Mordak

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Hello. I'm getting ready in the upcoming year to assess the job market. Are partnership tracks possible for new recruits anymore? Probable? Second, I feel I am receiving
Misinformation and am being told that research and publication record are vital to a job search, post fellowship. I doubt this is true, even for many academic places, but wanted to hear others' experiences. Last, has anyone in pathology taken advantage of the VA loan payback? (I believe it is up to a max of 120k over 5-6 years). Any issues when applying for this? I'm more concerned if it pathology meets requirements considered to be a difficult to recruit position to justify this loan payback. Thanks.
 

pathslides

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Aug 7, 2016
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Hello. I'm getting ready in the upcoming year to assess the job market. Are partnership tracks possible for new recruits anymore? Probable? Second, I feel I am receiving
Misinformation and am being told that research and publication record are vital to a job search, post fellowship. I doubt this is true, even for many academic places, but wanted to hear others' experiences. Last, has anyone in pathology taken advantage of the VA loan payback? (I believe it is up to a max of 120k over 5-6 years). Any issues when applying for this? I'm more concerned if it pathology meets requirements considered to be a difficult to recruit position to justify this loan payback. Thanks.
From my recent experience, in the community/private world the things that matter are:

Residency/fellowship hospital name recognition
References
Communication skills
Not being a total social freak who is hard to work with.
Research is worthless.
 
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icpshootyz

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From my recent experience, in the community/private world the things that matter are:

Residency/fellowship hospital name recognition
References
Communication skills
Not being a total social freak who is hard to work with.
Research is worthless.
Agree with this for private practice. No one cares about your obscure research in PP, just doesn't matter. As for the VA loan payback I don't know anyone that has. But you'd have to be able to compare what you could make outside the VA and see if the pay would more than make up for the $120K loan payback. I easily paid back almost all my loans in around 3 years in PP, just leaving my low rate ones (~3% APR) since the interest is less than I make investing.
 
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mikesheree

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Might sound a little cynical but connections and personality/affability
pretty much trump the rest unless your background/CV are full of
red flags. Oh, and being boarded.
This all assumes you are just starting and have zero post fellowship
experience.
 

cmz

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I am not opposed (in my group) to spreading the wealth with others as it attracts more talent and keeps all of the players vested in helping the company succeed. The only issue that I've seen so far is that some employees simply have an 'employee mentality.' There is nothing wrong with that at all. They come to work and do their job but offer little else... if you want partnership, the opportunity is there but you have to earn it. If you don't know what you need to do to get there, you aren't at that level yet.
 

jupiterianvibe

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I am not opposed (in my group) to spreading the wealth with others as it attracts more talent and keeps all of the players vested in helping the company succeed. The only issue that I've seen so far is that some employees simply have an 'employee mentality.' There is nothing wrong with that at all. They come to work and do their job but offer little else... if you want partnership, the opportunity is there but you have to earn it. If you don't know what you need to do to get there, you aren't at that level yet.
what does a pathologist need to do to get to partner?
 

yaah

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We are hiring for a partner position (we do not hire non-partners unless the person specifically wants to not be a partner).
In our group responsibilities, income, and status are ramped up over 3 years until becoming full partner. We haven't hired anyone since I've been here that hasn't deserved it so I don't know what happens. I guess we could theoretically fire someone. We don't hire people who just want to punch a clock and not contribute apart from reading slides.

The above comments are similar to my thoughts, what we are looking for (probably in order)
1) The right skills for the job (typically more than one area of expertise or interest, likely including something CP related so they can lead a section or lab, plus an AP area to concentrate on but also do something else)
2) Personality and fit (not a psycho, not an egocentric douche, not a flake, not a mean person, not a manipulator, not a work-shirker, someone who can communicate). This sounds obvious and not subtle but I would wager that at least 25% of US doctors have one or more of these negative characteristics).
3) Someone who wants to work with us and stay here (i.e. isn't taking the job because the job they really want in North Carolina isn't available yet)
4) References (can be the most important factor if they are significantly negative or significantly fantastic - has pushed a couple of candidates over the edge in both directions since I have been here)
5) Training background (but hard to find someone checking all the boxes in 1-4 above who doesn't have a good training background in some way or another - some start slow and then excel later on)
6) Things like board certification are non-negotiable anyway, many hospitals require you to be board certified, including ours. Same with criminal background checks.

Pathology is a small world. Almost every candidate will have a connection who also knows someone in the group. We inquire about these candidates even if the connection is not a reference. Residents should remember this. We have declined to interview many people because someone we know doesn't think very highly of said candidate.
 

cmz

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what does a pathologist need to do to get to partner?
We are hiring for a partner position (we do not hire non-partners unless the person specifically wants to not be a partner).
In our group responsibilities, income, and status are ramped up over 3 years until becoming full partner. We haven't hired anyone since I've been here that hasn't deserved it so I don't know what happens. I guess we could theoretically fire someone. We don't hire people who just want to punch a clock and not contribute apart from reading slides.

The above comments are similar to my thoughts, what we are looking for (probably in order)
1) The right skills for the job (typically more than one area of expertise or interest, likely including something CP related so they can lead a section or lab, plus an AP area to concentrate on but also do something else)
2) Personality and fit (not a psycho, not an egocentric douche, not a flake, not a mean person, not a manipulator, not a work-shirker, someone who can communicate). This sounds obvious and not subtle but I would wager that at least 25% of US doctors have one or more of these negative characteristics).
3) Someone who wants to work with us and stay here (i.e. isn't taking the job because the job they really want in North Carolina isn't available yet)
4) References (can be the most important factor if they are significantly negative or significantly fantastic - has pushed a couple of candidates over the edge in both directions since I have been here)
5) Training background (but hard to find someone checking all the boxes in 1-4 above who doesn't have a good training background in some way or another - some start slow and then excel later on)
6) Things like board certification are non-negotiable anyway, many hospitals require you to be board certified, including ours. Same with criminal background checks.

Pathology is a small world. Almost every candidate will have a connection who also knows someone in the group. We inquire about these candidates even if the connection is not a reference. Residents should remember this. We have declined to interview many people because someone we know doesn't think very highly of said candidate.
Essentially ALL of this...
 

tiredguy

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Pathology is a small world. Almost every candidate will have a connection who also knows someone in the group. We inquire about these candidates even if the connection is not a reference. Residents should remember this. We have declined to interview many people because someone we know doesn't think very highly of said candidate.
Completely true and what all residents should learn on the first day. This also can transcend experience...the junior resident you treat poorly today may be the one who is asked about you in the future.
 
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Alteran

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Completely true and what all residents should learn on the first day. This also can transcend experience...the junior resident you treat poorly today may be the one who is asked about you in the future.
In my case, the first year I trained several years ago as a fellow remembered me, gave my name to a group he is well connected to (family ties), and got me the interview that ultimately led me to taking a position with that group.
 

LADoc00

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I dont see a point in making someone partner, never did. You have a laundry list a mile long of solid professionals who will basically take per diem PT work IF you are in a good geographic location. Sure if you are in middle of nowhere you have entice people with partnership dreams, but I think that entire paradigm is dead now.

Now you have either employment model: ie Kaiser, Governmental or 1099-contractor model: private practice per diem for a set $ rate. Both have Positives and Negatives, but the old model of 1.) come in at low ball salary 2.) buy in to faux equity 3.) make tons of loot then rinse/repeat with next generation is totally dead.
 
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Pathbusiness

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Partnerships in a business which has any market value are rare these days. Becoming a partner in a captive corporation or hospital based practice which has no real value is not a partnership IMO.
 
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Mordak

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Thank you for the comments.

Is a "buy in" common place in with today's pathology practices? If this is an apparent shrinking business model with presumably less prospect of investment return, wouldn't my "buy in" best be suited in other investments or reduction of debt?

Why is partner in the sense of a captive corporation or hospital based practice not a true partnership?

My general worry is that investing in any sort of buy-in over the short term is now becoming too risky, and potentially I would be better served paying off my exorbitant student loan debt before even considering a "buy in" option. Perhaps in 5 years I could consider some sort of buy-in when I can assume more risk, but I am completely clueless as to the timeline/regularity of requests of "buy-in."
 

univlad

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Why is partner in the sense of a captive corporation or hospital based practice not a true partnership?
In the sense that the value of the corporation is only the contract with the hospital--which these days could easily be taken away at any time. Or if you're a corporation that owns that lab that services the hospital, the hospital system could decide to go with another lab leaving you without any business.

In our hospital based private practice, new members have historically joined as employees for two years, to ensure that they are good fit for the group and then are offered partnership where their salary is an equal share of the groups earnings. As employees, they are paid more than an hospital employee would be probably get paid, but less than a partner. Once a partner retires/leaves, they get paid a few months salary, but their actual shares aren't really worth anything. I think groups that charge an additional "buy in" with money are essentially just extending this period a little longer or actually have a business with tangible assets rather than just a contract with a hospital to buy into. While you are buying shares that could have some value at the end, they could be worth nothing. If during the payoff period, you're still making more than a hospital employee would make after the buy in portion is taken out of your check, it's probably worth the risk. The buy in types of practices I interviewed at just reduced your paychecks for the first year or two of partnership, but those buying in were still making more than they had made as employees.

With all the mergers and acquisitions going on, our contract seems at constant risk, but I think it would still be a good group to join into. We still make more than a hospital employed position would make. At some point, there will probably be a push to become employed...at that point we'd just have to make the decision to stay or go. Most of us are live below your means types, and have been preparing for that day.
 
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yaah

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We still have partners. As LADOc said, it might be easier to get someone to do per diem work or be an employee, but if you care about quality and relationships that makes it a lot harder. And as a group going through the hiring process now, it is surprisingly hard to find someone who is the right fit for our medium-sized group. We are stable, part of a large physician group intimately linked with the hospital, but on our own enough to control our $ and hires and business. So we may be technically employed by the physician group but we have far more autonomy and variable income than employees (i.e. no "bonuses" for productivity, just increased income). Many of the applicants simply don't have broad enough skills, or lack something significant personality-wise. I am not sure if there are an increasing proportion of pathologists who only have 1-2 areas of ability to cover, or the job market is not as tight as people say, or what the truth is. We are definitely getting a lot of weak applications though.
 

AZpath

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We still have partners. As LADOc said, it might be easier to get someone to do per diem work or be an employee, but if you care about quality and relationships that makes it a lot harder. And as a group going through the hiring process now, it is surprisingly hard to find someone who is the right fit for our medium-sized group. We are stable, part of a large physician group intimately linked with the hospital, but on our own enough to control our $ and hires and business. So we may be technically employed by the physician group but we have far more autonomy and variable income than employees (i.e. no "bonuses" for productivity, just increased income). Many of the applicants simply don't have broad enough skills, or lack something significant personality-wise. I am not sure if there are an increasing proportion of pathologists who only have 1-2 areas of ability to cover, or the job market is not as tight as people say, or what the truth is. We are definitely getting a lot of weak applications though.
100% agree with Yaah.
 

AZpath

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The last group I worked for your buy in was just based on the accounts receivable. It was a hospital group with no other assets.
Your buy in was group financed. On making partner your paycheck went up but a portion was allocated to the AR until paid off. This was usually done over a year or so.
Then you paycheck went up even more. You leave the group you get paid out a share of the AR.

There is really no risk to the this deal. The risky setup is if you have to self finance.

I only know of one pathologist burned with a buy in. He had to finance a big buy with a out side loan. Then the lab went under. He was stuck holding the bag.
 
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yaah

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We do not have buy-ins. Just gradual (over 3-4 years) financial equality. Subject to change if the hire turns out to be a dud or a problem, or by choice if the person wants to not have significant responsibility, but that has never happened in our group.

One also has to be aware of retired partners or other investors who make money off the group - they will always get paid first. If you are in a group with the power to not allow retired partners to continue drawing income from the group, do not allow retired partners to continue drawing income from the group. Make it a condition of partnership.
 

univlad

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We do not have buy-ins. Just gradual (over 3-4 years) financial equality. Subject to change if the hire turns out to be a dud or a problem, or by choice if the person wants to not have significant responsibility, but that has never happened in our group.

One also has to be aware of retired partners or other investors who make money off the group - they will always get paid first. If you are in a group with the power to not allow retired partners to continue drawing income from the group, do not allow retired partners to continue drawing income from the group. Make it a condition of partnership.
I have heard of several groups that have conditions on partnership that you will give up your partnership spot at 65. The group can keep you around as an employee if there is still a need.
 

icpshootyz

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I have heard of several groups that have conditions on partnership that you will give up your partnership spot at 65. The group can keep you around as an employee if there is still a need.
Yep, that's what my group does. You're cut off at 65, free to stay on as employed if you'd like. Most just retire. We also do a graduated "buy-in" where your pay just increases over a few years until you're at full partner.
 

acurax

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We still have partners. As LADOc said, it might be easier to get someone to do per diem work or be an employee, but if you care about quality and relationships that makes it a lot harder. And as a group going through the hiring process now, it is surprisingly hard to find someone who is the right fit for our medium-sized group. We are stable, part of a large physician group intimately linked with the hospital, but on our own enough to control our $ and hires and business. So we may be technically employed by the physician group but we have far more autonomy and variable income than employees (i.e. no "bonuses" for productivity, just increased income). Many of the applicants simply don't have broad enough skills, or lack something significant personality-wise. I am not sure if there are an increasing proportion of pathologists who only have 1-2 areas of ability to cover, or the job market is not as tight as people say, or what the truth is. We are definitely getting a lot of weak applications though.
Just curious, how does your group decide what a "weak application" is?
 
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yaah

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A weak application typically announces itself as a weak application.

Weak applications typically are those who apparently have not read the job ad (like a job looking for someone with hemepath skills with an application from someone who has never done hemepath but has 3 years of various surg path fellowships), who have significant red flags in their CV (like 5 jobs in 6 years), have multiple typos, have weak or even negative references, or who express their interest in a way that is off-putting (like bragging or insulting - seriously). They also often do not communicate when called or emailed to assess their interest, or if they do, communicate poorly.

There are other applications that are otherwise solid but simply not appropriate for our purposes (like someone who is AP only, or someone who only signs out breast path, or someone who hasn't signed out any non-prostate biopsy cases in more than 15 years).

Possible candidates are typically shared with other group members, and then we decide whether or not to interview.

I mean, seriously, I cannot stress this enough: If you come from a training program where the program director cannot recommend you, it is going to be difficult for you to find a job. If you are a current trainee, work hard and get along with your faculty. It will be to your detriment if you do not.
 
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