Medical practice partnership - schedule issues - advice needed

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Gemini
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Medical practice partnership - schedule issues - advice needed

Post by Gemini »

I recently became partner in a medical practice. It was a fight to land partnership, but it finally happened. Although I am a partner, my income is still x% less than the senior partners and I work my way in a couple of years to get the full distributed income. This is a big medical practice, with multiple departments and physicians, all under one umbrella and a CEO. In my department are two older senior partners. I assumed once I became partner my schedule would be on par with them i.e. work 4 or 4.5 days a week. I recently brought this up and apparently it came as a shock to the other partners. We had a meeting and the partners essentially said not gonna happen and you are a junior and have to wait your turn and pecking order and to stop asking for stuff and just work etc etc. My earnings are decent and I am not lagging behind the others. Matter of fact, I am bring in more than one of the partners. Meeting was very off putting, but I did not outright want to have a fight so I stayed quiet. There is nothing in contract that says anything about work hours etc etc. Just looking for advice and input and how to move forward.
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lthenderson
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Re: Medical practice partnership - schedule issues - advice needed

Post by lthenderson »

Your work schedule should have been brought up during negotiations for becoming partner and not after. Now that it is after the fact, your only plays are to accept it or secure a new job elsewhere and use that as a bargaining chip.
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Gemini
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Re: Medical practice partnership - schedule issues - advice needed

Post by Gemini »

lthenderson wrote:Your work schedule should have been brought up during negotiations for becoming partner and not after. Now that it is after the fact, your only plays are to accept it or secure a new job elsewhere and use that as a bargaining chip.
The partnership contract or any contract has no mention of the work hours. All of the partners have the same contract.
obgraham
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Re: Medical practice partnership - schedule issues - advice needed

Post by obgraham »

Sharing of the workload, the call load, and the cash load are the only reasons for a physician partnership.

If you didn't attend to those issues, whose fault is that?
mac808
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Re: Medical practice partnership - schedule issues - advice needed

Post by mac808 »

How long until one of the older partners retires? Can you ''wait it out'' or is the time horizon too far out?
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Gemini
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Re: Medical practice partnership - schedule issues - advice needed

Post by Gemini »

obgraham wrote:Sharing of the workload, the call load, and the cash load are the only reasons for a physician partnership.

If you didn't attend to those issues, whose fault is that?
Well the cash load is spelled out. The workload and the call load are not explicitly stated. For all intents and means, I was under the impression they are to be shared equally.
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Gemini
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Re: Medical practice partnership - schedule issues - advice needed

Post by Gemini »

mac808 wrote:How long until one of the older partners retires? Can you ''wait it out'' or is the time horizon too far out?
A few years I guess, maybe 5, but who knows? But should this be my plan. Just wait for 5 years and "hope"?
LiveItUpBySaving
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Re: Medical practice partnership - schedule issues - advice needed

Post by LiveItUpBySaving »

Sounds like your senior partners will ride you for as long as they can (and for as long as you can tolerate). It sounds like you've had enough of their dismissive behavior, and they only gave in and allowed you to become partner because you pestered them until you got what you wanted.

This trend will likely continue, as it doesn't sound like your partners will change their behavior. Look for another position, if only for your sanity. Burnout is much more expensive than changing jobs.
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Gemini
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Re: Medical practice partnership - schedule issues - advice needed

Post by Gemini »

LiveItUpBySaving wrote:Sounds like your senior partners will ride you for as long as they can (and for as long as you can tolerate). It sounds like you've had enough of their dismissive behavior, and they only gave in and allowed you to become partner because you pestered them until you got what you wanted.

This trend will likely continue, as it doesn't sound like your partners will change their behavior. Look for another position, if only for your sanity. Burnout is much more expensive than changing jobs.
There was some ambiguity in the language for partnership about when it begins.

Just trying to figure out what to do moving forward - the job otherwise is okay.
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Re: Medical practice partnership - schedule issues - advice needed

Post by BolderBoy »

Gemini wrote:I recently became partner in a medical practice. It was a fight to land partnership, but it finally happened.
Was it explicitly discussed that you'd be brought in as an 'equal' partner?
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Gemini
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Re: Medical practice partnership - schedule issues - advice needed

Post by Gemini »

BolderBoy wrote:
Gemini wrote:I recently became partner in a medical practice. It was a fight to land partnership, but it finally happened.
Was it explicitly discussed that you'd be brought in as an 'equal' partner?
Yes. I am an equal partner. I have the same stockholder agreement as everyone else.
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Re: Medical practice partnership - schedule issues - advice needed

Post by Jack FFR1846 »

So it sounds like there is no such thing as junior partner. Are you on equal footing legally and (as you say) contractually? If so, I would think that you could set your hours to match all other partners. If the "senior" partners don't like it, what recourse do they have? Perhaps have a lawyer review the partnership contract and spell out exactly what's expected of you and what you get in return.
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Gemini
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Re: Medical practice partnership - schedule issues - advice needed

Post by Gemini »

Jack FFR1846 wrote:So it sounds like there is no such thing as junior partner. Are you on equal footing legally and (as you say) contractually? If so, I would think that you could set your hours to match all other partners. If the "senior" partners don't like it, what recourse do they have? Perhaps have a lawyer review the partnership contract and spell out exactly what's expected of you and what you get in return.
Yes - no junior partner, but only difference in compensation. From what I was told and from what my lawyer advised, I am on equal footing contractually. I guess recourse would be they can kick me out? I am not sure, but the partnership contract does not spell out hours or days, but it does say termination for cause and without cause.
samsmith
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Re: Medical practice partnership - schedule issues - advice needed

Post by samsmith »

what specialty? And how is your compensation calculated? Specifically, if you take more call (and presumably do more work) do you get paid more, based on the partner contract formula?
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Gemini
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Re: Medical practice partnership - schedule issues - advice needed

Post by Gemini »

samsmith wrote:what specialty? And how is your compensation calculated? Specifically, if you take more call (and presumably do more work) do you get paid more, based on the partner contract formula?
No - the pie is split i.e. I don't work more and make more.
harrychan
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Re: Medical practice partnership - schedule issues - advice needed

Post by harrychan »

Maybe bring it up to the CEO in an amicable way?
This is not legal or certified financial advice but you know that already.
toofache32
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Re: Medical practice partnership - schedule issues - advice needed

Post by toofache32 »

Gemini wrote:
obgraham wrote:Sharing of the workload, the call load, and the cash load are the only reasons for a physician partnership.

If you didn't attend to those issues, whose fault is that?
Well the cash load is spelled out. The workload and the call load are not explicitly stated. For all intents and means, I was under the impression they are to be shared equally.
Simple. Call your scheduler tomorrow and tell her you will not be there on Mondays. Or Fridays.Or whichever day you don't want patients scheduled.

Why else would you pay them hundreds of thousands of dollars for your practice buy-in? It's sure as hell not to fatten THEIR wallets.
toofache32
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Re: Medical practice partnership - schedule issues - advice needed

Post by toofache32 »

Gemini wrote:
samsmith wrote:what specialty? And how is your compensation calculated? Specifically, if you take more call (and presumably do more work) do you get paid more, based on the partner contract formula?
No - the pie is split i.e. I don't work more and make more.
If the pie is split equally, then no wonder they want to work less and let you work more. This is why my group of 4 doctors has an "eat what you kill" model. One partner produces 40% of the revenue, but that means he also pays 40% of the overhead. I only produce 15% of the revenue because I travel regularly to conferences to give lectures. But they don't care because I am NOT taking taking their production while I am out of town earning nothing.
Last edited by toofache32 on Thu Nov 10, 2016 8:43 am, edited 1 time in total.
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White Coat Investor
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Re: Medical practice partnership - schedule issues - advice needed

Post by White Coat Investor »

I don't like a lot of what I'm hearing

- Fight for partnership
- Want you to work more for equal pay
- Four year partnership track
- Surprised you want to be treated equally
- "senior" partners

A partnership is a lot like a marriage. Are these really the people you want to be in business with? If the answer is no, then I would suggest figuring out soon the best time for you to move on and start looking at other arrangements.
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oragne lovre
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Re: Medical practice partnership - schedule issues - advice needed

Post by oragne lovre »

toofache32 wrote:
Gemini wrote:
samsmith wrote:what specialty? And how is your compensation calculated? Specifically, if you take more call (and presumably do more work) do you get paid more, based on the partner contract formula?
No - the pie is split i.e. I don't work more and make more.
If the pie is split equally, then no wonder they want to work less and let you work more. This is why my group of 4 doctors has an "eat what you kill" model. One partner produces 40% of the revenue, but that means he also pays 40% of the production. I only produce 15% of the revenue because I travel regularly to conferences to give lectures. But they don't care because I am taking taking their production while I am out of town earning nothing.
@toofache32,

Your "eat what you kill" model is interesting. What do you mean by "one partner produces 40% of the revenue, but that means he also pays 40% of the production?"
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Re: Medical practice partnership - schedule issues - advice needed

Post by obgraham »

Two more areas you should address that I suspect my have been glossed:
1.If you are in a high liability insurance specialty, who will pay for the "tail" policy if you leave the partnership, either with or without cause?
2.Is there a restrictive covenant?
kiddoc
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Re: Medical practice partnership - schedule issues - advice needed

Post by kiddoc »

I have developed some expertise in reviewing contracts from a physician's perspective over the years. If a contract doesn't clearly spell out work/ call schedule (or equal distribution per FTE at the very least), equal time off, buy-in, and compensation formulas, I tell people to walk away. I know this doesn't help you now but learning point: run contracts through mentor physicians/ lawyers who deal with physician contracts very frequently before signing anything.

The "pie split equally/ variation" is almost always a formula for senior partners to leech off junior partners. These contracts usually do not have any description of equal work/ time-off/ schedule control clauses. Partnership, by definition, is EQUAL.

Besides what WCI has mentioned above, a huge red flag for me is the termination without cause clause in a partner's agreement. Unless it says that you can be terminated without cause only by >75% of shareholder or unanimous vote, tell me how you are different than a glorified physician employee? Your salary is not affected as a partner by how much you work? That is absolutely not something that should be part of a partnership agreement. Typically, partnership compensation= Your collections- your share of overhead + profit distribution (split equally or incrementally).

Sorry to say this, but it sounds like you are being called a "partner" but have the rights/ liabilities of a physician employee. May I ask you what specialty you are in? Did you have to pay a buy-in? Did you use an experienced physician lawyer or something generic like contract diagnostics/ corporate lawyer?
White Coat Investor wrote: A partnership is a lot like a marriage. Are these really the people you want to be in business with? If the answer is no, then I would suggest figuring out soon the best time for you to move on and start looking at other arrangements
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desiderium
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Re: Medical practice partnership - schedule issues - advice needed

Post by desiderium »

This is, regrettably, not a unique situation. I would approach it in a very business-like way. Have a formal meeting with your colleagues, the CEO and if possible another physician partner outside the department. Express your unhappiness at the unequal call/schedule and point out the fact that you are carrying water for them on the compensation end already. Point out that they are imposing a non contractual obligation. If needed propose a meeting among the attorneys to resolve your situation. Hopefully they will get the message.
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Re: Medical practice partnership - schedule issues - advice needed

Post by qwertyjazz »

Figure out what you bought into. Given your description, what is to stop your senior partners from working 15 minutes a month and still taking the same percentage of revenue? Then when you know what the contract actually entails, talk to your partners and the CEO professionally or have that lawyer negotiate for you.
You may have been too fixated in the word partnership and sacrifices to get there to realize what happened. You cannot go back in time. Take a breath. Figure out exactly where you are and then make a plan. You should not look at sunk costs of your time to get where you are but rather the trade offs of partnership and what is out there.
Good luck
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ks289
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Re: Medical practice partnership - schedule issues - advice needed

Post by ks289 »

I remember your prior post when you were considering buying in to this practice.
viewtopic.php?f=2&t=194979&p=2987968#p2987968

I think you were concerned about alienating the administration and partners by seeking financial and structural details. Unfortunately, it sounds like your group has an egregiously unfair arrangement (equal revenue sharing and purposefully unequal work/responsibilities).
It is time to look for alternative opportunities (in case you cannot resolve this fairly) because this is not a sustainable model for you.
toofache32
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Re: Medical practice partnership - schedule issues - advice needed

Post by toofache32 »

duplicate, sorry.
Last edited by toofache32 on Thu Nov 10, 2016 8:42 am, edited 2 times in total.
toofache32
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Re: Medical practice partnership - schedule issues - advice needed

Post by toofache32 »

duplicate, sorry. Not sure what happened here.
Last edited by toofache32 on Thu Nov 10, 2016 8:42 am, edited 1 time in total.
toofache32
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Re: Medical practice partnership - schedule issues - advice needed

Post by toofache32 »

oragne lovre wrote:
toofache32 wrote:
Gemini wrote:
samsmith wrote:what specialty? And how is your compensation calculated? Specifically, if you take more call (and presumably do more work) do you get paid more, based on the partner contract formula?
No - the pie is split i.e. I don't work more and make more.
If the pie is split equally, then no wonder they want to work less and let you work more. This is why my group of 4 doctors has an "eat what you kill" model. One partner produces 40% of the revenue, but that means he also pays 40% of the production. I only produce 15% of the revenue because I travel regularly to conferences to give lectures. But they don't care because I am taking taking their production while I am out of town earning nothing.
@toofache32,

Your "eat what you kill" model is interesting. What do you mean by "one partner produces 40% of the revenue, but that means he also pays 40% of the production?"
Oops, I meant to say that ""one partner produces 40% of the revenue, but that means he also pays 40% of the overhead" I also just corrected my post on my last sentence to say "But they don't care because I am NOT taking taking their production while I am out of town earning nothing." One of my partners does procedures that are much more profitable than the ones that I do. We split most things up by production percentage. I previously produced only 10% of the revenue so I paid 10% of the overhead. These percentages change from year to year and we are rewarded for being more productive. My percentage was the lowest since I was the only one putting up with insurance, but now my production is increasing to around 17% on average since I have dropped almost all the insurance plans like my partners. But that also means I pay more of the overhead (17%). Capital purchases we split equally such as an xray machine we bought a few years ago for $180,000 and the 3D printer we are about to buy for $30,000.

We do not split call coverage equally because it is a no-pay burden and there is no incentive to take call. Our 2 senior guys takes call about half as many nights as myself and the other younger partner. But this was known and accepted from the beginning as we are very transparent with each other. Call is just community service although I'm not sure how long we'll keep doing that in our current culture where everyone thinks someone else is paying us while we work for free. The most senior partner originally did not take call when I came on board because he felt that was his earned right. I told him he needs to start sharing a little of the burden which he agreed to.
staythecourse
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Re: Medical practice partnership - schedule issues - advice needed

Post by staythecourse »

Been there and done that. This sounds EXACTLY like my previous employer. They use a mythical ivory tower senior partners philosophy. You will never be treated equal as that is not their intention.

If it bothers you then you will have to decide to accept as is or not. My guess, even if someone else retires they still will not let you cut down you hours.

I think you have a great case with the lawyers as I am sure they will expect if you are an equal in every other aspect as partner that include work hours as well. The problem is even if you are right legally they can just vote and fire you so that does you no good.

How are the restrictive covenant enforcement in your state? If they are unenforceable then can you see if their is a competing group you can join? If so, contact them queitly and see if that is an option.

Otherwise, you will just have to decide if you are going to passively allow someone taking advantage of you or not. That is a decision you have to make. I couldn't stand being treated different and left and went solo. Best move I could have EVER made, but that is for me. You have to decide what is best for your family and you.

Good luck.
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Gemini
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Re: Medical practice partnership - schedule issues - advice needed

Post by Gemini »

Just looked over the partner contract again : for without Cause, the board of directors must approve the termination and the notice must be signed by two-thirds (2/3’s). And then it lists other with cause possible terminations.

There is nothing stated in the partner contract or any contract about work hours, call load, etc.

Trying to figure out if this is something I should bring up again now and rock the boat or wait until a few months and then bring up again as we are expecting a child.
protagonist
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Re: Medical practice partnership - schedule issues - advice needed

Post by protagonist »

Gemini wrote: I assumed once I became partner my schedule would be on par with them i.e. work 4 or 4.5 days a week. I recently brought this up and apparently it came as a shock to the other partners. We had a meeting and the partners essentially said not gonna happen and you are a junior and have to wait your turn and pecking order and to stop asking for stuff and just work etc etc.
Some groups are much more hierarchical than others.

The bottom line is that you got your answer when you raised the issue: "not gonna happen".

If you are happy with this type of group and are willing to wait your turn at the top of the "pecking order", you are in the right place.

If you are unhappy with the hierarchical arrangement and would rather work in an environment where you are treated as more of an equal, you should seek another job.

Ultimately, it comes down to what makes you happy. For some, that may boil down to money. For me (retired physician), the most important factor was my working relationship with my colleagues.
Childay
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Re: Medical practice partnership - schedule issues - advice needed

Post by Childay »

Why in the world would you join a partnership where the pay is equal and the work is not? Much better to be "eat what you kill" as noted above. Even then it can be difficult to make it totally fair depending on fixed overhead expenses etc. But certainly better than siphoning money off for your "partners.."
Nowizard
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Re: Medical practice partnership - schedule issues - advice needed

Post by Nowizard »

65 y/o partner in medical practice was recently put in rotation for 11 pm to 7 am, on-site requirement to replace former ability to consult from home when on call for emergencies. Vacation time for upcoming year is set in November based on a lottery drawing for order of choice among other partners, with no allowance for seniority. Relative completing Fellowship joining practice with same vacation and scheduling restrictions/benefits as partner of 35 years. Apparently, this is fairly common and any concerns should have been brought up previously. High income comes with high responsibilities.

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Gemini
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Re: Medical practice partnership - schedule issues - advice needed

Post by Gemini »

So do you guys suggest I bring this up now or wait till there is another event like childbirth that I can use in my favor?
staythecourse
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Re: Medical practice partnership - schedule issues - advice needed

Post by staythecourse »

Gemini wrote:Just looked over the partner contract again : for without Cause, the board of directors must approve the termination and the notice must be signed by two-thirds (2/3’s). And then it lists other with cause possible terminations.

There is nothing stated in the partner contract or any contract about work hours, call load, etc.

Trying to figure out if this is something I should bring up again now and rock the boat or wait until a few months and then bring up again as we are expecting a child.
Sometime soon I would talk to them about wanting it have it down on paper that when the next partner leaves then you will be allowed to cut back on hours like the rest of the partners. If they balk then you know how you situation will eventually play out. Then it is up to you to decide to leave or not.

My guess is they will give you some lame answer and will just kick the can down the road hoping you don't bring it up again.

Good luck.
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Re: Medical practice partnership - schedule issues - advice needed

Post by qwertyjazz »

Gemini wrote:So do you guys suggest I bring this up now or wait till there is another event like childbirth that I can use in my favor?
Childbirth or your costs are your problems - not the partners
Their problem may be you leaving or suing. Figure out your options. Do not beg. You already know how that will go. You probably need professional help and you need to know your market

Good Luck
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toofache32
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Re: Medical practice partnership - schedule issues - advice needed

Post by toofache32 »

Nowizard wrote:65 y/o partner in medical practice was recently put in rotation for 11 pm to 7 am, on-site requirement to replace former ability to consult from home when on call for emergencies. Vacation time for upcoming year is set in November based on a lottery drawing for order of choice among other partners, with no allowance for seniority. Relative completing Fellowship joining practice with same vacation and scheduling restrictions/benefits as partner of 35 years. Apparently, this is fairly common and any concerns should have been brought up previously. High income comes with high responsibilities.

Im trying to understand if you are saying this is good or bad. "Seniority" only has value to the senior but there is no value to the others. Therefore the senior has to compensate the juniors for this. Why should anyone else care how long they have worked their when the others are paying him to buy in as a partner. I took out a loan for $660,000 to buy into my practice. I would be happy to let a "senior" partner take less call or have first choice of vacation time. But he would have to compensate me with a lower buy-in price.

Tim
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Raymond
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Re: Medical practice partnership - schedule issues - advice needed

Post by Raymond »

OP, perhaps I missed it in this thread - did you have a attorney specializing in contract law (particularly physician contracts) review the partnership agreement/contract beforehand?
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obgraham
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Re: Medical practice partnership - schedule issues - advice needed

Post by obgraham »

It's a quirk of medical business I never understood:
I took out a loan for $660,000 to buy into my practice
There are only two assets of value in a medical partnership worth buying into (excluding a high equipment type one, such as radiology): The building, and the accounts receivable.
The "goodwill", seniority, and other stuff old docs think is valuable is of no value in today's medical climate.
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Gemini
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Re: Medical practice partnership - schedule issues - advice needed

Post by Gemini »

Raymond wrote:OP, perhaps I missed it in this thread - did you have a attorney specializing in contract law (particularly physician contracts) review the partnership agreement/contract beforehand?
Yes - the schedule was never mentioned in any of the contracts
toofache32
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Re: Medical practice partnership - schedule issues - advice needed

Post by toofache32 »

obgraham wrote:It's a quirk of medical business I never understood:
I took out a loan for $660,000 to buy into my practice
There are only two assets of value in a medical partnership worth buying into (excluding a high equipment type one, such as radiology): The building, and the accounts receivable.
The "goodwill", seniority, and other stuff old docs think is valuable is of no value in today's medical climate.
Goodwill is extremely valuable IF it is transferred properly. I would have spent a similar amount buying my own equipment and taking out loans to make payroll since patient flow is nil for quite a while. Patients don't just show up at your office because you hang up a shingle with your diploma. Buying into a practice is generally a better financial deal because you are buying an instant income stream. I was able to make a profit my first month, while my 2 co-residents who started their own practices in the same city spent over a year before they made a profit. They had to use their loans to pay the staff.
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Re: Medical practice partnership - schedule issues - advice needed

Post by obgraham »

toofache32:
Of course, buying in to someone else gets cash coming sooner. But then you can't whine about how that someone else is taking advantage of you.
But new docs just need to understand those differences. And the Goodwill is something the predecessor built -- you have to build your own.

I too started a new practice, borrowed to make payroll, and had to wait for the income. In return for that I didn't have to go through what OP is discussing.
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