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I Now Pronounce You Doctor & Doctor – Partnership Practices

Physician Practice Models - Partnership Track
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There are many types of practice for one to consider. One that seems to have the best of many worlds is the partnership—small enough to allow individuality but with one or more people with whom to share the load, which makes life much easier. The trouble is, not every partnership can be John and Yoko. Just as in marriage, there can be divorce and the rocky relationship that leads to it. Don’t fool yourself. A medical partnership is indeed a marriage, so some caveats are in order before “marrying” into that partnership.

Monogamy

You may either join someone else or someone else may join you. It may be a true partnership or a senior/junior partnership. A true partnership, for example, may be two buddies who finish their residency to practice together in a new practice.

Alternately, the most common scenario is someone coming out of residency and joining someone already established, being placed on a salary, and if all works out (to the satisfaction of the alpha-doctor), equality bestowed upon the junior partner. This usually involves a “buy-in,” which means writing a check. Your senior partner isn’t going to just give you half of his or her building, infrastructure, expensive EHR, and patient data base. Some senior partners will allow a step-wise reduction in this buy-in the more years the junior partner works. Sooner or later, however, a day of reckoning will involve money. From you.

Before joining someone—or having someone join you—you should make sure, like a true marriage, that there’s love. I’m not talking of love between the two of you, but a love for the way a prospective partner practices. Translated, your way. For instance, if you want a day off every week, but your partner is a workaholic, there’s going to be trouble brewing if the income is split evenly. Also, if the income is split based on productivity, does that include a split in how overhead is divvied up? Fair is fair and unfair breeds resentment. The important thing is that you have to have the same mind set in the way you practice, and the money—income and outgo—must be fair, or you’ll end up at each other’s throat.

Bigamy and polygamy

Joining two other established doctors can be just as challenging. You will need to be prepared to be taken advantage of. The fact that it’s two against one means you are replaceable. You will be a very junior partner, possibly taking more than your share of call and making what is considered, in the physicians’ world, minimum salary. And this is true whether you do the minimum or the maximum; doing the minimum, however, will eventually show you how replaceable you are!

In a partnership of two or more doctors, you have to look at yourself 5 years from now. If this group is very successful, and the rewards are extravagant if you’re willing to eat a little mud for a while, consider your second-class status and abuse to be sweat equity toward that goal. However, if there seems to be no end in sight, better to leave ‘em at the altar on the front end.

Resistance is futile

Pay attention. Is this a well-run business? Do you want to share the liability equally if it isn’t? Just what will you own once you’re assimilated? Once you’re in, it’s like the Borg—resistance is futile.

Additionally, the more doctors, the more opinions on how they will want you to practice. True, you have a lot to learn from them, and that’s valuable, but if they insist on certain protocols to the point of forbidding you to, say, use Gentamycin—that’s going to get old fast. The more doctors, the more “my-way-or-the-highway” you risk.

The formula for how many right ways to practice in an established group:

(Number of doctors in the group + 1) – you.

Marriages in heaven

It is possible to partner with someone who is fair and honest and who won’t be ambitious at your expense. It is possible to partner with someone who has the same work ethic and the same moral high ground. It takes about three years for the warts to show, which is about the time you’ll be invited to write that buy-in check, so the three-year mark is a crucial milestone.

For the junior partner, the three-year mark may be the time for him or her to say, “What do I need this guy for?” That’s why there are non-compete clauses. If you’re the junior partner, this thought will be trying to seduce you with every huff of indignation. If marriage has the 7-year itch, a medical partnership has the 3-year itch.

Be careful. But if it works out, you can have a happy professional life for an entire career.

The right stuff:

  • Your partner should have the same work ethic. There should be no resentment that he or she is working harder than you, or that you are working harder than anyone.
  • Your partner should have your back. If income is based on productivity, there should be no overt flirting to get patients to switch from you. If a patient complains about you, your partner should be smart and loyal enough to defuse the situation by defending you in a way that makes the patient happy enough to stay with both of you. Badmouthing an intramural competitor always backfires, and it’s amazing how some doctors, so educated, can be so stupid to not see this.
  • You and your partner(s) should have the same 5-year goal for each other, for both (all) of you, and for the practice.
  • You and your partner(s) should agree on whether all of you will work to live or live to work.

These rules are easy to understand but difficult to keep. If you can satisfy this checklist about you and your partner, a partnership can be a very rewarding vocation.

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About Gerard DiLeo, M.D.

Dr. Gerard DiLeo, physician and published women's health author for McGraw-Hill, is now writing full time after a career of over 30 years in private OBGYN practice in the New Orleans area. He has served twice as Chief-of-Staff at a major regional hospital and 5 years in academics as Director of the Division of Pelvic Pain in the Dept. of OBGYN at the University of South Florida College of Medicine. He is an accomplished minimally invasive surgeon, laparoscopist, and an inventor (the catheter-stethoscope--U.S. Patent). He and his family live their post-Katrina life in Florida. He can be reached at drdileo@gmail.com.
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