Twelve tests for ‘making partner’: Deciding if your associate provider is ready for ownership

As demand for ophthalmologists skyrockets, it is crucial to maintain a high bar for practice partnership.

Quick decisions are unsafe decisions.

Sophocles

All our final decisions are made in a state of mind that is not going to last.

Marcel Proust

John B. Pinto

In most professional firms besides medicine, the pool of applicants materially exceeds the number of job openings. There can be scores of great applicants for a low-level associate position in a law, architectural or accounting firm. And 5 years later — commonly years of 60-hour weeks — elevation to partnership is by no means certain.

This is quite unlike medicine in general, and ophthalmology in particular, where the number of open positions is growing faster than the number of available candidates, while the demand for care is rising sharply with the influx of baby boomer seniors.

As a result of this, some practices are lowering their guards and their standards — admitting partner-track associates who are unlikely to ever be partner-worthy and offering partnerships to doctors who are destined to be a poor fit.

If you have a partner-track associate heading for partnership, or even if you are only starting to interview for a new doctor, here are 12 simple screens for compatibility.

Sufficient passage of time

The pre-partner associate period is typically as little as a year or as long as 5 years. The average figure in ophthalmology is 2 or 3 years. Does that figure sound familiar? It is about the same time that couples date before they seriously consider marriage. The similarities are apt. In both settings, everyone is on best behavior for at least the first year. But eventually, the true personality of both marital and business partnership candidates shines through (or fades to black). Beyond giving both sides time to see whether there is a fit, waiting at least a couple of years has a practical advantage in a medical context: Before this, it is unlikely that the new doctor has developed sufficient revenue productivity to be able to afford to start paying for a buy-in.

General affability

Pathologically unpleasant individuals, even the smartest ones, are usually screened out well before they complete an ophthalmology residency. Still, eye surgeons come in a wide array of flavors, from cuddly and affable to individuals who are described in this manner by everyone in their world: “Well, Dr. Andrews is not the kind of guy you go to for a good time, but he will give you a great surgical result.” If affability counts in your practice — and it should — hold out for Dr. Cuddly.

Clinical and judgment skills

These are two separate skills, and both should be mandatory in your candidate partner. Clinical skills are essential, obviously. But great didactic knowledge without the judgment to apply it properly will lead to disaster on the clinic floor — and in the courtroom.

Surgical skills

Over the last 31 years as an advisor to ophthalmologists, I’ve often asked the question: How do you know a great surgeon is a great surgeon? The answer that typically comes back is the same as Justice Potter Stewart’s 1964 Supreme Court dictum on pornography: “I know it when I see it.” And so will you if you’re judging your young colleague’s fitness for partnership. Watch carefully.

Compatible work ethic

At any one time, I am working with a large number of 60-something ophthalmologists who lament the lower work ethic of their 30-something colleagues. If you are a workaholic surgeon, it is not likely that you are going to be happy with the average new graduate’s idea of a full work week. You either need to accept that their work-life balance is going to work for you or keep looking for the uncommon young individual today who puts their career ahead of all other life domains.

Staff interaction

One of the best partnership screens is to stay keyed into what your staff members think about Dr. New becoming a partner. If their thumbs are still up in the air after a couple of years, yours should be too — and vice versa. If your candidate partner is humble and self-effacing, willing to drop what she or he is doing to help out the crew and someone who makes them proud to work as support staff in your practice, you are anointing the right candidate.

Patient relationships

Even the sweetest doctor will tote up a few patient complaints each year, especially when they are being compared to the “old man” who founded the practice. A few complaints per month should set off alarms. A few complaints per week should lead to termination. Let your patients vote your associate in or out of partnership.

Utilization and volumetric productivity

It is helpful to pull the last year’s CPT report on a candidate partner and check his or her utilization statistics against the average for the practice. If the existing partners have a 40% YAG rate and the junior doctor is at 15%, some comparisons around the table may be in order. The same goes for the utilization rates for special testing, assertiveness in charging for refractions and the overall revenue yield per patient visit. Laggards should be coaxed to higher performance before they become partners. Outliers who overtreat should be counseled and, if needed, removed.

A well-adjusted ethical compass

Most choirboy, Eagle Scout ophthalmologists do not have the belly for what modern medical economics has become, where being sufficiently assertive in coding and case selection is unfortunately obligatory for also making payroll and getting your rent check in on time. That said, aggressiveness has to be tempered by an underlying sense of what is defensible and absolutely in each patient’s individual interest. It is a fine line that is getting finer all the time. As the practice owner, you call the line. Make sure your partner-to-be is on the right side of it.

Financial productivity

I am often called with a question along the lines of: “I’m the founder of a two-doctor practice. Dr. Maybe has been on staff as an associate for 3 years. His collections were $620,000 last year. Mine were $1.9 million. Is it time to bring him on as a partner?” The answer is a definite “maybe.” If he passes the other screening dimensions discussed in this column, he could be a good fit. But since Dr. Maybe is only generating 25% of total practice collections, equal partnership may be less appropriate than a minority share of the company — or a delay in granting partnership until the two doctors are a little closer to being economic peers.

Business instincts and behaviors

When you nominate a new partner, you are not just advancing a clinical peer up the ranks; you are drafting a new board member. Each new addition to the table should ideally improve the net skill, judgment and commitment of the board to your company. Rethink your decision if the new owner candidate is overly timid, disruptive or absolutely disengaged from all business affairs (yet unwilling to trust and delegate business authority to others, such as you, who are interested).

Giver vs. taker mentality

As the old man used to say, there are only two kinds of people: givers and takers. Two willing givers make the best partnership. A taker can partner well with a long-suffering giver. The most toxic practice environment is a cohort of takers. Measure your candidate in black-and-white terms. This is not a matter of degrees; they are a giver or they are a taker. Do they volunteer for extra call? Cheerfully take on special projects? Or do they push work — as well as worry that they should personally bear — off onto others? Partnering with a taker, even the most productive one, sets the rest of your career up for misery.

• John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. He is the author of John Pinto’s Little Green Book of Ophthalmology; Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement; Cash Flow: The Practical Art of Earning More From Your Ophthalmology Practice; The Efficient Ophthalmologist: How to See More Patients, Provide Better Care and Prosper in an Era of Falling Fees; The Women of Ophthalmology; and his new book, Legal Issues in Ophthalmology: A Review for Surgeons and Administrators. He can be reached at 619-223-2233; e-mail: pintoinc@aol.com; website: www.pintoinc.com.