THE EFFICIENT OPHTHALMOLOGIST

What makes a good partnership work?

It’s in the details. Know what you want, make sure the potential candidate knows what is expected of him, gauge the all-important risk factor and this ‘marriage’ could work.

By Steven M. Silverstein MD, FACS

AMA statistics conservatively report that at least 80% of first-time medical partner associations dissolve. Many reasons can explain this phenomenon. The most common: the departing physician’s dispute over a contract clause; salary; and, the physician’s or spouse’s dislike of the chosen city. More recently, with the paradigm shift away from partnership in favor of long-term employment, differing practice models are also a leading etiology for physician departure.

What can we do to enhance the likelihood for a successful partnership?

FIRST, KNOW THYSELF

Seriously think through the mission statement of the practice and your expectations for a new associate. Is there a partnership track and a long-term employment track? I have found that many physicians coming out of training, both residency and fellowship, do not know themselves well enough to understand whether a partnership is right for them.

Originally I only offered a partnership track in our practice. I had two subspecialty-trained doctors join me immediately out of training; they both planned to become full partners after two years. But when the time came to discuss partnership, they said that while they were happy with the practice, they no longer envisioned themselves as owner/partners. The reasons? They did not want to deal with issues inherent with business ownership (i.e., overhead, HR, marketing). Now I offer both a partnership and employment track.

BECOME ALIGNED

Work ethic is paramount. Philosophies must be aligned in regard to the balance between work and personal time. The expectations of productivity — not a quota, but goals set for one’s self — should be in synch, or else the salary formula may be jeopardized. An eat-what–you–kill formula is most fair in practices with a wide disparity of productivity, whether it be for a newer associate or a senior associate who is slowing down. It compensates for both overhead responsibility and income distribution.

Yet many practices have varying degrees of a share formula, and in this situation, less productive associates could be viewed negatively for not carrying their weight.

Gauge your potential partner’s risk-ometer. Her level of interest in the practice’s growth, strategic planning, and willingness to assume additional debt service and subsequent risk to realize this growth is critical. Some physicians are happy remaining in a small practice with one or no partners, not looking to add subspecialists or new locations, while others have a different vision for the potential of the practice’s future. This is not about right or wrong, but about one’s comfort level with risk and debt.

A COMMON REFLECTION

Marketing is an important discussion point during the interview. Regardless of whether a group or individual participates in marketing initiatives, knowing that his opinions are aligned with yours is vital.

Marketing is a surprisingly personal decision about ethics, about a less tangible/trackable overhead expense, and about income. Marketing reflects everyone in the practice, so whether all physicians are participating or not, sharing common ideals expressed in these campaigns is very important.

Needless to say, contractual agreement is essential. Working out the terms and length of employment, salary and productivity bonus, and benefits (vacation, cell phone, insurance, 401k and so on) is baseline. I strongly suggest that the general pathway and price structure of the buy-in for those on a partnership track be made clear upfront, as well as voting privileges, shared call/consults, administrative functions, and practice ownership percentage details.

Lastly, when setting up the face-to-face interview, try to include the candidate’s significant other (SO), and arrange for a half-day tour with a Realtor to give the potential new associate and SO a sense of the community, and the housing options in their price range; this makes the opportunity feel much more real, and could set the stage for a good working relationship. OM

Steven M. Silverstein, MD, FACS, is a cornea-trained comprehensive ophthalmologist in practice at Silverstein Eye Centers in Kansas City, Mo. He invites comments. His e-mail is ssilverstein@silversteineyecenters.com.