Do you cherish autonomy? Doctors who like to do their own thing might find switching gears to a protracted decision-making process a harrowing experience, says Dahl. Physicians must acknowledge how much control they can comfortably relinquish. When members of Conti’s first practice decided to change the payment schedule from the “earn as much as you work” plan to a more communal strategy, Conti’s veto power was usurped.
Do you thrive better in a group? A veteran doctor often enters a partnership because of fatigue, Hertz explains. The burden of running the business alone and being on call all the time is exhausting. However, he warns, once a physician decides to partner, things will be different. Decision-making, staff management, and payment structures, to mention a few, will change when creating a partnership. The question becomes: How much change can you live with?
Do logic and data rule your brain? A new physician often partners because it makes sense, says Hertz. Negotiating managed-care contracts — where often there’s more strength in numbers — purchasing technology, navigating medical bureaucracy, and figuring out the complexities of modern healthcare make it difficult for solo doctors to do well, and often require the finesse and emotional stamina of a veteran medical “jack-of-all-trades.” Raymond explains: “We don’t get enough business classes in medical school.” She advises new doctors to decide how they want to practice medicine, and then to focus first on the management side.
Is practicing medicine a job or a passion for you? Raymond encourages physicians to ask themselves, “Am I working to live, or living to work?” There are those who want to work long hours and those who don’t. And the two sides rarely understand each other, Raymond cautions.
Each practice marches to its own tune, with the physicians deciding which song to sing. Raymond’s first practice was a democratically run group where everyone got a vote. In her second, one physician assumed the decision-making role and everyone else was fine with that. Both practices were great, she says, recalling wonderful colleagues. The first group was very efficient and made great money, but it wasn’t the ideal setup for Raymond to take time off for speaking engagements or seminars, something she loves.
A partnership is most worthwhile when the physician gets the right fit, Raymond says. Despite enjoying a successful “marriage” with both of her partnerships, she yearned to have more control over determining her own office hours. So, ultimately, Raymond went solo, where she now works part-time hours to allow for other pursuits: “I figured out how much I needed for overhead, how much I wanted to take home, and how many patients it would take for me to achieve that goal.”
Get it in writing
Consider everything before leaping into a partnership. How often do you want to see your family? How much money do you want to earn? How good are you with managing staff and collections? Are you satisfied with your negotiating power with managed care organizations and insurance companies?
If you decide to take the plunge, make sure you get all of the details in writing. “Partnering is like a marriage,” Hertz says, “Easy to get into, not so easy to get out of.” For doctors who aren’t happy, whether they’re continually outvoted on critical decisions or they find themselves working with physicians with whom they’re clinically incompatible, it becomes too much of a burden to maintain the relationship, Dahl explains.
When a well-written contract spells everything out, breaking up isn’t that hard to do. “Physicians tend to work things out amicably,” says Zarin. But bear in mind that even the most meticulously planned contracts can go awry, Conti says, recalling a long-ago legal snafu concerning ownership of patient panels after the departure of a partner, and all the usual hassles of paperwork and stress that subsequently ensued.
High-tech & secure
Michael Nochomovitz, president and chief medical officer of Cleveland-based University Hospitals Medical Practices, a 400-physician multispecialty practice network, says medical training grooms doctors to make independent decisions. This is a dilemma for solo-practice doctors who are considering a partnership, he says. The group Nochomovitz created, part of the University Hospitals system, embeds private practice culture into a group environment by allowing doctors to govern their individual multispecialty clusters, while still having access to the support of a larger network for issues they may not want to tackle, such as collections and accounting.
Another benefit to being part of a larger group is greater access to technology, Nochomovitz says, referring to electronic health records, document imaging systems, and other modern marvels that allow physicians to access patient test results or write prescriptions electronically. Solo practitioners and small group practices don’t have the resources to purchase all the technological bells and whistles. “The dollars aren’t substantial enough for a solo physician or small group to justify their cost, but what doctors need more than anything is less paper,” he explains.
Hertz adds that larger practices can add ancillary services by purchasing high-tech diagnostic tools and equipment. For primary-care doctors in a group, he says, this can significantly augment their income.
Charles Pavluk, a Westlake, Ohio, internist with University Hospitals, was searching for security and guidance to help him grow a practice that would provide quality care for patients. “I was in an independent group practice before, and it fell apart,” he says. “We all enjoyed working with each other. But my biggest worry was, what happens when I die?” Pavluk’s father, also a physician, died unexpectedly, and Pavluk’s mother was thrust into running the practice until someone else took over.
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