Residency Advisor
You’ve been an attending for a year or two. Your RVUs look solid, your schedule is full, patients are asking for you by name. The contract says there’s a “potential partner track after X years,” and leadership keeps tossing around phrases like “you’re on a good trajectory.”
But nobody is telling you what actually has to happen for that partner offer to land in front of you. Or who votes. Or what number they’re staring at on that spreadsheet while they “take your candidacy under consideration.”
Let me tell you what really happens behind that closed conference room door.
The Meeting You Are Not In
Most partner-track decisions happen in some version of the same scene.
End of quarter. 6 p.m. Conference room. The managing partner has a one-page summary on each associate: collections, RVUs, overhead share, new patients, call participation, maybe some notes about “team fit” and “staff feedback.” People are half-tired, half-cranky. This is not an academic promotion committee with formal criteria. This is a business meeting.
There is usually one or two people who drive the conversation. Everyone else chimes in, but the tone is set by:
- The managing partner or president
- The “numbers” partner (the one who lives in Excel)
- Sometimes, the senior rainmaker who brings in the referrals
They do not start by asking, “Is Dr. X clinically excellent?” They assume you can doctor. You would not still be there if you were unsafe or incompetent.
They start with one of three questions, depending on the culture:
- “Does this person make the pie bigger?”
- “Are they someone we want to split our pie with forever?”
- “Can we afford to keep them not a partner any longer without losing them?”
Notice what’s missing: anything about the vague garbage you were told at recruitment: “good fit,” “hard worker,” “team player.” Those matter, but only as they impact those three questions.
The Money Slides You Never See
Let’s strip the façade. Group practices are, bluntly, evaluating whether promoting you to partner is a good investment.
Some groups are sophisticated and run full partner-pro forma models. Others run back-of-the-envelope math. The logic is similar.
Behind the scenes, they’re looking at a few core numbers.
| Metric | What They Really Ask |
|---|---|
| Collections | Do they bring in enough top-line? |
| Overhead Impact | Are they covering their true costs? |
| RVUs / Volume | Is their productivity stable or rising? |
| Payer Mix | Are they seeing decent-paying patients? |
| Retention Risk | Will they leave if we delay partnership? |
Do not get distracted by the RVU target listed in your contract. That’s the visible hoop. The hidden conversation is about margin and risk.
A typical discussion sounds like this:
“She’s at 8,000 RVUs, collections about $950K, overhead runs high at first but looks normalized now. After true expenses, she’s throwing off maybe $200–250K to the group. If we make her partner, her draw goes up and our margin off her goes down. But if we do not, she’s going to take that book of business somewhere else.”
They care about three trends more than single thresholds:
- Are your collections >= what they’d expect for someone at your stage?
- Has your volume stabilized or is it still growing month over month?
- Are you consistently profitable after true overhead (not the simplified number they feed you)?
If your numbers are weak but they’re desperate for coverage, they’ll still consider you. But now the conversation is political: “We need her to cover call / that satellite clinic / that hospital contract — do we bite the bullet and bring her in?”
Do not kid yourself. If your production is mediocre and you’re high-maintenance or low-visibility, your partner conversation is easy for them: defer, defer, defer.
“Fit” Means Something Very Specific
Every group uses “fit” like it’s some spiritual thing. It isn’t. Fit in partner-track decisions is code for three concrete questions:
- Do the staff like working with you, or do they complain?
- Do the other docs trust you clinically and behaviorally?
- Do you make stakeholders outside the practice (referrers, hospital admins, payers) more or less likely to keep sending business?
I’ve sat in these meetings. A single nurse manager’s comment can sink or delay you for a year. The practice manager says: “Front desk says Dr. Y snaps at them, keeps changing the schedule last minute, and patients complain about wait times.” Boom. No partner vote this cycle. You’ll never hear that reason. You’ll see it as “let’s reassess next year.”
Contrast that with:
“She treats the staff well, picks up extra call when someone’s kid is sick, and the cath lab loves her.”
That buys you a lot of grace if your numbers are not perfect yet.
Clinical trust matters, but not in the way you think. They’re not doing peer-reviewed chart audits. They’re asking:
- “Would you send your family member to this person?”
- “Do they call for help appropriately?”
- “Do they own their complications?”
If there’s even a hint of “cowboy” or “dangerous,” they will delay partnership indefinitely or push you out. Nobody wants joint liability with a loose cannon.
The Real Politics of Voting You In (or Not)
Groups pretend decisions are objective. They aren’t. They’re relational.
Here’s what actually swings partner votes:
Who Is Your Champion?
If no current partner will go to bat for you, you’re not getting in. Period. There’s always someone in that room who says, “Listen, I work with her, she pulls her weight, the nurses love her, and we’re going to lose her if we don’t make a move.”
Or the opposite: silence.
You should know before the vote who your likely champions are. If you can’t identify them by name, that’s a problem.
Internal Factions
Most multi-partner practices have factions:
- The “growth” people: want more partners, more sites, more volume
- The “protectionist” people: want to keep partner numbers tight to protect income per partner
- The “legacy” folks: older partners who care more about stability and call coverage than maximized draw
Your fate depends on which faction is ascendant that year. If reimbursements just tanked, collections dropped, or they lost a hospital contract, the protectionists get loud. Partner offers slow down, thresholds mysteriously “tighten,” and the story to you is, “We just need a bit more data.”
Translation: the pie got smaller, and they do not want another mouth at the table yet.
Your Cost to Them
No one tells you this, but as an associate you are often a profit center. The group bills under your work, pays you a salary plus bonus, and keeps the spread. Once you’re a partner, more of that spread flows to you.
So they look at:
- What do we gain by making this person partner? (retention, goodwill, stability, business development)
- What do we lose? (share of profits, control)
If you’re generating big margins and seem pretty content as an employed doc, some groups drag their feet. Ethically questionable? Yes. Common? Also yes.
The moment they start to believe you’ll walk — because you hint at other offers, or a competitor opens across town, or you’re clearly interviewing — your leverage goes up. Suddenly that “not quite ready” becomes “let’s see if we can move up the timeline.”
What They Won’t Tell You About the Buy-In
Most candidates obsess over the headline buy-in number: $100K, $250K, $500K, sometimes more. They’re asking, “Can I afford this?”
Behind closed doors, the partners are asking a different question: “Can we justify this valuation in a way that keeps the current partners’ capital accounts from getting torched while still not scaring off this person we need?”
There are three games that get played here.
1. Inflated “Goodwill”
If you’re joining a legacy practice with aging partners, watch this closely.
You’ll see a breakdown something like:
- Accounts receivable
- Hard assets (buildings, equipment, etc.)
- Goodwill / intangible value
They quietly load value into “goodwill” to protect the older partners’ exit packages. On paper, it looks like you’re buying a piece of a thriving enterprise. In reality, you’re often buying into yesterday’s value at tomorrow’s risk.
You’re not in the room when they say, “We can’t drop goodwill too much or John’s retirement payout collapses.”
2. Multiple Classes of Partner
You will not see this mentioned in the glossy recruitment packet.
Some groups have:
- Full equity partners
- Junior or income partners (no or limited equity)
- “Surgical partners” vs “office & ancillaries” partners
The behind-the-scenes play is simple: they love calling you “partner” if they can do it without giving you full economic rights. You get the title, some bump in compensation, more call, more meetings. They keep imaging revenue, lab revenue, building ownership fenced off with a smaller inner circle.
The partner meeting includes a 15-minute pre-meeting before you walk in. That’s where the real decisions about ancillaries and capital flows are made.
3. Underestimated Risk
They frame the buy-in as, “You’re investing in yourself.” The hidden underwriting is more like: “You’re agreeing to share in business risk you previously did not bear.”
Privately, they ask each other:
- “Is this someone we trust to handle a capital call if we need one?”
- “Are they going to freak out if we have a bad year or a lawsuit hits?”
- “Will they hold the line on cost-cutting if reimbursements drop?”
Your ability to absorb risk — not just your enthusiasm — is on the table.
The Timeline Games: Why “3 Years to Partner” Rarely Means 3 Years
You saw it in the job posting: “2–3 year track to partnership.” Sounds clean, objective. It’s not.
Here’s how they stretch or compress that timeline behind the scenes.
The “More Data” Stall
Year 2 review. Your numbers are fine. You’ve had no major issues. You ask about partnership. You get:
“We’d like to see another full year of data. You’re on track.”
In the room, the conversation was:
- “We just had a rough year with collections.”
- “We promised two other people partnership last cycle; we do not want to dilute further yet.”
- “Let’s say we need more data, it’ll buy us time.”
No one wants to say, “We cannot afford you as a partner in this financial climate.”
The “Accelerate Before They Bolt” Move
You start interviewing elsewhere. A hospital across town offers you a guaranteed high base. You mention (subtly) that you’re considering it.
Now the managing partner comes back: “We’ve been very pleased with your performance; let’s talk seriously about partnership.”
Behind closed doors:
- “We really can’t lose him; he’s the only one who likes doing nights.”
- “If he leaves, the hospital will give that practice our cath lab block.”
- “We should bring him in before he gets poached.”
It’s not always this dramatic, but I continually see “standard” tracks mysteriously shorten when leverage changes.
The Soft Test Year
There’s also the unofficial “fourth” year. They won’t label it that way. They’ll give you more committee work, more visibility in decisions, maybe a partial profit share.
They’re watching: do you think like an owner or still like an employee?
- Do you complain about every inconvenience, or ask, “What’s best for the practice long-term?”
- Do you show up to meetings having read the financials, or are you scrolling your phone?
Those behaviors travel back into the next closed-door meeting.
How to Actually Position Yourself for a Partner Offer
You cannot control everything, but you have more real leverage than you think — if you understand how they’re thinking.
Own Your Numbers (Better Than They Do)
Do not wait for an annual review to find out your RVUs or collections. Get access to your monthly data and track:
- RVUs / month and rolling 12-month total
- Collections by payer type
- No-show/cancellation rates
- New patients per month
If you sit in a meeting and say, “Over the last 12 months my collections increased from ~$800K to ~$1.1M, with improving payer mix, and my fixed overhead share has stabilized,” you stop being “that young doc” and start sounding like a partner.
| Category | Value |
|---|---|
| Year 1 Q1 | 150000 |
| Year 1 Q2 | 180000 |
| Year 1 Q3 | 200000 |
| Year 1 Q4 | 220000 |
| Year 2 Q1 | 260000 |
| Year 2 Q2 | 290000 |
They notice who walks in prepared.
Secure Real Champions Early
Don’t randomly hope the group likes you. Pick two or three partners — ideally from different factions — and intentionally build working relationships:
- Offer to cover call swaps for them.
- Ask for their advice on a tricky clinical or systems problem, then act on it.
- Loop them into wins: “Your suggestion about restructuring my schedule freed up room; volume jumped 15%.”
By the time your name comes up for a vote, you want specific people saying, “Trust me, we want to keep her.”
Make Staff Your Quiet Lobbyists
You know who partner groups actually listen to? The long-tenured practice manager, the OR charge nurse, the scheduler who’s been there 15 years.
They hear everything. And they talk.
If staff like you, they will volunteer comments like, “Patients love Dr. X,” “He’s easy to work with,” “She always helps when we’re slammed.”
Those comments absolutely surface in the closed-door meeting.
If you’re brusque, unreliable, or entitled with staff, you will never hear the full damage, but you’ll live it in a quietly delayed partnership.
Think (and Talk) Like an Owner Before You Are One
This part is subtle but powerful.
Owners:
- Talk in “we” more than “they.”
- Worry about payor contracts, referral pipelines, OR block time, staff retention.
- Bring solutions, not just complaints.
When you consistently say things like, “We’re losing post-op follow-ups to the urgent care down the road, can we fix how we schedule post-discharge visits?” you’re signaling: I understand this is a business, and I’m invested in its health.
Those sentences get remembered.
Red Flags That They Will Never Make You Full Partner
Some of you are in groups that will never truly bring you into the inner circle, no matter what the brochure says. Let me be blunt about patterns I’ve seen repeatedly.
- Nobody under 45 is a full equity partner, and several mid-career folks are still “junior partners” after 8+ years.
- They keep changing the criteria or adding “one more thing” every time someone hits the bar.
- The buy-in is huge, opaque, and anchored to “goodwill,” with no real transparency on how they got the number.
- There is a smaller, quiet cluster of “founding partners” who own the building, imaging center, ASC, etc., and no path for you to ever buy into those assets. You get operations risk, not asset upside.
Inside the room, the thinking is: “We like having ambitious associates and junior partners to grind and feed the machine, but the real pie is reserved.”
You can waste many prime years waiting for a door that’s never opening.
A Quick Mental Flowchart for You
Forget their glossy brochure. Here’s how you should be thinking about their track, stripped down.
| Step | Description |
|---|---|
| Step 1 | Start as Associate |
| Step 2 | Get 2 years data |
| Step 3 | Improve volume or consider leaving |
| Step 4 | Build relationships or rethink fit |
| Step 5 | High risk of stalled or fake track |
| Step 6 | Negotiate timing and buy in |
| Step 7 | Explore other practices or employment |
| Step 8 | Decide to buy in or walk |
| Step 9 | Numbers strong and growing? |
| Step 10 | Clear champions? |
| Step 11 | Transparent path and terms? |
You’re running your internal closed-door meeting about them while they’re quietly running one about you.
That’s how you avoid walking blindly into a 20-year mistake.
FAQs
1. What RVU or collections number do I really need to be considered for partnership?
There is no universal cut-off, and anyone who gives you one number is either naive or selling something. The real bar is: can you at least match or exceed the median for that group’s existing partners at your stage, with a stable or upward trend? In many non-procedure specialties, that might be in the $700K–$1.1M collections range; for procedural folks (GI, cards, ortho), $1.2M–$2M+ is common. But the trend and your profitability after overhead carry more weight than a single-year figure. If your numbers are in the top half of the group and you’re still being stalled, the barrier is political, not productivity.
2. How much should I push or ask about partnership without looking “entitled”?
You should be asking early, but in a businesslike way. Within your first 6–9 months, ask: “How do you evaluate readiness for partnership in this group? What metrics do you look at?” At 18–24 months, show your numbers and ask, “Given this trajectory, what would a realistic timeline be?” Entitlement is walking in saying, “I’ve been here 2 years, I deserve partner.” Professional is: “Here’s my concrete contribution; here’s what I understand about your criteria; how do we align those?” If every answer you get remains vague after several attempts, that’s diagnostic in itself.
3. Is it ever smart to accept a ‘junior partner’ or ‘income partner’ role that isn’t full equity?
Sometimes yes, often no. It’s acceptable as a clearly defined stepping stone with: a written timeline to full equity, explicit criteria you can hit, and transparency about what economic rights you still lack. If it’s an indefinite plateau — you get the title, a modest pay bump, more responsibilities, but no real share in ancillaries or assets — you’re essentially agreeing to be a better-paid employee who shares more risk. I’ve seen too many physicians get stuck there. If they cannot articulate exactly how and when you can become a full economic partner, assume you won’t.
4. How do I evaluate a partner-track offer against a high-salary hospital-employed job?
Strip it to cash flows, risk, and control. A hospital job gives you high, predictable W-2 income with minimal business risk but zero equity and little control. Partnership potentially gives you lower short-term take-home (after buy-in) but upside in profits, ancillaries, and eventual buy-out — along with real risk if payors or volumes shift. Ask for actual historical K-1s for partners your age and stage, not hypothetical projections. If partner K-1s are only modestly higher than the hospital’s guaranteed salary, and the buy-in is steep, the risk-adjusted math may favor the hospital. But if real partner income (including ancillaries) is significantly higher and the group is stable, you’re buying a machine that will keep paying you long after the hospital would’ve capped you.
You’re past residency now. You’re not just selling your time; you’re deciding whether to buy into someone else’s machine or build your own over time. Behind every polite, “We see you as a future partner,” there’s a spreadsheet and a vote you never see.
Understand that meeting, and you stop being the junior doc hoping for an invitation. You become the professional deciding whether their partnership is worth your partnership.
With that mindset in place, you’re ready for the next phase: not just accepting offers, but shaping them. But that negotiation — and how to make them actually move on terms — is a story for another day.
