partnership thread 2.0

[fastosprintini]

I do think this too important and 'educational" to be left out. Although the first thread degenerated in a racist mudslinging, I'd like to hear from people in PP .... what are your thoughts on "unequal" partnerships, who holds the money , etc
fasto

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[Noyac]

In general I think its not a good situation. Everyone should be paid an equal wage for equal work. With that being said, I do believe it is a bit arrogant to walk into a long standing practice which has built its reputation for years solidifying its referral base and demand equal pay on day one, especially right out of training. There are groups that will pay equal on day one, mine is one of them if experience is there, but doing a short partnership tract is not a slap in the face as long as everyone is on the same page.

 

[mille125]

When looking at your question, it is important to try to look at it from both the employer and employee perspective. I have been in both situations. It was hard for me to see the employer perspective as a new grad.

There are definitely some employers out there who are trying to get something for nothing (ie giving new graduates a greater increased workload with little financial reward). However, most employers are not like this. They are hiring because they need help in order to carry out obligation to a hospital, ASC, etc. Offering someone immediate partnership or other benefits from day 1 is a scary proposition. If this arrangement doesnt work out, it can be very complicated to "untangle" this new individual from the practice. This individual will also have "trade secrets" for which he can damage the practice. Therefore, most employers feel a greater sense of comfort by offering a period prior to full ownership. This is reasonable.


The employee is looking to be fairly compensated for their services. This is also reasonable. Personally, I feel that a one or two year partnership track is reasonable.


Good luck..........

 

[Noyac]

When looking at your question, it is important to try to look at it from both the employer and employee perspective. I have been in both situations. It was hard for me to see the employer perspective as a new grad.

There are definitely some employers out there who are trying to get something for nothing (ie giving new graduates a greater increased workload with little financial reward). However, most employers are not like this. They are hiring because they need help in order to carry out obligation to a hospital, ASC, etc. Offering someone immediate partnership or other benefits from day 1 is a scary proposition. If this arrangement doesnt work out, it can be very complicated to "untangle" this new individual from the practice. This individual will also have "trade secrets" for which he can damage the practice. Therefore, most employers feel a greater sense of comfort by offering a period prior to full ownership. This is reasonable.


The employee is looking to be fairly compensated for their services. This is also reasonable. Personally, I feel that a one or two year partnership track is reasonable.


Good luck..........

Absolutely right.

There is no way I'm taking a chance on someone I DON'T KNOW without some security only to find out that they are a poor fit for the group.

Unfortunately, many residents these days think the world owes them something for nothing. Just look at the numbers wanting to do locums b/c they don't want to sign for anything less than the partners. I'm not talking about those that want locums while they try to figure out where they want to be.

On the other hand, you don't need to be slave labor either. If they are truly interested in you being a partner they will take care of you.

 

[deleted126335]

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[mille125]

Agree. But watch out for the bait and switch partnership. Where all "partners" supposedly are the same, upon partnership being granted after you put in the 1-3 years and buy the house, you find out that the partnership that you thought you were working for is not a true equal partnership. Voting rights for the company are controlled and always will be controlled by senior docs. A separate "billing company" exists that is owned by the senior docs whose fees are significant. Or senior docs whose family members are employed by "the company" etc., etc.

very very true....most of us unfortunately dont realize this until it is too late.....

 

[Fooper]

As a full partner with 15 years experience I've sometimes considered relocating just to try something new or live someplace new or be closer to family. I always let it drop though when I think about working at reduced salary for 2-3 years doing the same work as guys with less experience. It's a bummer to have to go through the buy-in process again just to try something different. I have heard of groups reducing the time to 6 months or a year based on experience but it doesn't seem common.

 

[Noyac]

As a full partner with 15 years experience I've sometimes considered relocating just to try something new or live someplace new or be closer to family. I always let it drop though when I think about working at reduced salary for 2-3 years doing the same work as guys with less experience. It's a bummer to have to go through the buy-in process again just to try something different. I have heard of groups reducing the time to 6 months or a year based on experience but it doesn't seem common.

It seems as though the smaller or newer groups offer shorter partnership tracts like 1 yr while the larger or more established ones have longer terms. This is obviously a generalization but not far from the norm.

 

[LonghornJPS]

I've been reviewing old threads on the subject of the job hunt, partnerships, questions to ask, etc... There is plenty of good information posted, and I've learned a ton.

...you find out that the partnership that you thought you were working for is not a true equal partnership. Voting rights for the company are controlled and always will be controlled by senior docs. A separate "billing company" exists that is owned by the senior docs whose fees are significant..

What can we do to find this out? If we are granted permission to see the books, will this scenario be evident or hidden? What are some good questions to ask?

 

[deleted126335]

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[deleted126335]

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[Noyac]

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On your interview look every partner in the eye and ask:

1. Who does the billing and do any partners have a financial interest?
2. When I am a partner will I have ALL the same rights and privileges as ALL the other partners? If not, when will I be a true equal?
3. Does the company have any employees who have a personal tie to any of the partners?
4. Ask if you could see the corporate bylaws.

2) And somewhere in your contract it should specify that you are no different than the longest standing partner once you are granted partnership.

Personally, I don't understand the family ties part of this. I'm sure I'm missing something but if my child wants to work for daddy at the fair market rate of the other employees then how is that an issue? Only if they are treated unfairly superior. And then thats another story.

 

[aredoubleyou]

\

On your interview look every partner in the eye and ask:

1. Who does the billing and do any partners have a financial interest?
2. When I am a partner will I have ALL the same rights and privileges as ALL the other partners? If not, when will I be a true equal?
3. Does the company have any employees who have a personal tie to any of the partners?
4. Ask if you could see the corporate bylaws.

How often do new grads ask these kinds of questions? Is there any negative connotation of asking multiple reimbursement/ bookeeping/ accounting/ fairness questions early on? I would immagine if they are looking for someone to abuse you'd less likely get the job, do you think it would turn more or less fair groups off?

What do you guys think?

 

[jwk]

How often do new grads ask these kinds of questions? Is there any negative connotation of asking multiple reimbursement/ bookeeping/ accounting/ fairness questions early on? I would immagine if they are looking for someone to abuse you'd less likely get the job, do you think it would turn more or less fair groups off?

What do you guys think?

I think a good group would think those types of questions are perfectly reasonable. A group looking for someone to abuse might think otherwise, which would probably be a red flag.

 

[mille125]

I think a good group would think those types of questions are perfectly reasonable. A group looking for someone to abuse might think otherwise, which would probably be a red flag.

I agree. If a grad asked me these questions, I would be impressed. I would feel that it would show both interest and maturity. Obviously, you should also ask some noneconomic questions as well.

 

[Gern Blansten]

How often do new grads ask these kinds of questions? Is there any negative connotation of asking multiple reimbursement/ bookeeping/ accounting/ fairness questions early on? I would immagine if they are looking for someone to abuse you'd less likely get the job, do you think it would turn more or less fair groups off?

What do you guys think?

As with anything else, there is a right way to ask questions and a wrong way. Try and ask in a curious and non accusatory way. If you can find the names of the people who have most recently left the group, that would be good info to have.

 

[Frank Rizzo]

Agree. We all crave security in an insecure world. A stable group that has minimal turnover (other than partners retiring), One that has had an exclusive contract for decades with a hospital system is as secure that you are going to find in this business. Most of us will pay up for this by way of a long buy in.

You description of this stable group is exactly the kind of group that has the 5-yr partnership track that I talked about in the original thread. Nobody ever leaves. Its the most stable and oldest group in the metro area. I plan on staying in the area, which is why, despite the long track, I am interested in the goup.

 

[thegasman]

You description of this stable group is exactly the kind of group that has the 5-yr partnership track that I talked about in the original thread. Nobody ever leaves. Its the most stable and oldest group in the metro area. I plan on staying in the area, which is why, despite the long track, I am interested in the goup.

Like I said in the other post - I am in a group like this on a partnership tract (3 year). It is a little bit of a gamble, or maybe just more delayed gratification (less money now with the hope of much more later).

 

[Leinie]

I went through this process a few years ago. I ended up working as an employed anesthesiologist for a hospital Most medical practices have a buy in due to their physical structures, equipment, community reputations, etc. Anesthesia practices frequently hve little of this. The only thing that makes a group profitable is a hospital contract. If they loose that contract, the value of their business goes up in smoke. Your buy in is just to compensate partners for getting there first and holding that contract.

The only partnership track positions one should take are those that compensate you fairly from day one. Practices like that are hard to find. Do what you need to in the short term to earn fair compensation while you look. Sign up with an AMC, become employed by a hospital, or just do locum tenens for awhile. Groups loose contracts all the time, and you should be satisfied with what a group paid you if you never see the partnership salary. Someone mentioned on another thread that in the future we will all be employees of an AMC or large group, which I think has a lot of merit. The political prospects for future medical reimbursement is uncertain too. 10-15 years from now a $500k salary for an anesthesiologist will be unheard of, so don't settle for $175k now thinking the payoff will come in the future.

 

[deleted126335]

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[Leinie]

You are over generalizing. Yes employed positions will be more common. No, we will not "All be employees of an AMC or large group" Yes, groups lose contracts, but it does not happen "all the time". For some working for a few years at reduced salary towards a partnership will be a bad investment, but for others it will be the best financial decision they ever make.

I may have been over generalizing. I live in a world where I do my own cases, never see a CRNA, and the hospital and surgeons appreciate me. Then I get on SDN every few months, read all the stuff about AMCs, CRNAs, healthcare reform, etc and it gets me depressed! I think my post reflected that.

I do some locum tenens on my vacation time, so I talk with lots of recruiters and hospital/AMC/group representatives. In the last two months I have talked with a large group in Texas with a new contract at a hospital (previously held by another large group), an AMC in the Southeast that got a a hospital contract (previously held by a private group), an AMC in New York that got a contract (previously held by a private group), and a hospital in Florida that was beginning to employ their anesthesiologists and had a number leaving. The hospital group I am at was private just 3 years ago. When I was finishing my fellowship I interviewed with a 14 hospital system that had not renewed their contract with three of their groups and were employing their anesthesiologist at those sites. They were recruiting leadership at that time too because the plan was to employ the anesthesiologists at all 14 sites in the future. That seems like a lot of groups losing contracts to me, and there are almost certainly many young anesthesiologists that worked at a reduced salary for a "buy in" that have nothing to show for it but a smaller retirement/bank account.

 

[BLADEMDA]

I may have been over generalizing. I live in a world where I do my own cases, never see a CRNA, and the hospital and surgeons appreciate me. Then I get on SDN every few months, read all the stuff about AMCs, CRNAs, healthcare reform, etc and it gets me depressed! I think my post reflected that.

I do some locum tenens on my vacation time, so I talk with lots of recruiters and hospital/AMC/group representatives. In the last two months I have talked with a large group in Texas with a new contract at a hospital (previously held by another large group), an AMC in the Southeast that got a a hospital contract (previously held by a private group), an AMC in New York that got a contract (previously held by a private group), and a hospital in Florida that was beginning to employ their anesthesiologists and had a number leaving. The hospital group I am at was private just 3 years ago. When I was finishing my fellowship I interviewed with a 14 hospital system that had not renewed their contract with three of their groups and were employing their anesthesiologist at those sites. They were recruiting leadership at that time too because the plan was to employ the anesthesiologists at all 14 sites in the future. That seems like a lot of groups losing contracts to me, and there are almost certainly many young anesthesiologists that worked at a reduced salary for a "buy in" that have nothing to show for it but a smaller retirement/bank account.

I agree with you to some extent that it can be a Gamble. Still you can improve the odds some by examing the group, the situation and asking a lot of questions. you won't ever get a guarantee and the odds probably wont exceed 90 percent in your favor