Friday, April 13, 2012

Perils of Partnership

Before I begin, is anyone else flashing back to Data from "The Goonies?" "Pinchers of Peril! I've been saved by my Pinchers of Peril!" Anyone? Just me? Ah, well.

So, hi! I guess working full time, having a 4 year old and an almost 8 (!) year old in multiple activities, actually having a bit of a social life from time to time, and experiencing a intense sense of perfectionism if I do have the chance to write = no blogging for me.

We've been keeping very busy in the practice, and I have been navigating the waters of working with a large group of physicians, who may or may not treat patients in the exact way that I would treat them. Sometimes, with the really complicated patients, it almost feels like a game of "hot potato," with each physician hoping that they are not the one left "holding the bag," so to speak. I've never experienced this to such a degree, and there is one culprit who rises to mind beyond the others. It really ruffles my feathers, because I was always trained to do the best thing for the patient at the time, even if it was inconvenient for you, as the physician. I don't know if this is something that comes with being older in practice, more burnt out, perhaps? Being one of the junior partners, I can't help but feel, at times, that I am expected to "prove myself" to the more senior physicians in the group, by working just a little harder, complaining a little less, and dealing with getting the less than desirable cases. Kind of like being a glorified resident in many respects, and, let me tell you, that is d*mn tough to swallow. I also feel like I have to fight to bring up to date practice standards into the group managed patients, in this, I am having some success. This makes me happy because I think it benefits all of our patients. I am really hoping to adjust the way that we see patients while on-call, and have been hashing out some ideas to discuss in some upcoming meetings. I am happy to say my schedule is always full, but this is also daunting, because sometimes it is over-full (am I forever doomed to struggle with scheduling issues??), and I have had patients tell me it is difficult to get an appointment with me. I suppose all of these issues are swirling around my brain because in a few short months I will have the opportunity to become a full partner in the business, and I don't know what I don't know.

I'm excited and nervous to make the next big step in my career. Any wise words from those who have gone before me? Any questions to ask? Things I need to know before signing the dotted line?

22 comments:

The Red Humor said...

Honestly, hearing your description of the practice situation (you, as the junior partner working to increase standards) makes me wish you were in academics, training residents! But I guess we all have to keep learning from each other.

I have nothing to contribute to your question as I am still in training myself and pondering the academics vs community question (although I would probably go the Kaiser route than private practice). I was really interested by your comment in the MiM site that the flexibility was a benefit of PP, because I never associated the two. I always thought, because of the bottom line issue, that PP was the least flexible. Keep blogging about how you come to this decision!

dr. whoo? said...

I went the private practice route because of my obsessive compulsion to keep other people from touching my patients. (Funny, huh?) I honestly enjoy teaching (in very small doses), but find the academic environment as a whole stifling and the undercurrent/drive to publish/climb the ladder unnerving. I think that the older physicians in my practice have just fallen behind in some current practice guidelines (WRT to GBS, GDM, etc.), not in a way that endangers patients, but I knew we could do better.

I do believe that private practice can be more flexible (once you are in the driver's seat, which, heretofore, I have not completely been). Some of my partners do GYN only, some of my partners work only 4 days a week instead of 5 (while still taking call), etc. They "eat what they kill," so they work as much or as little as they want to make in salary. That is where the flexibility lies...after partnership, supposedly, if I make it! :)

lasermed said...

Nice to see you back. I know how busy things are with kids and a practice. I enjoy your posts as often as you can.

Private practice allows you to do what you want only if you are solo. If you are in a group practice, you still have somewhat of a committee mentality. That's what you are running into. You need to decide if the advantages of sharing patients and call make up for the restraints of having to do some things as a group.

Keep us posted on your decision process.

headache said...

I don't have any answers but I'm very glad to see you blogging.

gcs15 said...

I have been a partner in a private practice for 10 years and would love to talk with you about this. You can email me or message me through bigtent...

mamadoc said...

Before you sign anything, read the contract yourself. Then make sure you have an attorney who has healthcare contracting experience review the contract. Then read it yourself again. Make sure you have all your questions answered and concerns addressed before you commit. Good luck!

Anonymous said...

I've been in private practice for 3years and have many of the same struggles. The balance of being a wife, mother (2 boys--20 months and 4 yo), and junior partner, and doing any of those things well seems to something that I fail at more often than succeed. I'm still struggling to bring my group up to current practice standards but overall they are very accepting. In my experience the schedule will never get better and you need to set some boundaries early. I'm the only female ob/gyn in town and have a 4 mo waiting list for annuals, 2 mo for gyn problems. My group shares OB but patients still wait several more weeks to have their initial visits with me. I can't fix that problem and I've finally had to committ to stop adding patients into appt spots that don't exist. I will get home every night for dinner (except the night I'm on call), and I won't work through lunch every single day. I don't think I've really helped answer your questions, but know you're not alone.

Daniel F. Kane said...

Partnerships are easy to get into, hard to get out of...make sure that you thoroughly understand how you leave, how partners leave, how partners are forcibly removed and how hostile issues like divorce, IRS troubles and non-medical litigation are handled. Not a physician but a medical physicist in a "eat what you kill" partnership since 1988.

Jenny Mandarin said...

I think you'll do great! Good luck with that! People like you are just awesome. Since your in the Doctor field I'll just ask. Do you know a good doctor that practices gynecology? I am looking for a good gynecologist.

Nathan said...

I dont think you are alone in being the younger person bringing better methods to the older generation.

Throughout various professions you can see the more experienced people, who love to think of themselves as being superior, produce worse results.

Whether this is through becoming to set in their ways or general boredom I'm unsure. But nice work pushing them to change.

We need more people who can push modernisation through, don't give up now!

hollo winds said...

Wonderful blog & good post.Its really helpful for me, awaiting for more new post. Keep Blogging!


Miami Ram

Anonymous said...

I love your blog! Please come back! :)

Bean + Rocco said...

Hi Ob/Gyn Kenobi,

I love this blog and your posts, especially because I'm considering a career in Ob/Gyn. I am currently doing a postbacc program and was originally planning on applying to medical school but am also considering midwifery (certified nurse midwife). I was wondering if you have ever worked with any certified nurse midwives and if you had any opinion on the career dilemma, I really appreciate your opinion and point of view. I think my personality fits in better in medicine but the kind of lifestyle I want (with plenty of family time and at least a little flexibility) doesn't seem to integrate into Ob/Gyn very well.

Thank you very much,
RS

Randy and Dionne Sillik said...

I know that you are asking for advice in this blog post but I was wondering if you could indulge me with some advice. I am a 4th yr OB/Gyn resident and am currently going through the interview process. As of now, I am about to interview with some private practices, and I was wondering if you had any advice about interviewing and navigating the tricky waters of finding a job after training. Thanks!

TheTracker said...

Just signed that first contract with the partnership . . . I guess I'm a little fatalistic about that stuff. The people with the institutional power are always going to set up the system and enforce norms that favor themselves. You are never going to be one of those people unless you are a political creature and if you were, you would know by now. People who got into doctoring to be doctors and still treat that as their priority are just going to have to find employment where these dynamics are not to egregious and keep their heads down.

Nur Albanat said...

i'm now still 3rd year medical student, i just want to know about shift HO? how about the progression? :) because i have 3 more years until my graduation day

Gordon Freeman said...

Thanks for this great information. I am trying to find a good obgyn in Honolulu. Do you have any suggestions? Thanks.

Nova Pena said...

well, I do hope that your open minded-ness rubs off on your other partners. It really isn't fair for the patients if the doctors do think like that, wouldn't it? I applaud your outlook. You'd be perfect as a part of the Memphis Gynecologist with that kind of opinion about patients. just saying.

Jason Knight said...

I was wondering, what exactly is obgyn? My sister in-law kept saying it wile talking to us, and I had no idea what she was talking about.

Dr. Pullen said...

I think given the description of the senior partners in the group you are associated with you need to know lots, use and attorney and maybe an accountant to scour the practice finances and your partnership agreement. Do you really want a career with these docs. I'd consider bailing out.

Lance Tankman said...

I love the name of your blog. Im a big Cincinnati obgyn fan!

Elizabeth said...

I know it's been over a year since you have updated, and I'm not sure you're even reading these comments anymore, but I want to thank you for your blog. I came across it during my last few weeks of pregnancy, and over the course of the last 6 or 7 months, I have read nearly the entire thing. It kept me smiling, kept me sane, and kept me from begging my own OB to induce at 37 weeks. ;) Thanks for putting yourself out there. All the best with the new practice.