Over the years, I’ve noticed that most physician-owned groups fall into one of four stages when it comes to partnership. Where your group sits on that spectrum can have enormous implications for your culture, your finances, and your future stability.
The Stage 1 model, which is by far the most common, is that new physicians work as employees for one or two years before automatically being offered partnership.
It’s pretty simple. There’s no additional screening to be done, criteria to be met, or decision to be made. All a new physician has to do is serve their time without making any big mistakes.
This Stage 1 model of partnership is rooted in the way things have been done in medicine over many, many years. And you could argue that it helps in today’s hiring environment, when you’d be happy to get a physician in place to help with patient access, call covered, etc. It can feel risky to add friction to the process.
But there are real downsides to staying in Stage 1 for too long.
When partnership is effectively automatic, your practice is making a long-term ownership decision based mostly on a hiring interview and a relatively short runway of observation. You may end up granting equity to physicians who may be clinically solid but haven’t demonstrated ownership-level behavior. I’m talking about things like citizenship, engagement, strategic thinking, or alignment with the group’s priorities.
It also makes course correction much harder. Once a physician is a partner, expectations feel negotiable. Conversations about productivity or finances feel political. If someone isn’t pulling their weight, the group often ends up absorbing the cost rather than confronting it.
If you’ve ever had a situation where senior partners grouse about junior partners not “pulling their weight”, you know exactly what I mean.
Perhaps most importantly, the Stage 1 model for partnership quietly communicates something about culture: that tenure matters more than standards.
If you’re interested in overcoming the weaknesses of the Stage 1 model by moving to Stage 2, 3, or even 4, don’t worry. You don’t have to put some heavy-handed system in place to improve your situation. Moving from this first stage to something more intentional can be surprisingly practical.
Here are two manageable improvements you could discuss with your physicians:
- To get to the Stage 2 model: Add a formal review before partnership is granted. A documented evaluation and a vote of existing partners create a pause for thoughtful decision making. You’re not creating a barrier, you’re creating intentionality. Partnership becomes something that has to be affirmed, not assumed.
- To get to the Stage 3 model: Set clear, written expectations for physicians and physician-owners in your group. Be specific. Even if the timeline on partnership remains the same, clarity changes the tone of conversations, starting at recruitment. And it gives administrators and physician leaders a north star, to assist in decision making.
While this conversation is most obviously relevant to physician-owned groups, there’s something to learn here even if you lead a group owned by a hospital or health system. Whether or not physicians hold equity, a key principle holds: clear expectations and consistent accountability shape culture far more effectively than compensation adjustments alone.
If you’re unsure what stage your group is operating in, or what it means for you as a leader, I’d be happy to talk it through. Sometimes an outside perspective is helpful to bring these things into focus.
