Solved! ‘I Want to Be a Partner’

Q: I have been in practice for four years. I’m working for a physician now but I’ve been assuming I’d eventually buy in and become his partner. I’m getting a little worried because he hasn’t said anything about it. I feel like I just pay for a ton of overhead, take all the call, and I’m not getting anything for it. The other physician even takes all the new-patient visits, so I’m not even growing my practice. Do I quit or what?

A: Let’s look at this through another lens: A marriage proposal comes after lots of waiting. You date and date for months or years and hope you get the offer. Becoming a partner in a practice has traditionally been analogous to this.

Well, those days are over. Now, the direct approach is the way to go.

A young physician today should appreciate a first job offer for what it is - a business and career opportunity - and get partnership issues out in the open right from the start. Partnership isn’t a mating ritual; it’s a business agreement.

Granted, a hiring physician can’t know from day one whether she’ll definitely be offering a junior associate a partnership. Still, the following should be thoroughly vetted and made absolutely clear to both sides early on:

• Is partnership on the table at all, and, if so, within what time frame? If you want an eventual partnership but the physician you’re interviewing with has no intention of giving up any control, then clearly that practice is not for you. Broaching this baseline question keeps everyone from wasting time and money. Similarly, it’s good to know what the physician’s ideal future vision does include: Many new partners, multiple locations, and huge growth? Or gradually winding down for retirement, and handing a small practice off to someone else? Your visions better agree before you start.

• How would a partnership offer be structured, if it were to be offered? For example, does the new physician have to buy in to the practice? How would the buy-in price be determined? How will overhead be split and call be shared? Bottom line: You don’t want to put in four or five years waiting for an offer only to find it untenable. If the senior physician insists on a $1 million buy-in, you might as well leave now.

• How well are you proceeding down the path to partnership? If partnership is in the future, you shouldn’t be hanging out for four years hoping against hope that everything is going well. You should know what the senior physician is looking for in a partner. Is it productivity? Then what are the standards? Is it care excellence? What does that mean, in a quantifiable sense? Will he establish benchmarks for you and compare your performance, perhaps? Regularly scheduled meetings to discuss your performance and set goals are a great idea.

Now, given that in your case, things weren’t mapped out from the get-go, how should you proceed?

Well, take control, my dear. There is no reason for you to wait for the other physician to make the first move, as it were. Ask what the deal is on partnership. Is he going to offer it or not?

Ask concrete questions about buy-in, call share, division of overhead and new patients. What is his vision for the future of the practice?

Here’s some more food for thought: Even if you aren’t a partner you should understand why your overhead cut is what it is. What are the total costs and what is your share? And even if you aren’t a partner, you can ask about getting more new-patient business - and check out the terms of any non-compete clauses in your contract.

You can have these conversations without being confrontational. Be polite, calm, friendly, and open-minded. Just state the obvious: You are investing time in the practice and, for the sake of your career and income, you need to know where things are heading. Don’t start by assuming anything. Start by asking about the situation, understanding the senior physician’s needs, then either offering a solution that satisfies everyone’s needs or deciding that’s impossible.

If you still consider leaving, keep in mind that it’s surprisingly easy to think you are solving a problem when really all you are doing is jumping to a different ship that’s also sinking. You need to understand what your current situation is and what the actual alternatives are before you make a decision.

Pamela L. Moore is director, content & strategy for Physicians Practice. She can be reached for solutions at pam.moore@cmpmedica.com.

This article originally appeared in the January 2009 issue of Physicians Practice.