The Partnership Track in Radiology

The authors of the recent 2015 ACR Commission on Human Resources Workforce Survey are cautiously optimistic about the current job market, but that doesn’t mean that all newly trained fellows feel the same way. Those looking for their first radiology jobs have decisions to make. They need to decide where in the country to apply, whether to look at academic or private practice jobs, and whether to apply to partnership-track or employed positions.

Sometimes they may not have a choice about the employment status of their desired job. “About 10% of practices have decided not to offer partnership slots,” said Lawrence Muroff, MD, CEO and president of Imaging Consultants in Tampa, FL. He said the figure comes from data generated through the Economics of Diagnostic Imaging National Symposium. “It’s a small number, but a disturbing one to me. Hopefully this will reverse as the job market improves.”

While some radiologists prefer an employee position, “what I’m concerned about is those few practices that aren’t offering partnership slots because they feel they don’t have to. The job market favors the groups over those seeking jobs,” Muroff said.

An unknown economic future is one reason that some groups don’t offer partnership positions, said Vikash Panghaal, MD, MBA. He finished his fellowship in 2011, and is now working for Mt. Kisco Medical Group in Westchester, New York, in a partnership-track position. He said that with uncertain reimbursement rates and radiology’s unclear fee structure for accountable care organizations, groups are holding back on offering partnership positions. “The trend is that partnership spots are decreasing,” he said.

If you’re open to location, there are plenty of partnership-track positions available, said Andrew Moriarity, MD, a partnership-track radiologist in his first year with Advanced Radiology Services in Grand Rapids, Michigan. When he applied for jobs last year, he found an even spread of private practice and academic jobs, in addition to employed and teleradiology positions.

What is Partnership?
Partnership goes by different names. “We use the term partnership incorrectly,” said Muroff, since “we’re all employed by a professional corporation or association, depending on what state you’re in and the applicable laws.” Probably a better term is shareholder, as doctors are shareholders of their corporation entity. The radiology culture hasn’t changed; partners or shareholders have an equal voice, vote and income, said Muroff.[[{"type":"media","view_mode":"media_crop","fid":"42613","attributes":{"alt":"partnership track radiology","class":"media-image media-image-right","id":"media_crop_654143840210","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4629","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 172px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©nasirkhan/Shutterstock.com","typeof":"foaf:Image"}}]]

But partnership might mean something different depending on the practice, said Moriarity. It might mean working for reduced salary for several years as sweat equity instead of buying into the practice with cash. Traditionally, he said, partnership-track radiologists have the same responsibility as a full partner, while working for less money and possibly a reduced vacation schedule.

Fellows searching for jobs need to look at more than just the partner or employee label. “Everybody does things slightly different. You have to get deeper than the label. Do they promote people? What are salary numbers, and what are you entitled to for bonus and benefits?” said Kurt Schoppe, MD, a radiologist with Radiology Associates of North Texas.

As a partner, there are extra responsibilities, like serving on hospital committees and participating in running the practice. “There’s no such thing as a free lunch,” said Schoppe.

Also, as a partner, your income isn’t set. “From a historical perspective, you have an idea,” said Muroff. “But radiology practices typically take the money that comes in and divvy it up on a monthly basis. So I may make $50,000 less or more one year.” It’s similar with vacations. “If I’m a shareholder and someone gets hit by a truck, we have to cover for his or her disability, so I take less vacation. When you’re the owner, you help build the practice, you are rewarded according to how the practice thrives or not. You do whatever is necessary.”

What is an Employed Radiologist?
Employed radiologists know their yearly salary and vacation time. They’re not expected to cover other shifts. There’s less (or no) hospital committee responsibility and they aren’t expected to do much administrative duty at the practice. “You show up to work and do the work,” said Moriarity.

An employed position is good for those who may not want committee responsibility, night call or weekend shifts, said Muroff. “Working in an office or women’s imaging center five days a week may be a slot that suits the person’s family or lifestyle needs,” he said.

Another good reason to take an employed position is if you plan to move to another area within a few years. “If you’re in the area temporarily, there’s a cost to taking a lower salary as partnership-track if you’re planning to move, or if you don’t have the same goals to be full partner in the group,” said Moriarity.

For example, before Schoppe’s practice changed to hiring all radiologists as “shareholder-eligible,” those on the partnership track got paid about 5% less than employed radiologists. Employed radiologists got a bonus based on how the group did, while first year radiologists on the partnership track don’t get the bonus. In subsequent years of the partnership track, radiologists got 20% to 40% of the partner bonus, but the rest was held back as equity buy-in. In this way, employed physicians made more the first few years than their partnership-track counterparts, but then they capped out.

There are dangers to employing radiologists who would rather be a partner. They might end up resentful, said Muroff. “If you are a partner and I am not, and you’re only three years ahead of me, I can become pretty resentful. That’s compounded by the fact that I might not have the job options open to me that people seven or eight years ago had when the market was pretty hot.”

Another concern is that employees may not work as hard as partners. “No one washes a rental car,” said Muroff. “You’re far more likely to work more diligently if you have equity in the company, than if you’re just an employee.”

But starting off as an employed radiologist doesn’t have to be a bad move, even if you prefer the partnership track, said Schoppe. “People hear ‘partner’ and nothing else, so they’re not familiar with other possible arrangements.” When Schoppe finished fellowship in June 2013, he narrowed his job search geographically, since his wife, also a doctor, already found a job. Schoppe said there were two dominant radiology groups in his geographical area, and he accepted a one year employee position with Radiology Associates of North Texas. The group had a three-year contract with a county hospital and didn’t want to add partner-track physicians with the uncertainty of the hospital contract renewal. “It was a good group and I was willing to take that, but I didn’t have a whole lot of other options,” Schoppe said.

His plan was to work hard and demonstrate his value, and consider the position a prolonged interview process. “I was always taught that the cream rises to the top,” he said. “If you show up and you’re good, you’ll be fine.” He’s now been voted in as a partner. One downside to going this route is that when moving from employee to partner track, you have to start over with the partner work-up for sweat equity buy-in, which means a pay decrease. This might be negotiable in a contract, however.  

Schoppe said his group saw that interviewees for the employee positions showed a lot of trepidation taking that role, and the group recently switched all new hires to “shareholder-eligible” status. “Employment has loosened up some. There’s now more competition,” he said. “A lot of groups have gone away from the employee versus shareholder model because they’re having to compete for candidates.”

And that’s some good news for radiologists entering the job market.