How Important Is Partnership?

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ItBurnsInMyHand

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Finally looking for a big person job out there. I was just wondering, given the fact that a lot of people I have talked to have said "most people don't stay at their first job," how important is it to look for a partnership track? I'm still trying to figure out if I want to go private or academic, but was wondering if I could eliminate this variable from play.
 
Well, partnerships (ie everyone equal? Tiered?) and partnership tracks vary... a lot. Anywhere from the 5 year near million-dollar buy in partnership track BS to the more coveted equitable 1-2 year tracks...
 
My buy-in was 18 months for full ownership share and 12 months for full board of director voting rights. It depends on the set-up. Personally I wanted to be in control with ownership stake. You also get all the headaches of ownership but it can be much more lucrative.
 
NICMAN said:
My buy-in was 18 months for full ownership share and 12 months for full board of director voting rights. It depends on the set-up. Personally I wanted to be in control with ownership stake. You also get all the headaches of ownership but it can be much more lucrative.
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how lucrative are we talking? Can you provide range?
 
I don't buy the whole "you don't stay at your first job" ordeal. I took it as combination of "we as residents don't have enough insight and often fall into a less optimal situation" and "people's priorities and life situation change" rather than "your first job is gonna suck so just settle for the best one short term"

I kinda think the best chance I get to be the doctor/partner I want to be is at my first job (granted I looked very broadly and picked the best long term situation). After the first job, youre less naive and less likely to buy into the whole "part of a team" mentality. (Check back with me in a few years to see if I'm still as naive)

That, again assumes you have done enough due diligence and really optimized your chances (most ca-3s don't).

That being said, it all purely depends on the reward vs how much work. Without some concrete ranges no one can tell you what it's worth.
 
I decided to go the partnership track route. After interviewing at a lot of places including a Mednax job that seemed less than ideal it was a no brainer.
 
Slothtronaut said:
What was wrong with the mednax job?
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The standard answer is always, “oh it’s site dependent.”

Keep in mind. #1 and only goal for these companies is to make a profit, everything else, EVERYTHING else is secondary. That includes, employee happiness, patient safety. You better document the **** out of everything, if they lose any billing because of your documentation you will be talked to. You better capture all charges.

If you’re working with crnas, and they’re currently hired by your group. You will lose a lot of say regarding how these nurses will work with you. Mendax can hire any crna and physicians without the group having any input.

But certainly everything depends on the local culture.
 
I would strenuously suggest EVERYONE who is looking for an anesthesiologist job look for a job paid by the hour.

NO other negotiations is necessary.

If they work you a million hours... you get paid a million hours.

If its not incentive based, THEY ARE RIPPING YOU OFF.
 
PieOHmy said:
I would strenuously suggest EVERYONE who is looking for an anesthesiologist job look for a job paid by the hour.

NO other negotiations is necessary.

If they work you a million hours... you get paid a million hours.

If its not incentive based, THEY ARE RIPPING YOU OFF.
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How common is this type of arrangement in permanent gigs?
 
Nothing wrong with staying at your first job forever provided you land a good gig right off the bat. See @dchz 's advice above.

The goal should be have to the fewest people/layers between the revenue you generate, and money you take home. The best way to achieve this is to be an owner (partner) of the practice.

Anytime someone is employing you, it is because they are making money off you. Why go through the hassle of having employees (it's a real pain in the ass) if they aren't putting money in your pocket?
 
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The mednax shop at my hospital apparently couldn’t get crnas to cover a bunch of shifts so they threw it up to the doctors. Guess who is getting screwed on an hourly rate? 150 for the docs but 200 when the crnas work it.

Mednax is not site dependent at all. They won’t budge of salary and when you break it down on an hourly basis your fighting for 10-15/hr extra.
 
The length of the track is just part of the game. It also depends on the % of take-home revenue before you become a partner.

Job one 2 years track: 60%, 75%. A total of 65% buy-in

Job two 3 years track: 75%, 85%, 90%. A total of 50% buy-in

So considering both the time and %, How much total is a reasonable buy-in at an average desirable place?
 
To the OP, remove any idealized notion of a partnership. Groups nowadays will sell to the highest bidder right under your nose. I don’t care what they promise you during dinner. Look at groups in Texas, it’s either USAP or Envision. I feel like find a group that pays the most coming out of residency with the least hours. Also, don’t buy a house or have any expensive toys until your school debt is gone and you have a million saved. Also, don’t knock on academics, especially state institutions. You have sovereign immunity, good mentors, slower pace and great retirement packages. I would recommend to stay in academics until you understand the business of medicine. It’s a crazy world out there.
 
User21218 said:
Until you save a MILLION? How would you do that if you’re aggressively paying down school debt?
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You get there by saving and not buying expensive toys. It’s as simple as that. It’s a tale as old as time, many a colleague have to work to pay off their toys and it’s not exclusive to just anesthesiologists. Get that million, have options, and walk away if the job is not paying enough to justify the hours.
 
I see three things that would doom a doctor to work for the man forever: marrying the wrong woman/man, buying a large house, and expensive toys. In my limited experiences, marrying the wrong person is the worst out of the three. So, please consider having a prenup. So many dudes have to keep working even harder post divorces. It’s Sad really.
 
In Florida due to no caps on malpractice awards, buying a large house is the best asset protection available since malpractice lawyers cannot touch your house, no matter how much it costs as long as it is on less than 0.5 acres in an incorporated area.
 
algosdoc said:
In Florida due to no caps on malpractice awards, buying a large house is the best asset protection available since malpractice lawyers cannot touch your house, no matter how much it costs as long as it is on less than 0.5 acres in an incorporated area.
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Can you buy a house on 0.5 acres and own the adjacent lot as a separate property? Seems like everyone in larger-lot areas would be wanting to subdivide their lots.
 
ItBurnsInMyHand said:
Finally looking for a big person job out there. I was just wondering, given the fact that a lot of people I have talked to have said "most people don't stay at their first job," how important is it to look for a partnership track? I'm still trying to figure out if I want to go private or academic, but was wondering if I could eliminate this variable from play.
Click to expand...

I would not write off partnership options. They may be your best option.

It depends on the groups in your area. Maybe there is a high paying, fair AMC or academic alternative, maybe not.

IME, im very happy im a partner.

Compared to others in my area I have higher income/less hours/more vacation
 
marr65 said:
I would recommend to stay in academics until you understand the business of medicine. It’s a crazy world out there.
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Heh, by far the most business-clueless doctors I've ever encountered have been career academicians at reknowned ivory towers.

The things they would say ...


I'd recommend the opposite. Get out there and work for and with other people who are doing cases, billing for them, and carving up the spoils. Even if you get burned a little you'll learn what part of the stove is hot and you'll take that knowledge to job #2. The absolute last place I would go to learn anything about the business of medicine would be an academic practice.
 
Most of the lots in the cities are less than 0.5 acres. Outside the incorporated areas, you can have up to 120 acres protected.
 
marr65 said:
You get there by saving and not buying expensive toys. It’s as simple as that. It’s a tale as old as time, many a colleague have to work to pay off their toys and it’s not exclusive to just anesthesiologists. Get that million, have options, and walk away if the job is not paying enough to justify the hours.
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Cmon man, I didnt delay gratification for 10 years to not buy an Aston Martin or a Lambo within the first couple of years while making attending money. I'm mostly debt free off school loans though.
 
marr65 said:
To the OP, remove any idealized notion of a partnership. Groups nowadays will sell to the highest bidder right under your nose. I don’t care what they promise you during dinner.
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If a group hasn't sold out by now, it's probably not going to, but that's just my sort of educated guess.
 
PieOHmy said:
If a group has not sold out yet, it probably is not worth buying!!
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LOL. We didn't sell out because none of those AMCs could come up with enough money to make it worth our while. Too bad for them, now we've been taking over their contracts.
 
PieOHmy said:
If a group has not sold out yet, it probably is not worth buying!!
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I don't think that is true. The acquisition rate has dropped greatly the past 6 months. The largest AMCs are more likely to lose a contract than gain one.
Mednax is a prime example of a shrinking AMC. AMCs don't really offer much to hospitals except their inflated billing rates. In fact, they have a lot of dead weight and overhead at an AMC that a private group wouldn't tolerate.
 
BLADEMDA said:
I don't think that is true. The acquisition rate has dropped greatly the past 6 months. The largest AMCs are more likely to lose a contract than gain one.
Mednax is a prime example of a shrinking AMC. AMCs don't really offer much to hospitals except their inflated billing rates. In fact, they have a lot of dead weight and overhead at an AMC that a private group wouldn't tolerate.
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once the anesthesia docs in their 50s retire... its game over for the AMCs. they are going to have to hire 2-3 docs for the 1 that is retiring. I know I do the work of 2-3 men personally.
 
PieOHmy said:
once the anesthesia docs in their 50s retire... its game over for the AMCs. they are going to have to hire 2-3 docs for the 1 that is retiring. I know I do the work of 2-3 men personally.
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I know everyone on SDN walks on water. But how are you able to do the work of 2-3 people??

More importantly, why are you doing the work of 3 people and not getting paid for the work of 3 people?
 
PieOHmy said:
If a group has not sold out yet, it probably is not worth buying!!
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Or they weren’t dumb enough to buy the doom and gloom spreading 5-10 years ago. Just look at which practices now have recruiting problems and which ones don’t.
 
nimbus said:
Or they weren’t dumb enough to buy the doom and gloom spreading 5-10 years ago. Just look at which practices now have recruiting problems and which ones don’t.
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They all have recruting problems now..
 
PieOHmy said:
once the anesthesia docs in their 50s retire... its game over for the AMCs. they are going to have to hire 2-3 docs for the 1 that is retiring. I know I do the work of 2-3 men personally.
Click to expand...

we have physicians in their 70s that take the same work load as physicians in their 30s
 
Mman said:
we have physicians in their 70s that take the same work load as physicians in their 30s
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tell us what that workload is?
is it 50 hours, 60 hours, 70 hours per week with overnight call?
I can't imagine a 70 year old taking overnight call in addition to to their reg 50 hour work week
 
PieOHmy said:
tell us what that workload is?
is it 50 hours, 60 hours, 70 hours per week with overnight call?
I can't imagine a 70 year old taking overnight call in addition to to their reg 50 hour work week
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we work about 45 hours per week, call once per week, plus weekends and holidays. Same as every other partner.
 
Mman said:
we work about 45 hours per week, call once per week, plus weekends and holidays. Same as every other partner.
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45 hours a week total or 45 hours plus whatever call hours are.?
 
PieOHmy said:
45 hours a week total or 45 hours plus whatever call hours are.?
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45 ish hours is about average including call, maybe 50 or so at busier times of the year
 
PieOHmy said:
tell us what that workload is?
is it 50 hours, 60 hours, 70 hours per week with overnight call?
I can't imagine a 70 year old taking overnight call in addition to to their reg 50 hour work week
Click to expand...

I know a 75yo plastic surgeon who takes call every night and actually comes in to do cases over half those nights.
 
Sounds like an idiot. Also what environment would necessitate plastics to be operating every other night?

nimbus said:
I know a 75yo plastic surgeon who takes call every night and actually comes in to do cases over half those nights.
Click to expand...
 
btbam said:
Sounds like an idiot. Also what environment would necessitate plastics to be operating every other night?
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Peds hospital or hand surgery coverage or breast coverage. Maybe all of the above.
 
nimbus said:
I know a 75yo plastic surgeon who takes call every night and actually comes in to do cases over half those nights.
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I work with two who do exactly the same, both are at least 70 if not 75.

Level 1 trauma and pediatrics hospital call q3days or something.
 
AdmiralChz said:
I work with two who do exactly the same, both are at least 70 if not 75.

Level 1 trauma and pediatrics hospital call q3days or something.
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Yep 95% of plastic surgeons in town do not take hospital ER call. Which leaves a lot of call for those who are willing. This is a guy who never spends more than $5k for a car (he has 2 1980’s Mercedes diesels and a 1988 bmw convertible), has 1 wife and no kids. Also hasn’t taken a vacation in over 20 years. Some people don’t have the same motives as others. I find them to be interesting characters. He is often found sleeping in a chair waiting to start a case. We take selfies with him while he’s asleep.
 
nimbus said:
Yep 95% of plastic surgeons in town do not take hospital ER call. Which leaves a lot of call for those who are willing. This is a guy who never spends more than $5k for a car (he has 2 1980’s Mercedes diesels and a 1988 bmw convertible), has 1 wife and no kids. Also hasn’t taken a vacation in over 20 years. Some people don’t have the same motives as others. I find them to be interesting characters. He is often found sleeping in a chair waiting to start a case. We take selfies with him while he’s asleep.
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Where does the money go? Wife? Hidden mistress(es) and kids?
 
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