That was back in the days when a senior doctor could recruit a new physician and be able to reasonably anticipate that the practice would grow substantially enough (doubling or more) that the bringing in of the new doctor as a practice co-owner within a couple of years of the inception of employment would present little or no economic risk to the senior doctor.

In today’s much tougher economic times in medicine, those days are long gone.

We often work with medical groups as they evaluate whether or not a young associate should be brought into partnerships/co-ownership status. I try to remind those clients that qualification for partnership status involves much more than merely having been a satisfactory clinician for a number of years.

At the same time, one must recognize that the decision is not so objective that one can make it easily by checking off "yes" and "no" boxes.

Many times, personalities, interrelationships, trust, respect from many standpoints, confidence, and one’s gut feelings about an individual go a long way in helping the owner-doctors decide whether or not to accept this individual as a new partner.

Many believe that having a partner is a lot like having a spouse. You go through an engagement period to see how well you get along and interact. It also helps you determine if you are compatible philosophically. If you feel uncomfortable, then the plunge should not be taken. In other words, it is a lot more than merely saying that a doctor has great technical skills and an impressive resume.

I will set forth below some of the more important factors to be critically evaluated.

In today’s world, a partner needs to be actively involved in the practice, emotionally as well as physically. This includes exhibiting high levels of energy, intellect, ambition, and "caring" about the practice and its success. Too often we have seen that new additions to the ownership group do not exhibit the same "blood, sweat and tears" mentality that the initial founder did. Sometimes, that causes the young doctor to have a feeling of entitlement, since the perception is that all is already in place and there is little or no urgency. It is a lot harder to create and build something from scratch as opposed to moving into a ready made situation and maintaining things.

Becoming a partner does not mean that one needs to work or care less than before because now the mountain has been climbed. In reality, a good partner understands that the "buck stops here" and that the success or failure of the practice is dependent on what he/she does.

To truly be a partner, a doctor must understand and accept that there are risks as well as rewards involved. Too often, an individual will shy away from making the best decision for the practice, by looking purely at how his/her pocketbook would be immediately impacted. That is not always the best way to go. For example, a practice may decide that it would generate a lot more revenue (in the long run) by buying an expensive piece of equipment, moving to more efficient and larger quarters, by hiring another physician, and the like. Some individuals may decide against voting for that because they do not want to take any chance of their compensation decreasing, even in the short term. A good partner needs to have the "backbone" to make decisions that are best for the practice in the big picture. Here again, this points out the importance of the owner-doctors being philosophically compatible and having similar risk tolerance levels. If not, there may be big problems.

A good partner should be willing to go "the extra mile" in order for the practice to succeed. Rolling up one’s sleeves to get the job done and being a true team player is very important. It shows that the doctor wants to do this so that his/her practice will maximize its potential and succeed.

A true Partner needs to be an individual who wants to grow the practice, has the capabilities of doing so, and is willing to do what it takes to market the practice and satisfy its referral sources and patients. In order to succeed in the ever-changing medical world, a practice must keep on adapting and growing or else it will slowly "die on the vine." Adding a partner should allow the practice to have new blood that will keep it thriving, if not growing, instead of being static. You do not want a partner who is merely willing to "gather the fruit brought in by the seniors."

A partner should be someone who the other owners trust to continue the practice successfully upon the demise, illness or disability of a senior doctor. It also should be a situation whereby one would have faith that upon retirement this individual or individuals would be able to maintain the practice. Too often, we have seen senior doctors who have been the driving force behind the establishment and growth of a very successful practice. If they do not have a successor or successors with the ability to keep things going well once the seniors cut back or leave entirely, the practice will likely suffer and perhaps die.

It goes without saying that, before becoming a partner, that doctor must be personally productive as well as clinically sound. You do not want to bring someone in as a net income sharer who will merely be draining funds from the other partners and not carrying his/her own weight.

Compatibility is very important. Being able to have open discussions and make joint decisions on all sorts of practice issues is crucial. If every minute issue becomes "World War III," I have to question whether or not it makes sense to become a co-owner with such an individual. Life is too short for that. It certainly would not be the most efficient way of having a good practice. People would not be as happy and therefore not as productive. There are many issues which one must deal with in a practice. We have seen groups complain about what color rug to have in the reception area, for example. Other practice management-related issues also need to be dealt with. These may include things such as hiring and firing of staff and other professionals, reimbursement issues, expansion issues, compensation issues, and the like. Ideally, one wants to believe that the decisions are made with the best interests of the practice being paramount. That does not mean that every decision will be an easy one and that the parties will always agree. However, if things are addressed in a respectful fashion without "getting personal," and without rancor, then things should work out. Also be wary of "passive aggressive" individuals who may not openly tell you that they disagree with something, but then sabotage things by talking it down to others, not fully cooperating later on, and the like.

As we have told many of our clients over the years, it is pretty easy to be generous and bring someone in as a partner, even though you have many doubts before doing so. However, just like in a marriage, it is very difficult, traumatic, and expensive to break up with a partner. That does not even talk about what it is like to have to "live" with a partner for whom there is little or no mutual respect and understanding. When we hear a doctor expressing serious doubts about an individual before partnership is offered, we discourage them from making the move. The odds of long term success are greatly diminished when one enters such a "marriage" in spite of all of the warning signs.

Some people decide to bring someone in as a partner because they are fearful of the financial costs if they deny partnership status and that doctor leaves the practice. That can be difficult. It sometimes drives practices to bring someone in, even though they have many concerns and doubts about that individual. Ideally, you should not take that step and "bite the bullet." Hopefully, any shortfall would be temporary since you would hopefully be able to look at your overhead and make some good decisions in that regard as well as recruit and hire a new replacement doctor who will hopefully better fit your situation.

In closing, please take to heart how important the "partnership decision" is and the pain (financially, emotionally and otherwise) you may suffer if the wrong decision is made.