Q&A: Not-So-Fake Partnerships

January 18, 2018

Lawrence Muroff, MD, doesn’t want radiologists to worry about fake partnerships.

On Jan. 5, Diagnostic Imaging published a blog about the rise of fake partnerships in radiology. The post pointed to an increase, in certain areas of the country, where practices are offering partnership-track positions to new hires without the intention to follow through with the career advancement.

Some readers disagreed that this phenomenon is a common national trend. We spoke with Lawrence Muroff, MD, chief executive officer and president of Imaging Consultants, Inc., about whether fake partnerships are common.

DI: Are fake partnerships a wide-spread practice?
Muroff: When you look at the data from the Economics of Diagnostic Imaging National Symposia and from my anecdotal, but broad, experience consulting nationwide with practices and interacting with practice leaders at a variety of meetings sponsored by the ACR, this data and experience would suggest that fake partnerships are the exception rather than the rule. The culture of radiology was, and still is for the most part, a culture in which a young radiologist out of training joins a practice and, after a short period of time, is transitioned to partnership. They have full and equal partnership in terms of voice, vote, and income stream.

There are exceptions to that. For the last two or three years, the data from the Economics National Symposia suggest that somewhere around 10% of practices don’t offer partnership opportunities. One can speculate why this small minority of practices does not. One reason might be, as Dr. Postal suggested, an over-saturation of the market in a very desirable place to live. But, equally, or more relevant to this small component of practices, has been the formation of national companies which vary enormously from one another.

Partnership opportunities, therefore, vary from one national practice/company/entity to the next. Generally, these entities offer no partnership to new hires or the path to partnership is far more restricted than in the usual private practice setting.

Interestingly enough, someone in response to the blog suggested that partnerships soon would be granted based on the value that a new hire brings to the practice. While that is, I think, an intriguing concept and one that certainly merits thoughtful consideration, it is not the norm. Right now, it is “time in the seat” at the practice that appears to be the major, or sole, determinant for partnership in most practices.

I also want to mention that the concept of fake partnerships is not new. There were rumors back in the early 1970s when I was in training in New York that practices in Philadelphia were doing this. And, if you went to visit practices in Philadelphia, you’d find that it wasn’t true. But, they would say that practices in Boston were doing it. The bottom line is, if you are in a robust job market, like we’re in right now, if practices did not offer to potential new hires what is the norm for the culture of radiology, word of that would very quickly spread. Those practices would be unable to attract good or, perhaps, any candidates.

DI: What are your main concerns about the assertion that fake partnerships are common?
Muroff: I have two main concerns. The first is if, indeed, this is happening in a specific area or group of areas then, perhaps, there should be a bright light shone on those areas. Be specific. Name names and geographical areas and open a dialogue among radiologists, young and old, so that this practice could be exposed in other than a general sense.

The second problem I have is that the fake partnership conversation could dissuade medical students who are contemplating a career in radiology from entering the field because it implies, although it does not definitely state, that practices are deceitful and misrepresenting the options that are available - that they’re, in general, basically bad people. I don’t think that this is the case in a broad national sense, and I think that the message young people should be hearing is that radiology is the place to be. It is the profession to choose. It is intellectually stimulating; it is financially rewarding; and the quality of life is difficult to beat. We see all the interesting patients in the hospital. We should be actively participating in decision making and treatment of patients based on the interpretations we make and the procedures we perform. In general, it is difficult, at least for me, to conceive of a better opportunity for a young medical student contemplating his or her future.

DI: How do you see that partnerships have changed over the past decade?
Muroff: I think it’s changed somewhat although not very much. It’s been changed somewhat by these national entities that are buying practices and basically paying top dollar. These entities reward the existing partners, but most do not provide for young, newer members who will join the practices or those who have already joined the practice but who aren’t yet partners. That said, as I mentioned earlier, the culture of radiology was, and still is to an overwhelming extent, that partnership is viable in private practice. It is typically a full and equal partnership, which means that the new young hire will have the same voice, vote, and income stream as even the founder of the practice. It’s a very egalitarian situation. In fact, I was quoted in two Diagnostic Imaging articles 15 years apart, and they used the same “call-out”. I was quoted as saying radiologists are pathologically addicted to democracy. We bend over backwards to attract the best and the brightest. Our buy-ins are artificially low, as are the buy-outs of our practices. We do that so young people can achieve full and equal partnership relatively quickly. The average time right now to partnership in private practice is about two years. Other professions, such as law, would find that astounding; and, in other professions, partnerships offered are not full and equal. In radiology, the culture is still full and equal partnerships.

DI: What does the data show about partnerships, and how should it be characterized?
Muroff: The data comes from a survey of practices through the Economics of Diagnostic Imaging Symposia. It probably, over the past couple of years, has included input from 60 to 100 practices. Ten percent of them don’t offer partnership.

DI: With this topic, what is your main concern?
Muroff: My main concern is that I don’t want to see young physicians dissuaded from a career choice based on anecdotal experience that is not consonant with what’s actually happening throughout the country.