When solo is no longer enough

Kagan began looking for an associate, but didn't want to spend the thousands of dollars a headhunter would charge. "In the fall of 1996, a third-year resident approached me at the hospital and asked if I knew how he could get a job in this area when he graduated," Kagan continues. "We arranged for him to spend a month rotating at my office in the spring of 1997, and soon after that I offered him a job."

Like Kagan, soloists typically start thinking about teaming up with another physician when the demands on their clinical-and perhaps personal-time can no longer be managed comfortably. Joining forces can make for a more fulfilling work life and allow for more hours away from the office. It can also make your patients' and employees' lives easier.

And two physicians can usually practice more cheaply than one. "Although you may need additional staff, exam rooms, and back-office space, you can share reception, front-office, and medical records space, plus hallways, bathrooms, and everyday expenses," says Kenneth Hertz, a consultant with the Medical Group Management Association who's based in Alexandria, LA. You also can divide the costs and duties of promoting your practice.

Like marriages, however, not all medical unions are gratifying or enduring. But you can maximize your chances of success if you select your potential partner carefully and re-engineer your practice accordingly, says Hertz, who adds a caveat: "You have to be prepared for and comfortable with the notion of compromise."

The transition from a solo practice to a partnership can be accomplished by merging two practices or by inviting another doctor to join yours. Here are the pluses and minuses of each, and how to make the new entity work.

Merging with another practice When two solo practices come together, far more decision-making and reorganization is required than when a freshly minted or hospital-based physician signs on with a soloist.

"Before you move forward, each practice has to understand the other thoroughly," says Hertz. "Draw up a checklist of all the things you and your advisers need to evaluate, including the accounts receivable, fee schedules, payer mix, referral patterns, hospital relationships, and staff salaries. If Dr. Smith pays his LPN $11 an hour and Dr. Jones pays his $17 an hour, what will the Smith & Jones practice pay their LPNs? No one wants to come into a partnership making less money than they did the day before."