Importance of Partnership?

[KCBarbarossa]

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Posted in another thread, but this should have been a separate, new thread. Here it is.

As a CA3, currently looking for jobs, it seems that the market (at least in my area) is GOOD but not great.

The super lucrative partnership track positions are seemingly being distributed very very cautiously by those lucrative groups/partners. Fellowships in such groups are probably going to be required.

That being said, I'm finding opportunities for new grads. I think the "norm" is going to be much different as many on this forum have echoed many times. Mid-range salaries (300-400) as partners are probably going to be much more common than ever before.

Some groups are offering employee positions in larger (more desirable?) cities which are actually pretty nice to start (300-350) etc.

Mediocre paying partnerships seem to be offering "typical" partnership buy ins of 250k or so with a 2 year track.

Given the uncertainty of our future earnings, it seems that being a partner is important. Sure, there are uncertainties and nobody has a crystal ball but my instinct is to take a 250k offer for future partnership earnings in the 300-400 range (with growth potential if you can grow the business) versus an employee job making perhaps more even.

I feel that a non-fellowship trained employee is much more vulnerable to whims of the "market" than a partner. Arguably, a non-fellowship trained partner is more secure than a fellowship employee. Many of the fellowship "requirements" are not legitimate in my opinion, but are being used as marketing tools or simple barriers to entry for most groups. You don't really need a peds fellowship to do general peds ENT stuff. B&B hearts at a small cardiac program? Not so much. Yet, it's true that some groups are using this as a barrier to partnership.

It seems that partners/owners control things. How many PP jobs are requiring fellowships when the senior partners don't have fellowships? Lots. A double standard? Yep, but if you're a partner it doesn't matter really does it? How many partnerships are offering "salary only" positions with virtual moratoriums on offering partnership tracks? Many, it seems.

What do you guys think? Is securing a partnership every more urgent/crucial than ever before? Securing them while they still exist, that is? (or being offered I should say).

I'm not seeing an end to partnership structures. But, it seems they are changing. Hiring CRNA's is becoming more common as are partnerships only offering employee positions, for example.

 

[KCBarbarossa]

Guys, come on. 388 posts and zero responses?

I'm interested in hearing some of the senior PP guys' opinions on this.

 

[BLADEMDA]

Guys, come on. 388 posts and zero responses?

I'm interested in hearing some of the senior PP guys' opinions on this.

As I have posted previously the contract shoud include a clause where after 12 months you are included in any gains from the sale of the company.

Partnership is preferable most of the time if offered/available.

 

[KCBarbarossa]

As I have posted previously the contract shoud include a clause where after 12 months you are included in any gains from the sale of the company.

Partnership is preferable most of the time if offered/available.

Blade, I've been following your posts for a while now. I'm aware of your thoughts on fellowships.

That being said, if one could secure such a clause, do you agree with my view on partner versus employee?

Sure, employee positions are good for many people. Mon-Fri, no weekends, no call. Works for some. I'm not that guy, however.

I want to work hard, and this opportunity is with a handful of partners. They've been comfortable over the years but are average compensation, not 90%-ers. They have never (yet plan to in the future) gone after other contracts (easier said than done I know). They've not really hustled but rather had a nice contract with steady volume. They've indicated that they want to change this and are looking to add some young guys to balance out the ages within the group. They seem to be thinking long term, in spite of 2 senior guys planning to retire in 5 years or so (I realize this would make your 12 mo. clause all the more important).

Bottom line: There are equal paying employee jobs locally, available at this time. Is the "control factor" of being one of the partners in a smaller (10-15) group worth it in terms of trade off for more immediate compensation versus a 250 buy in over 2 years for middle-tier income as partner? I feel there is upside to this opportunity with some of the younger, hungry, guys I've already met and plan on being one of.

I know this is hard without specifics, but am I on the right track? It's always seemed the way to go to me, but I'm open to others opinions, and don't want to be naive about this. Interested in thoughts on this matter.

 

[IlDestriero]

The super lucrative partnership track positions are seemingly being distributed very very cautiously by those lucrative groups/partners.

That being said, I'm finding opportunities for new grads. I think the "norm" is going to be much different as many on this forum have echoed many times.

Mediocre paying partnerships seem to be offering "typical" partnership buy ins of 250k or so with a 2 year track.

Given the uncertainty of our future earnings, it seems that being a partner is important. Sure, there are uncertainties and nobody has a crystal ball but my instinct is to take a 250k offer for future partnership earnings in the 300-400 range (with growth potential if you can grow the business) versus an employee job making perhaps more even.

I feel that a non-fellowship trained employee is much more vulnerable to whims of the "market" than a partner.

Yet, it's true that some groups are using this as a barrier to partnership.

What do you guys think? Is securing a partnership every more urgent/crucial than ever before? Securing them while they still exist, that is? (or being offered I should say).

Great jobs are always difficult to find, usually not advertised, and infrequently hire. Average jobs are everywhere, that's why they're average. People don't leave great jobs often.

The norm is a 50th percentile job. The frequent posts from the 90th percentile guys are not the norm, but those jobs are there if you're willing to relocate, etc.

That kind of 2-4 year partner track is the norm from what I know and has been for some time.

If you're only making 3-400k as a partner, why take a partner track? You can make that in a non partner track. If partners aren't making well north of 400, it may not be worth it. Though as a partner you have ownership and MAY be harder to let go.

Fellowships are not an excuse to not offer partner tracks, they just don't want to dilute their bloated income stream. Otherwise they could just hire all fellowship folks from the start. Make no mistake, they're getting rich off your work and they don't want to expand and potentially make less.

Partner tracks are less frequently offered now because of many things, including greed and uncertainty about future earnings. But, they own the business so they make the rules. Take it or leave it.

As for hiring more CRNAs than MDs, if you are covering 3 or 4 to one, you need more CRNAs than MDs and if you decrease the ratio to hire more MDs, you're losing money.

 

[KCBarbarossa]

Great jobs are always difficult to find, usually not advertised, and infrequently hire. Average jobs are everywhere, that's why they're average. People don't leave great jobs often.

The norm is a 50th percentile job. The frequent posts from the 90th percentile guys are not the norm, but those jobs are there if you're willing to relocate, etc.

That kind of 2-4 year partner track is the norm from what I know and has been for some time.

If you're only making 3-400k as a partner, why take a partner track? You can make that in a non partner track. If partners aren't making well north of 400, it may not be worth it. Though as a partner you have ownership and MAY be harder to let go.

Fellowships are not an excuse to not offer partner tracks, they just don't want to dilute their bloated income stream. Otherwise they could just hire all fellowship folks from the start. Make no mistake, they're getting rich off your work and they don't want to expand and potentially make less.

Partner tracks are less frequently offered now because of many things, including greed and uncertainty about future earnings. But, they own the business so they make the rules. Take it or leave it.

As for hiring more CRNAs than MDs, if you are covering 3 or 4 to one, you need more CRNAs than MDs and if you decrease the ratio to hire more MDs, you're losing money.

Isn't the underlined the answer to the bold? It seems like being the one making the rules (or one of them) is ever important. I'm not saying a partnership is always the way to go, but to me, making the rules and having a say as to the future business direction is worth a lot.

 

[IlDestriero]

Isn't the underlined the answer to the bold? It seems like being the one making the rules (or one of them) is ever important. I'm not saying a partnership is always the way to go, but to me, making the rules and having a say as to the future business direction is worth a lot.

As long as your group keeps it's contracts.

 

[KCBarbarossa]

As long as your group keeps it's contracts.

I realize that this can be a convoluted/complicated issue, but this group is small and has excellent relationships with the surgeons. Not everything, but they are viewed as providing a good service. Administration seems like a bit of a headache.

I know keeping contracts is a real issue, but something tells me that this can be an O.K. reimbursement career with good upside. If the upside doesn't materialize, then the status quo is decent. Steady volume, and according to the chairman, there will always be work at their existing two coverage sites.

They realize that they need to grow or they will be more vulnerable. It seems like a nice, albeit somewhat risky, chance to get things going and help build the practice. I hope I'm not being naive.

 

[BLADEMDA]

I realize that this can be a convoluted/complicated issue, but this group is small and has excellent relationships with the surgeons. Not everything, but they are viewed as providing a good service. Administration seems like a bit of a headache.

I know keeping contracts is a real issue, but something tells me that this can be an O.K. reimbursement career with good upside. If the upside doesn't materialize, then the status quo is decent. Steady volume, and according to the chairman, there will always be work at their existing two coverage sites.

They realize that they need to grow or they will be more vulnerable. It seems like a nice, albeit somewhat risky, chance to get things going and help build the practice. I hope I'm not being naive.

Subsidy? Will they sell out to an AMC? What's the long term plan about Obamacare and ACOs?

 

[KCBarbarossa]

Subsidy? Will they sell out to an AMC? What's the long term plan about Obamacare and ACOs?

Historically no subsidy. They may need to ask for one now, with them employing the CRNA's. Also, there is chatter about OB coverage 24/7 since that's been a loser for them for a long time.

I think all options are on the table as for the future, but they want to remain independent and grow by picking up more work. Of course, if it turns out that they become an attractive target for an AMC, then that would be considered by the partners. Again, a 12 mo. partnership clause would be in order. Thanks for that advise.

This group has been very transparent about their challenges and compensation package. They had a detailed comp. package available at my interview and it looks about right for this kind of gig. Once again, this is not a 90 percentile opportunity but those seem very scarce right now, if available at all without a fellowship, and specifically that specific fellowship a group may need.

This is a good compensation opportunity but not great. I do feel that there is a lot of upside as the group is doing things which suggest they are serious about no longer doing business as usual, and realizing they need to grow to stay viable over the long run.

 

[G0S2]

Good luck finding any med to large group that allows such a clause.

 

[countingdays]

Unless you don't mind moving, probably to some backwater in the future, I'd go partnership track, even for less pay.
If salaries start to drop, partners may try to maintain their salaries by increasing supervision ratios. Who do you think is going to be looking for a job, a weak partner or a skilled employed doc? When push comes to shove, partners are going to look out for themselves and each other. You are much better off being in the club, being in the meetings where decisions are made, not just hoping they'll consider your needs. Maybe they would like to help you too, but that'll only get you so far.
I would discourage you going to any place that doesn't offer partnership or taking a non-partnership job at a place with partners. Some people won't have a choice, but being an employed commodity without voting rights is not a good position to be in.

 

[Mman]

Agree with the general sentiment that being a partner is far better than being an employee. Far more long term job security and a say in how a group advances over time.

 

[KCBarbarossa]

Unless you don't mind moving, probably to some backwater in the future, I'd go partnership track, even for less pay.
If salaries start to drop, partners may try to maintain their salaries by increasing supervision ratios. Who do you think is going to be looking for a job, a weak partner or a skilled employed doc? When push comes to shove, partners are going to look out for themselves and each other. You are much better off being in the club, being in the meetings where decisions are made, not just hoping they'll consider your needs. Maybe they would like to help you too, but that'll only get you so far.
I would discourage you going to any place that doesn't offer partnership or taking a non-partnership job at a place with partners. Some people won't have a choice, but being an employed commodity without voting rights is not a good position to be in.

This is exactly what I believe. Also, what Mman said.