When I was a third-year resident, I was invited to join a practice owned by a doctor who had once been my chief resident. This was considered by all of my fellow residents to be the plum job in town, and I was thrilled. The doctor, whom I shall call “John,” was smart and funny and had a huge practice that he had purchased from a retiring physician. We figured out the logistics — he wanted us to be separate practices sharing office space, patients and employees. I signed the contract.
I thought things started out fine, although on the second day of practice I did not have any patients on my schedule. I sat at my desk pondering my debts and wondered how I would ever support myself with no patients. Fortunately, my schedule soon started filling up. I told John that I could see some of his overflow of sick patients to help him out, as his schedule was packed. He told me no that he didn’t want his income to go down. That should have been my first clue that all was not ideal in practice paradise. But I just worked on building up my own patient panel.
We still made hospital rounds in those days and had quite a busy hospital practice. Or rather, John did, and mine consisted of maybe two or three inpatients a day. We rounded and took call on our own patients each day and covered for each other every other weekend. I saw my few patients in the hospital each weekday. On alternating weekends I saw up to 12 to 14 of John’s patients, plus my own. The call could be brutal as I fielded messages from patients in the practice, hospital nurses and ER doctors. However, John would not let me bill for the inpatients of his that I saw on the weekend. He billed for them as if he had seen them. I didn’t feel that I had any choice in the matter, so I did what John told me to do.
Weeknight call wasn’t too bad until John started asking me to cover for him frequently when he wanted a night out. As soon as he signed out to me, the nurses at the hospital deluged me with calls of patients who had fevers, chest pain, and falls. John’s absences during weeknights became more frequent. When I timidly mentioned to John that it seemed that I was covering for him an awful lot, he put me in my place. He said, “Well that is why I got you!” Obviously, he did not consider me his equal.
One day John confronted me with the idea that I was not bringing enough money into the practice. True, I scheduled four patients per hour, and he booked nine per hour. I brought in about 30 percent of the income and so paid 30 percent of the overhead, by his stipulation in my contract. But he wanted me to pay 50 percent of the overhead. I realized that my $40,000-a-year salary would fall precipitously if I did so. We discussed the matter, and I thought the issue settled. However, one day after three years at the practice, I discovered my 60-day notice sitting on my desk.
I stood in my office and hyperventilated. I actually had crushing chest pain for about a minute until I could calm myself down. I then saw patients for the rest of the day. John had already left the office. I spoke to him the next morning and was so upset that I could barely get words out of my mouth. John was very nonchalant and told me that the letter meant that we would renegotiate my contract. He just wasn’t going to pay 70 percent of the overhead any longer. I thought fine — he could pay 100 percent of the overhead. See you later, jerk.
I found another position almost immediately and was offered double my salary. The last days in the practice were difficult. John locked up my insurance reimbursement checks in his desk and prohibited the staff from working my insurance claims, everything to starve me out. I spent my final days there wondering how John had turned from such a great chief resident into an ogre.
After several years, I started my own practice, and my husband became my office manager. We have been independent since then.
What about John? After a number of years, John divorced his wife and married the office manager. John expanded his office hours and dubbed them “Alimony Thursday.” Then suspicious types started patronizing the office, paying the receptionist cash for prescriptions.
One day, John appeared on the news. The DEA raided his office, confiscating charts and computers. He was charged with running a pill mill and was deemed responsible for the deaths of seven patients who had overdosed on medications that he had prescribed. John was eventually sentenced to nearly six years in federal prison.
In my weaker moments, I think this couldn’t have happened to a nicer guy. But I am grateful that he fired me when he did. There was no opioid overprescribing when I was there, thankfully. And he indirectly allowed me to start my own practice. By the time John is released from prison, he will be approaching 70. By that point, I hope to be retired and reasonably comfortable.
My perspective has certainly changed since I left John’s practice. What I once considered a setback was really an opportunity. For anyone joining a practice now, here is my advice: Be sure to negotiate a strong exit strategy, just in case things don’t work out. If your corporation/partner(s) do not value you, look somewhere else. Consider every experience, even a bad one, as a learning opportunity. Finally, consider running your own practice. It is the best decision I ever made. John did me a huge favor a couple of decades ago, and for that I am grateful.
The author is an anonymous physician.
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