When it appears that “irreconcilable differences” are tearing your practice apart, it’s not uncommon to consider “divorcing” your business partner. Such breakups happen every day when physicians leave medical practices in which they had been partners or employees. Many depart voluntarily; others do not. Some physicians take leave of their practice colleagues on good terms; others don’t.

When the breakup is messy — as with marriages — the fallout can take its toll. Issues like custody (ownership of patient records) and property division (splitting practice assets) come into play. You and your former partner’s attorneys end up talking more than you and your erstwhile “spouse.”

Of course, you can always seek counseling if you both are willing to try to save the relationship. Sometimes you can resolve your differences and become more understanding partners. Perhaps you can negotiate a compromise. Or maybe talking out your problems will reveal that your best option is to go your separate ways.

Whether you’re considering leaving your current practice for greener pastures or wishing one of the physicians in your group would hit the road, remember the wise words of practice management consultant Bob Bohlmann: “If things aren’t friendly, there can only be two winners: the consultant and the attorney you’ll have to hire.”

When a partnership hits the rocks

Joining a successful practice and entering a successful marriage can be very similar experiences. Just ask Timothy Boden, who spent 10 years as a clergyman before becoming a practice administrator.

“A successful practice is not just about what goes on in the exam room or the emergency room,” says Boden, who is now the manager of Northwest Mississippi Kidney Center in Greenville. “It’s about sharing the vision of the organization.”

He adds, “I don’t know anyone who has been asked to leave a group because of bad medicine or bad science; it’s always touchy-feely stuff: communications, relationships with employees — all the things that drive docs crazy.”

Among the principal reasons a practice partnership can run into trouble?

• Money. Spats can erupt over how much physicians are paid and who works harder. Partners may balk at their colleagues’ plans to invest in state-of-the-art billing systems, purchase electronic medical records, take on a new partner, or simply remodel an outdated waiting room.
  
  
• Generational conflicts. “Younger physicians want a life and won’t commit to working at the intense level the older docs did,” Boden says. “They’ll think older partners are self-seeking — just wanting to support personal financial goals.” Vince Manoogian, a St. Louis-based consultant, says he also sees the flip side of this conflict: “Younger physicians want to take on debt to expand, while older physicians refuse to go deep in debt because it might hurt their retirement strategies.”
  
  
• Management style. “I’ve had situations where the wife manages the practice and a new partner comes in thinking the agreement is to get more professional management but it never comes about,” says Manoogian, who has guided many practice mergers and dissolutions as a principal with Southwind Health Partners.
  
  
• Operations. Money conflicts may be rooted in dysfunctional billing, lax patient collections, or obtuse scheduling schemes.
  
  
• Specialty differences. Like the fractured marriage in the Hollywood classic, “A Star Is Born,” one partner may be on the way up professionally while the other is on the way down. For example, cardiovascular-thoracic surgeons’ incomes have declined recently, while cardiologists’ pay has risen. “A few years ago those two specialists could be in the same group and an equal revenue split looked fair, but now one specialist might feel he isn’t getting his fair share,” says Manoogian.
  
  
• Bad attitudes. Boden calls baby boom doctors “the disappointed generation.” They aren’t getting the big bucks they wanted, and they resent having to work so hard just to keep up, he says. But still they won’t scale back their expectations. Bitter people are hard to work with.