How does partnership work?

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gaslearnt

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How does becoming a partner in a group alter your pay/work structure? Are the salaries that people post including the bump in pay from becoming a partner? Do partners have additional responsibilities?

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Highly dependent on the group. Most posted salaries are the finally partner structure. Would be difficult to recruit if you posted the buy-in numbers. Just not that attractive.

Additional responsibilities depends on the group size and structure. I was in a smaller group, we had to share duties. If there's 100 or more docs, there just aren't that many tasks to distribute.

Read some of the other threads around here. Private Practice and Partnerships are changing, quickly.
 
Well here is how it usually “works”. You are hired on for a partnership track position for 2-6 years out of residency depending on the desirability of the job. After that 2-6 year period of working like a dog and getting paid 20-50% what partners make the partners will vote and determine if they want to string you along for another couple years. They will offer you “partner” which sometimes means nothing, sometimes it means you get some extra pay and/or vacation but never really get into the “circle of trust”, and rarely (rare as a white whale) you are hired and make roughly what the old guys make.
 
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How does becoming a partner in a group alter your pay/work structure?

Not in our group.


Do partners have additional responsibilities?


Nonclinical work (hospital and group committee work, schedule making, etc) is voluntary but encouraged for both partners and nonpartners. It is compensated at a rate similar to clinical time.

Basically nothing changes when you become a partner in our group.
 
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Get hosed for awhile and then if your timing is good, join that inner circle to hose others.
 
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It works because new hires overestimate the value of partnership and underestimate the true cost of the buy in.
 
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In our group everyone works equal shifts. Non-partners are salaried. The amount of salary and vacation increases each year. The buy-in is the lower salary and a small (1k) official buy-in when you become a partner. Partners take a lower salary but get group profits in quarterly K1 distributions. The amount of vacation and overall compensation for partners depends on how the group is doing financially year to year.
 
It doesn't work.
It didn’t work for my sister and couple of other guys who got lured in 5 year partnership track

Basically gave up 300k of income each year x 5 years. That’s 1.5 million given up. That was over 20-25 years ago.

I know of zero partnership track these days and I know tons of places all over the country. I don’t consider usap a partnership by the way.

I think the hourly worker is the wave of the future. Get ready for it.

Work more hours. Get paid more

Work less. Get paid less

Work undesirable weekends get paid more per hour. Very simple
 
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It didn’t work for my sister and couple of other guys who got lured in 5 year partnership track

Basically gave up 300k of income each year x 5 years. That’s 1.5 million given up. That was over 20-25 years ago.

I know of zero partnership track these days and I know tons of places all over the country. I don’t consider usap a partnership by the way.

I think the hourly worker is the wave of the future. Get ready for it.

Work more hours. Get paid more

Work less. Get paid less

Work undesirable weekends get paid more per hour. Very simple
Holy ****.
 
I got done interviewing recently with a group that is super secretive and supposedly one of the best around. The offer that they gave me was absolutely horrendous. It was absolutely free labor and I plan on telling them how dumb they are based on the other offers I have.
 
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I got done interviewing recently with a group that is super secretive and supposedly one of the best around. The offer that they gave me was absolutely horrendous. It was absolutely free labor and I plan on telling them how dumb they are based on the other offers I have.
When practices do this. They really don’t need you. It’s the truth. Even in this high labor demand market.
 
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The pendulum from great to horrible swings further in PP depending on the people.

You know what you’re getting with an AMC.
 
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The pendulum from great to horrible swings further in PP depending on the people.

You know what you’re getting with an AMC.
Correct. AMCs will pay you extra to work extra so most can make 550k, sometimes even 600k off a base of 450k with extra weekends and calls these days

The old days where the partners made 700-800k really depended on the partnership track people making 250k-300k and working them like dogs. So for the partnership track people to make 400k. It really required them to put in what amounts to 800k of labor. 50% of that going back to the partners pot to split. So the more the juniors worked. 50% kept going back to the partners who were sleeping at home over 3-5 years.
 
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I got done interviewing recently with a group that is super secretive and supposedly one of the best around. The offer that they gave me was absolutely horrendous. It was absolutely free labor and I plan on telling them how dumb they are based on the other offers I have.
I'm torn

I know there are practices out there that are clueless and/or depend on exploiting a steady stream of naive new grads.

On the other hand, you've written some bizarrely wacky stuff on this forum that makes me wonder if maybe what you're relating is coming from a skewed or unrealistic perspective.

What was the offer?
 
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I know some.
My sister place is true partnership in a mega city. 2 years. Very equal partnership.

Thats the main issue with the practice. As hard and weird as it. The truth is most people want unequal partnerships. Meaning the partners work 40-45 hour a week for 800k-1 million. While the juniors work 65-70 hours for the equivalent of 500k now in today’s money. That’s just not happening at my sister practice. Everything is even after 2 years and it’s only a 10% hit the first two years.

The juniors see AMC paying upwards to 600/650k guarantee if they work those same 65-70 hours. And would rather take the guaranteed amc money.
 
It didn’t work for my sister and couple of other guys who got lured in 5 year partnership track

Basically gave up 300k of income each year x 5 years. That’s 1.5 million given up. That was over 20-25 years ago.

I know of zero partnership track these days and I know tons of places all over the country. I don’t consider usap a partnership by the way.

I think the hourly worker is the wave of the future. Get ready for it.

Work more hours. Get paid more

Work less. Get paid less

Work undesirable weekends get paid more per hour. Very simple


I have someone in my extended family who had a 1.5 million dollar buy in and a three year partnership track. Texas. Made partner, worked like crazy before and after she made partner.

I wonder if we are talking about the same group
 
What about places that don’t offer parternship track, but if you are partner you just get a extra vacation week and some more retirement contribution that’s it, base salary is still the same, same amount of call etc pretty much everything else is the same if you are partner vs not

What’s the point of being partner in these places then? And why are some groups more fair vs others

Is there something I’m missing that’s not obvious?

Why is there such a huge difference amount groups, I’m genuinely asking I have no idea

And if the old timers in the group retire, does that mean parternhsip spots open up?
 
I have someone in my extended family who had a 1.5 million dollar buy in and a three year partnership track. Texas. Made partner, worked like crazy before and after she made partner.

I wonder if we are talking about the same group
No. My sister on east coast

But yes. Texas similar structure. 40%, 30%, 20% , 10% salary reduction plus 6% billing each year.
 
What about places that don’t offer parternship track, but if you are partner you just get a extra vacation week and some more retirement contribution that’s it, base salary is still the same, same amount of call etc pretty much everything else is the same if you are partner vs not

What’s the point of being partner in these places then? And why are some groups more fair vs others

Is there something I’m missing that’s not obvious?

Why is there such a huge difference amount groups, I’m genuinely asking I have no idea

And if the old timers in the group retire, does that mean parternhsip spots open up?
It’s like any job anywhere. Those who have control can offer what they want. That may be a true partnership (equal hours, pay, voting etc), or it could be much less. If the partners are interested in being fair, they’ll offer you a true partnership. If they want to make money off of you they’ll offer whatever it takes to get you in the door. Maybe you are equal in the future, or maybe they exploit you forever.
 
I'm torn

I know there are practices out there that are clueless and/or depend on exploiting a steady stream of naive new grads.

On the other hand, you've written some bizarrely wacky stuff on this forum that makes me wonder if maybe what you're relating is coming from a skewed or unrealistic perspective.

What was the offer?
I wish I could describe it on here because I think y'all's input would be valuable. however I would probably give myself away in case certain people prowled this forum. I'm still considering the offer after talking to some attendings who have been in the game for a while. There is a very small, albeit, possible scenario where I have had a dumb opinion on this.
 
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I wish I could describe it on here because I think y'all's input would be valuable. however I would probably give myself away in case certain people prowled this forum. I'm still considering the offer after talking to some attendings who have been in the game for a while. There is a very small, albeit, possible scenario where I have had a dumb opinion on this.
I would be very reluctant to take any offer from any group in the country with significant buy-in. There are a few groups that truly have great setups. Still not worth it imo. A LOT can change in 3 years. The group may not even exist. The crazier things have happened.
 
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I would love the opportunity for pgg and arch to publicly shame me for thinking a deal is bad.
 
Bottom line is the lost compensation in the first four years for private practice will be close to 700k. Versus taking a private equity job.
 
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Geeze reading some of these… I just signed, 1.5 years to partner making 90%. Great area in the mountain west and will be working ~40hrs/week, partners are 474-550k. Group is phenomenal and I feel like I hit a unicorn
 
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Geeze reading some of these… I just signed, 1.5 years to partner making 90%. Great area in the mountain west and will be working ~40hrs/week, partners are 474-550k. Group is phenomenal and I feel like I hit a unicorn
Pay is pretty low guy.
 
Geeze reading some of these… I just signed, 1.5 years to partner making 90%. Great area in the mountain west and will be working ~40hrs/week, partners are 474-550k. Group is phenomenal and I feel like I hit a unicorn
Agree that pay is low unless you are getting 12 weeks vacay and no call. Even then....
 
Well here is how it usually “works”. You are hired on for a partnership track position for 2-6 years out of residency depending on the desirability of the job. After that 2-6 year period of working like a dog and getting paid 20-50% what partners make the partners will vote and determine if they want to string you along for another couple years. They will offer you “partner” which sometimes means nothing, sometimes it means you get some extra pay and/or vacation but never really get into the “circle of trust”, and rarely (rare as a white whale) you are hired and make roughly what the old guys make.
It’s sad, but at a number of PPs this is basically how it works. A core group of “old guard” partners rules the roost, and has set up the institution to funnel money away from the newcomers to themselves. There may be other “partners”, but often the partnership has been structured to heavily favor the core group in terms of income or power differential. Sometimes becoming a “partner” in these groups means very little if you’re not in the core group - sometimes it means more.

Occasionally you will find a truly democratic, fair, and reasonable group who is interested sharing the milk and honey and hearing what the youngsters have to say in terms of running the place…but this is less common than you might think.

(Also, another recurring theme I’ve noticed after working at two PPs is that the “old guard” doctors usually…suck. At best, they are practicing medicine decades out of date and at worst, they’re floridly incompetent individuals who are a liability risk to the institution.)
 
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I would love the opportunity for pgg and arch to publicly shame me for thinking a deal is bad.

:shrug:

You deleted a couple posts that had more information to retain some anonymity, which is of course reasonable. I won't cite anything specific that you deleted, though I'll say that I broadly agree with your reservations about taking it.


In general, I think long partnership tracks (>1 year) are a big red flag these days, unless "partnership" just means voting rights and there isn't a large buy-in and/or pay disparity while on the track.

But if the paycheck during the track period is enough, and the prize as a partner is tempting, go for it. It's very common on this forum lately for people to get wrapped up on how to absolutely maximize their income. Egos are getting in the way and there's a whole lot of fixation on what people deserve in this market. Pay everywhere is pretty good now. At some point, it might be best for a person to decide how much is enough and then take it and then choose to be happy.

Your personal preferences regarding practice type, location, or other factors can certainly trump any financial issue.
 
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That 40 hours a week most likely doesn’t include call or hours on pager or else you would only be working 3-4 normal daytime shifts a week which never happens.

It’s 3-4 call days a month (rare call in), with one weekend every other month. Sounds like doing 5 cases in a weekend is a big weekend for the group. I’m about lifestyle over chasing dollar signs. Someone is always gonna be making more
 
:shrug:

You deleted a couple posts that had more information to retain some anonymity, which is of course reasonable. I won't cite anything specific that you deleted, though I'll say that I broadly agree with your reservations about taking it.
:shrug:

You deleted a couple posts that had more information to retain some anonymity, which is of course reasonable. I won't cite anything specific that you deleted, though I'll say that I broadly agree with your reservations about taking it.


In general, I think long partnership tracks (>1 year) are a big red flag these days, unless "partnership" just means voting rights and there isn't a large buy-in and/or pay disparity while on the track.

But if the paycheck during the track period is enough, and the prize as a partner is tempting, go for it. It's very common on this forum lately for people to get wrapped up on how to absolutely maximize their income. Egos are getting in the way and there's a whole lot of fixation on what people deserve in this market. Pay everywhere is pretty good now. At some point, it might be best for a person to decide how much is enough and then take it and then choose to be happy.

Your personal preferences regarding practice type, location, or other factors can certainly trump any financial issue.
I think location is the biggest factor for me far and away which the private equity job fits best. And half a million at the private equity job out of the gate is more than I ever hoped for when I started residency. So I think that is enough for me.
 
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I would be very reluctant to take any offer from any group in the country with significant buy-in. There are a few groups that truly have great setups. Still not worth it imo. A LOT can change in 3 years. The group may not even exist. The crazier things have happened.
Yeah, what are you buying into nowadays? You're really overpaying for office furniture, computers, pens & paper, etc. The group isn't going to be bought out by private equity at inflated prices. The group exists only at the discretion of the hospital administrations at the facilities they've contracted with. It can go up in flames at any point.
 
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If money was everything we'd all be torturing ourselves working locums in desperate, toxic, miserable hospitals. Living in hotels. Driving rental cars.

Money isn't everything.
You just described my life! You forgot to add the overpriced, underwhelming local dining experience to that description.
 
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Well here is how it usually “works”. You are hired on for a partnership track position for 2-6 years out of residency depending on the desirability of the job. After that 2-6 year period of working like a dog and getting paid 20-50% what partners make the partners will vote and determine if they want to string you along for another couple years. They will offer you “partner” which sometimes means nothing, sometimes it means you get some extra pay and/or vacation but never really get into the “circle of trust”, and rarely (rare as a white whale) you are hired and make roughly what the old guys make.
Sounds like you are describing 10-15 years ago. Now these predatory practices can’t even get an applicant to interview.
 
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It’s sad, but at a number of PPs this is basically how it works. A core group of “old guard” partners rules the roost, and has set up the institution to funnel money away from the newcomers to themselves. There may be other “partners”, but often the partnership has been structured to heavily favor the core group in terms of income or power differential. Sometimes becoming a “partner” in these groups means very little if you’re not in the core group - sometimes it means more.

Occasionally you will find a truly democratic, fair, and reasonable group who is interested sharing the milk and honey and hearing what the youngsters have to say in terms of running the place…but this is less common than you might think.

(Also, another recurring theme I’ve noticed after working at two PPs is that the “old guard” doctors usually…suck. At best, they are practicing medicine decades out of date and at worst, they’re floridly incompetent individuals who are a liability risk to the institution.)
This.
 
It’s sad, but at a number of PPs this is basically how it works. A core group of “old guard” partners rules the roost, and has set up the institution to funnel money away from the newcomers to themselves. There may be other “partners”, but often the partnership has been structured to heavily favor the core group in terms of income or power differential. Sometimes becoming a “partner” in these groups means very little if you’re not in the core group - sometimes it means more.

Occasionally you will find a truly democratic, fair, and reasonable group who is interested sharing the milk and honey and hearing what the youngsters have to say in terms of running the place…but this is less common than you might think.

(Also, another recurring theme I’ve noticed after working at two PPs is that the “old guard” doctors usually…suck. At best, they are practicing medicine decades out of date and at worst, they’re floridly incompetent individuals who are a liability risk to the institution.)
@Endorphins98 It's a good gig if that's where you want to live

Yep. And even when their is pay equity senior members find the cushier gigs, the lower call; it's exactly how no efficient business would operate for equal partners. It can take years to figure out the loopholes. What loopholes has everyone on here seen (besides the partnership track buy-in)? I'll give my experience:

Work groups: 4 senior people get together to work for 3 FTE, they make and control their own schedule/vacation. If the group isn't flush they can pick up work when they want and take off when they want. New hires struggle to get one day off to see the dentist. My friend worked at a group like this, when people starting jumping ship bc of the long hours/increased call she had to have a real come to jesus talk with the senior partners.

ASCs: This one is more difficult, you do need anesthesiologists the surgeons are comfortable with, but I was involved with one that was hospital owned with a vast array of surgeons. Only problem was when an opening happened it was never advertised within the group, even if you do have to turn down people in the group it stinks when only the anesthesia medical director's friends get in despite surgeon complaints. There will always be, and probably has to be, some bias, but it needs to be transparent and balanced.
 
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I personally find the whole concept of partnership as shackles.
I’d rather earn a little less but be independent and retain 100% of what I earn.
This way I retain control of work environment, hours, schedules and can say no. Essentially, to me having limits and boundaries when it comes to all that is vvip.
 
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@Endorphins98 It's a good gig if that's where you want to live

Yep. And even when their is pay equity senior members find the cushier gigs, the lower call; it's exactly how no efficient business would operate for equal partners. It can take years to figure out the loopholes. What loopholes has everyone on here seen (besides the partnership track buy-in)? I'll give my experience:

Work groups: 4 senior people get together to work for 3 FTE, they make and control their own schedule/vacation. If the group isn't flush they can pick up work when they want and take off when they want. New hires struggle to get one day off to see the dentist. My friend worked at a group like this, when people starting jumping ship bc of the long hours/increased call she had to have a real come to jesus talk with the senior partners.

ASCs: This one is more difficult, you do need anesthesiologists the surgeons are comfortable with, but I was involved with one that was hospital owned with a vast array of surgeons. Only problem was when an opening happened it was never advertised within the group, even if you do have to turn down people in the group it stinks when only the anesthesia medical director's friends get in despite surgeon complaints. There will always be, and probably has to be, some bias, but it needs to be transparent and balanced.

4 anesthesiologists sharing 3 FTEs doesn't exactly have to be a problem as long as they take proportional burden (call, weekends, etc) and they don't take 3 FTE worth of fall but take 4 FTE worth of the gold shifts.

We have a couple older FT docs that share a FTE. The additional flexibility they can provide with last minute coverage is valuable and can cost less than hiring an additional FT person or using locums and they are more reliable and available than random per diems
 
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4 anesthesiologists sharing 3 FTEs doesn't exactly have to be a problem as long as they take proportional burden (call, weekends, etc) and they don't take 3 FTE worth of fall but take 4 FTE worth of the gold shifts.

We have a couple older FT docs that share a FTE. The additional flexibility they can provide with last minute coverage is valuable and can cost less than hiring an additional FT person or using locums and they are more reliable and available than random per diems
I would argue that your gold shifts should be the most burdensome to relieve that burden. and that a reduction in FTE should be a reduction in all shifts. One medical consultant I heard talk said you can tell if your call/weekend or shift is properly incentivized by how easy it is to give away, and also which ones should contribute more to the common pool by how hard they are to give away. I've worked OB shifts at a very busy place with eat-what-you-kill...10-15 epidurals a night (billing 12 hours each), 3-4 sections. You could give away a call on our chat and in 30 seconds have multiple answers. Also worked an OB at a slightly less busy place doing it for a low hourly rate. No one would take that shift and no one picked it up when people offered.

Having working groups isn't the problem. It's the way they are formed. Over years people form small groups when the group is flush to optimize their schedule. When the group is thin, they say they need to hire more.

You could say 'well that's seniority,' except when that thin period is extended it turns into people working for years with no schedule flexibility. When I heard about this from my friend and her previous group I made sure to ask about it on interviews. She wanted to drop down her FTE bc of her kid's health issues, group couldn't do it but then when she asked the people who were regularly getting days left off she found out about the work group scheme. And I said previous group, their group is AMC owned.

So you could say to everyone: what percent FTE do you want? Then hire up to that number, makes scheduling tougher but the group happier (maybe not the previous work groups). This also helps in really tight times with high calls: everyone takes an equal increase in FTEs, the 0.8 goes to 0.9, the 0.5 to 0.6/0.7 etc...the pain is equally distributed. Having to break up a work group is very difficult; they can always just say: hey you need to hire more, I have my schedule.
 
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I would argue that your gold shifts should be the most burdensome to relieve that burden. and that a reduction in FTE should be a reduction in all shifts. One medical consultant I heard talk said you can tell if your call/weekend or shift is properly incentivized by how easy it is to give away, and also which ones should contribute more to the common pool by how hard they are to give away. I've worked OB shifts at a very busy place with eat-what-you-kill...10-15 epidurals a night (billing 12 hours each), 3-4 sections. You could give away a call on our chat and in 30 seconds have multiple answers. Also worked an OB at a slightly less busy place doing it for a low hourly rate. No one would take that shift and no one picked it up when people offered.

Having working groups isn't the problem. It's the way they are formed. Over years people form small groups when the group is flush to optimize their schedule. When the group is thin, they say they need to hire more.

You could say 'well that's seniority,' except when that thin period is extended it turns into people working for years with no schedule flexibility. When I heard about this from my friend and her previous group I made sure to ask about it on interviews. She wanted to drop down her FTE bc of her kid's health issues, group couldn't do it but then when she asked the people who were regularly getting days left off she found out about the work group scheme. And I said previous group, their group is AMC owned.

So you could say to everyone: what percent FTE do you want? Then hire up to that number, makes scheduling tougher but the group happier (maybe not the previous work groups). This also helps in really tight times with high calls: everyone takes an equal increase in FTEs, the 0.8 goes to 0.9, the 0.5 to 0.6/0.7 etc...the pain is equally distributed. Having to break up a work group is very difficult; they can always just say: hey you need to hire more, I have my schedule.

Yes it is very frustrating when you have people getting 2 or 3 days off a week regularly but they won't give you one day off.
 
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