Some Physician Groups are Misleading Job Candidates About Ownership

Howard Mell , MD, MPH

Emergency Physician, Presence Resurrection Medical Center

Published July 09, 2020

Doctor in a white coat playing a shell game with pills

Many physician job seekers are attracted to the benefits of ownership. Of all the physician group practice models, ownership offers doctors the most control over their practice and patient-care decisions.

But when potential employers claim to be "physician-owned partnerships," can you trust them?

The answer, unfortunately, is no. Not every group that claims to be physician-owned gives all doctors an equal voice and vote in practice matters.

It's therefore important to ask the right questions, or else you might set out to become an owner — and end up working as a contractor or an employee.

Why physician group practice models matter

In today's competitive hiring market, physician job seekers have several group practice models to choose from. However, joining a physician-owned partnership has a number of advantages for doctors:

An equal vote in practice matters
Financial transparency
Due process protections (can't be "fired" at will)
A culture of partnership and shared accountability (being "in this together" with other owners)
Commitment to physicians' ethical duties to protect patients and avoid conflicts of interest
An owner's pride in one's practice

Having worked in several types of medical practice from small-group partner to corporate physician executive, I'm 100% convinced that a physician-owned partnership is the best group practice model for me. And I'm definitely not alone.

Unfortunately, groups beholden to investors have caught on to the power of ownership. They realize that a physician-owned partnership is exactly what many physician job seekers are looking for.

When it comes to ownership, they can't offer the real thing. So to compete in a tough hiring market, they're trying to redefine "ownership" to fit the corporate model.

As I type this, I've got an emergency medicine trade journal sitting on my desk. And every job ad in it promises "autonomy," "leadership," and "work-life balance." Some even allude to "ownership" or "partnership."

But what does that mean when a group has sold a significant interest to a private equity firm? It means that while they might call their employees "owners" or "partners," those physicians will not enjoy the benefits of ownership such as an equal voice in the practice.

Getting honest about physician group practice models

Recruiting tactics can muddy the waters for job seekers interested in true ownership. It's important to find out whether your potential "partners" are business people who want to use you or doctors who want to partner with you.

Here are some tips to help you separate the wheat from the chaff.

Question ambiguous wording around ownership.

Overzealous recruiters may tell you things like:

The group "functions like" a partnership of shared owners.
You will have an "ownership interest" in your local practice site.

If language about ownership sounds ambiguous, immediately start asking questions and digging deeper.

Ask how voting is structured.

Voting rights should be equitable and transparent, with all shared owners achieving full partnership and voting power in a reasonable time frame. Keep in mind that in some self-proclaimed "democratic" groups, super partners or super owners control the lion's share of the votes. In these groups, physicians may be owners in name, but they don't have the benefits of true ownership.

Look at the board of directors and the senior executive team.

A true physician-owned, physician-led group should have a board of directors and senior leadership team made up of physicians — not financiers, bankers, or professional executives. Physicians know and understand the needs of physicians best.

Look on the company's website. Who's listed on their board of directors? (Do they even post their leadership team?) If your boss, or your boss's boss (or even your boss's boss's boss) aren't all physicians, you aren't in a physician-owned and physician-led organization.

Ask about investors and private equity.

When a physician group accepts capital from a nonphysician investor, that group is no longer "physician-owned." Individual physicians may continue to have an ownership stake. But they must now consider the interests of the investor as well as those of their patients.

Ask how your income will be reported.

To be a true physician owner, you must be recognized by the IRS as an owner. This means that 100% of your pay, including both regular and bonus pay, must flow through a Schedule K. True physician owners are generally not paid by W-2 (for employees) or 1099 (for contractors).

Request to see a copy of the partnership agreement before you make a decision.

If the recruiter/interviewer hands you an employment contract or contracting agreement instead, they are not planning to bring you on as a true and equal owner. Feel free to point out that as an owner, it's impossible for you to sign an employment contract with yourself!

But isn't "ownership" just a word?

Words matter when we talk about physician group practice models, because they define the legality and structure of our work. Simply put, there is a difference between being an owner and not being an owner, being a partner and not being a partner.

One thing I appreciate about Vituity is that words have a clear and transparent meaning. When we say we are a "physician-owned partnership," it means that 100% of our doctors are owners. Period. We don't have to twist the words and put a million caveats on them to make them true.

Being an owner isn't perfect. Your bonuses may vary from year to year. And in a physician-run partnership, you can't turn to the business world and hire a hotshot CEO and a shark VP of finance (unless they also happen to be physicians).

But for me, there's simply no other way to practice medicine. As a physician owner, I never have to choose between profits and patients. And as a Vituity Partner, I enjoy the benefits of democratic partnership plus the support and stability of a large national organization.

So if you are a physician who is serious about ownership, don't be afraid to ask hard questions. The process of digging for the truth may be awkward at times. But finding a true ownership situation where you can have a long and thriving career will be worth it.

Originally published October 2, 2019. Updated July 9, 2020.

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