so much better when everyone plays for the same team. Contracts may be exclusive, but they aren't indefinite. Think you can do it better, then make a run on the contract. It wouldn't be the first time it's happened. Maybe then you will appreciate the (unreimbursed) work and time it takes to not only secure but also maintain an anesthesia contract. You'll understand the value in a functional anesthesia group and why as the owner of a successful business, you have every right to sell it if you see fit.
