Expecting the unexpected

Key Points

That's why, as many physicians in solo or group practice consider a merger or sale to an integrated group practice, it's crucial to think beyond salary, paid meetings, and vacation time. The doctor and the organization need to consider all the potential eventualities of human frailty, behavior, and the realities of practice life.

In my own experience, having developed a 10-physician multispecialty group that includes outpatient surgery, laboratory, audiology, midlevels, and ownership in a 42,000-square-foot building, it was imperative that the realities of bringing new physicians into or getting old physicians out of the organization had to be addressed in detail.

Beginning from that position, the question had to be asked, "Why would a physician shareholder want to leave the practice?" Some of the answers were empirically obvious-retirement being number one. That departure was easiest to structure because retirement dates are generally known years in advance, and the organization would begin recruiting a replacement for the retiring physician 3 to 4 years before the planned retirement date. By starting recruitment early, a suitable new physician who fit into the practice environment could be found and then buy out the retiring physician's shares. Straightforward enough, but only the tip of the iceberg.

Looking below the surface, it became obvious that a physician may choose to leave an organization for a variety of reasons-some simple, some very painful. It became clear that structuring a successful departure involves more than money. An unplanned departure can include issues of divorce, noncompete clauses, retirement planning, death, and disability. Some of these issues are interrelated and require comprehensive solutions.