Making partner for new grads

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aimedicine

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How difficult is it to find partnership jobs these days for new grads, and what do you guys foresee the future of partnership jobs in 4yrs?

some are quoting only 25% partnership opportunities, is it really that bad???
 
aimedicine said:
How difficult is it to find partnership jobs these days for new grads, and what do you guys foresee the future of partnership jobs in 4yrs?

some are quoting only 25% partnership opportunities, is it really that bad???
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it's all about who you know. the good jobs don't advertise and only hire people they personally know. Your best bet is to talk to faculty and former residents and see what type of jobs they got (and got offered) and might be hiring again for.
 
I would say that of those 10% of jobs that are for partnership, only 10% of that 10% are for real partnerships. The rest are fake or just a way to get you to sign a contract at a lower salary. There are a lot of predators out there.

In this day and age of employment, I think it will be imperative for docs to get their hours spelled out EXACTLY in the contract and what the compensation will be if you work over those hours. If you don't have very specific workload language written in your contract then these employers will have no problem increasing your workload without increasing compensation. In that sense, we will almost have to take a page out of the nursing book and possibly demand hourly compensation with premiums on overtime, nights, holidays, and weekends. I also think a real physician union will become necessary.
 
GravelRider said:
I would say that of those 10% of jobs that are for partnership, only 10% of that 10% are for real partnerships. The rest are fake or just a way to get you to sign a contract at a lower salary. There are a lot of predators out there.

In this day and age of employment, I think it will be imperative for docs to get their hours spelled out EXACTLY in the contract and what the compensation will be if you work over those hours. If you don't have very specific workload language written in your contract then these employers will have no problem increasing your workload without increasing compensation. In that sense, we will almost have to take a page out of the nursing book and possibly demand hourly compensation with premiums on overtime, nights, holidays, and weekends. I also think a real physician union will become necessary.
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so 1% of new grads will make true partnership? lol
 
if you want hours spelled out and accounted for, should probably prepare for punching the time clock (literally, not figuratively)
 
Mman said:
if you want hours spelled out and accounted for, should probably prepare for punching the time clock (literally, not figuratively)
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And there we have the blue-collar worker.
 
So out of 1500 new grads this summer, only 15 of them will make partnership?...
 
aimedicine said:
So out of 1500 new grads this summer, only 15 of them will make partnership?...
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Good partnership? Possibly. Remember, in a truly good partnership there are no super or senior partners.

Also, any partnership track that does not include fair compensation for the extra work, if the person does not make it to partner, is basically a sucker position. Better be a regular employee. It's like renting vs buying in an uncertain housing market.

@Mman is right: the best jobs come through word of mouth and networking. How many grads will have a mentor who both has the connections and is willing to help them land a great job (better than the mentor has)? Much easier to attend a big name residency or fellowship, where the diploma speaks for itself, and where one can make many friends and connections.

P.S. If only I were as good at following my own advice as at giving it... 🙁
 
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But...
 

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aimedicine said:
But...
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If I hire you for a 3-year partnership track, just to let you go after 3 years, rinse and repeat, how is that called? It's very easy to build some paperwork that shows that you suck. Every time somebody complains, every time you have an imperfect outcome, I just put it on paper. Or I can just give you the crappiest cases and longest rooms, the worst vacation schedule etc., till you leave on your own. Three years is a long time, especially for a new grad. That's why it's important for any partnership track contract to contain provisions that protect one in case of not making partner.

Also, it's very easy to make you some kind of junior partner, like a second-rate citizen. You'll do better than an employee, but you won't be my equal, neither in income or in power. Or you will be equal, but the majority of the partners will be crooks, who will vote themselves a system where they make more and easier money. Etc. Why do you think people leave partnership positions? (That should be a huge red flag for any applicant.)

That study would be much more useful had they followed it up for 4-5 years and seen how many of those people actually made it to partner and are happy with their jobs. Especially nowadays, every employer just wants to make hay till the sun shines, everybody else be damned. Welcome to capitalism, bernist millennial! 🙂

I am not saying there are no great jobs or partnerships. Just they are rarer than most people think. If you find one, stick to it like glue. Also, the chances for finding one are much higher if you know an insider.
 
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There are many solid partnership tracks still available all over the country. As said above...you need to network. A lot of the PP jobs have very non-specific language in the contract. If you gave a lawyer the contract they probably would color it red but at the same time the partnership track is often real and the group is solid and fair. Network to confirm that the group is not predatory.

The whole AMC BS is a bubble and people are cashing in on it and I don't blame them. But in no way will AMCs be the future of our profession.
 
Plus…how many of you have been successful in negotiating specific language for workday in schedule? Curious as to how that has gone. I've seen a few contracts over the past few years, and most have been quite vague with regards to workday or anesthesia services.
 
FFP said:
You pushed my favorite button, and here's the knee jerk: why do so many pain docs go back to anesthesia nowadays, or work as employees?
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Im sure u have an answer, let me hear it.
 
Stank811 said:
There are many solid partnership tracks still available all over the country. As said above...you need to network. A lot of the PP jobs have very non-specific language in the contract. If you gave a lawyer the contract they probably would color it red but at the same time the partnership track is often real and the group is solid and fair. Network to confirm that the group is not predatory.

The whole AMC BS is a bubble and people are cashing in on it and I don't blame them. But in no way will AMCs be the future of our profession.
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Seriously???
They are not the future... they are the present!!!
 
aimedicine said:
Im sure u have an answer, let me hear it.
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I don't have one, I am just wondering whether the pain market sucks more than the anesthesia one. When I ask, I hear about reimbursement problems.

I have seen personally how useless many pain treatments are, long-term, so I am not surprised. It's like having to go to a dentist for the same tooth every few weeks or months. So there are few patients who would pay well, out of pocket, for them.

Plus there are a number of specialties whose graduates can subspecialize in pain.
 
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FFP said:
I don't have one, I am just wondering whether the pain market sucks more than the anesthesia one. I hear about reimbursement problems left and right. And I have seen personally how useless many pain treatments are, long-term, so I am not surprised. It's like having to go to a dentist for the same tooth every few weeks or months.
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But i think reimbursement is a problem in medicine in general
 
aimedicine said:
But i think reimbursement is a problem in medicine in general
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Still, anesthesia is doing better, hence many pain docs are moving back into anesthesia, hence one of the reasons for the current anesthesia provider inflation.

Pain docs used to give up OR anesthesia forever. Not anymore.
 
FFP said:
Still, anesthesia is doing better, hence many pain docs are moving back into anesthesia, hence one of the reasons for the current anesthesia provider inflation.

Pain docs used to give up OR anesthesia forever. Not anymore.
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Any data to prove what you're saying?
 
Planktonmd said:
Seriously???
They are not the future... they are the present!!!
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The only reason they are talked about so much know is bc they are throwing chunks of money around buying up groups....they do not bring much to the table for health care systems outside of a bunch of promises that rarely pan out in the end. Just bc they are the present doesn't make them the future.
 
Real Partnership jobs are out there. Midwest, West, Southwest, etc and the odds improve of landing one of those jobs. My guesstimate is that 10-15% of jobs are real partnership track opportunities.

There are even partnership jobs on the East coast but those are more like 5% of job openings.
 
Im not doubting you guys, but where are u getting these 10% number from...any data on this?
 
AMCs are a bubble that will burst. The future is employment by behemoth hospital systems. Hospitals want control.

The east coast is by far the most populated area of the United States. Some people consider Boston, MA to Richmond, VA to be one giant megalopolis. Because it is the most populated area of the United States by far, it stands to reason that the vast majority of physician jobs are located there. Sure, you can find a great private practice job in rural Midwest, but that is such a small percentage of the actual job opportunities out there. The east coast is a wasteland of AMC and hospital employment.

If it's blue collar to want to be compensated fairly for my time and have good representation when negotiating employment then put a pair of ripped jeans on me, give me a punch card and hard hat.
 
I live in a metro area of 3.5 million people that has 13 PP groups, all with real, actual, honest-to-God equal partnerships. The only employees in the whole area are at the University and the VA. Of course, last week one of the mid-sized ones sold out to an AMC (the first AMC foray in my state), so who knows what the future holds. For now, it's partnerships as far as the eye can see!
 
True partnership tracks are definitely hard to find but I don't think its as bad as the 10% number some are using. I've recently even seen a few groups that have not offered true partnership in years to go back to offering it. The reason being is that they're having a difficult time finding good talent.
 
Mman said:
if you want hours spelled out and accounted for, should probably prepare for punching the time clock (literally, not figuratively)
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My former colleague actually did this finally for a Sheridan run place in Florida

He's 63 years old and they didn't believe him when he said he was averaging 65 hours in the hospital. They claimed he was inflating the hours by adding in beeper hours from home.

Than they finally had him clock in and out and low and behold he's averaging 128 hours every 2 weeks. 64 hours a week for $380k with 7 weeks paid. And their health benefits aren't great either.

Now they have a "metric". His "work hours" documented. They are going back to administration of hospital to try to demand more subsidy saying their anesthesiologista are working too many hours!!

This is how management companies steal contracts. If group is taking a 2 million dollar subsidy. They will tell admin they can do it for a 1 million dollar subsidy

So hospital saves 1 million on paper. Executives give them sleeves a $100k bonus off the 1 million savings.

Sheridan works on razor thin staffing to shave more money. And my friend is doing 600k of work for $380k.

My friend gave his notice and his last day is this week there.

My former resident classmate was a former partner at the same hospital Sheridan took over last year and he was making $550k as partner from
2006-2010

So that's how much money hear companies make off people.
 
FFP said:
I have seen personally how useless many pain treatments are, long-term, so I am not surprised. It's like having to go to a dentist for the same tooth every few weeks or months. So there are few patients who would pay well, out of pocket, for them
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That hasn't stopped chiropractors yet!

As long as insurance companies demand trials of "non-surgical" treatment options before authorizing an operation, pain docs will have jobs.
 
aneftp said:
This is how management companies steal contracts. If group is taking a 2 million dollar subsidy. They will tell admin they can do it for a 1 million dollar subsidy
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Most management companies do not steal contracts, groups sell to them voluntarily in exchange for cash. But now we are seeing backlash by hospitals against them because when they need changes made to things, they'd rather just talk to the guys/gals working in the OR rather than be given a 1-800 number to call to get someone authorized to make a decision.
 
So do you guys see anesthesiologist regaining control of the field back from AMC in the future?
 
aimedicine said:
So do you guys see anesthesiologist regaining control of the field back from AMC in the future?
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Well lucky for us we're not the first field to have this happen. The ER guys went through the AMC/hospital employee movement years before it was a thing in anesthesia. How is for them these days? Did doc owned groups come back, or are they still all workin for da man??
 
aimedicine said:
Any data to prove what you're saying?
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i concur with FFP. I left PP pain after 6 months. As a new grad who could do either field, it certainly felt "risky" to say the least to completely commit myself to pain, a field where i felt my main treatments, opioids and injections, were often ineffective. I wasnt sure I wanted this to be my purpose in life and my forever. After all I had only really done it for a year. I felt that in anesthesia I had more overall value as a doctor, better stories, better experiences. To each there own...The money is certainly there in pain though, so they're not leaving because of money. I personally think IPMs future is more questionable than anesthesia for MDs.
 
I think the thing ER got goingfor them is that its shift work and they get paid by the hours....i wouldn't mind this for anesthesia.
 
Hoya11 said:
i concur with FFP. I left PP pain after 6 months. As a new grad who could do either field, it certainly felt "risky" to say the least to completely commit myself to pain, a field where i felt my main treatments, opioids and injections, were often ineffective. I wasnt sure I wanted this to be my purpose in life and my forever. After all I had only really done it for a year. I felt that in anesthesia I had more overall value as a doctor, better stories, better experiences. To each there own...The money is certainly there in pain though, so they're not leaving because of money. I personally think IPMs future is more questionable than anesthesia for MDs.
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What about 50/50 pain/anesthesia?
 
B-Bone said:
I live in a metro area of 3.5 million people that has 13 PP groups, all with real, actual, honest-to-God equal partnerships. The only employees in the whole area are at the University and the VA. Of course, last week one of the mid-sized ones sold out to an AMC (the first AMC foray in my state), so who knows what the future holds. For now, it's partnerships as far as the eye can see!
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I would tend to say the same thing for the area around me. We swooped in and grabbed up two top performers from a group in nearby metro that sold to AMC, but to my knowledge there are only partnership groups vs hospital employees within 100 miles of me, with the exception of that one group owned by an AMC, and one other that is in the process of negotiating a sell out. Hospital employees are all within the same 2 hospital systems or a couple <4 OR places.

It does make it harder for new grads to compete for partnership slots vs experienced guys who dont want to become employees. I expect we will have to choose our next new hire between a new grad vs one of guys from a large practice ~70 miles away. That group got told they have just initiated their last 3 year contract with the hospital before they will become/be replaced by hospital employees.

I think depending on the region, 10% partnership track is WAY low, but it seems the rest of the country is being decimated by this blight. My residency class had ~25% who became academic, 25% employment, and 50% partnership track. 4 years out the ones I have kept up with are all partners (except the one poor sucker who was on a 5 year track), and one who decided they disliked their group and traded for an employment job.

I will now place my head firmly back in the sand. It is nice here, and I dont want it to change.


Sent from my iPad using SDN mobile app
 
Mman said:
Most management companies do not steal contracts, groups sell to them voluntarily in exchange for cash. But now we are seeing backlash by hospitals against them because when they need changes made to things, they'd rather just talk to the guys/gals working in the OR rather than be given a 1-800 number to call to get someone authorized to make a decision.
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Yes and no.

Groups that rely on big subsidies have been losing contracts left and right.

And occasionally the management companies will "dangle" a hanging fruit to former group members partners to stay by offering them a $100-300k rentention contract bonus for 2 years or so. Cause it will cost management company money to recruit more people or pay locums fees. It cost anywhere between $20-40k to recruit one MD.

It gets expensive for management companies.

So group does lose contract but it's a buy out at the same time.

Mednax has done this up north. Team health has done similar "buyout/take over arrangement" down south.

Of course the super profitable groups will sell out first. But groups with big subsidies are losing their contracts and they just end up staying for a min amour of money
 
aimedicine said:
I think the thing ER got goingfor them is that its shift work and they get paid by the hours....i wouldn't mind this for anesthesia.
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Anesthesia can be easily set up as a shift work schedule too. Kaiser does it that way.
 
pjl said:
I would tend to say the same thing for the area around me. We swooped in and grabbed up two top performers from a group in nearby metro that sold to AMC, but to my knowledge there are only partnership groups vs hospital employees within 100 miles of me, with the exception of that one group owned by an AMC, and one other that is in the process of negotiating a sell out. Hospital employees are all within the same 2 hospital systems or a couple <4 OR places.

It does make it harder for new grads to compete for partnership slots vs experienced guys who dont want to become employees. I expect we will have to choose our next new hire between a new grad vs one of guys from a large practice ~70 miles away. That group got told they have just initiated their last 3 year contract with the hospital before they will become/be replaced by hospital employees.

I think depending on the region, 10% partnership track is WAY low, but it seems the rest of the country is being decimated by this blight. My residency class had ~25% who became academic, 25% employment, and 50% partnership track. 4 years out the ones I have kept up with are all partners (except the one poor sucker who was on a 5 year track), and one who decided they disliked their group and traded for an employment job.

I will now place my head firmly back in the sand. It is nice here, and I dont want it to change.


Sent from my iPad using SDN mobile app
Click to expand...

In your region there may be a high % of private practice groups. But, in my entire state which is the 4th largest in the nation there are likely just a handful of true private practice groups remaining and I doubt more than a few are offering partnerships any longer. Thus, in my state I'd say the % is like 5% (or less) which more than makes up for your state based on population or numbers of surgical cases performed each year.

Hence, I'll stilck with the 15% number as the % of jobs offering partnerships overall in the USA.
 
aneftp said:
Groups that rely on big subsidies have been losing contracts left and right.
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I guess I haven't seen that happening anywhere near me, then again I'm not sure what a "big" subsidy is. There are still various private groups within 500 miles of me with all sorts of models. Every single group I personally know that is now run by an AMC was sold out by partners.
 
Stank811 said:
The only reason they are talked about so much know is bc they are throwing chunks of money around buying up groups....they do not bring much to the table for health care systems outside of a bunch of promises that rarely pan out in the end. Just bc they are the present doesn't make them the future.
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The mega AMCs who are aggressively taking over practices nationwide are the future along with some percentage of hospital employment. The reason for their success is simple: It has become too expensive and too complicated to run an anesthesia group as a small business while keeping up with all the new quality reporting requirements and the increasingly complex and dwindling billing.
It's what happens in a free market when a big corporation opens a big store that sells the same goods for less money next to mom and pop's store!
So you can keep dreaming and convince yourself that the past will come back or decide to accept reality and adapt to this new situation.
 
Mman said:
I guess I haven't seen that happening anywhere near me, then again I'm not sure what a "big" subsidy is. There are still various private groups within 500 miles of me with all sorts of models. Every single group I personally know that is now run by an AMC was sold out by partners.
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Just to name one of several. The group in Daytona beach "sold out" cause they were being pressured to reduce level 1 center subsidy. They just saw another group lose their cash cow 6 OR/GI center lose their outpatient to Sheridan (that group also had hospital contract in the area as well).

The big group in Macon Ga "sold out" also relying on big subsidies cause admin keeps cutting subsidies.

The other one up in northern VA with Mednax (not fairfax, they were first group to sell out to Mednax back in 2007/2008). But another one. Mednax originally offered the smaller practice around $500k each than took it by force. Than offers remaining members around $300k to remain for 2 years.

You just get to a point the big AMCs come in and say "we are gonna to play nice, here's the money". Stay and cooperate. Or be taken over with no monetary return.

Big subsidy being 3 million or more to provide anesthesia services in ritual or underserved area.
 
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