Consider the case of Ralph Conti. Upon graduating from medical school in 1990, the pediatrician launched a solo practice in Henderson, Nev. But just four years later, he changed course. His penchant for collegiality and desire to spend more time with family won out over issues like autonomy and flexibility. “I don’t like working alone,” says Conti. “I need to bounce cases off other doctors, and I like it when they bounce cases off me. I love the intelligent banter.”
So Conti forged his first partnership with three other physicians. The group flourished and quickly grew to include 14 doctors. But disagreements erupted about the compensation structure. When Conti eventually lost his veto power, he left.
But he was undaunted and undeterred. Conti is now part of a successful eight-physician partnership with five offices in the Henderson area.
Has it been worth the time and effort? “I survived,” he says, laughing. And he learned a lot. Here are some things you should consider before making the decision to partner.
Where there’s a will
Collegiality certainly factors into the decision, says Kenneth Hertz, a senior consultant with the Medical Group Management Association. That, and seizing the right opportunity. “Suppose the doctor from a small town is fresh out of medical school,” says Hertz. “He knows a senior doctor there who’s retiring.” Hertz explains that a smooth transition — the new doctor is ramping up his practice as the senior doctor is winding down — can be one good reason to partner and grow a practice.
But you can fly solo and still enjoy collegiality, says Randall Zarin, senior manager with UHY Advisors — a national tax and business consulting firm that serves the healthcare industry — although you may have to go out of your way to do so. Reach out to other colleagues in the community. Their feedback won’t always be immediate due to varying physical proximity, but the intellectual exchange will be worth it if collegiality is your goal.
Call coverage is another major factor. Patricia Raymond, a gastroenterologist in solo practice in Chesapeake, Va., says primary-care physicians generally like to partner because they handle the lion’s share of patient calls — every runny nose, every high fever in the middle of the night. There’s strength in numbers, she says, when handling a boatload of calls.
But don’t count out solo practice if that is your calling. You can work with other solo practitioners to provide call coverage. “Sometimes, the only other choice in some areas is to turn to your competition, or join a network of solo practitioners to provide coverage when you want time off,” says Owen Dahl, a practice management consultant based in The Woodlands, Texas. But it may be worth it for Gen Xers, he argues, who place time off and involvement with family high on their priority list.
Zarin maintains that solo physicians shouldn’t be deterred by the possibility of losing their patients to the competition. There’s an ethical code between on-call physicians, he says, where emergency patients still belong to the primary physician. That doesn’t always stop your patient from fancying the on-call doctor and deciding to switch, but all in all, Zarin says, it’s a congenial atmosphere. “You cover for them, they cover for you. It’s a give and take.”
Specialists enter the picture when the emergency is acute — say, a surgeon for a ruptured appendix. And, while a group of physicians in the same specialty area create a center for excellence by playing off each other’s strengths and enjoying a high level of collegiality, mixed specialty groups often encounter problems with compensation, says Zarin. Namely, who is worth more?
But sometimes, more so than compensation, it all boils down to personalities. Communication is the key. For the most part, physicians try to work things out, Zarin says, but personalities can get in the way. Raymond advises physicians to say what’s on their minds, and seek an environment that works best for them.
Seeking answers within
“Why do I want to partner or stay solo?” That’s the one nagging question a doctor has to answer clearly, Hertz insists. Write down the pros and cons on a sheet of paper. He’s quick to point out that a physician shouldn’t be surprised by the negatives of partnership — for example, loss of autonomy and less input on staff management.
It’s important for physicians to know themselves, as well as the groups on all sides of the fence, says Raymond, who was a member of two partnerships before going solo. Take some time to investigate your own core values:
