patnerships

[GA8314]

So, our group extended a partner track offer to someone when I was 6 mo out from partner myself. Thus, I was not part of the decision (though perhaps should have been). I did put forth my surprise and stated she would not have been my choice (ballsy to say at the time).

This person has always been very mediocre in my eyes, but she runs hard, can run 4 rooms with blocks (with efficiency and without pissing surgeons off with delays), can get the job done, mans her battle station and is always around when needed (doesn't disappear) and can handle higher acuity cases also for the most part. She really hasn't failed. She is a bit high strung and gets stressed/flustered a bit easily, but doesn't get pushed around by CRNA's and has a bit of feistyness to her (which I think is a good thing). Potential for leadership is sketchy but in fairness also untested.

This sentiment is also now shared by at least 50% of my partners.....

She's 1 year into a 2 year track. Very mixed feelings.

What to do? Am I being too critical? We are a 75% group at least in all measured categories....

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[skypilot]

She sounds like a workhorse. Why wouldn't you want to keep a person like that around? There can only be so many chiefs. You need people to pull the wagon too.

 

[pgg]

What do you mean by she can handle higher acuity cases “for the most part”? Do you not trust her to do cases any generalist ought to be able to do? What cases can’t she do?

OTOH, if she’s getting cases done safely and efficiently, and plays well with others, what’s the problem?

 

[AdmiralChz]

You said a bunch of things she can do, but didn’t really expand on your concerns at all. Why are you troubled by this?

 

[GassmanMD]

Sounds like it's a personality thing if I am reading between the lines?

 

[dabears505]

You sound a little douchy to me. You are not even a partner and feel you should be entitled to have consideration in who becomes partner. And you say she does a good job, but still don't want her to become partner?

 

[nimbus]

Except the high strung part, sounds good to me. In my group everyone makes partner unless there are serious issues that affect actual job performance. Sounds like she gets the job done. We'll take her. We have all kinds of personalities.

 

[GA8314]

Sounds like it's a personality thing if I am reading between the lines?

The person has a nervous, immature way about her. Yes, she's not my favorite, but admit that is non-objective.

 

[GA8314]

You sound a little douchy to me. You are not even a partner and feel you should be entitled to have consideration in who becomes partner. And you say she does a good job, but still don't want her to become partner?

I was not a partner when they made her an offer. I am over 1 year full partner now.

I'll admit that I have a hard time seeing her as equal although I don't have that "issue" with others whom would have made a better choice, IMO.

Am I off track here??

 

[GA8314]

Except the high strung part, sounds good to me. In my group everyone makes partner unless there are serious issues that affect actual job performance. Sounds like she gets the job done. We'll take her. We have all kinds of personalities.

Yes. She has not failed.

Pgg, to your point, she's not the best at cardiac or perhaps when sh.t hits the fan, but not bad either.... But, yes, she gets the job done.

 

[sleepallday]

You're the white supremacist guy from the other thread, right?

 

[nimbus]

The person has a nervous, immature way about her. Yes, she's not my favorite, but admit that is non-objective.

Is she a new grad? If so she will mature with more experience. She sounds like she has the clinical basics down and she's a team player with a good work ethic. Regarding her weaknesses, is she willing to work on them or is she a know it all? Part of the role of a good group is to be supportive and foster professional development. With the right mentoring you may find yourself with a great partner a few years down the road.

 

[Man o War]

My yard stick for this question provided they have a good EQ and keep the surgeons/admin happy: would I feel safe letting this person perform anesthesia on me or a loved one? If the answer is yes, partner her.

 

[GA8314]

Is she a new grad? If so she will mature with more experience. She sounds like she has the clinical basics down and she's a team player with a good work ethic. Regarding her weaknesses, is she willing to work on them or is she a know it all? Part of the role of a good group is to be supportive and foster professional development. With the right mentoring you may find yourself with a great partner a few years down the road.

Yes, she's a new grad, and I agree that she will mature in time. Not a know it all, but lacks some aspects of confidence, but does not allow CRNA's to push her around or dictate to her which is a strong plus. I also agree that we need to step up and foster the leadership we so desire.

I appreciate the input. More is appreciated.

 

[GA8314]

My yard stick for this question provided they have a good EQ and keep the surgeons/admin happy: would I feel safe letting this person perform anesthesia on me or a loved one? If the answer is yes, partner her.

EQ is mediocre. I would have her do other than very sick or cardiac for me, although she gets through them.

 

[Ezekiel2517]

This thread makes me question how deserving the OP is more than anything else.

 

[Man o War]

EQ is mediocre. I would have her do other than very sick or cardiac for me, although she gets through them.

Is she obviously far below the rest of the partners in taking care of really sick/cardiac or is it just a matter of being new and that skill will catch up with time?
This is a legitimate concern if surgeons are going to complain about her care of those patients.

 

[deleted171991]

If you all have decided she is not partner material, it's just fair to let her know as soon as possible. Don't wait out the two years. Also, make up your mind whether you want her as an employee. Don't push her out; give her options, be nice and professional. Not burning bridges goes both ways.

I don't know your parternship track contract, but also make sure your butts are covered. Document every case where she underperforms, in case she becomes litigious. Although I doubt she could have a basis for that. The sooner you let her know, the better for you.

You have to think like a business person: What does this person bring to the group? Can the group afford to lose her? In certain markets, it's not so easy to find a replacement.

 

[GA8314]

This thread makes me question how deserving the OP is more than anything else.

You're judgement of me is clouded perhaps by jealousy or some other factor. Perhaps you don't fully appreciate that once someone has shares, that's it. It's not a decision to be taken lightly.

Again, the silent, non-binding preliminary vote we took last night showed 5/4 yes/no (and i voted FOR her). We did this because about 50% of my partners share similar sentiments, as I've stated. I am simply asking for input, some of which was constructive, unlike yours.

 

[GA8314]

Is she obviously far below the rest of the partners in taking care of really sick/cardiac or is it just a matter of being new and that skill will catch up with time?
This is a legitimate concern if surgeons are going to complain about her care of those patients.

It's not mandatory for her to be ABLE to handle advanced echo, but she has not shown initiative as one might expect. Rather, she complained about our volume being low (which is legit but it's not like any of us are doing loads of cardiac the way we spread it around).

She has been spoken to about her attitude 6 months ago. This was our 6 mo follow up. I'm just not sure we aren't piling onto someone who has less than endeared herself to key members of our group. So, I'm trying to be objective and not let my own bias against her get in the way.....

As stated above, I did give her a nod in our "what would you vote for if the vote was today" exercise we did..... And I also spoke to her defense, albeit mainly to placate a good friend and ally within my group whom is someone I respect in terms of her own insight and acumen.

 

[AdmiralChz]

Again, the silent, non-binding preliminary vote we took last night showed 5/4 yes/no (and i voted FOR her).

I’m confused. Why did you vote for her if you had these concerns?

 

[GA8314]

I’m confused. Why did you vote for her if you had these concerns?

Because I sort of made a gentlemen's agreement with a friend and ally in my group. We support each other on key matters. She felt strongly (one of the most ardent supporters in fact) that she should be partner. Objectively, she has not failed but I feel she was a bad choice. I overcame (clearly not really) my own bias for that reason and also considering a year of opportunity cost and disinterest in dealing with a fall out.

But, I also feel we may need to make a tough choice. I'm conflicted.

 

[deleted162650]

If essentially 1/2 the partners don't like her, then she's just a bad fit. Fit is important especially in a small group like that. Doesn't mean she is a bad human or bad 'ologist. Just not the right one for your group. End things now so both parties can move on. Please don't drag it out and string her along.

 

[Man o War]

It's not mandatory for her to be ABLE to handle advanced echo, but she has not shown initiative as one might expect. Rather, she complained about our volume being low (which is legit but it's not like any of us are doing loads of cardiac the way we spread it around).

She has been spoken to about her attitude 6 months ago. This was our 6 mo follow up. I'm just not sure we aren't piling onto someone who has less than endeared herself to key members of our group. So, I'm trying to be objective and not let my own bias against her get in the way.....

As stated above, I did give her a nod in our "what would you vote for if the vote was today" exercise we did..... And I also spoke to her defense, albeit mainly to placate a good friend and ally within my group whom is someone I respect in terms of her own insight and acumen.

I get it. What do the surgeons say? We always use surgeon input when considering partership offers.
I also think if someone has even a hint of attitude problems during their "probation" it will only get worse after they partner and don't have to be on their best behavior anymore.
You can't easily get rid of her once she's a partner so careful consideration and pause is smart.

 

[deleted171991]

Because I sort of made a gentlemen's agreement with a friend and ally in my group. We support each other on key matters.

This is OK for now (because it's still not the time for offering the partnership) but, long-term, it's a very bad idea. This is a business decision. You don't "ally" in business decisions unless you don't disagree with the other person. Otherwise, the most you should do is maaaybe abstain, or not speak out against your friend. You definitely don't support something that you think is bad for the business. Don't forget, you are a partner, too; it's your business, too.

I agree with the others that a partnership requires quasi-unanimity. It's like a marriage.

 

[GA8314]

I get it. What do the surgeons say? We always use surgeon input when considering partership offers.
I also think if someone has even a hint of attitude problems during their "probation" it will only get worse after they partner and don't have to be on their best behavior anymore.
You can't easily get rid of her once she's a partner so careful consideration and pause is smart.

I think our cardiothoracic guys probably don't get the warm fuzzy. I imagine the ortho guys probably like her (she does produce on that side). But, she just lacks maturity which I'm not sure is a great excuse over 30 years of age. Sure, one gains wisdom and may settle down a bit, but a fundamental maturity issue is a problem for me and others. As well, I'm not sure how she will do given a real sense that she's not so comfortable in her own skin, sitting on an important committee which we currently encourage and expect of all incoming partners. Leadership potential is low IMO.

 

[GA8314]

This is OK for now (because it's still not the time for offering the partnership) but, long-term, it's a very bad idea. This is a business decision. You don't "ally" in business decisions unless you don't disagree with the other person. Otherwise, the most you should do is maaaybe abstain, or not speak out against your friend. You definitely don't support something that you think is bad for the business. Don't forget, you are a partner, too; it's your business, too.

I agree with the others that a partnership requires quasi-unanimity. It's like a marriage.

I agree.

 

[ZzzPlz]

Hey brah

You sure she don't SDN?

 

[dchz]

I have a few questions that i think would help clarify the situation to the thread readers. Remember this is an anonymous (semi anonymous) forum, so feel free to be more specific. also moving this to the private forum might help you too if you want to keep it more private.

The potential partner lacks maturity. I find this odd, 90% of surgeons have a very juvenile sense of humor, a lot stuff that goes on in the OR doesn't really qualify for being "professional" or "mature". Are you saying not mature in the sense that she can't handle a diss every once in a while and fires back too hard? because it sounds like she's got enough work ethic to improve on any type of medical mistake.

What is "advanced echo" or "high acuity" case for your practice? are we talking about sickest of the ASA 4s or are we talking some ASA 3s? do you have an example of the type of pt she handled well and the type she didn't handle well?

I completely agree with FFP's point given the size of the practice, near unanimous vote is good for the practice in the long run. Accordingly, business decisions shouldn't be made on emotional decisions, but this is a double edged sword.

From what I've read, it seems like the good BUSINESS decision is letting her be partner; she is productive and a very positive contributor to the practice. It sounds like some personal differences are affecting your objective decision making.

Furthermore, how does the potential partner see her own situation?

 

[pgg]

But, she just lacks maturity which I'm not sure is a great excuse over 30 years of age. Sure, one gains wisdom and may settle down a bit, but a fundamental maturity issue is a problem for me and others.

What exactly does that mean?

Is this a personality issue or a genuine professionalism issue?

 

[Ezekiel2517]

You're judgement of me is clouded perhaps by jealousy or some other factor. Perhaps you don't fully appreciate that once someone has shares, that's it. It's not a decision to be taken lightly.

Again, the silent, non-binding preliminary vote we took last night showed 5/4 yes/no (and i voted FOR her). We did this because about 50% of my partners share similar sentiments, as I've stated. I am simply asking for input, some of which was constructive, unlike yours.

WTF are you talking about? I have no clue who you are. I do recall you essentially stating in another recent thread that you are a racist, however. But that has no bearing on anything I say here.

What kind of person brings a discussion like this pertaining to one single anesthesiologist to a public fukn forum? You and your group can't figure this **** out amongst yourselves?

 

[dchz]

WTF are you talking about? I have no clue who you are. I do recall you essentially stating in another recent thread that you are a racist, however. But that has no bearing on anything I say here.

What kind of person brings a discussion like this pertaining to one single anesthesiologist to a public fukn forum? You and your group can't figure this **** out amongst yourselves?

I disagree with this sentiment. This forum is a place to share ideas, this thread has given me a very unique perspective on this issue and i'm sure tons of other posters/lurkers appreciate this perspective. This is a mutually beneficial exchange of ideas.

A lot of ad hominem attacks, not sure if its warranted or true. Even if OP is a racist (ironically, tons of minorities are also just as racist if not more so. I recall many instances where I was targeted because of my race by another minority), i still have much to gain from the perspective that this thread provides.

 

[Southpaw]

It is difficult to give guidance based on what you've said about this person, which objectively is all positive. You have a subjective opinion about her, which your partners appear to share, but it's very vague and not specific at all. Perhaps going into detail isn't appropriate here?

As far as I can tell, she's a strong worker who doesn't cower to CRNAs or surgeons. If I were your group, I'd bring her in and be supportive as she grows. But that's an opinion on very limited information.

 

[Man o War]

WTF are you talking about? I have no clue who you are. I do recall you essentially stating in another recent thread that you are a racist, however. But that has no bearing on anything I say here.

What kind of person brings a discussion like this pertaining to one single anesthesiologist to a public fukn forum? You and your group can't figure this **** out amongst yourselves?

Rough call night?

 

[pgg]

Speaking of professionalism, let's keep this thread professional. There's no need to attack each other.

I think this discussion has potential to be a good one re: partner tracks and the hidden politics behind becoming a partner or being squeezed out for good reasons vs vague "fit" reasons. But if it devolves into a rehash of an argument in another thread, I'll just close it.

 

[GA8314]

What exactly does that mean?

Is this a personality issue or a genuine professionalism issue?

I don't think, objectively, it's a professionalism issue. She gives off a persona of being uncomfortable in her skin, which translates to a lack of self confidence as interpreted by myself and others in the group. But, she has not been unprofessional.

To all responders. I've read every single response. I greatly appreciate the input (barring the one guy trolling me), and it's very valuable. As others have said, we are a smaller group and it's an important decision.

Speaking of our acuity. We do mostly bread and butter types of cardiac. Some dual valves. All total sternotomy. Occasional DHCA. A good amount of VATS and Thors. No heads for now. Plenty of sick patients which she is capable of taking care of. The fact that she's no cardiac queen doesn't mean much to me or my group frankly.

We did send her to an Echo course to help develop her echo skills. When we asked how it went, she was dismissive to the point of saying "ah, it was all this academic mumbo jumbo, and mostly over my head"...... That kind of stuff seems to come from her, albeit randomly. It's hard to describe. But, in the end, her echo skills have not improved. Attitude....

I am trying to avoid the PLAGUE of every partner in the history of partnerships thinking THEY are the ideal partner....... I am aware of this bias.

But, on my own track, I asked several key guys what else can I do to add value to the group? Anything I can do to help? Can I take that off your shoulders? That kind of thing. I did this monthly. I also asked for feedback. Is there anything I could be doing better? Anything else I could be doing guys? That type of thing.

When you are a 75% plus group, I feel you can and should be selective, but I'm aware of the "I'm the best" complex which I have myself been on the receiving end in my own job hunt from about 4 years ago. Hence, asking for advice.

 

[dchz]

You keep saying the words "75% plus group", is that like you're above the 75th percentile in some objective measure? the idea is not clear in my head.

 

[nimbus]

You keep saying the words "75% plus group", is that like you're above the 75th percentile in some objective measure? the idea is not clear in my head.

Prob MGMA

 

[GA8314]

You keep saying the words "75% plus group", is that like you're above the 75th percentile in some objective measure? the idea is not clear in my head.

as nimbus suggests, I'm talking about MGMA data for our region.

 

[BLADEMDA]

I don't think, objectively, it's a professionalism issue. She gives off a persona of being uncomfortable in her skin, which translates to a lack of self confidence as interpreted by myself and others in the group. But, she has not been unprofessional.

To all responders. I've read every single response. I greatly appreciate the input (barring the one guy trolling me), and it's very valuable. As others have said, we are a smaller group and it's an important decision.

Speaking of our acuity. We do mostly bread and butter types of cardiac. Some dual valves. All total sternotomy. Occasional DHCA. A good amount of VATS and Thors. No heads for now. Plenty of sick patients which she is capable of taking care of. The fact that she's no cardiac queen doesn't mean much to me or my group frankly.

We did send her to an Echo course to help develop her echo skills. When we asked how it went, she was dismissive to the point of saying "ah, it was all this academic mumbo jumbo, and mostly over my head"...... That kind of stuff seems to come from her, albeit randomly. It's hard to describe. But, in the end, her echo skills have not improved. Attitude....

I am trying to avoid the PLAGUE of every partner in the history of partnerships thinking THEY are the ideal partner....... I am aware of this bias.

But, on my own track, I asked several key guys what else can I do to add value to the group? Anything I can do to help? Can I take that off your shoulders? That kind of thing. I did this monthly. I also asked for feedback. Is there anything I could be doing better? Anything else I could be doing guys? That type of thing.

When you are a 75% plus group, I feel you can and should be selective, but I'm aware of the "I'm the best" complex which I have myself been on the receiving end in my own job hunt from about 4 years ago. Hence, asking for advice.

This post I'm going to make is definitely NOT politically correct. But, the fact is for a FEMALE Anesthesiologist your future partner is pretty good. The are two standards in our field like it or not: Male vs Female. I'd rather not post much more on this topic but I've worked with many female Anesthesiologists, many with fantastic skills and just as talented as me in their own areas, but when it comes to the "can you cut me slack" the pendulum tilts their way. I enjoy working with talented Female Anesthesiologists but when it comes to be being seen as "equals" they don't view it the same way: They firmly believe they are superior and their needs/goals/desires come first.

This isn't going to be changing in the next 20 years. As the women deal with full time jobs, motherhood, etc their stress and views are much different than Men. Perhaps, they deserve to be treated differently (better?) than their male colleagues doing the same job for the same pay. I don't know but if I were you I'd just shut up about it and accept her for who she is now as there is no way in hell her partnership status gets denied.

Before you liberal die-hards jump down my throat I believe women are equal to men especially in our specialty; but, that goes both ways and the demands for special treatment and using the gender card when it suites them isn't fair or equal.

 

[dhb]

Patners makes some damn fine ships.

 

[dchz]

This isn't going to be changing in the next 20 years. As the women deal with full time jobs, motherhood, etc their stress and views are much different than Men. Perhaps, they deserve to be treated differently (better?) than their male colleagues doing the same job for the same pay. I don't know but if I were you I'd just shut up about it and accept her for who she is now as there is no way in hell her partnership status gets denied.

Oh wise Blade, please explain to me why the bold portion is true. It seems like her partnership is literally teetering on the verge of getting denied? I've personally heard many stories of partnerships getting denied. It feels like if OP voted no, her partnership will be denied?

 

[Noyac]

The larger a group gets the more the partners will differ. Don't get caught up in the personalities, as long as they are not malignant. Personally, your concerns sound superficial and annoying.
Think about this, she is a woman in what is still a very male dominated field and therefore her day and her interactions are very different from yours at times. With all this external pressure, she seems to perform pretty well. Possibly better than you would in her shoes.
From what you have presented, I would make her partner and move on.

 

[GA8314]

The larger a group gets the more the partners will differ. Don't get caught up in the personalities, as long as they are not malignant. Personally, your concerns sound superficial and annoying.
Think about this, she is a woman in what is still a very male dominated field and therefore her day and her interactions are very different from yours at times. With all this external pressure, she seems to perform pretty well. Possibly better than you would in her shoes.
From what you have presented, I would make her partner and move on.

At this point, she would lack the supermajority vote necessary even given that I "voted" yes when we went around the room. Hearing the issues my other partners have had have admittedly fueled my own bias. I can tell you that maturity is a factor, however.

Adding insult to injury one of our (also female) daytime docs has excelled to the point that she is liked and respected by every single one of us, and I think we are experiencing buyers remorse to some extent.

 

[pjl]

She sounds like an above average anesthesiologist in an above average practice. She handles her work, gets along well with surgeons and staff, and doesn't make demands.
Being a female sometimes does force a different management style and interaction with coworkers, so consider that. I get automatic respect for being a tall white male, so can make statements that get second guessed constantly when made by female colleagues.

Unless your practice is all cardiac, who cares if she isn't as good? Whatever the case, it may make more sense to limit cardiac to the top few people to concentrate experience if your volume is that low. I mean, if you guys are one or two cases a month, you aren't serving anyone best by forcing her into it.

If you drop her, contact me, we are always looking for good people. I would gladly make an honest team player a partner, even if they are unlikely to become a true leader.

Also, for what it is worth, our partnership is voted on by all surgeons after being passed by our group, just as I get to vote on all surgeon partners.

 

[deleted162650]

Not sure I'd even want to become partner in a group where 1/2 the current partners voted against me.

 

[dchz]

She sounds like an above average anesthesiologist in an above average practice. She handles her work, gets along well with surgeons and staff, and doesn't make demands.
Being a female sometimes does force a different management style and interaction with coworkers, so consider that. I get automatic respect for being a tall white male, so can make statements that get second guessed constantly when made by female colleagues.

Unless your practice is all cardiac, who cares if she isn't as good? Whatever the case, it may make more sense to limit cardiac to the top few people to concentrate experience if your volume is that low. I mean, if you guys are one or two cases a month, you aren't serving anyone best by forcing her into it.

If you drop her, contact me, we are always looking for good people. I would gladly make an honest team player a partner, even if they are unlikely to become a true leader.

Also, for what it is worth, our partnership is voted on by all surgeons after being passed by our group, just as I get to vote on all surgeon partners.

Good point on the cardiac cases.

Even more interestingly, your group is structured with surgeon votes? can you explain how that came to be? and what geographic/sized city you're in?

 

[dchz]

Not sure I'd even want to become partner in a group where 1/2 the current partners voted against me.

Does the potential partner even have this information?

 

[GA8314]

Does the potential partner even have this information?

She's being given the information (in more or less terms) in order to take corrective action. That was not my choice to do so. I'm more concerned with opportunity cost.