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Four steps to increase the odds of a partner-track ophthalmologist making partner
The probability of a physician making partner is decreasing, but there are ways to improve the chances.
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“In the minds of great managers, consistent poor performance is not primarily a matter of weakness, stupidity, disobedience, or disrespect. It is a matter of miscasting.”
– Marcus Buckingham
“No great manager or leader ever fell from heaven. It’s learned, not inherited.”
– Tom Northup
“When things haven’t gone well for you, call in a secretary or a staff man and chew him out. You will sleep better and they will appreciate the attention.”
– Lyndon B. Johnson
The modern odds of hiring a partner-track physician and having him or her actually make partner one day are dreadful and getting worse. This is frustrating for practice boards and candidates alike, and driven by numerous errors, omissions and false hopes on both sides of the aisle.
Only half of the time does an intended partner doctor actually make it to ownership. The rest of the time, something gets in the way.
- The young doctor fails to thrive economically, clinically or surgically.
- There are miscommunications about the actual terms of employment or partnership.
- Interpersonal frictions arise.
- The family does not settle into the community.
Not all of these difficulties can be foreseen, and despite best efforts by candidate and practice alike, the odds of a final fit will never approach 100%. But as a practice, you can up your chances for a fit by addressing four key areas.
1. Manage your practice well
Is your practice partner-worthy in today’s more competitive environment? Only some of this is under your control.
If you practice in Los Angeles and are forced to accept 80% of Medicare allowable contracts, your practice’s profit margins will never shine compared with Midwestern clinics. But if you can run a tighter Southern California practice than your regional peers, you will be a competitive choice for candidates who are willing to gain sunny skies for a trade-off in earnings.
If you practice in Upper Manhattan, where ophthalmologists operate on each other to stay busy, but still run a tight organization with good control over referral sources, you will be a top pick for top applicants.
A practice is well run not just in profit margin or population-per-provider terms, but also in such dimensions as:
- Having existing partner cohesion. This is critically important to most applicants; after all, who wants to join a club where the members are at odds with each other?
- Having a positive history of prior associates making partner.
- Having a written business plan and a clearly articulated, plausible vision for the future (including a succession plan for any older “rainmaker” members of the practice).
- Employing a strong management team, with skills deep enough in financial, IT, marketing and regulatory dimensions to stand up to the challenges of the day.
- Providing active assistance with practice building, with direct-to-consumer marketing where indicated, internal referral support and lay staff support to make referring doctor outreach less daunting.
- Possessing, especially for subspecialists, the clinical and surgical instruments and resources needed to pursue the latest in patient care.
- Allowing providers the flexibility of crafting the professional life of their dream, which increasingly, with young candidates, means working less than full time.
With these attributes, you will be attractive to a deeper candidate pool at the front end and increase the odds of picking a potentially compatible candidate. And when the time comes for a young associate to become an owner, your relative progressiveness and business control will reduce your odds of having to start all over again.
2. Select the right partner-to-be
It should go without saying that the six-figure investment you make in a new associate provider — much less a prospective professional peer and partner — should be undertaken with abundant caution. But it must also be said that such hires are often under-vetted.
It helps to start with the cynical but protective premise that half of all ophthalmologist job applicants to your practice are below average. With that as a starting point:
- Generate the largest possible candidate pool. In the current competitive environment, that often means hiring one or more recruiting firms, sending out direct mail appeals to surgeons licensed in your state or region, and pestering your drug and equipment reps for leads.
- Do not settle for less than you need. If you are looking for a hard-charging, workaholic cataract surgeon who is going to take your practice to the next level, do not hire Dr. Milquetoast who wants a 32-hour-a-week job and no call.
- Beware the obvious warning signs: job hopping, equivocal reference checks with past employers and interviewees who do not take responsibility for why their last job did not work out.
- Consider not just new grads but mid-career providers, who have a job history you can investigate and whose maturity is likely higher than a new grad’s.
- Do not make a hire until you have flown to the candidate’s current setting and personally observed him or her in clinic and surgery.
3. Offer contemporary, competitive and transparent terms
Thirty-five years ago, when I first became a practice adviser, training programs were increasing the number of newly minted ophthalmologists by more than 2% a year, way faster than the growth in patient demand. A newly graduated ophthalmologist was happy to get a five-figure salary and a pat on the head, with only loose promises of future ownership.
Fast forward to 2014. Training programs have tapered their output to a pace resulting in essentially zero net ophthalmologist growth rates at a time when the demand for care is growing about 5% per year and a large cohort of baby boomer ophthalmologists are heading for the door.
As a result, the average peri-graduate (or mid-career doc in a job hunt) now has several job offers to mull over. As a result, you have to outcompete your fellow practices, with favorable employment and partnership terms.
No more head-patting about the partnership details. Before you post your job offer, you should spell out in writing, and your board should preapprove:
- Associate period employment terms such as base wages, bonuses, benefits and work requirements.
- Future buy-in terms, inclusive of the rationale for any goodwill buy-in component, which is commonly contested and has been whittled down over the years.
- Details about any finite thresholds a candidate will have to attain to be considered for partnership. This is a commonly overlooked area, for fear of offending. As a result, an associate MD generating $500,000 in collections in her second year may silently presume she is on track for partnership at the same time that her employers are complaining in the boardroom about her inability to thrive.
In addition, for finalists — and increasingly commonly, their business advisers — you should be prepared to release the performance details of your practice:
- The last few years of financial statements.
- Volume performance data such as visits, cases and referral patterns.
- The current and prospective buy-in and buy-out documents.
- The story behind any recently departing associates who have not become partners.
- Information on adverse conditions such as pending lawsuits, adverse compliance audits or contract loss.
4. Actively manage the candidate partner’s career
This is one of the most common employing practice flaws leading to an associate doctor’s premature departure. New providers in your practice are an expensive, hard-to-replace resource. They should be actively supervised and supported. This means:
- The practice is “professionalized.” That is, it is a serious, professional environment with every effort made to provide the best care possible. There are monthly all-hands provider meetings, giving owners and non-owners alike a chance to rub shoulders and exchange pearls. And even if a new doctor has made a mistake, this is never berated within earshot of a non-owner.
- Reporting lines are clear. Every associate provider, both partner-track and durable employees, should have a defined partner-level doctor who meets with the associate at least monthly.
- Lay staff are trained to be respectful and supportive of associate doctors. Too often, lay staff treat pre-partner doctors as second-class citizens. Some of this is understandable; it is natural that a founding board member commands more respect than a 30-something newbie. But it is important that the practice’s lay leaders, such as the administrator and mid-level managers, personally demonstrate their support for partner-track providers.
- Regular performance feedback and active coaching. About quarterly, every partner-track associate should sit down with his or her managing partner and the administrator and be walked through performance stats: cases, visits, collections, revenue and surgical densities, patient satisfaction survey results, and the like for the prior period. Throughout the initial 2 or 3 year pre-partnership period, the associate should be continuously aware of his or her prospects for ownership and any overt performance gaps.