Making partner for new grads

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chocomorsel said:
How long does this bull**** of "I am gonna speak to your attending" last anyway? Do you really think that how someone did in residency is exactly how they would perform in the real world? In residency, people have you by the balls and abuse is not uncommon. Residents getting in trouble due to bull**** reasons like "Unprofessionalism" is also not uncommon.

I am speaking from experience here. It happened to me and to lots of people I know. Most of them minorities and or Women. But Thankfully none of that fake ass you-are-a-crappy-Doctor because you have pissed off the wrong people and are unprofessional has followed me into private practice.

Why is that? Maybe because in the real world people are actually nice and reapectful towards me so I don't feel the need to stand up to bullies and be "defensive" like I did in residency?

Residency is not the end all be all. A lot of the drama that happens in the residency bubble does not happen in the real world.

When do you PP partners start looking at someone's work history beyond residency and put more stock into that aspect of their careers?

Please have coffee with my attendings. Some of them are good storytellers and act like they are above and beyond, when in reality, they are in academics for a reason. And not a good one either.
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Sorry, but I can't disagree more. I have perfectly good friends that are academic attendings and they are happy to share the low down on how good or bad someone is and what their work ethic is like. If you were out working somewhere else as an attending and I knew people there, I'd ask about you from them too. It's all about knowing people that will give you an honest opinion. It isn't BS. It isn't you pissed off the wrong people. It's figuring out who is far worse in the real world than they look on paper. We all know those kind of people and we try not to hire them. The best way to get the real scoop is to speak to people that have actually worked with someone, whether that's in residency or as an attending afterwards. If you don't get that's how the world works, I can't help you.

I'm not asking some vindictive, backstabbing attending what they think of a resident that didn't call them sir often enough. I'm asking honest attendings that have a long history of providing me with good information. And when I hear the same thing from 3 or 4 different people, well a pattern starts to become clear (good or bad).
 
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Mman said:
Sorry, but I can't disagree more. I have perfectly good friends that are academic attendings and they are happy to share the low down on how good or bad someone is and what their work ethic is like. If you were out working somewhere else as an attending and I knew people there, I'd ask about you from them too. It's all about knowing people that will give you an honest opinion. It isn't BS. It isn't you pissed off the wrong people. It's figuring out who is far worse in the real world than they look on paper. We all know those kind of people and we try not to hire them. The best way to get the real scoop is to speak to people that have actually worked with someone, whether that's in residency or as an attending afterwards. If you don't get that's how the world works, I can't help you.

I'm not asking some vindictive, backstabbing attending what they think of a resident that didn't call them sir often enough. I'm asking honest attendings that have a long history of providing me with good information. And when I hear the same thing from 3 or 4 different people, well a pattern starts to become clear (good or bad).
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I know how the world works. It's all about who you know. I get it. I am asking about you going back to the residency attendings. Not the real world, PP attendings and asking their opinions. My point is, residency can be very stressful and some residents have a difficult time in it for a number of reasons. Those same residents may do just fine out in PP where the world is a whole lot different.

How far back do you go and for how long after someone graduates from residency do you go back to those attendings? That's my real question here.
 
chocomorsel said:
I know how the world works. It's all about who you know. I get it. I am asking about you going back to the residency attendings. Not the real world, PP attendings and asking their opinions. My point is, residency can be very stressful and some residents have a difficult time in it for a number of reasons. Those same residents may do just fine out in PP where the world is a whole lot different.

How far back do you go and for how long after someone graduates from residency do you go back to those attendings? That's my real question here.
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The real answer is we ask everyone we know that knows someone. How long after someone graduates residency? I have no idea. This thread was regarding newly graduating residents, not people that have been in practice for 10+ years. I would hope people that far out would already know how to get a job.
 
Well, I haven't been out of residency that long.
Mman said:
The real answer is we ask everyone we know that knows someone. How long after someone graduates residency? I have no idea. This thread was regarding newly graduating residents, not people that have been in practice for 10+ years. I would hope people that far out would already know how to get a job.
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Well, I haven't been out of residency that long.
 
Not just jobs.

When I was applying for fellowship, one program called one of their former graduates, who had been an attending at my residency program. I hadn't listed him as a reference. Hadn't seen or talked to him in almost 7 years. The program just checked their files and made a phone call.

It's a small world.

So there's one data point showing that 7 years isn't long enough for people to quit caring about your residency. And the network still exists and works without your input.
 
FFP said:
Sounds almost like an old boys' club. 😉
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The real issue is that when you get applicants, you have no idea how good they are clinically, or what their work ethic is. Your only insight into this is the letters or references that they provide you, which are presumably the people who will paint them in the best light.
I would rather ask a random attending at the program they come with than the references provided. Fortunately, most of the area programs have current staff that were in residency with me or one of my partners, so of course I am going to get the opinion of someone I not only trained at the same time as, but had over for dinner, had kid playdates with, and go on vacations with now. Just as I know they will tell me if someone sucks, they know that if I recommend a medical student that rotates with us for their program, they are getting the best of the class. In both cases you are trying to make your friends life better.
Hiring decisions that are wrong cost hundreds of thousands of dollars, and lots of political capital at your hospital. Not to mention that if you choose someone who is terrible, then dont have them become partner your group can quickly become tagged as predatory.


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*edit for spelling
 
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Come on, how much background checking do you need for someone to do preops and sign CRNA charts?

In all seriousness, CRNAs seem to bounce around to area jobs with ease. There's no background checking going on with CRNAs. They also seem to have no restrictive covenant in that they all do per diem shifts at any and all hospitals in an area. They love the per diem night shifts at the local non-trauma center where they get "paid to sleep." Meanwhile if I try to find moonlighting gigs in my other specialty, I have to pretty much get permission from the Pope.
 
GravelRider said:
Come on, how much background checking do you need for someone to do preops and sign CRNA charts?

In all seriousness, CRNAs seem to bounce around to area jobs with ease. There's no background checking going on with CRNAs. They also seem to have no restrictive covenant in that they all do per diem shifts at any and all hospitals in an area. They love the per diem night shifts at the local non-trauma center where they get "paid to sleep." Meanwhile if I try to find moonlighting gigs in my other specialty, I have to pretty much get permission from the Pope.
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Partner means something, if I was hiring an employee it would be much lower standard. Plus, we do our own cases a fair amount of the time 🙂



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pjl said:
Partner means something, if I was hiring an employee it would be much lower standard. Plus, we do our own cases a fair amount of the time 🙂


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Click to expand...

Eeeeeeeew!
 
GravelRider said:
Come on, how much background checking do you need for someone to do preops and sign CRNA charts?

In all seriousness, CRNAs seem to bounce around to area jobs with ease. There's no background checking going on with CRNAs. They also seem to have no restrictive covenant in that they all do per diem shifts at any and all hospitals in an area. They love the per diem night shifts at the local non-trauma center where they get "paid to sleep." Meanwhile if I try to find moonlighting gigs in my other specialty, I have to pretty much get permission from the Pope.
Click to expand...

CRNAs are nurses. Nurses change jobs all the time. Anesthesiologists are physicians. Physicians tend to stay in one job for a very long time. When we hire a physician we assume they will work with us til they voluntarily retire.
 
chocomorsel said:
How long does this bull**** of "I am gonna speak to your attending" last anyway? Do you really think that how someone did in residency is exactly how they would perform in the real world? In residency, people have you by the balls and abuse is not uncommon. Residents getting in trouble due to bull**** reasons like "Unprofessionalism" is also not uncommon.

I am speaking from experience here. It happened to me and to lots of people I know. Most of them minorities and or Women. But Thankfully none of that fake ass you-are-a-crappy-Doctor because you have pissed off the wrong people and are unprofessional has followed me into private practice.

Why is that? Maybe because in the real world people are actually nice and reapectful towards me so I don't feel the need to stand up to bullies and be "defensive" like I did in residency?

Residency is not the end all be all. A lot of the drama that happens in the residency bubble does not happen in the real world.

When do you PP partners start looking at someone's work history beyond residency and put more stock into that aspect of their careers?

Please have coffee with my attendings. Some of them are good storytellers and act like they are above and beyond, when in reality, they are in academics for a reason. And not a good one either.
Click to expand...
This BS is unfortunately very common among private groups in desirable markets. Many of these groups had metamorphosed into a sort of fraternity with a strong relationship with a nearby equally full of **** residency program, and they both (the group and the residency program) think of themselves as God's gifts to anesthesia and monopolize the market! Until the day comes and the "senior or founding partners" decide it's time to sell out to an AMC, that's when all that elitism suddenly disappears!
 
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pjl said:
The real issue is that when you get applicants, you have no idea how good they are clinically, or what their work ethic is. Your only insight into this is the letters or references that they provide you, which are presumably the people who will paint them in the best light.
I would rather ask a random attending at the program they come with than the references provided. Fortunately, most of the area programs have current staff that were in residency with me or one of my partners, so of course I am going to get the opinion of someone I not only trained at the same time as, but had over for dinner, had kid playdates with, and go on vacations with now. Just as I know they will tell me if someone sucks, they know that if I recommend a medical student that rotates with us for their program, they are getting the best of the class. In both cases you are trying to make your friends life better.
Hiring decisions that are wrong cost hundreds of thousands of dollars, and lots of political capital at your hospital. Not to mention that if you choose someone who is terrible, then dont have them become partner your group can quickly become tagged as predatory.


Sent from my iPad using SDN mobile app
*edit for spelling
Click to expand...

then why ask them for letter of reference if you are just going to ignore it
 
Mman said:
CRNAs are nurses. Nurses change jobs all the time. Anesthesiologists are physicians. Physicians tend to stay in one job for a very long time. When we hire a physician we assume they will work with us til they voluntarily retire.
Click to expand...

Not any longer. I was just reading an article (I forget where) talking about how one of the negative impacts of physician employment is doctors are no longer serving their communities for years. They are moving from job to job.

Midlevels are continuing to encroach yet they are not held to the same employment restrictions.
 
GravelRider said:
Not any longer. I was just reading an article (I forget where) talking about how one of the negative impacts of physician employment is doctors are no longer serving their communities for years. They are moving from job to job.

Midlevels are continuing to encroach yet they are not held to the same employment restrictions.
Click to expand...

Plenty of CRNAs have to sign noncompetes
 
aimedicine said:
ya but you guys would see it as a red flag if he didn't provide one....wouldn't u?
Click to expand...

no

We ask for a CV so we can verify training and work history. We make phone calls to people that can verify them as a person and work ethic and technical skills. We interview them in person to make sure they seem like a personality fit. A letter from someone that likes a candidate doesn't really mean anything. I mean literally every graduating resident in the country can come up with someone to write a nice letter. That doesn't mean every one of them would be a good hire.
 
GravelRider said:
Think of a partnership track as an investment. You are not only potentially investing money, but you are investing your most precious resource...time. Would you invest a significant amount of money in a company that you knew nothing about? Would you invest in a company where you didn't know much about the leadership or the direction the company is headed in? If someone came up to you and said give me $100k to invest in my company, but they refused to share the financial status of that business, would you invest? If a group is not transparent then they don't deserve your investment.
Click to expand...
Nice post. This is as true as a post as they come. Lots of suckers out there. Including myself perhaps. But ive never bought into this partnership track ****. Every group that I was interested that mentioned partner track I asked one question and never got a real answer. If there is a buy in, what is the buy out? Radio Silence so i have always declined or was never offered the position. Gravelrider you have some good thoughts and seem to know what is going on...
 
Wiscoblue said:
It's not as simple as you make it out to be. When I quit my faculty job to go into private practice, I went on pure faith. On the word of the chairman and power of trust in a hand shake. My contract did not get to me till 6 months into the job. I signed it without reading it. Over the years I have been the recruiter for our group and everyone that we have hired has always made partner except for one crazy angry guy. We are up front and honest in our hiring process but when we get guys who show the contract to their lawyers and want the language changed and start asking for new clauses to be added we get wary. Usually the group will vote to move on to the next candidate. Unfortunately the potential new hire is not in a position to make demands. There are plenty of people waiting in the wings to invest that $100k as you put it. That's the reality.
Click to expand...
So you are saying that your lawyer can look at the contract but my lawyer cant? You are a predator my friend. A predator. And just because you were naive enough to sign a unread contract does not make that advice to dole out. In fact, no one will advise you of this.
 
criticalelement said:
Nice post. This is as true as a post as they come. Lots of suckers out there. Including myself perhaps. But ive never bought into this partnership track ****. Every group that I was interested that mentioned partner track I asked one question and never got a real answer. If there is a buy in, what is the buy out? Radio Silence so i have always declined or was never offered the position. Gravelrider you have some good thoughts and seem to know what is going on...
Click to expand...
The buyout is probably zero, my friend, because the business value is really minimal, beyond the contract and how much you can personally produce without somebody skimming off the top (plus a proportional participation to the profit from employing suckers). So if you produce zero, you get zero. (I don't think they will let you take your part of the employee cream while you are just nominally a partner.)

Best case scenario they'll give you back your buy-in.
 
chocomorsel said:
Please have coffee with my attendings. Some of them are good storytellers and act like they are above and beyond, when in reality, they are in academics for a reason. And not a good one either.
Click to expand...

Right on!!!
If you want to know how NOT to do things, go into an academic anesthesia department where to invertebrate anesthesia chairmen (and those in charge) do ZERO things clinical and speaks like they do. They dont take the risks and liability that the rank and file do, they dont take call, they are just waste products. Mostly.
We cover a few endo centers and sometimes we have the folks at the local residency program cover. these folks cant get through even colonscopies without the gastroenterologists calling me and complaining about their sedation. Whereas i have three NON boarded anesthesiologists who never ever have problems
 
GravelRider said:
Come on, how much background checking do you need for someone to do preops and sign CRNA charts?

In all seriousness, CRNAs seem to bounce around to area jobs with ease. There's no background checking going on with CRNAs. They also seem to have no restrictive covenant in that they all do per diem shifts at any and all hospitals in an area. They love the per diem night shifts at the local non-trauma center where they get "paid to sleep." Meanwhile if I try to find moonlighting gigs in my other specialty, I have to pretty much get permission from the Pope.
Click to expand...


there are a lot.. and I mean a lot of anesthesiologists with personality disorders. I am NOT kidding about this one. They have to flex their muscles, argue with surgeons yell at nurses about IV placement, demean CRNAs it goes on and on and on. And if you happen to be around one of these people and hire them... it is t just an absolute downer on everyone. It just sucks the life out of everyone. So the people doing the hiring have to make sure they dont get that person.. I totally get it.

You dont have to get permission from the pope but you cant be an dingus
 
FFP said:
The buyout is probably zero, my friend, because the business value is really minimal, beyond the contract and how much you can personally produce without somebody skimming off the top (plus a proportional participation to the profit from employing suckers). So if you produce zero, you get zero. (I don't think they will let you take your part of the employee cream while you are just nominally a partner.)

Best case scenario they'll give you back your buy-in.
Click to expand...

The buy-in is the AR you will get paid day 1 as a partner that was earned prior, the buy-out is the AR yet to be collected you will be paid after you leave. They are generally the same, though can fluctuate based on collection efficiency over time. So yes, you do get a buy-out when you leave for whatever reason (retire, change jobs, etc).
 
Mman said:
I think a primary question med students should ask on interview days is about where their former residents are working. I mean in the end you go to residency to get a job afterwards. If you don't like the sound of where their former grads are working then you might not want to do residency there. I was fortunate enough to do a residency at an elite academic name that also had lots of grads working in PP groups around the country. So when I was winding down in residency I had a network of contacts at good jobs to see who was hiring.

Also, don't be a lazy resident. We know people. We aren't just looking at an official letter of rec. We'll buy your attendings a few beers and get the real scoop on who we'd want to work with and who we wouldn't.
Click to expand...

Fortunately (and unfortunately) this is the world.


chocomorsel said:
How long does this bull**** of "I am gonna speak to your attending" last anyway? Do you really think that how someone did in residency is exactly how they would perform in the real world? In residency, people have you by the balls and abuse is not uncommon. Residents getting in trouble due to bull**** reasons like "Unprofessionalism" is also not uncommon.

I am speaking from experience here. It happened to me and to lots of people I know. Most of them minorities and or Women. But Thankfully none of that fake ass you-are-a-crappy-Doctor because you have pissed off the wrong people and are unprofessional has followed me into private practice.

Why is that? Maybe because in the real world people are actually nice and reapectful towards me so I don't feel the need to stand up to bullies and be "defensive" like I did in residency?

Residency is not the end all be all. A lot of the drama that happens in the residency bubble does not happen in the real world.

When do you PP partners start looking at someone's work history beyond residency and put more stock into that aspect of their careers?

Please have coffee with my attendings. Some of them are good storytellers and act like they are above and beyond, when in reality, they are in academics for a reason. And not a good one either.
Click to expand...

Unfortunately (and fortunately) this is still America.

I would think the further you get out (say beyond 3 to 5 years) your residency reviews become less relevant and your current partners and surgeons you work with become more relevant. This is both good and bad. As you said, the PP environment is different and tends to be less combative, ie more collegial, which leads to less issues of "unprofessionalism", but there is a bad apple everywhere. The flip side is that any riff you may have may stand out a little more in which you have to be careful of the label of "pattern of behavior". These private hospitals are all about customer service and a negative review/complaint/etc tends to bring out all the committees. If you're in a competitive market, you could be finding yourself unemployed quick. (I myself have to sometimes check myself). And despite how much others may disagree with the next statement I'll say it anyway, it goes nearly double if you're a person of color or a woman. Mistakes / unprofessionalism / etc is viewed under a microscope so that even a small disagreement, small show attitude, or small difficulty with a procedure turns into "combative", "unprofessional", and "lacks skills".

When people resign voluntarily, so long as they weren't crazy, I feel like most places/people will say they were a fine worker and have ability. I would assume. (I hope) If you find yourself "dismissed" I have no idea how people get their next job. I know of two people throughout my career (residency and PP) who were "dismissed" and I assume the first found work and I know the second did (woman and minority....long interesting story) so it's definitely possible.

I also hear the further you get away the less people care (also depends on their need for workers), for instance people in Texas may not care what a NH attending says (maybe). But if you worked in Houston and move to Austin expect people to call people. So to answer @chocomorsel overall question...I think time and distance are the factors.
 
You can add immigrant to your favorite persecution list. 🙂

Actually, you can add all minorities who qualify for protection under the Civil Rights Act, it just depends what part of the country you are in, especially those which have clear majority of a type. Feel better now?

Funny thing: since nobody knows that discriminating against foreign-born Americans is as illegal as discriminating against an African American, everybody is afraid to be accused of discrimination against the latter, and piss on the former.
 
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FFP said:
Beats me why more groups don't test candidates as locums, for a few months, and the other way round, especially.
Click to expand...
Kaiser SoCal started doing this around 2010. Yes Kaiser is a weird partnership entity/pension after 20 years which people double dipping around age 50 back at other jobs.

But I digress. Kaiser had some bad hires around 2006-2008. So they don't offer full time immediately that I know of. And they pay a ridiculously low per hour w2 rate of like $125/hr.
 
aneftp said:
Kaiser SoCal started doing this around 2010. Yes Kaiser is a weird partnership entity/pension after 20 years which people double dipping around age 50 back at other jobs.

But I digress. Kaiser had some bad hires around 2006-2008. So they don't offer full time immediately that I know of. And they pay a ridiculously low per hour w2 rate of like $125/hr.
Click to expand...
Really? That was close to my rate at my last permanent attending job. Lost your respect? 🙂
 
FFP said:
Really? That was close to my rate at my last permanent attending job. Lost your respect? 🙂
Click to expand...
Really?

Were u working 60 plus hours in hospital? Beeper?

I don't make a lot of money as some of my friends who make 500-600k range). I probably make around $400k-420k gross income (subtract pretax stuff like Heath malpractice liberal CME (slush cme/vacation cruises 🙂. So we usually give ourselves a w2 around 320-340k.

My weeks vary so much. This week I only worked 25 hours and had even Monday off cause it was light and Friday I left at 11am, went to watch the captain America. I am on "beeper" for around 12 total hours but rarely called in.

Next week is my busy week. Probably looking at 55-60 hours in hospital plus 20-30 hours beeper (we have 48 hour weekend calls every 6th weekend). But work varies so much. Some weekends I may work 10-12 hours each day. Last weekend call I worked a total of 5 hours combined both days and done at 9-10am

I probably "average" 40-45 hours of work plus 10-12 hours of beeper each week. Rarely get called back after 9-10pm if we are on call. We take calls around 1/5 or 1/6.

So I don't know exactly what my "hourly rate" would be cause beeper hours have to be included. We all take 9 weeks off.

But the current job I have is a lot better than the 425k 1099 I was making at outpatient multi speciality where I was literally working 6am-4-5pm almost every day with 6 weeks off. That's around 50-52 hours a week with no earlier days. Obviously no call no weekends.

So my hours were similar but I feel my lifestyle is better at my current hospital based group (have off days/short days to balance the late days/calls).
 
criticalelement said:
Right on!!!
If you want to know how NOT to do things, go into an academic anesthesia department where to invertebrate anesthesia chairmen (and those in charge) do ZERO things clinical and speaks like they do. They dont take the risks and liability that the rank and file do, they dont take call, they are just waste products. Mostly.
We cover a few endo centers and sometimes we have the folks at the local residency program cover. these folks cant get through even colonscopies without the gastroenterologists calling me and complaining about their sedation. Whereas i have three NON boarded anesthesiologists who never ever have problems
Click to expand...
The typical academic "attending" is usually good at one thing: taking something very simple and turning it into a complete and utter dramatic disaster!
 
FFP said:
You can add immigrant to your favorite persecution list. 🙂

Actually, you can add all minorities who qualify for protection under the Civil Rights Act, it just depends what part of the country you are in, especially those which have clear majority of a type. Feel better now?

Funny thing: since nobody knows that discriminating against foreign-born Americans is as illegal as discriminating against an African American, everybody is afraid to be accused of discrimination against the latter, and piss on the former.
Click to expand...
Bigots are everywhere my friend and most of the times they attract other bigots and have their own bigot good ol' boy practices!
They tend to be the ones with the contracts in the desirable locations because most of those desirable locations became desirable because they keep those who don't fit the typical profile out!
The typical profile in desirable locations is white, blue eyes, preferably with blond hair and an avid follower of Fox news!
 
I echo everything everyone said above about how residency can be tough ffor some esp minority....i had one attending this year write me a subpar eval when my total interaction with him was probably 5hrs total (80% of those hrs was spent spreading butt cheeks apart in OR while he does his hemorroidectomies)...he never once asked me a medical related question. I was shocked to see my eval, esp given how several chief residents told me my medical knowledge was comparable to 2nd year surgical residents and how i do a good job teaching med studemts ...and i worked with those chief residents on a daily bases with plenty of pimping sessions. I refuse to let that eval stand, i wrote an email to the attending for him to simply elaborate on how he was able to judge my medical knowledge based on very limited interaction if not nonexistence(he has yet to reply)...i mean not once did he ask me one medical/surgical question. Im not trying to be cocky, but damn it, i know my shyt cold.

That really pissed me off! Hopefully my anesthesia program durector won't hold this against me.
 
I recently moved from one job to another. I looked for a good 2-3 years before I found the perfect fit. I only looked at MD only partnership tracks with good groups (either by reputation or by colleagues I knew in residency). There are plenty of them still out there.

I would suggest that when signing on for a partnership track, you try and incorporate a clause in your contract that says that if the group sells, you get x$$or % of buyout (to be negotiated with you and the group).
If the group is unwilling to do this, this may be a clue as to fairness of the group or the fact that the group could be in negotiations with an AMC.
 
Planktonmd said:
The typical academic "attending" is usually good at one thing: taking something very simple and turning it into a complete and utter dramatic disaster!
Click to expand...

I've been taught at least 73 different "correct" ways to tape a tube and which tape is better and why. Yet I still tape my tubes the way my very first attending taught me. Sometimes in residency you just nod your head and let the attending go through his or her hysterics and make a mental note not to model your future behavior after those attendings.
 
Planktonmd said:
Bigots are everywhere my friend and most of the times they attract other bigots and have their own bigot good ol' boy practices!
They tend to be the ones with the contracts in the desirable locations because most of those desirable locations became desirable because they keep those who don't fit the typical profile out!
The typical profile in desirable locations is white, blue eyes, preferably with blond hair and an avid follower of Fox news!
Click to expand...

This ^^^^^
 
GravelRider said:
I've been taught at least 73 different "correct" ways to tape a tube and which tape is better and why. Yet I still tape my tubes the way my very first attending taught me. Sometimes in residency you just nod your head and let the attending go through his or her hysterics and make a mental note not to model your future behavior after those attendings.
Click to expand...

And this ^^^^^

took me a minute to pick up on this one and believe it or not, if you want a stress free private practice life/career you need to do the same
 
There is still a demand for good physicians. If you are applying with a company that is doctor owned, I would make it part of your contract, after so many year(s) of service you become a partner. I use to work for a company that is doctor owned and the company used it as a perk to get the best of the best physicians.
 
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