fellowship and partnership

[phillyfornia]

i recently spoke with a graduating anesthesiology resident who will be going into private practice next year. he ended up taking a job with a group who will offer him partnership in TWO years. is this the average time it takes to make partner these days? this guy is smart/competent, comes from a good program, and had good recs so i assume that he was getting great job offers.

i ask because two years seems like a long time to make partner. i'd be scared that i would work two years and then get fired before they started paying me the partner money.

also, would doing a year of fellowship help someone make partner faster? in other words, do groups offer shorter partnership tracks if you are fellowship trained?

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[urge]

Unlikely. Unless you are in the bundocks and they are desperate. 2 years is average. I interviewed in a group that asked for 4- I turned them down. I have heard of a group that asks for 7. They got to have strippers in Dr lounge...

 

[drccw]

I would say that of the jobs I looked at, most were 2 years to partner.. Some were three though. If a job says instant partner, or one year to partner then I would think that that would be a place I wouldnt want to be...

 

[Pilot Doc]

I would say that of the jobs I looked at, most were 2 years to partner.. Some were three though. If a job says instant partner, or one year to partner then I would think that that would be a place I wouldnt want to be...

Agree about instant partnerships ... but 1 year might be OK. That reflects that the job is not attracting lots of applicants. If the job is somewhere desirable ... the problem is the job. If the job is somewhere few people want to live then the job itself might be fine.

 

[huron]

I would say that of the jobs I looked at, most were 2 years to partner.. Some were three though. If a job says instant partner, or one year to partner then I would think that that would be a place I wouldnt want to be...

Anesthesia groups have no assets, so why would anyone sign up for a smaller salary and more work? That might be understandable if the practice had assets like an office or equipment, but the only asset the Anesthesia group might possess is the contract with the hospital, which can be taken away in an instant by the hospital administrators.

The best situation is where you do your own cases and get to bill for them if you have to join a partnership you are very likely propping up someone else salary. You are getting paid less for doing more or the same amount of work as someone else for the empty promise of “making partner and finally getting paid “fairly and equally”

Unfortunately there are many bad partnerships out there. Places that will pay you little work you hard for three or more years without offering partnership then fire you and find a new graduate. Places where even when you make partner you find out there are two levels of partners and you are only eligible to do the crappy cases and get paid less.

You need to learn as much as you can about the group that you are joining, You need to go into that job knowing whether you will be offered partnership or be cast off like the last new grad they hired who worked for very little for three years and then got the boot.

 

[militarymd]

I love these myths and legends that you guys are perpetuating.....do you know what you guys are doing to our new grads?????

You guys are driving them into LT jobs.....which is worse for our profession than working for AMC's.

 

[Coastie]

I love these myths and legends that you guys are perpetuating.....do you know what you guys are doing to our new grads?????

You guys are driving them into LT jobs.....which is worse for our profession than working for AMC's.

What are LT jobs?

Mil, I'm interested on your perspective. Would a fellowship trained grad be more desirable for your practice? If so, which ones?

 

[badgas]

What are LT jobs?

Mil, I'm interested on your perspective. Would a fellowship trained grad be more desirable for your practice? If so, which ones?

Locums

 

[deleted126335]

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[militarymd]

yes, and any.

As for those who says that a group doesn't "own" anything, then you are looking at things only in a very concrete, near sighted manner.

There are other things that one can "own" that is MORE valuable than an office, computer, or whatever.

When I interview potential candidates, one of the questions that I ask is this: What are you leaving behind that you will miss the most?

The ones who answered: my house, the restaurants where I used to eat, the lake house where I water ski.....they usually don't work out.


The ones who answered: I will miss leaving my reputation behind....and who realize that it is the most important thing that they will need and will have to rebuild are the ones who have become successful.

Reputation, political capital, etc, etc.....all things that have NO monetary value but which I have spent countless hours (and frequently at inconvenient times) working to accrue are things which a new hiree has NONE of...and which is given as loan by the group...the new hiree who makes an unpopular decision at work....ie delay cases, or even worse cancelling them......guess who your customers (surgeon, patients, hosital administrator) go to to see if it was an appropriate decision.....the person/group who has all the political capital...and I'll give you a hint...it's not the new hiree...regardless of how many years of experience you have...how many boards you hold....or EVEN IF you ARE Ron Miller himself....

That's how things work in PP.....you don't have to like it....it's just the way it is.

What are LT jobs?

Mil, I'm interested on your perspective. Would a fellowship trained grad be more desirable for your practice? If so, which ones?

 

[deleted126335]

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[Coastie]

Thanks for the prompt reply.

Just like any business, relationships are EVERYTHING. Most docs never understand this, and it's led to a lot of problems we have in medicine today.

yes, and any.

As for those who says that a group doesn't "own" anything, then you are looking at things only in a very concrete, near sighted manner.

There are other things that one can "own" that is MORE valuable than an office, computer, or whatever.

When I interview potential candidates, one of the questions that I ask is this: What are you leaving behind that you will miss the most?

The ones who answered: my house, the restaurants where I used to eat, the lake house where I water ski.....they usually don't work out.


The ones who answered: I will miss leaving my reputation behind....and who realize that it is the most important thing that they will need and will have to rebuild are the ones who have become successful.

Reputation, political capital, etc, etc.....all things that have NO monetary value but which I have spent countless hours (and frequently at inconvenient times) working to accrue are things which a new hiree has NONE of...and which is given as loan by the group...the new hiree who makes an unpopular decision at work....ie delay cases, or even worse cancelling them......guess who your customers (surgeon, patients, hosital administrator) go to to see if it was an appropriate decision.....the person/group who has all the political capital...and I'll give you a hint...it's not the new hiree...regardless of how many years of experience you have...how many boards you hold....or EVEN IF you ARE Ron Miller himself....

That's how things work in PP.....you don't have to like it....it's just the way it is.

 

[urge]

Hey Mil,

Why is it you think locums are bad for the specialty?

I would love to hop on a wannebago and do locums for a few yrs but wife is not interested in the gypsy life. It's a great way to "try before you buy".

Times change. Just like surgeons have mellowed over the years, anesthesiologists have lost interest in partnerships.

Mil, what you are calling an asset is Trust. They trust you because you have been there for a while doing a good job/hard work. I just don't see why you should bill the new guy for that.

 

[huron]

I love these myths and legends that you guys are perpetuating.....do you know what you guys are doing to our new grads?????

You guys are driving them into LT jobs.....which is worse for our profession than working for AMC's.

To say that because a group offers instant partnership or one year to partnership makes it an undesirable group or location, while a group that offers three years to partnership is a desirable location, is a misguided statement. If they believe this nonsense they are setting themselves up for a partner track that is three or more years, while there are good groups in desirable locations that will make you partner immediately or at the end of a year, Thus avoiding two or more year of working for less than full pay.


Locums is a good choice, If someone can't find the perfect opportunity right after residency or needs to take some time to sample different private practice environments, while earning good money. I have learned much more about a group by working there for a full week as a paid locum that in a one day interview visit plus you don't get paid to interview. It's a great way to "try before you buy" and learn type of groups you like and what types you need to avoid.

 

[militarymd]

The new guy is getting something ....you call it "trust" by mere association with people who have earned it.....do you think they should not be "charged" for it?

If that's how you want to spend your "political capital" with a practice that you've spent countless hours building...that's fine...I just don't feel the same....I went through hard times making the practice a nice place to work....so I'm to let a new guy ( who I know nothing about) in to share in the benefits that I've worked hard for.....I don't think so, but if that's what you want to do with your sweat...that's fine.

As for Locums....it is EXACTLY same as an AMC, just under a different guise.....You have become an hourly employee expecting to leave a 3 pm or get overtime.....does that remind you of another kind of anesthesia provider who can do just about everything that you can do?

Hey Mil,

Why is it you think locums are bad for the specialty?

I would love to hop on a wannebago and do locums for a few yrs but wife is not interested in the gypsy life. It's a great way to "try before you buy".

Times change. Just like surgeons have mellowed over the years, anesthesiologists have lost interest in partnerships.

Mil, what you are calling an asset is Trust. They trust you because you have been there for a while doing a good job/hard work. I just don't see why you should bill the new guy for that.

 

[urge]

Double post

 

[urge]

As for Locums....it is EXACTLY same as an AMC, just under a different guise.....You have become an hourly employee expecting to leave a 3 pm or get overtime.....does that remind you of another kind of anesthesia provider who can do just about everything that you can do?

Are you talking about that anesthesia provider that gets better compensated than us factoring the amount of work/responsibility they have? We should learn from them.

Especially when they are paid by the hour and you see them in street clothes(been relieved for 30 min) waiting in front of the punch clock so they can bill another 15 min.

 

[zippy2u]

LT guys ain't nuthin' but Great White Sharks with voracious appetites for coin. Trustworthy and fair aren't in their realm of existence. Last time I checked, most people have a fear of sharks---even asians. Regards, ----Zip

 

[Coastie]

Partnership tracks are the way of life in business. Medicine shouldn't be any different. Crooked partnerships are throughout business. As a grad in a few years, my interest is learning in how to avoid these, and to discern which practices are the good ones.

Personally, I'd probably rather be in a place that has a partnership track versus one that doesn't, but it depends on the whole package deal. You're right though, new guys don't deserve the same deal as the old guys who have been developing RELATIONSHIPS, TRUST, and NETWORKS, which far out-value the pure RVU reimbursement someone gets for their time punching the clock.

The new guy is getting something ....you call it "trust" by mere association with people who have earned it.....do you think they should not be "charged" for it?

If that's how you want to spend your "political capital" with a practice that you've spent countless hours building...that's fine...I just don't feel the same....I went through hard times making the practice a nice place to work....so I'm to let a new guy ( who I know nothing about) in to share in the benefits that I've worked hard for.....I don't think so, but if that's what you want to do with your sweat...that's fine.

As for Locums....it is EXACTLY same as an AMC, just under a different guise.....You have become an hourly employee expecting to leave a 3 pm or get overtime.....does that remind you of another kind of anesthesia provider who can do just about everything that you can do?

 

[urge]

...............

 

[jwk]

Anesthesia groups have no assets, so why would anyone sign up for a smaller salary and more work? That might be understandable if the practice had assets like an office or equipment, but the only asset the Anesthesia group might possess is the contract with the hospital, which can be taken away in an instant by the hospital administrators.

Besides the excellent list of "assets" from Mil, I would disagree that groups have no assets. It all depends on the group and it's structure. Many groups do in fact have offices and equipment. Both the groups I have worked with own their offices. My current group has more than 30 non-clinical employees. And assets include accounts receivables, which at any given time can be many hundreds of thousands of dollars or more, even in a small group.

 

[urge]

Besides the excellent list of "assets" from Mil, I would disagree that groups have no assets. It all depends on the group and it's structure. Many groups do in fact have offices and equipment. Both the groups I have worked with own their offices. My current group has more than 30 non-clinical employees. And assets include accounts receivables, which at any given time can be many hundreds of thousands of dollars or more, even in a small group.

I wouldn't call the pot, where your next paycheck is coming from, an asset.
Let's say the group is terminated in mid august and they owe you 2 weeks of pay. Unless they have any savings (which I doubt), you(and the other partners) will be paid when bills are collected; leaving nothing in the pot.

In case the groups has savings, then the savings are the asset, not the accounts receivable.

Most groups have little to no assets. To those who are constantly asking which questions should I ask on the interview: Which assets I'm I buying into, by taking a forced paycut for the next 2 years? Why should I pay for something that has no warranty? Why should I pay for something that has no market value? If I am a partner and the group is dissolved, what do I get to keep?


Think about all this for a while and you will arrive at one conclusion: groups are "Ponzi schemes". http://en.wikipedia.org/wiki/Ponzi_scheme
It's great while you have new people coming in, but the whole thing in itself is a scam. Fair deal is "eat what you kill" or maybe salaried employee.


BTW, Don't you work for a university?

 

[jwk]

BTW, Don't you work for a university?

Nope - large PP group