I should've listened to my father. He's a seasoned, small-town family physician, and he warned me.
- "Ask to see the books."
- "Know the provisions for buying in, and, even more important, for buying out."
- "Review your contract with an attorney who understands medical practices."
- "Finding a practice partner is like finding a marriage partner."
He was right. But I was naive and enthusiastic. I'd spent the year after my family practice residency as a locum tenens, finishing
up two months as a volunteer in Papua New Guinea. Now I was looking for my first practice job, and this one seemed ideal.
Maybe if I'd followed my father's advice, I'd have seen the flaws. Instead, I had to learn the hard way. Over the next two
years, my "ideal" job became the source of increasing frustration and anger. It ended on a cool October morning when I arrived
at work to learn that the clinic had been closed by judicial order, a casualty of feuding partners.
"Ask to see the books"At the beginning, it seemed like the right place to begin my career. The clinic was owned by two physicians; I would make
the second physician employee. I knew both partners slightly—they were young, intelligent, hardworking, and good doctors.
Their recruitment approach emphasized collegiality over financial concerns. As the partner who served as medical director
put it, "I have no intention of making any money off of you."
Maybe not. But as I tried to determine whether my contract was fair, I began to wonder if the partners actually had any idea
whether they were making money at all.
My compensation was to be made up of a base salary plus a production bonus. The base was about three-fourths of the average
pay for employed physicians in the community. The bonus would pay me a percentage of the revenue I generated after overhead
costs.
I had no experience with practice expenses, but if my pay was going to be partly based on them, I thought I should at least
know how much they were. So, acting on my father's wisdom, I asked to see the books.
The partners were surprised by my request. The medical director said they didn't keep an itemized list of overhead costs,
nor did they know the percentage of gross income that was taken up by expenses. It turned out that the amount of revenue I
had to generate before I became eligible for the production bonus was an estimate set more or less arbitrarily, not based
on true overhead.
The more I pressed to see the financial records, the more evasive my prospective partners became. It should've made me suspicious;
instead, it made me feel guilty for not trusting them. "If there's a pot of money left over," the medical director assured
me, "I'll make it right."
So I signed on. But I still wanted to understand the practice finances, and I kept asking questions. Each time, the medical
director seemed more upset by my curiosity.
"How much is our lease payment, anyway?" I asked.
"I don't recall."
"Do you know about how much it is?"
"Something like $4.75 a square foot."
Needless to say, nobody knew how many square feet the clinic occupied. The other employed doctor and I joked about sneaking
around the exam rooms late at night with a tape measure. Maybe we should have.